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Meng F, Ren N, Zhang G, Xu R, Tian M, Sun X, Zhao L. Comprehensive analysis of surgical strategies and prognosis for non-small cell lung cancer with pleural metastasis detected intraoperatively. BMC Cancer 2024; 24:1303. [PMID: 39438866 PMCID: PMC11494768 DOI: 10.1186/s12885-024-13029-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 10/04/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Lung cancer is one of the prevailing malignancies worldwide. Surgical interventions hold an important position in the treatment framework for lung cancer. Pleural metastasis is often assumed to be a surgical contraindication, but not all instances of pleural metastasis can be accurately identified before surgery. The question of how to address pleural metastasis detected intraoperatively is still undecided. METHODS This retrospective study included 187 lung cancer patients who underwent surgery from 2005 to 2017 in whom pleural metastasis was discovered incidentally during the operation. Data on demographic, surgical, pathological, postoperative treatment, and survival information were collected for further analysis. RESULTS For patients with intraoperatively detected pleural metastasis, two independent protective prognostic factors were receiving primary tumor resection (compared to only receiving pleural nodule biopsy, HR = 0.079, p = 0.022) and receiving postoperative adjuvant chemotherapy (HR = 0.081, p < 0.001). Simultaneously, performing systematic lymph node dissection during primary tumor resection was found to be detrimental to long-term prognosis (HR = 2.375, p = 0.044). However, the resection of pleural metastatic lesions did not significantly impact patient prognosis. CONCLUSION Our study supports the implementation of major tumor resection in patients with pleural metastasis detected intraoperatively but not lymph node dissection or the resection of pleural metastatic lesions. Postoperative chemotherapy is also necessary.
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Affiliation(s)
- Fanmao Meng
- Department of Thoracic Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli No 17, Chaoyang District, Beijing, 100021, The People's Republic of China
| | - Na Ren
- Department of Thoracic Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli No 17, Chaoyang District, Beijing, 100021, The People's Republic of China
| | - Guochao Zhang
- Department of Thoracic Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli No 17, Chaoyang District, Beijing, 100021, The People's Republic of China
| | - Ruifeng Xu
- Department of Thoracic Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli No 17, Chaoyang District, Beijing, 100021, The People's Republic of China
| | - Mengbai Tian
- Department of Thoracic Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli No 17, Chaoyang District, Beijing, 100021, The People's Republic of China
| | - Xin Sun
- Department of Medical Management, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli No 17, Chaoyang District, Beijing, 100021, The People's Republic of China.
| | - Liang Zhao
- Department of Thoracic Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli No 17, Chaoyang District, Beijing, 100021, The People's Republic of China.
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Kuang L, Wang P, Zhou L, Li Y. Strategies and influencing factors for the treatment of advanced non-small cell lung cancer based on epidermal growth factor receptor tyrosine kinase inhibitors: a narrative review. Transl Cancer Res 2024; 13:5123-5140. [PMID: 39430833 PMCID: PMC11483425 DOI: 10.21037/tcr-24-637] [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: 04/18/2024] [Accepted: 07/19/2024] [Indexed: 10/22/2024]
Abstract
Background and Objective Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are the primary treatment for advanced non-small cell lung cancer (NSCLC) patients with EGFR mutations, significantly enhancing patient prognosis. Despite the efficacy of EGFR-TKIs, monotherapy faces challenges such as variability among individuals and early drug resistance. This article aims to explore the treatment strategies and influencing factors for advanced NSCLC patients treated with EGFR-TKIs, optimize treatment plans, and improve the prognosis of patients with advanced NSCLC. Methods We undertook a comprehensive, narrative review of the latest literature to define the current application and progress of EGFR-TKIs in treating patients with advanced NSCLC. Key Content and Findings The efficacy and promise of EGFR-TKIs, both as monotherapy and combined with other agents, for treating patients with advanced NSCLC are outlined. The study delves into the mechanisms of resistance and the ongoing development of EGFR-TKIs. Various factors influencing the treatment of advanced NSCLC patients with EGFR-TKIs are also examined. Conclusions EGFR-TKIs alone improve survival in patients with advanced NSCLC. Combined with other agents, some regimens have shown improved benefits in overcoming drug resistance and prolonging patient survival. It is imperative to focus on developing novel EGFR-TKIs and investigate innovative combination therapies to maximize patient benefit.
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Affiliation(s)
- Linwu Kuang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Peng Wang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Lin Zhou
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yangkai Li
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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Pan J, Zhang Y, He L, Wu Y, Xiao W, Zhang J, Xu Y. STRIP2 is regulated by the transcription factor Sp1 and promotes lung adenocarcinoma progression via activating the PI3K/AKT/mTOR/MYC signaling pathway. Genomics 2024; 116:110923. [PMID: 39191354 DOI: 10.1016/j.ygeno.2024.110923] [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: 02/22/2024] [Revised: 07/26/2024] [Accepted: 08/19/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Patients with lung adenocarcinoma (LUAD) generally have poor prognosis. The role of striatin-interacting protein 2 (STRIP2) in LUAD remain unclear. METHODS Liquid chromatography-mass spectrometry analyses were used to screen the STRIP2-binding proteins and co-immunoprecipitation verified these interactions. A dual luciferase reporter assay explored the transcription factor activating STRIP2 transcription. Xenograft and lung metastasis models assessed STRIP2's role in tumor growth and metastasis in vivo. RESULTS STRIP2 is highly expressed in LUAD tissues and is linked to poor prognosis. STRIP2 expression in LUAD cells significantly promoted cell proliferation, invasion, and migration in vitro and in vivo. Mechanistically, STRIP2 boosted the PI3K/AKT/mTOR/MYC cascades by binding AKT. In addition, specificity protein 1, potently activated STRIP2 transcription by binding to the STRIP2 promoter. Blocking STRIP2 reduces tumor growth and lung metastasis in xenograft models. CONCLUSIONS Our study identifies STRIP2 is a key driver of LUAD progression and a potential therapeutic target.
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Affiliation(s)
- Junfan Pan
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Yuan Zhang
- The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Liu He
- School of Basic Medicine, Fujian Medical University, Fuzhou 350004, China
| | - Yue Wu
- School of Basic Medicine, Fujian Medical University, Fuzhou 350004, China
| | - Weijin Xiao
- Department of Pathology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China.
| | - Jing Zhang
- Department of Thoracic Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China.
| | - Yiquan Xu
- Department of Thoracic Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China.
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Singh A, Mazzola E, Xie Y, Marshall MB, Jaklitsch MT, Wilder FG. Lung cancer outcomes in the elderly: potential disparity in screening. Eur J Cardiothorac Surg 2024; 65:ezae080. [PMID: 38445715 DOI: 10.1093/ejcts/ezae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES The aim of this study was to analyse outcomes of lung cancer in the elderly. METHODS A retrospective analysis was performed of patients in the National Cancer Database with NSCLC from 2004 to 2017 grouped into 2 categories: 70-79 years (A) and 80-90 years (B). Patients with multiple malignancies were excluded. Kaplan-Meier curves estimated the overall survival for each age group based on stage. RESULTS In total, 466 051 patients were included. Less-invasive techniques (imaging and cytology) diagnosed cancer as a function of age: 14.6% in A vs 21.3% in B [P < 0.001, standardized mean difference (SMD) 0.175]. Clinical stage IA was least common in B (15%) compared to 17.3% in A (P < 0.001, SMD 0.079). Approximately 83.0% in B did not receive surgery compared to 70.0% in A (P < 0.001, SMD 0.299). Of the 83.0%, 8.0% were considered poor surgical candidates because of age or comorbidities compared with 6.2% in A (P < 0.001, SMD 0.299) For 71.0% in B, surgery was not the first treatment plan compared to 62.0% in A (P < 0.001, SMD 0.299). Survival curves showed worse prognosis for each clinical and pathologic stage for B compared to A. CONCLUSIONS Patients older than 80 years present less frequently as clinical stage IA, are less commonly offered surgical intervention and are more frequently diagnosed using less accurate measures. They also have worse outcomes for each stage compared to younger patients.
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Affiliation(s)
- Anupama Singh
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Emanuele Mazzola
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yue Xie
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - M Blair Marshall
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Fatima G Wilder
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Jin X, Pan Y, Zhai C, Shen H, You L, Pan H. Exploration and machine learning model development for T2 NSCLC with bronchus infiltration and obstructive pneumonia/atelectasis. Sci Rep 2024; 14:4793. [PMID: 38413705 PMCID: PMC10899628 DOI: 10.1038/s41598-024-55507-6] [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: 10/25/2023] [Accepted: 02/24/2024] [Indexed: 02/29/2024] Open
Abstract
In the 8th edition of the American Joint Committee on Cancer (AJCC) staging system for Non-Small Cell Lung Cancer (NSCLC), tumors exhibiting main bronchial infiltration (MBI) near the carina and those presenting with complete lung obstructive pneumonia/atelectasis (P/ATL) have been reclassified from T3 to T2. Our investigation into the Surveillance, Epidemiology, and End Results (SEER) database, spanning from 2007 to 2015 and adjusted via Propensity Score Matching (PSM) for additional variables, disclosed a notably inferior overall survival (OS) for patients afflicted with these conditions. Specifically, individuals with P/ATL experienced a median OS of 12 months compared to 15 months (p < 0.001). In contrast, MBI patients demonstrated a slightly worse prognosis with a median OS of 22 months versus 23 months (p = 0.037), with both conditions significantly correlated with lymph node metastasis (All p < 0.001). Upon evaluating different treatment approaches for these particular T2 NSCLC variants, while adjusting for other factors, surgery emerged as the optimal therapeutic strategy. We counted those who underwent surgery and found that compared to surgery alone, the MBI/(P/ATL) group experienced a much higher proportion of preoperative induction therapy or postoperative adjuvant therapy than the non-MBI/(P/ATL) group (41.3%/54.7% vs. 36.6%). However, for MBI patients, initial surgery followed by adjuvant treatment or induction therapy succeeded in significantly enhancing prognosis, a benefit that was not replicated for P/ATL patients. Leveraging the XGBoost model for a 5-year survival forecast and treatment determination for P/ATL and MBI patients yielded Area Under the Curve (AUC) scores of 0.853 for P/ATL and 0.814 for MBI, affirming the model's efficacy in prognostication and treatment allocation for these distinct T2 NSCLC categories.
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Affiliation(s)
- Xuanhong Jin
- Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yang Pan
- Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, China
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Chongya Zhai
- Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hangchen Shen
- Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Liangkun You
- Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
| | - Hongming Pan
- Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
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Sasieni P, Smittenaar R, Hubbell E, Broggio J, Neal RD, Swanton C. Modelled mortality benefits of multi-cancer early detection screening in England. Br J Cancer 2023; 129:72-80. [PMID: 37185463 PMCID: PMC10307803 DOI: 10.1038/s41416-023-02243-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Screening programmes utilising blood-based multi-cancer early detection (MCED) tests, which can detect a shared cancer signal from any site in the body with a single, low false-positive rate, could reduce cancer burden through early diagnosis. METHODS A natural history ('interception') model of cancer was previously used to characterise potential benefits of MCED screening (based on published performance of an MCED test). We built upon this using a two-population survival model to account for an increased risk of death from cfDNA-detectable cancers relative to cfDNA-non-detectable cancers. We developed another model allowing some cancers to metastasise directly from stage I, bypassing intermediate tumour stages. We used incidence and survival-by-stage data from the National Cancer Registration and Analysis Service in England to estimate longer-term benefits to a cohort screened between ages 50-79 years. RESULTS Estimated late-stage and mortality reductions were robust to a range of assumptions. With the least favourable dwell (sojourn) time and cfDNA status hazard ratio assumptions, we estimated, among 100,000 screened individuals, 67 (17%) fewer cancer deaths per year corresponding to 2029 fewer deaths in those screened between ages 50-79 years. CONCLUSION Realising the potential benefits of MCED tests could substantially reduce late-stage cancer diagnoses and mortality.
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Affiliation(s)
- Peter Sasieni
- Comprehensive Cancer Centre, King's College London, Guy's Campus, Great Maze Pond, London, SE1 1UL, UK.
| | | | | | - John Broggio
- NHS Digital, 7 and 8 Wellington Place, Leeds, West Yorkshire, LS1 4AP, UK
| | - Richard D Neal
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Charles Swanton
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, WC1E 6DD, UK
- Cancer Evolution and Genome Instability Laboratory, Francis Crick Institute, London, NW1 1AT, UK
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Zhang X, Chen Q, He Y, Shi Q, Yin C, Xie Y, Yu H, Bao Y, Wang X, Tang C, Dong Z. STRIP2 motivates non-small cell lung cancer progression by modulating the TMBIM6 stability through IGF2BP3 dependent. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2023; 42:19. [PMID: 36639675 PMCID: PMC9837939 DOI: 10.1186/s13046-022-02573-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/15/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Striatin interacting protein 2 (STRIP2) is a core component of the striatin-interacting phosphatase and kinase (STRIPAK) complexes, which is involved in tumor initiation and progression via the regulation of cell contractile and metastasis. However, the underlying molecular mechanisms of STRIP2 in non-small cell lung cancer (NSCLC) progression remain largely unknown. METHODS The expressions of STRIP2 and IGF2BP3 in human NSCLC specimens and NSCLC cell lines were detected using quantitative RT-PCR, western blotting, and immunohistochemistry (IHC) analyses. The roles and molecular mechanisms of STRIP2 in promoting NSCLC progression were investigated in vitro and in vivo. RESULTS Here, we found that STRIP2 expression was significantly elevated in NSCLC tissues and high STRIP2 expression was associated with a poor prognosis. Knockdown of STRIP2 suppressed tumor growth and metastasis in vitro and in vivo, while STRIP2 overexpression obtained the opposite effect. Mechanistically, P300/CBP-mediated H3K27 acetylation activation in the promoter of STRIP2 induced STRIP2 transcription, which interacted with insulin-like growth factor 2 mRNA-binding protein 3 (IGF2BP3) and upregulated IGF2BP3 transcription. In addition, STRIP2-IGF2BP3 axis stimulated m6A modification of TMBIM6 mRNA and enhanced TMBIM6 stability. Consequently, TMBIM6 involved NSCLC cell proliferation, migration and invasion dependent on STRIP2 and IGF2BP3. In NSCLC patients, high co-expression of STRIP2, IGF2BP3 and TMBIM6 was associated with poor outcomes. CONCLUSIONS Our findings indicate that STRIP2 interacts with IGF2BP3 to regulate TMBIM6 mRNA stability in an m6A-dependent manner and may represent a potential prognostic biomarker and therapeutic target for NSCLC.
