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Wang C, Fang J, Jiang T, Hu S, Wang P, Liu X, Zou S, Yang J. Development and validation of a prognostic nomogram model in locally advanced NSCLC based on metabolic features of PET/CT and hematological inflammatory indicators. EJNMMI Phys 2024; 11:24. [PMID: 38441779 PMCID: PMC10914655 DOI: 10.1186/s40658-024-00626-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/27/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND We combined the metabolic features of 18F-FDG-PET/CT and hematological inflammatory indicators to establish a predictive model of the outcomes of patients with locally advanced non-small cell lung cancer (LA-NSCLC) receiving concurrent chemoradiotherapy. RESULTS A predictive nomogram was developed based on sex, CEA, systemic immune-inflammation index (SII), mean SUV (SUVmean), and total lesion glycolysis (TLG). The nomogram presents nice discrimination that yielded an AUC of 0.76 (95% confidence interval: 0.66-0.86) to predict 1-year PFS, with a sensitivity of 63.6%, a specificity of 83.3%, a positive predictive value of 83.7%, and a negative predictive value of 62.9% in the training set. The calibration curves and DCA suggested that the nomogram had good calibration and fit, as well as promising clinical effectiveness in the training set. In addition, survival analysis indicated that patients in the low-risk group had a significantly longer mPFS than those in the high-risk group (16.8 months versus 8.4 months, P < 0.001). Those results were supported by the results in the internal and external test sets. CONCLUSIONS The newly constructed predictive nomogram model presented promising discrimination, calibration, and clinical applicability and can be used as an individualized prognostic tool to facilitate precision treatment in clinical practice.
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Affiliation(s)
- Congjie Wang
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Jian Fang
- Department of thoracic surgery, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Tingshu Jiang
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Shanliang Hu
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Ping Wang
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Xiuli Liu
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Shenchun Zou
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Jun Yang
- Department of Oncology, Yantai Yuhuangding Hospital, No.20 Yuhuangding East Road, Yantai, 250117, Shandong, China.
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Beers CA, Pond GR, Wright JR, Tsakiridis T, Okawara GS, Swaminath A. The impact of staging FDG-PET/CT on treatment for stage III NSCLC - an analysis of population-based data from Ontario, Canada. Front Oncol 2023; 13:1210945. [PMID: 37681028 PMCID: PMC10482027 DOI: 10.3389/fonc.2023.1210945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/24/2023] [Indexed: 09/09/2023] Open
Abstract
Purpose Fluoro-2-deoxyglucose positron-emission tomography (FDG-PET/CT) is now considered a standard investigation for the staging of new cases of stage III NSCLC. However, there is not published level 3 evidence demonstrating the impact of FDG-PET/CT on appropriate therapy in this setting. Using retrospective population-based data, we sought to examine the role and timing that FDG-PET/CT scans play in influencing treatment choice, as well as survival in patients diagnosed with stage III NSCLC. Materials and methods A retrospective cohort of patients diagnosed with stage III NSCLC from 2009-2017 in Ontario were identified from the IC/ES (formerly Institute of Clinical Evaluative Sciences) database. FDG-PET/CT utilization over time, trends in mediastinal biopsy technique and usage, the impact of FDG-PET/CT on overall survival (OS), and its influence on use of concurrent chemoradiotherapy (CRT) were explored. The impact of timing of pre-treatment FDG-PET/CT on OS was also analyzed (≤28 days prior to treatment, 29-56 days prior, and >56 days prior). Results Between 2007 and 2017, a total of 13 796 people were diagnosed with stage III NSCLC in Ontario. FDG-PET/CT utilization increased over time with 0% of cases in 2007 and 74% in 2017 with pre-treatment FDG-PET/CT scans. The number of patients who received a mediastinal biopsy similarly increased in this timeframe increasing from 41% to 53%. More patients with pre-treatment FDG-PET/CT scans received curative-intent therapy than those who did not: 23% vs 13% for CRT (p<0.001), and 23% vs 10% for surgery (p<0.001). Median OS was longer in those with FDG-PET/CT scans prior to treatment (17 vs 11 months), as was 5-year survival (22% vs 14%, p<0.001), and this held true on both univariate and multivariate analyses. Timing of FDG-PET/CT scan relative to treatment was not associated with differences in OS. Conclusion Improvements in OS were seen in this cohort of stage III NSCLC patients who underwent a pre-treatment FDG-PET/CT scan. This can likely be attributed to stage-appropriate therapy due to more complete staging using FDG-PET/CT. This study stresses the importance of complete staging for suspected stage III NSCLC using FDG-PET/CT, and a need for continued advocacy for increased access to FDG-PET/CT scans.
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Affiliation(s)
- Craig A. Beers
- Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Gregory R. Pond
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - James R. Wright
- Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Theodoros Tsakiridis
- Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Gordon S. Okawara
- Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Anand Swaminath
- Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Lele W, Lei L, Liting Q. Resveratrol sensitizes A549 cells to irradiation damage via suppression of store-operated calcium entry with Orai1 and STIM1 downregulation. Exp Ther Med 2021; 21:587. [PMID: 33850559 PMCID: PMC8027717 DOI: 10.3892/etm.2021.10019] [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: 01/04/2020] [Accepted: 11/26/2020] [Indexed: 01/04/2023] Open
Abstract
Resveratrol is a natural polyphenol with multiple positive biofunctions and was found to have potential as a radiosensitizer with an intricate molecular mechanism. Store-operated calcium entry (SOCE) is a novel intracellular calcium regulatory pattern that is mainly mediated by iron channels, such as by the stromal interaction molecule (STIM) and calcium release-activated calcium channel protein (Orai) families. SOCE was recently reported to be suppressed via the downregulation of STIM or Orai families for the promotion of tumor cell death induced by resveratrol. In the present study, resveratrol combined with irradiation treatment were found to induce more evident cell damage compared with irradiation treatment alone, as shown with Cell Counting Kit-8 assay and mitochondrial membrane potential detection with rhodamine 123. Additionally, resveratrol combined with irradiation treatment decreased the expression of STIM1 and Orai1, while it had no effects on STIM2, Orai2 and Orai3. Moreover, resveratrol combined with irradiation treatment lead to alleviated thapsigargin-induced SOCE. In addition, overexpression of STIM1 and Orai1 reversed resveratrol-induced SOCE inhibition and reduced death in A549 cells under irradiation. In summary, the present results revealed that resveratrol can significantly enhance the effect of irradiation damage on lung adenocarcinoma A549 cells, and this effect may be mediated by suppression of SOCE with reduced expression of both