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Affiliation(s)
- Xilin Zhang
- grid.411440.40000 0001 0238 8414Huzhou Key Laboratory of Translational Medicine, First Affiliated Hospital of Huzhou University, Huzhou, 313000 Zhejiang China
| | - Qiuqiang Chen
- grid.411440.40000 0001 0238 8414Department of Cardiothoracic Surgery, First Affiliated Hospital of Huzhou University, Huzhou, 313000 Zhejiang China
| | - Ying He
- grid.411440.40000 0001 0238 8414Huzhou Key Laboratory of Translational Medicine, First Affiliated Hospital of Huzhou University, Huzhou, 313000 Zhejiang China
| | - Qian Shi
- grid.411440.40000 0001 0238 8414Huzhou Key Laboratory of Translational Medicine, First Affiliated Hospital of Huzhou University, Huzhou, 313000 Zhejiang China
| | - Chengyi Yin
- grid.411440.40000 0001 0238 8414Department of Cardiothoracic Surgery, First Affiliated Hospital of Huzhou University, Huzhou, 313000 Zhejiang China
| | - Yanping Xie
- grid.411440.40000 0001 0238 8414Department of Cardiothoracic Surgery, First Affiliated Hospital of Huzhou University, Huzhou, 313000 Zhejiang China
| | - Huanming Yu
- grid.411440.40000 0001 0238 8414Department of Cardiothoracic Surgery, First Affiliated Hospital of Huzhou University, Huzhou, 313000 Zhejiang China
| | - Ying Bao
- grid.411440.40000 0001 0238 8414Department of Cardiothoracic Surgery, First Affiliated Hospital of Huzhou University, Huzhou, 313000 Zhejiang China
| | - Xiang Wang
- grid.411440.40000 0001 0238 8414Huzhou Key Laboratory of Translational Medicine, First Affiliated Hospital of Huzhou University, Huzhou, 313000 Zhejiang China
| | - Chengwu Tang
- grid.411440.40000 0001 0238 8414Huzhou Key Laboratory of Translational Medicine, First Affiliated Hospital of Huzhou University, Huzhou, 313000 Zhejiang China
| | - Zhaohui Dong
- grid.411440.40000 0001 0238 8414Department of Cardiothoracic Surgery, First Affiliated Hospital of Huzhou University, Huzhou, 313000 Zhejiang China
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Wu B, Chen J, Zhang X, Feng N, Xiang Z, Wei Y, Xie J, Zhang W. Prognostic factors and survival prediction for patients with metastatic lung adenocarcinoma: A population-based study. Medicine (Baltimore) 2022; 101:e32217. [PMID: 36626448 PMCID: PMC9750683 DOI: 10.1097/md.0000000000032217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The prognosis of metastatic lung adenocarcinoma (MLUAD) varies greatly. At present, no studies have constructed a satisfactory prognostic model for MLUAD. We identified 44,878 patients with MLUAD. The patients were randomized into the training and validation cohorts. Cox regression models were performed to identify independent prognostic factors. Then, R software was employed to construct a new nomogram for predicting overall survival (OS) of patients with MLUAD. Accuracy was assessed by the concordance index (C-index), receiver operating characteristic curves and calibration plots. Finally, clinical practicability was examined via decision curve analysis. The OS time range for the included populations was 0 to 107 months, and the median OS was 7.00 months. Nineteen variables were significantly associated with the prognosis, and the top 5 prognostic factors were chemotherapy, grade, age, race and surgery. The nomogram has excellent predictive accuracy and clinical applicability compared to the TNM system (C-index: 0.723 vs 0.534). The C-index values were 0.723 (95% confidence interval: 0.719-0.726) and 0.723 (95% confidence interval: 0.718-0.729) in the training and validation cohorts, respectively. The area under the curve for 6-, 12-, and 18-month OS was 0.799, 0.764, and 0.750, respectively, in the training cohort and 0.799, 0.762, and 0.746, respectively, in the validation cohort. The calibration plots show good accuracy, and the decision curve analysis values indicate good clinical applicability and effectiveness. The nomogram model constructed with the above 19 prognostic factors is suitable for predicting the OS of MLUAD and has good predictive accuracy and clinical applicability.
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Affiliation(s)
- Bo Wu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianhui Chen
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiang Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Nan Feng
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhongtian Xiang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiping Wei
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Junping Xie
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- * Correspondence: Wenxiong Zhang, Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang 330006, China (e-mail: )
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Tie X, Chen L, Li X, Zha W, Liu Y. A nomogram model of postoperative prognosis for metastatic lung adenocarcinoma: A study based on the SEER database. Medicine (Baltimore) 2022; 101:e31083. [PMID: 36254027 PMCID: PMC9575752 DOI: 10.1097/md.0000000000031083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We have observed that patients with metastatic lung adenocarcinoma can obtain survival benefits from surgical resection of the primary tumor. A model was developed to evaluate the prognosis of patients. The patients with metastatic lung adenocarcinoma were identified in the Surveillance, Epidemiology, and End Results database and divided into surgery group and non-surgical group. Through Kaplan-Meier analysis, the survival rate of the non-surgical group was found to be significantly lower no matter before or after propensity score matching. One thousand one hundred and seventy surgical patients were divided into a training group and a verification group. In the training group, univariate and multivariate Cox models were used to explore the prognostic factors, and logistic regression was used to establish a nomogram based on significant predictors. In total, 12,228 patients with metastatic lung adenocarcinoma were recognized; primary tumor surgery accounted for 9.5%. After propensity score matching, the median survival time of 2 groups was significantly different. For the training group, univariate and multivariate COX analysis was conducted, and a nomogram was constructed. Acceptable agreement has been achieved between the predicted and observed survival rates, and the nomogram can divide patients with metastatic lung adenocarcinoma into different risk groups and predict their prognostic survival rate.
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Affiliation(s)
- Xiaowei Tie
- Taixing People’s Hospital Affiliated with Bengbu Medical College, Bengbu, China
| | - Lianlian Chen
- Taixing People’s Hospital Affiliated with Bengbu Medical College, Bengbu, China
| | - Xiaomin Li
- Taixing People’s Hospital Affiliated with Bengbu Medical College, Bengbu, China
| | - Wenjuan Zha
- Taixing People’s Hospital Affiliated with Bengbu Medical College, Bengbu, China
| | - Yangchen Liu
- Taixing People’s Hospital Affiliated with Bengbu Medical College, Bengbu, China
- *Correspondence: Yang Chen Liu, Taixing People’s Hospital Affiliated with Bengbu Medical College, Bengbu, China (e-mail: )
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10
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Ma C, Peng S, Zhu B, Li S, Tan X, Gu Y. The nomogram for the prediction of overall survival in patients with metastatic lung adenocarcinoma undergoing primary site surgery: A retrospective population-based study. Front Oncol 2022; 12:916498. [PMID: 36033482 PMCID: PMC9413074 DOI: 10.3389/fonc.2022.916498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background Lung adenocarcinoma (LUAD) is the most common type of Non-small-cell lung cancer (NSCLC). Distant metastasis of lung adenocarcinoma reduces the survival rate. we aim to develop a nomogram in order to predict the survival of patients with metastatic lung adenocarcinoma. Methods We retrospectively collected patients who were initially diagnosed as metastatic LUAD from 2010 to 2015 from SEER database. Based on the multivariate and univariate Cox regression analysis of the training cohorts, independent prognostic factors were assessed. The nomogram prediction model was then constructed based on these prognostic factors to predict the overall survival at 12, 24 and 36 months after surgery. Nomogram were identified and calibrated by c-index, time-dependent receiver operating characteristic curve (time-dependent AUC) and calibration curve. Decision curve analysis (DCA) was used to quantify the net benefit of the nomogram at different threshold probabilities, and to better compare with the TNM staging system, we calculated the c-index of this nomogram as well as the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI). Result A total of 1102 patients with metastatic LUAD who met the requirements were included for analysis. They were randomly divided into 774 in the training cohorts and 328 in the validation cohorts. As can be seen from the calibration plots, the predicted nomogram and the actual observations in both of the training and validation cohorts were generally consistent. The time dependent AUC values of 12 months, 24 months and 36 months were 0.707, 0.674 and 0.686 in the training cohorts and 0.690, 0.680 and 0.688 in the verification cohorts, respectively. C-indexes for the training and validation cohorts were 0.653 (95%CI 0.626-0.68)and 0.663 (95%CI 0.626-1), respectively. NRI and IDI show that the model is more clinical applicable than the existing staging system. In addition, our risk scoring system based on Kaplan Meier (K-M) survival curve can accurately divide patients into three hierarchy risk groups. Conclusion This has led to the development and validation of a prognostic nomogram to assist clinicians in determining the prognosis of patients with metastatic lung adenocarcinoma after primary site surgery.
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Affiliation(s)
- Chao Ma
- School of Public Health, Wuhan University, Wuhan, China
| | - Shuzhen Peng
- Department of Health Management, Huang pi District People’ Hospital, Wuhan, China
| | - Boya Zhu
- School of Public Health, Wuhan University, Wuhan, China
| | - Siying Li
- School of Public Health, Wuhan University, Wuhan, China
| | - Xiaodong Tan
- School of Public Health, Wuhan University, Wuhan, China
- *Correspondence: Xiaodong Tan, ; Yaohua Gu,
| | - Yaohua Gu
- School of Public Health, Wuhan University, Wuhan, China
- *Correspondence: Xiaodong Tan, ; Yaohua Gu,
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11
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Zhang C, Zhang Y, Li D, Jia W. Survival benefits of primary tumor surgery for synchronous brain metastases: A SEER-based population study with propensity-matched comparative analysis. Cancer Med 2022; 12:2677-2690. [PMID: 35965407 PMCID: PMC9939173 DOI: 10.1002/cam4.5142] [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: 04/02/2022] [Revised: 07/17/2022] [Accepted: 08/02/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Evidence about the prognostic value of primary tumor surgery (PTS) in patients with brain metastatic malignancies is ambiguous and controversial. This study assessed the survival benefits of primary tumor surgery in patients with brain metastases (BMs). METHODS Adults patients with BMs that originated from lung, breast, kidney, skin, colon, and liver diagnosed between 2010 and 2018 were derived from the Surveillance, Epidemiology, and End Results database (SEER). Propensity score matching (PSM) was used to balance the bias between patients with or without PTS. Then the prognostic value of PTS was estimated by Kaplan-Meier analysis and Cox proportional hazard regression models. RESULTS A total of 32,760 patients with BMs secondary to non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), breast cancer, renal cancer, melanoma, colorectal cancer, and liver cancer were identified from the database. After PSM at 1:1 ratio, PTS appeared to significantly prolong cause-specific survival (CSS) time for patients with BMs secondary to NSCLC, breast cancer, renal cancer, and colorectal cancer (hazard ratio [HR] = 0.60 [0.53-0.68], 0.56 [0.43-0.73], 0.47 [0.37-0.60], and 0.59 [0.37-0.95], respectively, all p < 0.05). Patients with earlier T and N classifications, no extracranial metastasis, and cancer-specific subtypes (adenocarcinoma in NSCLC, hormone receptor-negative breast cancer) may derive more survival benefits from PTS when suffering from BMs. CONCLUSION This population-based study supported PTS could provide survival benefits for patients with BMs secondary to NSCLC, breast cancer, renal cancer, and colorectal cancer. More emphasis should be put on PTS of selected patients with BMs.
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Affiliation(s)
- Chengkai Zhang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yuan Zhang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Deling Li
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Wang Jia
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,Beijing Neurosurgical InstituteBeijingChina
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12
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Yang FR, Li SY, Hu XW, Li XR, Li HJ. Identifying the Antitumor Effects of Curcumin on Lung Adenocarcinoma Using Comprehensive Bioinformatics Analysis. Drug Des Devel Ther 2022; 16:2365-2382. [PMID: 35910781 PMCID: PMC9329682 DOI: 10.2147/dddt.s371420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background As the main component of turmeric (Curcuma longa L.), curcumin is widely used in the treatment of various diseases. Previous studies have demonstrated that curcumin has great potential as a therapeutic agent, but the lack of understanding of the functional mechanism of the drug has hindered the widespread use of the natural product. In the present study, we used comprehensive bioinformatics analysis and in vitro experiments to explore the anti-tumor mechanism of curcumin. Materials and Methods LUAD mRNA expression data were obtained from TCGA database and differentially expressed genes (DEGs) were identified using R software. Functional enrichment analysis was conducted to further clarify its biological properties and hub genes were identified by a protein–protein interaction (PPI) network analysis. Survival analysis and molecular docking were used to analyze the effectiveness of the hub genes. By an in vitro study, we evaluated whether curcumin could influence the proliferation, migration, and invasion activities of LUAD cells. Results In this study, 1783 DEGs from LUAD tissue samples compared to normal samples were evaluated. Functional enrichment analysis and the PPI network revealed the characteristics of the DEGs. We performed a topological analysis and identified 10 hub genes. Of these, six genes (INS, GCG, SST, F2, AHSG, and NPY) were identified as potentially effective biomarkers of LUAD. The molecular docking results indicated that curcumin targets in regulating lung cancer may be INS and GCG. We found that curcumin significantly inhibited the proliferation, migration, and invasion of LUAD cells and significantly decreased the expression of the INS and GCG genes. Conclusion The results of this study suggest that the therapeutic effects of curcumin on LUAD may be achieved through the intervention of INS and GCG, which may act as potential biomarkers for LUAD prevention and treatment.
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Affiliation(s)
- Fei-Ran Yang
- College of First Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of China
| | - Si-Yi Li
- College of First Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of China
| | - Xi-Wen Hu
- College of First Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of China
| | - Xiu-Rong Li
- Department of Oncology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of China
| | - Hui-Jie Li
- Department of Oncology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of China
- Correspondence: Hui-Jie Li; Xiu-Rong Li, Department of Oncology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jingshi Road, Jinan, Shandong, 250014, People’s Republic of China, Email ;
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13
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Zhang Y, Zhang Y, Cheng X, Dai K, Xu B, Liang S, Chen M, Zhang H, Chen Z. The Prognostic Impact of Lymph Node Dissection on Primary Tumor Resection for Stage IV Non-Small Cell Lung Cancer: A Population-Based Study. Front Oncol 2022; 12:853257. [PMID: 35600401 PMCID: PMC9117632 DOI: 10.3389/fonc.2022.853257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/05/2022] [Indexed: 01/19/2023] Open
Abstract
Objective Selected patients with stage IV non–small cell lung cancer (NSCLC) who underwent primary tumor resection have witnessed a survival benefit. Whether additional lymph node dissection (LND) would result in a better effect remain unknown. We investigated the prognostic impact of LND on patients with stage IV NSCLC who received primary tumor resection (PTR). Methods Patients with stage IV NSCLC who underwent PTR were identified from the Surveillance, Epidemiology, and End Results database from 2004 to 2016. Propensity-score matching was performed to minimize the confounding effect, and lung cancer-specific survival (CSS) and overall survival (OS) were compared after matching. Multivariable Cox regression was used to identify prognostic factors and to adjust for covariates in subgroup analysis. The effect of the number of lymph nodes examined on the CSS was evaluated by repeating the Cox analysis in a binary method. Results A total of 4,114 patients with stage IV NSCLC who receive surgery met our criteria, of which 2,622 (63.73%) underwent LND and 628 patients were identified 1:1 in LND and non-LND groups after matching. Compared with the non-LND group, the LND group had a longer CSS (median: 23 vs. 16 months, p < 0.001) and OS (median: 21 vs. 15 months, p < 0.001). Multivariable regression showed that LND was independently associated with favorable CCS [hazard ratio (HR) = 0.78, 95% confidence interval (CI) 0.69–0.89, P < 0.001] and OS (HR = 0.79, 95% CI 0.70–0.89, P < 0.001). Subgroup analysis suggested that LND is an independent favorable predictor to survival in the surgical patients who were older age (>60 years old), female, T3-4, N0, and M1a stage and those who underwent sublobar resection. In addition, a statistically significant CCS benefit was associated with an increasing number of lymph nodes examined through 25 lymph nodes. Conclusions LND with a certain range of lymph nodes number examined was associated with improved survival for patients with stage IV NSCLC who received primary tumor resection. The results may have implications for guidelines on lymph nodes management in selective advanced NSCLC for surgery.
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Affiliation(s)
- Yudong Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yichi Zhang
- Department of Thoracic Surgery and Oncology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xinxin Cheng
- Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Keyao Dai
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Bo Xu
- Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shujun Liang
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Minsheng Chen
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Honglang Zhang
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Zhenguang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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14
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Zhang D, Deng T, Yuan W, Chen T, Jiang S. Glaucocalyxin A induces apoptosis of NSCLC cells by inhibiting the PI3K/Akt/GSK3β pathway. Clin Exp Pharmacol Physiol 2022; 49:797-804. [PMID: 35576104 DOI: 10.1111/1440-1681.13667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/27/2022] [Accepted: 05/08/2022] [Indexed: 11/28/2022]
Abstract
Lung cancer is one of the fastest growing malignancies in morbidity and mortality, and current therapies are in general not sufficiently effective for this deadly disease. This study characterizes the anti-cancer effects of Glaucocalyxin A (GLA) and explores the underlying mechanisms using human non-small cell lung carcinoma (NSCLC) cells. First, our data showed that GLA suppressed the viability of cancer cells, while no effect was observed in the normal bronchial epithelial cell Bease 2B cells. Second, GLA inhibited colony formation, induced apoptosis of cancer cells. Third, GLA down-regulated the expression of B-cell lymphoma-2 (Bcl-2) protein, up-regulated the expression of Bcl2-associated X protein (Bax) , and strengthened cleavage of Caspase-3 and poly ADP-ribose polymerase (PARP). Fourth, GLA also diminished mitochondrial membrane potential and inhibited phosphatidylinositol 3-kinase (PI3K)/Akt/ glycogen synthase kinase-3β (GSK3β) pathway. In addition, injection of GLA (20 mg/kg) every two days significantly inhibited A549 xenograft tumor growth, accompanied by increased apoptosis and decreased proliferation. Together, our study provides evidence that the anticancer effect of GLA in NSCLC is mediated by inducing apoptosis through inhibiting PI3K/Akt/GSK3β pathway and suggests that GLA may be used as a promising natural medicine for NSCLC therapy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- De Zhang
- School of Basic Medicine, Gannan Medical University, Ganzhou, China
| | - Ting Deng
- School of Basic Medicine, Gannan Medical University, Ganzhou, China
| | - Wa Yuan
- School of Basic Medicine, Gannan Medical University, Ganzhou, China
| | - Tongqiang Chen
- School of Basic Medicine, Gannan Medical University, Ganzhou, China
| | - Shuping Jiang
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, China.,School of Basic Medicine, Gannan Medical University, Ganzhou, China.,Key Laboratory of Biomaterials and Bio-fabrication in Tissue Engineering of Jiangxi Province, Ganzhou, China
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15
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Kuo SW, Chen PH, Lu TP, Chen KC, Liao HC, Tsou KC, Tsai TM, Lin MW, Hsu HH, Chen JS. Primary Tumor Resection for Stage IV Non-small-cell Lung Cancer Without Progression After First-Line Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor Treatment: A Retrospective Case-Control Study. Ann Surg Oncol 2022; 29:4873-4884. [PMID: 35254583 DOI: 10.1245/s10434-022-11483-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/03/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND In studies of stage IV epidermal growth factor receptor (EGFR)-mutant nonsmall-cell lung cancer (NSCLC), <10% of patients underwent surgery; thus, the effect of surgery in these patients remains unclear. We investigated whether primary lung tumor resection could improve the survival of patients with stage IV EGFR-mutant NSCLC without progression after first-line EGFR-tyrosine kinase inhibitor (EGFR-TKI) treatment. METHODS This retrospective case-control study included patients treated with first-line EGFR-TKIs without progression on follow-up imaging. Patients in the surgery group (n = 56) underwent primary tumor resection, followed by TKI maintenance therapy. Patients in the control group (n = 224; matched for age, metastatic status, and Eastern Cooperative Oncology Group performance status) received only TKI maintenance therapy. Local ablative therapy for distant metastasis was allowed in both groups. The primary endpoint was progression-free survival. The secondary endpoints were overall survival, failure patterns, and complications/adverse events. RESULTS The median time from TKI treatment to surgery was 5.1 months. For the surgery and control groups, the median follow-up periods were 34.0 and 38.5 months, respectively, with a median (95% confidence interval) progression-free survival of 29.6 (18.9-40.3) and 13.0 (11.8-14.2) months, respectively (P < 0.001). Progression occurred in 29/56 (51.8%) and 207/224 (92.4%) patients, respectively. The median overall survival in the surgery group was not reached. The rate of surgical complications of grade ≥2 was 12.5%; complications were treated conservatively. CONCLUSIONS Primary tumor resection is feasible for patients with EGFR-mutant nonprogressed NSCLC during first-line EGFR-TKI treatment and may improve survival better than maintenance EGFR-TKI therapy alone.
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Affiliation(s)
- Shuenn-Wen Kuo
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City 100, Taiwan
| | - Pei-Hsing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan
| | - Tzu-Pin Lu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City 100, Taiwan.,Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City 100, Taiwan
| | - Ke-Cheng Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City 100, Taiwan
| | - Hsien-Chi Liao
- Department of Traumatology, National Taiwan University Hospital, Taipei City 100, Taiwan
| | - Kuan-Chuan Tsou
- Department of Surgery, Taipei City Hospital, Taipei City, 115, Taiwan
| | - Tung-Ming Tsai
- Department of Surgical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei City 106, Taiwan
| | - Mong-Wei Lin
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City 100, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City 100, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City 100, Taiwan. .,Department of Surgical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei City 106, Taiwan.
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16
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Shi S, Wang H, Liu X, Xiao J. Prediction of overall survival of non-small cell lung cancer with bone metastasis: an analysis of the Surveillance, Epidemiology and End Results (SEER) database. Transl Cancer Res 2022; 10:5191-5203. [PMID: 35116369 PMCID: PMC8797363 DOI: 10.21037/tcr-21-1507] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022]
Abstract
Background The prognosis of non-small cell lung cancer (NSCLC) patients with bone metastasis is extremely repulsive. The aim of this study was to potentially characterize the prevalence, associated factors and to establish a prognostic nomogram to predict the overall survival (OS) of NSCLC patients with bone metastasis. Methods The Surveillance, Epidemiology and End Results (SEER) database was used to collected NSCLC cases during 2010–2015. The cases with incomplete clinicopathological information were excluded. Finally, 484 NSCLC patients with bone metastasis were included in the present study and randomly divided into the training (n=340) and validation (n=144) cohorts in a ratio of 7:3 based on R software. NSCLC patients with bone metastasis were selected to investigate predictive factors for OS and cancer-specific survival (CSS) using the multivariable Cox proportional hazards regression. A nomogram incorporating these prognostic factors was developed and evaluated by a concordance index (C-index), calibration plots, and risk group stratifications. Results In the Cox proportional hazards model, sex, race, American Joint Committee on Cancer (AJCC) N, T stage, liver metastasis, and chemotherapy were regarded as prognostic factors of OS. The nomogram based on sex, race, AJCC N, T stage, liver metastasis and chemotherapy was developed for cancer-specific death to predict 1-, 3-, and 5-year survival rate with good performance. The C-index of established nomogram was 0.695 for cancer-specific death in the study population with an acceptable calibration. Conclusions The female gender, the patients with chemotherapy and not liver metastasis may indicate improved survival. However, the global prospective data with the latest tumor, node, metastasis (TNM) classification is needed to further improve this model.
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Affiliation(s)
- Si Shi
- The Respiratory Department, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongwei Wang
- The Respiratory Department, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaohui Liu
- The Respiratory Department, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jinling Xiao
- The Respiratory Department, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
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17
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Deng HY, Li D, Ren Y, Wang K, Tang X. Targeted Therapy Followed by Salvage Surgery and Adjuvant Therapy: A Promising Therapy for Lung Cancer With Malignant Pleural Effusion From a Case Report. Front Surg 2021; 8:659983. [PMID: 34957195 PMCID: PMC8702428 DOI: 10.3389/fsurg.2021.659983] [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: 01/28/2021] [Accepted: 11/10/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction: Malignant pleural effusion was encountered in about 8–15% of lung cancer patients at initial cancer diagnosis. The optimal therapeutic strategies for lung cancer with malignant pleural effusion (MPE) remain unclear. Case Description: In this study, we reported a case of lung cancer with MPE, which was successfully managed with a multidisciplinary therapeutic strategy. The patient initially received gefitinib for 4 months with excellent response and he underwent salvage thoracoscopic lobectomy and systematic lymphadenectomy. Pathological complete response was confirmed for the patient and he discontinued gefitinib but received 4 cycles of adjuvant chemotherapy instead. The patient is still alive without disease progression for 62 months after surgery. Conclusions: Combining targeted therapy, salvage surgery, and adjuvant therapy may be a promising treatment strategy for lung cancer with MPE harboring oncogene-targeted mutations.
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Affiliation(s)
- Han-Yu Deng
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Deyan Li
- Operating Room, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Ren
- Department of Outpatient, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaojun Tang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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18
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Zhu S, Ge T, Hu J, Jiang G, Zhang P. Prognostic value of surgical intervention in advanced lung adenocarcinoma: a population-based study. J Thorac Dis 2021; 13:5942-5953. [PMID: 34795942 PMCID: PMC8575796 DOI: 10.21037/jtd-21-997] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/19/2021] [Indexed: 12/24/2022]
Abstract
Background Surgical intervention is generally not considered as a treatment option in patients with advanced non-small cell lung cancer (NSCLC). Accumulating data suggest that surgery may have beneficial effects for these advanced patients. However, no evidence supports the significance of primary tumor resection (PTR) and metastatic tumor resection (MTR) in patients with stage IV lung adenocarcinoma (LUAD). Methods A total of 32,497 patients diagnosed with primary stage IV LUAD were selected through the Surveillance, Epidemiology, and End Results (SEER) database. Possible confounders were eliminated by propensity score matching (PSM). The overall survival (OS) and lung cancer-specific survival (LCSS) were estimated as the primary endpoints. Furthermore, the independent prognostic factors of patients with the surgical intervention were retrospectively analyzed. Results Patients underwent surgical intervention had better OS and LCSS than those who did not (P=0.001 for OS; P<0.001 for LCSS). Meanwhile, patients who underwent surgery combined with lymph node dissection had better survival outcomes (P<0.001 for OS and LCSS) in the K-M analysis. For different metastatic sites, PTR was beneficial to the survival of patients with isolated lung metastases (LUM) and multiple organ metastases (MOM) (LUM: P=0.041; MOM: P=0.003). As for metastatic surgery, no patients were found to benefit from resection of metastatic tumor [bone metastasis (BOM): P=0.696; brain metastasis (BRM): P=0.951; LUM: P=0.402; MOM: P=0.365]. Conclusions Surgical intervention strategies can prolong survival to some extent, depending on different sites of metastasis and highly selected patients.
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Affiliation(s)
- Shuncang Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Ge
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junjie Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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19
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Chao C, Qian Y, Li X, Sang C, Wang B, Zhang XY. Surgical Survival Benefits With Different Metastatic Patterns for Stage IV Extrathoracic Metastatic Non-Small Cell Lung Cancer: A SEER-Based Study. Technol Cancer Res Treat 2021; 20:15330338211033064. [PMID: 34496678 PMCID: PMC8442485 DOI: 10.1177/15330338211033064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: With the knowledge of oligometastases, primary surgery plays an increasingly
vital role in metastatic non-small cell lung cancer. We aimed to evaluate
the survival benefit of primary surgery based on metastatic patterns. Materials and Methods: The selected patients with stage IV extrathoracic metastatic (m1b) non-small
cell lung cancer between 2010 and 2015 were included in a retrospective
cohort study from the Surveillance, Epidemiology, and End Results (SEER)
database. Multiple imputation was used for the missing data. Patients were
divided into 2 groups depending on whether surgery was performed. After
covariate balancing propensity score (CBPS) weighting, multivariate Cox
regression models and Kaplan-Meier survival curve were built to identify the
survival benefit of different metastatic patterns. Results: Surgery can potentially increase the overall survival (OS) (adjusted HR:
0.68, P < 0.001) of non-small cell lung cancer. The
weighted 3-year OS in the surgical group was 16.9%, compared with 7.8% in
the nonsurgical group. For single organ metastasis, surgery could improve
the survival of metastatic non-small cell lung cancer. Meanwhile, no
significant survival improvements in surgical group were observed in
patients with multiple organ metastases. Conclusion: The surgical survival benefits for extrathoracic metastatic non-small cell
lung cancer could be divided by metastatic pattern.
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Affiliation(s)
- Ce Chao
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yongxiang Qian
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xihao Li
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chen Sang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Bin Wang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiao-Ying Zhang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
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20
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Coster JN, Groth SS. Surgery for Locally Advanced and Oligometastatic Non-Small Cell Lung Cancer. Surg Oncol Clin N Am 2021; 29:543-554. [PMID: 32883457 DOI: 10.1016/j.soc.2020.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Locally advanced non-small cell lung cancer is a heterogeneous group of tumors that require multidisciplinary treatment. Although there is much debate with regard to their management, a multimodal treatment strategy for carefully selected patients that includes surgery can extend survival compared with nonoperative definitive therapy. As the role of targeted therapies and immune checkpoint inhibitors for these tumors becomes better defined, practices will continue to evolve.
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Affiliation(s)
- Jenalee N Coster
- Division of Thoracic Surgery, Micheal E. DeBakey Department of Surgery, Baylor College of Medicine, 7200 Cambridge St, Ste 6A. Houston, TX 77030, USA
| | - Shawn S Groth
- Division of Thoracic Surgery, Micheal E. DeBakey Department of Surgery, Baylor College of Medicine, 7200 Cambridge St, Ste 6A. Houston, TX 77030, USA.
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21
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Shyr BS, Huang CS, Chen HS, Hsu PK, Chiu CH, Hsu HS, Tsai CM, Chen YM. Sequence For Surgical Resection of Primary Lung Tumor For Oligometastatic Non-Small Cell Lung Cancer. Ann Thorac Surg 2021; 113:1333-1340. [PMID: 33964254 DOI: 10.1016/j.athoracsur.2021.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Differing surgical series for the treatment of primary lung tumor with synchronous oligometastatic stage IV non-small cell lung cancer (NSCLC) have been published; however, outcomes remain ambiguous. METHODS Patients with synchronous oligometastatic stage IV NSCLC treated from 2005 to 2017 were enrolled to identify the impact of treatment sequence (primary lung resection versus systemic treatment) on progression-free survival (PFS) and overall survival (OS). RESULTS Fifty-one patients received tumor resection (84% adenocarcinoma, 55% non-smokers, and 65% driver gene mutation). Resection occurred before or after systemic treatment in 33 (64.7%) and 18 (35.3%) patients, respectively. Patients who received resection first were older (62.1 vs. 54 year) and at a less advanced intrathoracic stage (18% vs. 44%). No significant differences were noted regarding perioperative complication (30% vs. 28%), length of hospital stay (9.0 vs. 10.5 days), percentage of disease progression (91% vs. 94%), overall death (70% vs. 78%), median PFS (14.0 vs. 22.8 months) and OS (44.6 vs. 53.2 months). Patients with single-organ metastasis had significantly longer PFS and OS than those with oligometastases (17.5 vs. 12.8 months, p=0.040 and 55.6 vs. 39.8 months, p=0.035), respectively. Multivariable Cox analysis identified non-solitary metastasis as the only independent predictor of PFS (hazard ratio 2.27; 95% CI, 1.07-4.81, p=0.033). CONCLUSIONS Primary lung resection before or after induction systemic therapy may benefit patients with oligometastatic NSCLC. Future randomized clinical trials examining the effect of treatment sequence is recommended.
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Affiliation(s)
- Bor-Shiuan Shyr
- Department of Surgery, Taipei Veterans General Hospital; Taipei, Taiwan
| | - Chien-Sheng Huang
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital; Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao Tung University, Taiwan; School of Medicine, National Yang-Ming University, Taiwan.
| | - Hui-Shan Chen
- Department of Health Care Administration, Chang Jung Christian University, Tainan City, Taiwan
| | - Po-Kuei Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital; Taipei, Taiwan
| | - Chao-Hua Chiu
- Division of Thoracic Oncology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Shui Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital; Taipei, Taiwan
| | - Chun-Ming Tsai
- Division of Thoracic Oncology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuh-Min Chen
- Division of Thoracic Oncology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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22
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Fu F, Wen Z, Gao Z, Zhao Y, Li Y, Zhang Y, Chen H. Primary Tumor Resection Improves Survival for EGFR-TKI-Treated Patients With Occult M1a Lung Adenocarcinoma. Front Oncol 2021; 11:622723. [PMID: 33954108 PMCID: PMC8092396 DOI: 10.3389/fonc.2021.622723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/30/2021] [Indexed: 12/25/2022] Open
Abstract
Background The role of primary tumor resection in occult M1a lung adenocarcinoma remains unclear, especially for patients receiving targeted therapy. The purpose of this study is to assess the effect of primary tumor resection on overall survival (OS) in lung adenocarcinoma patients with occult pleural disseminations receiving targeted therapy. Methods Lung adenocarcinoma patients with intraoperatively-confirmed occult pleural dissemination (M1a), who hospitalized in the Department of Thoracic Surgery in Fudan Shanghai Cancer Center from May 2008 to December 2017 and received EGFR-TKIs therapy, were enrolled. Log-rank tests were used to compare the survival differences between groups. Results 34 patients receiving EGFR-TKIs were enrolled. The majority of them were never smokers (29/34, 85.3%). Among the enrolled patients, 20 (58.8%) patients underwent primary tumor resection, while 14 (41.2%) patients not. There was no distributional difference of baselines between patients undergoing and not undergoing primary tumor resection. Further analyses demonstrated that the patients undergoing primary tumor resection had a prolonged OS compared with those not (log-rank P= 0.042). The 2-year and 5-year OS for patients receiving primary tumor resection and EGFR-TKIs was 90.0% and 60.1%. Conclusions Primary tumor resection was associated with improved survival in patients with occult intraoperatively-confirmed M1a adenocarcinoma receiving EGFR-TKIs.
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Affiliation(s)
- 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
| | - Zhexu Wen
- 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
| | - Zhendong Gao
- 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
| | - Yue Zhao
- 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
| | - Yuan Li
- Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center, 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
| | - Haiquan Chen
- 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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23
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Hao Z, Liang H, Zhang Y, Wei W, Lan Y, Qiu S, Lin G, Wang R, Liu Y, Chen Y, Huang J, Wang W, Cui F, Goto T, Jeong JY, Veronesi G, Lopez-Pastorini A, Igai H, Liang W, He J, Liu J. Surgery for advanced-stage non-small cell lung cancer: lobectomy or sub-lobar resection? Transl Lung Cancer Res 2021; 10:1408-1423. [PMID: 33889519 PMCID: PMC8044485 DOI: 10.21037/tlcr-21-39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Metastatic non-small cell lung cancer (NSCLC) has many comorbidities, such as chronic obstructive pulmonary disease, coronary heart disease, and older age-related comorbidities. A survival benefit was observed in such patients who underwent surgery for selected oligometastatic disease. However, to the best of our knowledge, there is no evidence to support whether lobectomy (compared with sub-lobar resection) would further prolong these patients' lives. Methods Patients with metastatic NSCLC who underwent primary tumor resection were identified from the Surveillance, Epidemiology, and End Results (SEER) database and then divided into lobectomy and sub-lobar resection groups. Propensity score matching (PSM, 1:1) was performed to match the baseline characteristics of the two groups. Cancer-specific survival (CSS) was estimated. Results In total, 24,268 patients with metastatic NSCLC were identified; 4,114 (16.95%) underwent primary tumor surgery, and of these, 2,045 (49.71%) underwent lobectomy and 1,766 (42.93%) underwent sub-lobar resection. After PSM, 644 patients in each group were included. Lobectomy was independently correlated with longer median CSS time [hazards ratio (HR): 0.70, 95% confidence interval (CI): 0.61-0.80, P<0.001]. The 1, 2, and 3-year survival rates after PSM also favored the lobectomy group. However, no significant survival difference was found for wedge resection and segmentectomy (HR: 0.96, 95% CI: 0.70-1.31, P=0.490). The 1-, 2-, and 3-year survival rates after PSM also exhibited no difference within the sub-lobar group. We explored whether lymph node dissection would provide additional survival benefits for stage IV NSCLC patients. According to the multivariate Cox analysis of the matched population, lymph node dissection was independently associated with better CSS (HR: 0.76, 95% CI: 0.66-0.88, P<0.001) and overall survival (OS) (HR: 0.74, 95% CI: 0.65-0.86, P<0.001). We confirmed this result in the different types of surgery and found that the lymph node dissection group consistently had better survival outcomes both in the lobectomy group and sub-lobar resection population. According to the subgroup analysis, with the exception of stage T4 and brain metastatic patients, all of the patient subtypes exhibited greater benefit from lobectomy than sub-lobar resection. Conclusions Lobectomy has a greater survival benefit in metastatic NSCLC patients compared with sub-lobar resection when radical treatment of primary site was indicated.
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Affiliation(s)
- Zhexue Hao
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yichi Zhang
- Department of Clinical Medicine, Guangzhou Medical University, Guangzhou, China
| | - Wei Wei
- Department of Thoracic Surgery, Huizhou Municipal Central Hospital, Huizhou, China
| | - Yuting Lan
- Department of Clinical Medicine, Guangzhou Medical University, Guangzhou, China
| | - Shuxian Qiu
- Department of Clinical Medicine, Guangzhou Medical University, Guangzhou, China
| | - Guo Lin
- Department of Clinical Medicine, Guangzhou Medical University, Guangzhou, China
| | - Runchen Wang
- Department of Clinical Medicine, Guangzhou Medical University, Guangzhou, China
| | - Yulin Liu
- Department of Clinical Medicine, Guangzhou Medical University, Guangzhou, China
| | - Yingying Chen
- Department of Clinical Medicine, Guangzhou Medical University, Guangzhou, China
| | - Jun Huang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wei Wang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Fei Cui
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Jin Yong Jeong
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Giulia Veronesi
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Lopez-Pastorini
- Department of Thoracic Surgery, Lung Clinic, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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24
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Kaba E, Yardımcı EH, Kakuturu J, Toker A. In Spite of Curative Radical Pulmonary Procedures, Lesser Pulmonary Resection Shows More Favorable Prognosis in Surgically Treated NSCLC With Synchronous Isolated Cranial Oligometastases. Front Surg 2021; 8:645870. [PMID: 33718430 PMCID: PMC7947805 DOI: 10.3389/fsurg.2021.645870] [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: 12/24/2020] [Accepted: 02/03/2021] [Indexed: 12/25/2022] Open
Abstract
Oligometastatic disease in lung cancer is not a rare condition as previously thought. Among 812 non-small cell lung cancer patients treated surgically with lung resection between October 2011 and October 2018 at the Department of Thoracic Surgery, Florence Nightingale Hospitals, Turkey, 28 patients (3.4%) had synchronous cranial metastases. We analyzed synchronous isolated cranial metastases patients treated by locally ablative treatments (surgery, radiotherapy, or both). Metastases existing at the diagnosis of primary cancer were considered as synchronous, and their treatment was performed before (at least 1 month) or after (for maximum 1 month) surgery of the primary lung lesion. Prognostic factors affecting survival are evaluated retrospectively to identify clinical factors predicting survival in an effort to better select patients for surgery. Patients having T1-T2 primary lung tumors, no mediastinal lymph node metastasis, receiving minor anatomical lung resection, receiving neoadjuvant chemotherapy, having single cranial metastasis, and receiving surgical cranial metastasectomy were found to have better survival. According to tumor histology, having adenocarcinoma, and not having lymphovascular or visceral pleura invasion correlated with better survival. Average survival time was 52.1 months and median survival was 32 months. The last mortality during the follow-up was at 24 months; cumulative survival was 48.3% at that time. Our study was designed to define the criteria for patients with oligometastatic disease who may benefit from lung resection.
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Affiliation(s)
- Erkan Kaba
- Department of Thoracic Surgery, Group Florence Nightingale Hospitals, Demiroglu Bilim University, Istanbul, Turkey
| | - Eyüp Halit Yardımcı
- Department of Thoracic Surgery, Group Florence Nightingale Hospitals, Demiroglu Bilim University, Istanbul, Turkey
| | - Jahnavi Kakuturu
- Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart & Vascular Institute, Morgantown, WV, United States
| | - Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart & Vascular Institute, Morgantown, WV, United States
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25
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Durosini I, Janssens R, Arnou R, Veldwijk J, Smith MY, Monzani D, Smith I, Galli G, Garassino M, Katz EG, Bailo L, Louis E, Vandevelde M, Nackaerts K, de Wit GA, Pravettoni G, Huys I. Patient Preferences for Lung Cancer Treatment: A Qualitative Study Protocol Among Advanced Lung Cancer Patients. Front Public Health 2021; 9:622154. [PMID: 33634069 PMCID: PMC7900128 DOI: 10.3389/fpubh.2021.622154] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/08/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction: Lung cancer is the deadliest and most prevalent cancer worldwide. Lung cancer treatments have different characteristics and are associated with a range of benefits and side effects for patients. Such differences may raise uncertainty among drug developers, regulators, payers, and clinicians regarding the value of these treatment effects to patients. The value of conducting patient preference studies (using qualitative and/or quantitative methods) for benefits and side effects of different treatment options has been recognized by healthcare stakeholders, such as drug developers, regulators, health technology assessment bodies, and clinicians. However, evidence-based guidelines on how and when to conduct and use these studies in drug decision-making are lacking. As part of the Innovative Medicines Initiative PREFER project, we developed a protocol for a qualitative study that aims to understand which treatment characteristics are most important to lung cancer patients and to develop attributes and levels for inclusion in a subsequent quantitative preference survey. Methods: The study protocol specifies a four-phased approach: (i) a scoping literature review of published literature, (ii) four focus group discussions with stage III and IV Non-Small Cell Lung Cancer patients, (iii) two nominal group discussions with stage III and IV Non-Small Cell Lung Cancer patients, and (iv) multi-stakeholder discussions involving clinicians and preference experts. Discussion: This protocol outlines methodological and practical steps as to how qualitative research can be applied to identify and develop attributes and levels for inclusion in patient preference studies aiming to inform decisions across the drug life cycle. The results of this study are intended to inform a subsequent quantitative preference survey that assesses patient trade-offs regarding lung cancer treatment options. This protocol may assist researchers, drug developers, and decision-makers in designing qualitative studies to understand which treatment aspects are most valued by patients in drug development, regulation, and reimbursement.
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Affiliation(s)
- Ilaria Durosini
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Rosanne Janssens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Reinhard Arnou
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Jorien Veldwijk
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Meredith Y Smith
- Alexion Pharmaceuticals, Inc., University of Southern California School of Pharmacy, Los Angeles, CA, United States
| | - Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ian Smith
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Giulia Galli
- Unit of Thoracic Oncology, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina Garassino
- Unit of Thoracic Oncology, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Eva G Katz
- Janssen Research and Development, Raritan, NJ, United States
| | - Luca Bailo
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Evelyne Louis
- Department of Pneumology/Respiratory Oncology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - Marie Vandevelde
- Department of Pneumology/Respiratory Oncology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - Kristiaan Nackaerts
- Department of Pneumology/Respiratory Oncology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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26
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Sanookpan K, Nonpanya N, Sritularak B, Chanvorachote P. Ovalitenone Inhibits the Migration of Lung Cancer Cells via the Suppression of AKT/mTOR and Epithelial-to-Mesenchymal Transition. Molecules 2021; 26:molecules26030638. [PMID: 33530617 PMCID: PMC7866203 DOI: 10.3390/molecules26030638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 12/09/2022] Open
Abstract
Cancer metastasis is the major cause of about 90% of cancer deaths. As epithelial-to-mesenchymal transition (EMT) is known for potentiating metastasis, this study aimed to elucidate the effect of ovalitenone on the suppression of EMT and metastasis-related behaviors, including cell movement and growth under detached conditions, and cancer stem cells (CSCs), of lung cancer cells. Methods: Cell viability and cell proliferation were determined by 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazo-liumbromide (MTT) and colony formation assays. Cell migration and invasion were analyzed using a wound-healing assay and Boyden chamber assay, respectively. Anchorage-independent cell growth was determined. Cell protrusions (filopodia) were detected by phalloidin-rhodamine staining. Cancer stem cell phenotypes were assessed by spheroid formation. The proteins involved in cell migration and EMT were evaluated by Western blot analysis and immunofluorescence staining. Results: Ovalitenone was used at concentrations of 0–200 μM. While it caused no cytotoxic effects on lung cancer H460 and A549 cells, ovalitenone significantly suppressed anchorage-independent growth, CSC-like phenotypes, colony formation, and the ability of the cancer to migrate and invade cells. The anti-migration activity was confirmed by the reduction of filopodia in the cells treated with ovalitenone. Interestingly, we found that ovalitenone could significantly decrease the levels of N-cadherin, snail, and slug, while it increased E-cadherin, indicating EMT suppression. Additionally, the regulatory signaling of focal adhesion kinase (FAK), ATP-dependent tyrosine kinase (AKT), the mammalian target of rapamycin (mTOR), and cell division cycle 42 (Cdc42) was suppressed by ovalitenone. Conclusions: The results suggest that ovalitenone suppresses EMT via suppression of the AKT/mTOR signaling pathway. In addition, ovalitenone exhibited potential for the suppression of CSC phenotypes. These data reveal the anti-metastasis potential of the compound and support the development of ovalitenone treatment for lung cancer therapy.
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Affiliation(s)
- Kittipong Sanookpan
- Cell-Based Drug and Health Product Development Research Unit, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (K.S.); (N.N.)
- Department of Pharmacology and Physiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nongyao Nonpanya
- Cell-Based Drug and Health Product Development Research Unit, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (K.S.); (N.N.)
- Department of Pharmacology and Physiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Boonchoo Sritularak
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Pithi Chanvorachote
- Cell-Based Drug and Health Product Development Research Unit, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (K.S.); (N.N.)
- Department of Pharmacology and Physiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
- Correspondence: ; Tel.: +662-218-8344
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27
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Jia J, Guo B, Yang Z, Liu Y, Ga L, Xing G, Zhang S, Jin A, Ma R, Wang J. Outcomes of local thoracic surgery in patients with stage IV non-small-cell lung cancer: A SEER-based analysis. Eur J Cancer 2020; 144:326-340. [PMID: 33388490 DOI: 10.1016/j.ejca.2020.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/09/2020] [Accepted: 12/02/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The outcomes of thoracic surgery for patients with stage IV non-small-cell lung cancer (NSCLC) are controversial and uncertain. PATIENTS AND METHODS The National Cancer Institute's Surveillance, Epidemiology, and End Results was queried for patients with stage IV NSCLC, including those treated with surgery-participated therapy modalities. Overall survival (OS) was evaluated using a variety of statistical analyses. RESULTS The analysis was carried out for 90,982 patients from 1975 to 2016 who had been diagnosed as stage IV NSCLC. Propensity score-matched (PSM) analyses that were well-balanced with all the important confounding covariates revealed improved OS (median survival time [MST]) with patients receiving surgery versus non-surgery (MST: 15 versus 8 months, P < 0.001); undergoing surgery plus chemotherapy versus chemotherapy (MST: 19 versus 11 months, P < 0.001); and having surgery plus chemoradiation versus chemoradiation (MST: 18 versus 11 months, P < 0.001). Sequential landmark analyses for long-term survivors of ≥1 and ≥3 years all indicated improved OS (P < 0.001) on univariate and multivariate analyses for the patients receiving the three surgery-related treatment patterns listed earlier, relative to the corresponding surgery-absent treatment modalities. For synchronous presentations of varied treatment paradigms, surgical intervention significantly led to increased OS (MST, months) benefits following treatment paradigms: surgery plus chemotherapy (22), surgery plus chemoradiation (18), chemotherapy (10), surgery only (9), chemoradiation (9), surgery plus radiation (6) and radiation alone (2). The subgroup analysis demonstrated that the elevated OS associated with local thoracic surgery in addition to chemotherapy (versus chemotherapy) or chemoradiation (versus chemoradiation) fell in the subcategories of T0-3, N0-2 and 0-1 (metastatic sites) tumours. The comparison of the aforementioned two types of treatment patterns indicated that the optimal patients for the surgery were those with any combination of T1-4, N0-3, Msite0-1 and adeno- or squamous carcinoma. CONCLUSIONS The patients with T1-4, N0-3, Msite0-1 and adeno- or squamous carcinoma of stage IV NSCLC had a longer OS with local thoracic surgery in combination with chemotherapy or chemoradiation.
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Affiliation(s)
- Jianlong Jia
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Bin Guo
- Department of Urologic Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhiyi Yang
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Yang Liu
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Latai Ga
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Guangming Xing
- Department of General Surgery, The Second Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Shiqing Zhang
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Aquan Jin
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Ruichen Ma
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Jun Wang
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China.
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28
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Zeng B, Ji P, Chen C, Sun J, Gu C, Shang A, Wu J, Sun Z, Li D. A nomogram from the SEER database for predicting the prognosis of patients with non-small cell lung cancer. Int J Biochem Cell Biol 2020; 127:105825. [PMID: 32898690 DOI: 10.1016/j.biocel.2020.105825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The purpose of this study was to establish and validate a nomogram to predict the prognosis in patients with non-small cell lung cancer (NSCLC) from multiple perspectives. RESULTS A total of 98,640 eligible patients were randomly divided into a training set (n = 69,048) and a validation set (n = 29,592). The baseline characteristics of the two sets were similar. We used clinical data from patients in the training set for univariate and multivariate Cox regression analyses. Twelve independent risk factors were incorporated for constructed a prognostic nomogram. And the nomogram with a concordance index of 0.777 (95 % CI, 0.775 to 0.779) for overall survival. The calibration curve results showed that the actual survival rate was consistent with the predicted survival rate. The area under curve of the receiver operating characteristic curves demonstrated that the nomogram has a high prediction of the overall survival rate in patients with NSCLC. CONCLUSION We have developed a nomogram with high prediction accuracy and discrimination ability, which can help clinicians making personalized survival predictions for NSCLC patients.
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Affiliation(s)
- Bingjie Zeng
- Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Road, Shanghai, 200065, China
| | - Ping Ji
- Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Road, Shanghai, 200065, China
| | - Chen Chen
- Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Road, Shanghai, 200065, China
| | - Junjun Sun
- Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Road, Shanghai, 200065, China
| | - Chenzheng Gu
- Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Road, Shanghai, 200065, China
| | - Anquan Shang
- Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Road, Shanghai, 200065, China
| | - Junlu Wu
- Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Road, Shanghai, 200065, China
| | - Zujun Sun
- Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Road, Shanghai, 200065, China.
| | - Dong Li
- Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Road, Shanghai, 200065, China.
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29
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Abstract
Lung cancer is the most common cause of cancer mortality globally. A vast majority of lung cancer cases are diagnosed at advanced stages. Management of advanced lung cancer requires several diagnostic and therapeutic procedures provided by various specialists. To optimise the entire diagnostic and therapeutic process, a concept of care provided simultaneously by a multidisciplinary team (MDT) has been developed and implemented in specialised centres worldwide. Observational studies suggest that integrated and coordinated care increases adherence to clinical guidelines, significantly shortens the interval from diagnosis to treatment, and may increase survival and quality of life (QoL). Prospective studies are warranted to assess the real impact of MDT on treatment outcomes and to further refine this approach.
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Affiliation(s)
- Anna Kowalczyk
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
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30
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Chen XR, Hou X, Li DL, Sai K, Dinglin XX, Chen J, Wang N, Li MC, Wang KC, Chen LK. Management of Non-Small-Cell Lung Cancer Patients Initially Diagnosed With 1 to 3 Synchronous Brain-Only Metastases: A Retrospective Study. Clin Lung Cancer 2020; 22:e25-e34. [PMID: 32839132 DOI: 10.1016/j.cllc.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/17/2020] [Accepted: 07/25/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The treatment options for newly diagnosed non-small-cell lung cancer (NSCLC) patients with 1 to 3 synchronous brain metastases (BM) remain controversial. The current study aimed to comprehensively analyze the characteristics, local treatment paradigms, and survival outcomes in these populations. PATIENTS AND METHODS A total of 252 NSCLC patients initially diagnosed with 1 to 3 synchronous brain-only metastases were enrolled onto this study. Local therapy (LT) to primary lung tumors (PLT) and BM included surgery, radiotherapy, or both. Median overall survival (mOS) was measured among patients who received LT to both PLT and BM (all-LT group), patients who were treated with LT to either PLT or BM (part-LT group), and patients who did not receive any LT (non-LT group). RESULTS The mOS for all-LT (n = 70), part-LT (n = 113), and non-LT (n = 69) groups was 33.2, 18.5, and 16.8 months, respectively (P = .002). The OS rates at 5 years for the all-LT, part-LT, and non-LT groups were 25.5%, 16.2%, and 0, respectively. Multivariable analysis revealed that all-LT versus non-LT, pretreatment Karnofsky performance status > 70, histology of adenocarcinoma, thoracic stage I-II, EGFR mutation, ALK positive, and second-line systemic therapies were independent prognostic factors for improved mOS. CONCLUSIONS The current study showed that LT for both PLT and BM is associated with superior OS in appropriately selected NSCLC patients initially diagnosed with 1 to 3 synchronous BM. Prospective trials are urgently needed to confirm this finding.
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Affiliation(s)
- Xin-Ru Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Xue Hou
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - De-Lan Li
- Department of Chemotherapy, Zhongshan City People's Hospital, Zhongshan, PR China
| | - Ke Sai
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Xiao-Xiao Dinglin
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, PR China
| | - Jing Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Na Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Mei-Chen Li
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Kai-Cheng Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Li-Kun Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China.
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Chao X, Yi L, Lan LL, Wei HY, Wei D. Long-term PM 2.5 exposure increases the risk of non-small cell lung cancer (NSCLC) progression by enhancing interleukin-17a (IL-17a)-regulated proliferation and metastasis. Aging (Albany NY) 2020; 12:11579-11602. [PMID: 32554855 PMCID: PMC7343463 DOI: 10.18632/aging.103319] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/28/2020] [Indexed: 05/03/2023]
Abstract
PM2.5 is a class of airborne particles and droplets with sustained high levels in many developing countries. Epidemiological studies have indicated that PM2.5 is closely associated with the increased morbidity and mortality of lung cancer in the world. Unfortunately, the effects of PM2.5 on lung cancer are largely unknown. In the present study, we attempted to explore the role of PM2.5 in the etiology of NSCLC. Here, we found that long-term PM2.5 exposure led to significant pulmonary injury. Epithelial-mesenchymal transition (EMT) and cancer stem cells (CSC) properties were highly induced by PM2.5 exposure. EMT was evidenced by the significant up-regulation of MMP2, MMP9, TGF-β1, α-SMA, Fibronectin and Vimentin. Lung cancer progression was associated with the increased expression of Kras, c-Myc, breast cancer resistance protein BCRP (ABCG2), OCT4, SOX2 and Aldh1a1, but the decreased expression of p53 and PTEN. Importantly, mice with IL-17a knockout (IL-17a-/-) showed significantly alleviated lung injury and CSC properties following PM2.5 exposure. Also, IL-17a-/--attenuated tumor growth was recovered in PM2.5-exposed mice injected with recombinant mouse IL-17a, accompanied with significantly restored lung metastasis. Taken together, these data revealed that PM2.5 could promote the progression of lung cancer by enhancing the proliferation and metastasis through IL-17a signaling.
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Affiliation(s)
- Xie Chao
- Department of Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong Province, P.R. China
| | - Liu Yi
- Centers of Disease Control and Prevention of Shandong Province, Jinan 250014, Shandong Province, P.R. China
| | - Li Lan Lan
- Affiliated Hospital of Binzhou Medical College, Binzhou 256603, Shandong Province, P.R. China
| | - Han Yun Wei
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Shihuan Province, P.R. China
| | - Dong Wei
- Department of Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong Province, P.R. China
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Li F, Chen H, Wang D. Silencing of CD276 suppresses lung cancer progression by regulating integrin signaling. J Thorac Dis 2020; 12:2137-2145. [PMID: 32642118 PMCID: PMC7330387 DOI: 10.21037/jtd.2020.04.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Non-small cell lung cancer (NSCLC) is one of the cancers with the highest morbidity and mortality among the world. Studies have shown that the invasion and metastasis of tumor are biological characteristics of lung cancer, and also the main cause of treatment failure and patient death. In-depth study of lung cancer invasion related genes will help to explore the etiology of lung cancer, molecular typing and individualized treatment of lung cancer. Studies have shown that CD276 molecules are closely related to the prognosis of tumors, but the exact mechanism remains to be unclear. Methods We used the UALCAN and KM-plotter databases to investigate the expression of CD276 in human NSCLC and adjacent normal tissues, and its correlation with clinicopathology. In addition, we analyzed the function of CD276 in NSCLC cell by suppressing the expression of CD276 in A549 and H460 cells. Results In this study, we found that CD276 expression was significantly up-regulated in NSCLC tissues, and its expression was positively correlated with tumor stage in NSCLC. Silencing in CD276 inhibited cell invasion and migration by reducing integrin-associated protein expression. Conclusions Our results indicate functional role of CD276 in the progression of NSCLC.
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Affiliation(s)
- Fang 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 100021, China
| | - Hengchi Chen
- 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 100021, China
| | - Dali Wang
- 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 100021, China
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Yin G, Xiao H, Liao Y, Huang C, Fan X. Construction of a Nomogram After Using Propensity Score Matching to Reveal the Prognostic Benefit of Tumor Resection of Stage IV M1a Nonsmall Cell Lung Cancer Patients. Cancer Invest 2020; 38:277-288. [PMID: 32267175 DOI: 10.1080/07357907.2020.1753761] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The aim of this work was to determine whether tumor resection could improve the prognosis of M1a nonsmall-cell lung cancer (NSCLC) patients. We obtained patient data from the Surveillance, Epidemiology, and End Results (SEER) database and used propensity score matching (PSM) to reduce the influence of confounding variables. Univariate and multivariate Cox regression analyses were used to identify independent prognostic factors, and the prediction results were visualized using the nomogram. A total of 772 patients with and without tumor resection were enrolled after PSM, and the nomogram combined with independent prognostic factors including age, sex, histological type, grade, T stage, N stage, chemotherapy, and surgery showed great prediction and discriminatory ability. Tumor resection is possibly a better choice for these patients.
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Affiliation(s)
- Guofang Yin
- Department of Respiratory and Critical Care Medicine II, The Affiliated Hospital of Southwest Medical University, Luzhuo, Sichuan Province, People's Republic of China
| | - Hua Xiao
- Department of Respiratory and Critical Care Medicine II, The Affiliated Hospital of Southwest Medical University, Luzhuo, Sichuan Province, People's Republic of China
| | - Yi Liao
- Department of Respiratory and Critical Care Medicine II, The Affiliated Hospital of Southwest Medical University, Luzhuo, Sichuan Province, People's Republic of China
| | - Chengliang Huang
- Department of Respiratory and Critical Care Medicine II, The Affiliated Hospital of Southwest Medical University, Luzhuo, Sichuan Province, People's Republic of China
| | - Xianming Fan
- Department of Respiratory and Critical Care Medicine II, The Affiliated Hospital of Southwest Medical University, Luzhuo, Sichuan Province, People's Republic of China
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Oral nutritional supplement prevents weight loss and reduces side effects in patients in advanced lung cancer chemotherapy. Amino Acids 2020; 52:445-451. [DOI: 10.1007/s00726-020-02822-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
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Gu Y, Zhang J, Zhou Z, Liu D, Zhu H, Wen J, Xu X, Chen T, Fan M. Metastasis Patterns and Prognosis of Octogenarians with NSCLC: A Population-based Study. Aging Dis 2020; 11:82-92. [PMID: 32010483 PMCID: PMC6961775 DOI: 10.14336/ad.2019.0414] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/14/2019] [Indexed: 12/28/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is the most common cancer and the leading cause of cancer-related deaths worldwide. Age at diagnosis of advanced NSCLC is much older, but studies describing the practice patterns for octogenarians with distant metastasis NSCLC are limited. A retrospective, population-based study using national representative data from the Surveillance, Epidemiology, and End Results (SEER) program was conducted to evaluate 34 882 NSCLC patients with extrathoracic metastases from 2010 to 2013. Patients were classified into three groups (older group: ≥80 yrs, middle-aged group: 60-79 yrs, and younger group: ≤59 yrs). The role of different age at diagnosis of NSCLC in metastasis patterns was investigated, and survival of different age groups of metastatic NSCLC was assessed. The analysis revealed that older patients were more likely to only have bone or liver metastasis (p< 0.001), but less likely to have brain only metastasis (p<0.001) and multiple metastatic sites (p< 0.001) than other two groups. Age at diagnosis was an independent risk factor for different metastasis types. Older group had the worst overall survival (p<0.001) and cancer-specific survival (p<0.001). Furthermore, older age patients with only bone metastasis had the best cancer specific survival (p<0.05) while younger patients with only brain metastasis had the best prognosis (p<0.001). Over 60% octogenarians with metastatic NSCLC did not receive anti-cancer therapy and had the highest rate of cancer deaths among all patients. Our results may help clinicians make positive decisions regarding personalized treatment of metastatic NSCLC in the elderly.
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Affiliation(s)
- Yu Gu
- 1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Junhua Zhang
- 1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Zhirui Zhou
- 1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Di Liu
- 1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Hongcheng Zhu
- 1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Junmiao Wen
- 1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xinyan Xu
- 1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Tianxiang Chen
- 3Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Min Fan
- 1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Aoki T, Akiba T, Nishiyama J, Tajiri S, Hayama N, Takahashi G, Tanaka J, Sato M, Takiguchi H, Tomomatsu H, Tomomatsu K, Takihara T, Niimi K, Oguma T, Kohno M, Masuda R, Urano T, Itoh H, Kajiwara H, Nakamura N, Kunieda E, Matsumae M, Iwazaki M, Asano K. Analysis of key clinical features for achieving complete remission in stage III and IV non-small cell lung cancer patients. Respir Res 2019; 20:263. [PMID: 31752884 PMCID: PMC6873580 DOI: 10.1186/s12931-019-1235-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 11/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although development of immune checkpoint inhibitors and various molecular target agents has extended overall survival time (OS) in advanced non-small cell lung cancer (NSCLC), a complete cure remains rare. We aimed to identify features and treatment modalities of complete remission (CR) cases in stages III and IV NSCLC by analyzing long-term survivors whose OS exceeded 3 years. METHODS From our hospital database, 1,699 patients, registered as lung cancer between 1st Mar 2004 and 30th Apr 2011, were retrospectively examined. Stage III or IV histologically or cytologically confirmed NSCLC patients with chemotherapy initiated during this period were enrolled. A Cox proportion hazards regression model was used. Data collection was closed on 13th Feb 2017. RESULTS There were 164 stage III and 279 stage IV patients, including 37 (22.6%) and 51 (18.3%) long-term survivors and 12 (7.3%) and 5 (1.8%) CR patients, respectively. The long-term survivors were divided into three groups: 3 ≤ OS < 5 years, 5 years ≤ OS with tumor, and 5 years ≤ OS without tumor (CR). The median OS of these groups were 1,405, 2,238, and 2,876 days in stage III and 1,368, 2,503, and 2,643 days in stage IV, respectively. The mean chemotherapy cycle numbers were 16, 20, and 10 in stage III and 24, 25, and 5 in stage IV, respectively. In the stage III CR group, all patients received chemoradiation, all oligometastases were controlled by radiation, and none had brain metastases. Compared with non-CR patients, the stage IV CR patients had smaller primary tumors and fewer metastases, which were independent prognostic factors for OS among long-term survivors. The 80% stage IV CR patients received radiation or surgery for controlling primary tumors, and the surgery rate for oligometastases was high. Pathological findings in the stage IV CR patients revealed that numerous inflammatory cells existed around and inside resected lung and brain tumors, indicating strong immune response. CONCLUSIONS Multiple line chemotherapies with primary and oligometastatic controls by surgery and/or radiation might achieve cure in certain advanced NSCLC. Cure strategies must be changed according to stage III or IV. This study was retrospectively registered on 16th Jun 2019 in UMIN Clinical Trials Registry (number UMIN000037078).
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Affiliation(s)
- Takuya Aoki
- Respiratory Division, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan.
| | - Takeshi Akiba
- Department of Radiation Oncology, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Jun Nishiyama
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Sakurako Tajiri
- Respiratory Division, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Naoki Hayama
- Respiratory Division, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Genki Takahashi
- Respiratory Division, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Jun Tanaka
- Respiratory Division, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Masako Sato
- Respiratory Division, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Hiroto Takiguchi
- Respiratory Division, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Hiromi Tomomatsu
- Respiratory Division, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Katsuyoshi Tomomatsu
- Respiratory Division, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Takahisa Takihara
- Respiratory Division, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Kyoko Niimi
- Respiratory Division, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Tsuyoshi Oguma
- Respiratory Division, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Mitsutomo Kohno
- Department of Thoracic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Ryota Masuda
- Department of Thoracic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Tetsuya Urano
- Respiratory Division, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Hitoshi Itoh
- Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Hiroshi Kajiwara
- Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Naoya Nakamura
- Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Etsuo Kunieda
- Department of Radiation Oncology, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Mitsunori Matsumae
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Masayuki Iwazaki
- Department of Thoracic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Koichiro Asano
- Respiratory Division, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
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Wei L, Liu Y, Ma Y, Ding C, Zhang H, Lu Z, Gu Z, Zhu C. C-X-C chemokine receptor 2 correlates with unfavorable prognosis and facilitates malignant cell activities via activating JAK2/STAT3 pathway in non-small cell lung cancer. Cell Cycle 2019; 18:3456-3471. [PMID: 31731888 DOI: 10.1080/15384101.2019.1689471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This study aimed to investigate the correlation of C-X-C chemokine receptor 2 (CXCR2) with clinicopathological characteristics and survival in non-small cell lung cancer (NSCLC) patients and further explore its effect on proliferation, apoptosis, invasion, stemness, chemosensitivity as well as JAK2/STAT3 pathway in NSCLC cells. The expression of CXCR2 in tumor tissues and adjacent tissues from 340 NSCLC patients received surgery was detected by immunohistochemistry. CXCR2 overexpression and knockdown were constructed through plasmid transfection and the effect of CXCR2 dysregulation on cell proliferation, apoptosis, invasion, stemness, chemosensitivity as well as its regulatory effect on JAK2/STAT signaling pathway was assessed in NCI-H1437 cells and NCI-H1299 cells. CXCR2 expression was higher in tumor tissues than that in paired adjacent tissues, and it was correlated with poor pathological differentiation, greater tumor size, lymph node metastasis, higher TNM stage and poor survival in NSCLC patients. In vitro, CXCR2 expression was increased in human NSCLC cell lines compared with human normal lung bronchus epithelial cells. CXCR2 promoted cell proliferation and invasion, while suppressed cell apoptosis in NCI-H1437/NCI-H1299 cells. Additionally, CXCR2 increased CD133+ cell rate and cell sphere-forming ability, while reduced chemosensitivity to cisplatin and gemcitabine in NCI-H1437/NCI-H1299 cells. Besides, CXCR2 activated the JAK2/STAT3 signaling pathway in NCI-H1437/NCI-H1299 cells. In conclusion, the clinical implication and the molecular function of CXCR2 discovered in our study reveal the potential of CXCR2 as a future target for disease monitoring and treatment of NSCLC.
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Affiliation(s)
- Lin Wei
- Department of Thoracic Surgery, Xi'an Chest Hospital,Xi'an, Shaanxi, China
| | - Yugang Liu
- Department of Thoracic Surgery, Xi'an Chest Hospital,Xi'an, Shaanxi, China
| | - Yuefeng Ma
- Department of Thoracic Surgery, The Second Affiliated Hospital, Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chao Ding
- Department of Thoracic Surgery, Xi'an Chest Hospital,Xi'an, Shaanxi, China
| | - Huijun Zhang
- Department of Thoracic Surgery, Xi'an Chest Hospital,Xi'an, Shaanxi, China
| | - Zhenghui Lu
- Department of Thoracic Surgery, Xi'an Chest Hospital,Xi'an, Shaanxi, China
| | - Zhenning Gu
- Department of Thoracic Surgery, Xi'an Chest Hospital,Xi'an, Shaanxi, China
| | - Changsheng Zhu
- Department of Thoracic Surgery, Xi'an Chest Hospital,Xi'an, Shaanxi, China
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Zhang JT, Liu SY, Yan HH, Wu YL, Nie Q, Zhong WZ. Recursive partitioning analysis of patients with oligometastatic non-small cell lung cancer: a retrospective study. BMC Cancer 2019; 19:1051. [PMID: 31694572 PMCID: PMC6836326 DOI: 10.1186/s12885-019-6216-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/30/2019] [Indexed: 02/07/2023] Open
Abstract
Background Local consolidative treatment (LCT) is important for oligometastasis, defined as the restricted metastatic capacity of a tumor. This study aimed to determine the effects and prognostic heterogeneity of LCT in oligometastatic non-small cell lung cancer. Methods This retrospective study identified 436 eligible patients treated for oligometastatic disease at the Guangdong Provincial People’s Hospital during 2009–2016. A Cox regression analysis was used to identify potential predictors of overall survival (OS). After splitting cases randomly into training and testing sets, risk stratification was performed using recursive partitioning analysis with a training dataset. The findings were confirmed using a validation dataset. The effects of LCT in different risk groups were evaluated using the Kaplan-Meier method. Results The T stage (p = 0.001), N stage (p = 0.008), number of metastatic sites (p = 0.031), and EGFR status (p = 0.043) were identified as significant predictors of OS. A recursive partitioning analysis was used to establish a prognostic risk model with the following four risk groups: Group I included never smokers with N0 disease (3-year OS: 55.6%, median survival time [MST]: 42.8 months), Group II included never smokers with N+ disease (3-year OS: 32.8%, MST: 26.5 months), Group III included smokers with T0–2 disease (3-year OS: 23.3%, MST: 19.4 months), and Group IV included smokers with T3/4 disease (3-year OS: 12.5%, MST: 11.1 months). Significant differences in OS according to LCT status were observed in all risk groups except Group IV (p = 0.45). Conclusions Smokers with T3/4 oligometastatic non-small cell lung cancer may not benefit from LCT.
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Affiliation(s)
- Jia-Tao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Key Laboratory of Lung Cancer Translational Medicine, South China University of Technology & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Si-Yang Liu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Key Laboratory of Lung Cancer Translational Medicine, South China University of Technology & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Hong-Hong Yan
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Key Laboratory of Lung Cancer Translational Medicine, South China University of Technology & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Key Laboratory of Lung Cancer Translational Medicine, South China University of Technology & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Qiang Nie
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Key Laboratory of Lung Cancer Translational Medicine, South China University of Technology & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Key Laboratory of Lung Cancer Translational Medicine, South China University of Technology & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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Mazzella A, Loi M, Mansuet-Lupo A, Bobbio A, Blons H, Damotte D, Alifano M. Clinical Characteristics, Molecular Phenotyping, and Management of Isolated Adrenal Metastases From Lung Cancer. Clin Lung Cancer 2019; 20:405-411. [DOI: 10.1016/j.cllc.2019.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/16/2019] [Accepted: 06/06/2019] [Indexed: 11/15/2022]
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40
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Bertolaccini L, Spaggiari L. The radical approach to the oligometastatic not small cell lung cancer patient: which? how? when? where? J Thorac Dis 2019; 11:S2023-S2025. [PMID: 31632815 DOI: 10.21037/jtd.2019.06.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Luca Bertolaccini
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Clark JM, Boffa DJ, Meguid RA, Brown LM, Cooke DT. Regionalization of esophagectomy: where are we now? J Thorac Dis 2019; 11:S1633-S1642. [PMID: 31489231 DOI: 10.21037/jtd.2019.07.88] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The morbidity and mortality benefits of performing high-risk operations in high-volume centers by high-volume surgeons are evident. Regionalization is a proposed strategy to leverage high-volume centers for esophagectomy to improve quality outcomes. Internationally, regionalization occurs under national mandates. Those mandates do not exist in the United States and spontaneous regionalization of esophagectomy has only modestly occurred in the U.S. Regionalization must strike a careful balance and not limit access to optimal oncologic care to our most vulnerable cancer patient populations in rural and disadvantaged socioeconomic areas. We reviewed the recent literature highlighting: the justification of hospital and surgeon annual esophagectomy volumes for regionalization; how safety performance metrics could influence regionalization; whether regionalization is occurring in the US; what impact regionalization may have on esophagectomy costs; and barriers to patients traveling to receive oncologic treatment at regionalized centers of excellence.
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Affiliation(s)
- James M Clark
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA, USA
| | - Daniel J Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA
| | - Robert A Meguid
- Division of Thoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lisa M Brown
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA, USA
| | - David T Cooke
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA, USA
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Deng C, Wu SG, Tian Y. Lung Large Cell Neuroendocrine Carcinoma: An Analysis of Patients from the Surveillance, Epidemiology, and End-Results (SEER) Database. Med Sci Monit 2019; 25:3636-3646. [PMID: 31095532 PMCID: PMC6537662 DOI: 10.12659/msm.914541] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to assess the incidence, clinicopathologic characteristics, prognostic factors, and treatment outcomes in lung large cell neuroendocrine carcinoma (LCNEC). Material/Methods Patients diagnosed with lung LCNEC between 2000 and 2013 were identified using the Surveillance, Epidemiology, and End-Results database. Kaplan–Meier methods and univariate and multivariate analyses were used for statistical analysis. Results A total of 2097 patients were identified. The total age-adjusted incidence rate of lung LCNEC was 0.3/100 000, with a rise in incidence over the study period. The 5-year lung cancer-specific survival (LCSS) and overall survival (OS) were 20.7% and 16.7%, respectively. Multivariate analysis indicated that age ≥65 years, male sex, advanced tumor stage, advanced nodal stage, not undergoing surgery. and not undergoing chemotherapy were independent adverse indicators for survival outcomes. After stratification by tumor stage, undergoing surgery was associated with more favorable LCSS and OS compared with those without surgery, regardless of tumor stage. Conclusions LCNEC is a rare lung cancer subtype with a dismal prognosis. Primary surgical treatment has significant survival benefits, even for stage IV patients. The optimal treatment strategies for lung LCNEC require further investigation.
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Affiliation(s)
- Chong Deng
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Institute of Radiotherapy and Oncology, Soochow University, Suzhou, Jiangsu, China (mainland)
| | - San-Gang Wu
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, Fujian, China (mainland)
| | - Ye Tian
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Institute of Radiotherapy and Oncology, Soochow University, Suzhou, Jiangsu, China (mainland)
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Toubat O, Farias AJ, Atay SM, McFadden PM, Kim AW, David EA. Disparities in the surgical management of early stage non-small cell lung cancer: how far have we come? J Thorac Dis 2019; 11:S596-S611. [PMID: 31032078 DOI: 10.21037/jtd.2019.01.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
It is currently estimated that nearly one-third of patients with newly diagnosed non-small cell lung cancer (NSCLC) have stage I-II disease on clinical evaluation. Curative-intent surgical resection has been a cornerstone of the therapeutic management of such patients, offering the best clinical and oncologic outcomes in the long-term. In 1999, Peter Bach and colleagues brought attention to racial disparities in the receipt of curative-intent surgery in the NSCLC population. In the time since this seminal study, there is accumulating evidence to suggest that disparities in the receipt of definitive surgery continue to persist for patients with early stage NSCLC. In this review, we sought to provide an up-to-date assessment of 20 years of surgical disparities literature in the NSCLC population. We summarized common and unrecognized disparities in the receipt of surgical resection for early stage NSCLC and demonstrated that demographic and socioeconomic factors such as race/ethnicity, special patient groups, income and insurance continue to impact the receipt of definitive resection. Additionally, we found that discrepancies in patient and provider perceptions of and attitudes toward surgery, access to invasive staging, distance to treatment centers and negative stigmas about lung cancer that patients experience may act to perpetuate disparities in surgical treatment of early stage lung cancer.
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Affiliation(s)
- Omar Toubat
- Keck School of Medicine of USC, Los Angeles, CA, USA.,Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Scott M Atay
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - P Michael McFadden
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Anthony W Kim
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth A David
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
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Galata C, Wimmer E, Kasper B, Wenz F, Reißfelder C, Jakob J. Multidisciplinary Tumor Board Recommendations for Oligometastatic Malignancies: A Prospective Single-Center Analysis. Oncol Res Treat 2019; 42:87-94. [PMID: 30814474 DOI: 10.1159/000495474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/15/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND The treatment of oligometastatic disease is challenging and few data exist to guide treatment decisions. The objective of this study was to improve the data on the prevalence and treatment of patients with oligometastatic disease. METHODS We conducted a prospective single-center analysis that included all consecutive patients discussed in multidisciplinary tumor boards (MDT) between February and July 2017. Patients with oligometastatic disease were identified and treatment strategies were evaluated. RESULTS 1,673 patients were included in this study, 609 (36.4%) presented with metastatic disease, 151 (9%) had oligometastatic disease. Common metastatic sites were brain, liver, and lung. Lung cancer patients were the largest cohort (20.5%) among all patients with oligometastatic disease compared with other tumor entities. The majority of oligometastatic patients (68.9%) received local treatment with or without additional chemotherapy, 17.9% were recommended systemic therapy alone. MDT recommended watchful waiting for 4.6% of the patients. CONCLUSION Patients with oligometastatic disease represent a considerable proportion of all patients in MDT. In this study, 68.9% of patients with oligometastatic disease received regional treatment. This shows a possible treatment shift from palliative to potentially curative intent. These data may be used to design prospective clinical trials to optimize the treatment of oligometastatic disease.
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Loi M, Mazzella A, Mansuet-Lupo A, Bobbio A, Canny E, Magdeleinat P, Régnard JF, Damotte D, Trédaniel J, Alifano M. Synchronous Oligometastatic Lung Cancer Deserves a Dedicated Management. Ann Thorac Surg 2018; 107:1053-1059. [PMID: 30476480 DOI: 10.1016/j.athoracsur.2018.10.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/02/2018] [Accepted: 10/08/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Oligometastatic stage IV non-small lung cancer (NSCLC) patients have a 5-year overall survival of 30% versus 4% to 6% in historical cohorts of stage IV NSCLC patients. We reviewed data and patterns of care of patients affected by oligometastatic NSCLC in our center between 2001 and 2017. METHODS We retrospectively reviewed clinical and pathological files of all patients with lung cancer and synchronous isolated adrenal or brain metastases, or both, treated by locally ablative treatments (surgery or radiotherapy, or both) of both primary cancer and distant metastasis. Statistical analysis was performed to assess the effect on overall survival of patient- and tumor-related characteristics and therapeutic approaches. Overall survival was assessed by the Kaplan-Meier method. Survival rates were compared by log-rank test. Significance was accepted at a level of p of less than 0.05. RESULTS Our department treated 51 patients affected by NSCLC and synchronous brain metastasis (n = 41), adrenal metastasis (n = 9), or both (n = 1). Median survival was 42 months (95% confidence interval, 22.3 to 63.7). Overall survival was 62% at 2 years and 34.4% at 5 years. A univariate and multivariate analysis the positive prognostic factors for survival was cessation of smoking (p = 0.006) and lymphovascular and perineural spreading in the tissues (p = 0.024). CONCLUSIONS In selected oligometastatic synchronous NSCLC patients, a multimodality approach encompassing radical treatment of the primary tumor and ablative treatment of concurrent metastases is recommended, with encouraging results. Smoking cessation is a part of the treatment sequence.
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Affiliation(s)
- Mauro Loi
- Department of Thoracic Surgery, Paris Center University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France; Department of Radiotherapy, Hopital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Antonio Mazzella
- Department of Thoracic Surgery, Paris Center University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Audrey Mansuet-Lupo
- Department of Pathology, Paris Center University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Antonio Bobbio
- Department of Thoracic Surgery, Paris Center University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Emelyne Canny
- Department of Thoracic Surgery, Paris Center University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Pierre Magdeleinat
- Department of Thoracic Surgery, Paris Center University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Jean-François Régnard
- Department of Thoracic Surgery, Paris Center University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Diane Damotte
- Department of Pathology, Paris Center University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Jean Trédaniel
- Thoracic Oncology Unit, St. Joseph Hospital, Paris Descartes University, Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, Paris Center University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
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Deng J, Ren Z, Wen J, Wang B, Hou X, Xue Z, Chu X. Construction of a nomogram predicting the overall survival of patients with distantly metastatic non-small-cell lung cancer. Cancer Manag Res 2018; 10:6143-6156. [PMID: 30538562 PMCID: PMC6257075 DOI: 10.2147/cmar.s183878] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose This study aimed to establish a nomogram to predict the overall survival (OS) of the general non-small-cell lung cancer (NSCLC) patients with distant metastasis. Patients and methods We investigated Surveillance, Epidemiology, and End Results database for NSCLC patients with distant metastasis diagnosed between 2010 and 2014. Statistically significant prognostic factors were identified using uni- and multivariable Cox regression analyses. A nomogram incorporating these prognostic factors was developed and evaluated by the Harrell's concordance index (C-index), calibration plots, and risk group stratifications. Results We finally included 18,209 patients for analysis. These patients were divided into two groups, 14,567 cases for the training cohort and 3,642 for the validation cohort. Marital status, sex, race, age, histology, T stage, N stage, histological differentiation, bone metastasis, brain metastasis, liver metastasis, with M1a disease, surgery of primary cancer, and chemotherapy were identified as the prognostic factors of the OS and integrated to construct the nomogram. The nomogram had a C-index of 0.704 (95% CI: 0.699-0.709) in the training set and 0.699 (95% CI: 0.689-0.709) in the validation set. The calibration curves for 1- and 2-year OS in the training and validation sets showed acceptable agreement between the predicted and observed survival. Also, the nomogram was capable of stratifying patients into different risk groups within the patients who presented with bone, liver, or brain metastasis, as well as in each T, N stage, respectively. Conclusion A nomogram was established and validated to predict individual prognosis for the general patients with distantly metastatic NSCLC. Global prospective data with the latest TNM classification and more comprehensive prognostic factors are needed to improve this model.
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Affiliation(s)
- Jianqing Deng
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Zhipeng Ren
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Jiaxin Wen
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Bo Wang
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Xiaobin Hou
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Zhiqiang Xue
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
| | - Xiangyang Chu
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China,
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Wang H, Han X, Guo J, Wang Z. Characteristics and survival difference of clinical tumor size 0 extensive-stage small cell lung cancer with different metastasis pattern. J Thorac Dis 2018; 10:5414-5420. [PMID: 30416789 DOI: 10.21037/jtd.2018.09.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Few studies were focused on the characteristics and survival prognosis of clinical tumor size 0 (cT0) extensive-stage small cell lung cancer (ES-SCLC) patients with distant metastasis. Methods The proper patients were screened based on the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2013. Chi-square test was used to analyze the characteristics of cT0 stage. The risk factors on cT0 stage were analyzed by Logistic regression model. The survival difference was compared by the Log rank test. The prognostic factors on survival were analyzed by univariate and multivariate Cox regression model. Results Only 1.2% of patients were diagnosed at cT0 stage. Clinical nodal status 0 (cN0) stage, no bone metastasis and no lung metastasis were all risk factors on cT0 stage. The patients at cT0 stage had better cancer specific survival (CSS) benefit (P=0.011). The cT0 stage was also an independent prognostic factor on CSS (P=0.018). Conclusions The patients at cT0 stage was a different subgroup compared with the patients at cT1-4 stage for ES-SCLC patients with distant metastasis.
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Affiliation(s)
- Haiyong Wang
- Department of internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Xiao Han
- Department of internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Jun Guo
- Department of internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Zhehai Wang
- Department of internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
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Planchard D, Popat S, Kerr K, Novello S, Smit EF, Faivre-Finn C, Mok TS, Reck M, Van Schil PE, Hellmann MD, Peters S. Metastatic non-small cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv192-iv237. [PMID: 30285222 DOI: 10.1093/annonc/mdy275] [Citation(s) in RCA: 1482] [Impact Index Per Article: 247.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- D Planchard
- Department of Medical Oncology, Thoracic Group, Gustave-Roussy Villejuif, France
| | - S Popat
- Royal Marsden Hospital, London
| | - K Kerr
- Aberdeen Royal Infirmary, Aberdeen University Medical School, Aberdeen, UK
| | - S Novello
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - E F Smit
- Thoracic Oncology Service, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C Faivre-Finn
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - T S Mok
- Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - M Reck
- LungenClinic Airway Research Center North (ARCN), German Center for Lung Research, Grosshansdorf, Germany
| | - P E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | | | - S Peters
- Medical Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Wang H, Yan L, Li C, Wang Z. Surgical intervention may be a therapeutic option for NSCLC patients with AJCC stage IV: a large population-based study. Cancer Manag Res 2018; 10:3219-3226. [PMID: 30233238 PMCID: PMC6130287 DOI: 10.2147/cmar.s171589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Few studies have focused on the role of surgery in the treatment of stage IV non-small cell lung cancer (NSCLC). In our study, we mainly focused on the surgical therapeutic option for NSCLC patients with American Joint Committee on Cancer stage IV. Patients and methods Using the Surveillance Epidemiology and End Results database, we screened out an appropriate patient population with stage IV NSCLC treated between 2004 and 2013. Kaplan–Meier curve analysis was used to compare the survival between patients receiving surgery and standard of care. The effect of surgery on primary and regional/distant sites on overall survival (OS) was further evaluated by Cox proportional hazard model. Finally, subgroup analysis based on patient and disease variables was conducted by Cox proportional hazard and presented as a forest plot. Results A total of 61,418 stage IV NSCLC patients were enrolled. However, only 11.6% received local surgical treatment. Surgery to primary and regional/distant sites were both independent prognostic factors of OS (P<0.001). Survival advantage was identified in those patients who received surgery to primary sites for all subgroup variables (P<0.001). However, survival benefit was not demonstrated for patients with surgery to regional/distant sites in some subgroup variables, including black racial background, squamous cell carcinoma, large cell carcinoma, and N1 staging (all, P>0.1). Importantly, we observed that surgery of primary tumor sites at stage N0 showed the maximum OS benefit (P<0.001). Conclusion These findings about N staging and primary tumor site treatment should be taken into consideration by surgeons when determining the suitability of surgery for stage IV NSCLC patients.
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Affiliation(s)
- Haiyong Wang
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital, Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China,
| | - Lei Yan
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital, Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China,
| | - Cheng Li
- Department of School of Health Care Management, Shandong University, Key Laboratory of Health Economics and Policy Research, Jinan 250100, China
| | - Zhehai Wang
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital, Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China,
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Schad F, Thronicke A, Steele ML, Merkle A, Matthes B, Grah C, Matthes H. Overall survival of stage IV non-small cell lung cancer patients treated with Viscum album L. in addition to chemotherapy, a real-world observational multicenter analysis. PLoS One 2018; 13:e0203058. [PMID: 30148853 PMCID: PMC6110500 DOI: 10.1371/journal.pone.0203058] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 08/14/2018] [Indexed: 12/15/2022] Open
Abstract
Background Stage IV non-small cell lung cancer (NSCLC) is associated with a five-year survival rate of around 1%. Treatment with Viscum album L. (VA) extracts has been shown to reduce chemotherapy (CTx)-related adverse events, decrease CTx dose reductions and improve quality of life in a number of cancers. Recent data suggest a beneficial effect of add-on treatment with Viscum album L. (VA, European mistletoe) on survival in cancer patients. The objective of this study was to evaluate the effect of VA in addition to chemotherapy on survival in stage IV NSCLC patients. Methods The observational study was conducted using data from the Network Oncology clinical registry which is an accredited conjoint clinical registry of German oncological hospitals, practitioners and out-patient centers.Patients were included if they had stage IV NSCLC at diagnosis, lived at least for four weeks post-diagnosis and received chemotherapeutic treatment. Patients with EGFR mutations as well as patients receiving tyrosine kinase inhibitors or immune checkpoint inhibitors were not included. Overall survival and impact on hazard in patients with chemotherapy (CTx) to patients receiving CTx plus VA were compared. To identify factors associated with survival and to address potential sources of bias a multivariate analyses using Cox proportional hazard model was performed. Results The median age of the population was 64.1 years with 55.7% male patients. The highest proportion of patients had adenocarcinoma (72.2%) and most of the patients were current or past smokers (70.9%). Of 158 stage IV NSCLC patients, 108 received CTx only and 50 additional VA. Median survival was 17.0 months in the CTx plus VA group (95%CI: 11.0–40.0) and was 8.0 months (95%CI: 7.0–11.0) in the CTx only group (χ2 = 7.2, p = .007). Overall survival was significantly prolonged in the VA group (HR 0.44, 95%CI: 0.26–0.74, p = .002). One-year and three-year overall survival rates were greater with CTx plus VA compared to CTX alone (1y: 60.2% vs. 35.5%; 3y: 25.7% vs. 14.2%). Conclusion Our findings suggest that concomitant VA is positively associated with survival in stage IV NSCLC patients treated with standard CTx. These findings complement pre-existing knowldedge of add-on VA’s clinical impact, however, results should be interpreted with caution in light of the study’s observational character.
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Affiliation(s)
- Friedemann Schad
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
- Interdisciplinary Oncology and Palliative Care, Hospital Havelhöhe, Berlin, Germany
- * E-mail:
| | - Anja Thronicke
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
| | - Megan L. Steele
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Antje Merkle
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
- Interdisciplinary Oncology and Palliative Care, Hospital Havelhöhe, Berlin, Germany
| | - Burkhard Matthes
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
- Interdisciplinary Oncology and Palliative Care, Hospital Havelhöhe, Berlin, Germany
| | - Christian Grah
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
- Lung Cancer Center and Department of Pneumology, Hospital Havelhöhe, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe, Hospital Havelhöhe, Berlin, Germany
- Medical Clinic for Gastroenterology, Infectiology and Rheumatology CBF and Institute of Social Medicine, Epidemiology and Health Economics CCM, Charité University Medicine Berlin, Berlin, Germany
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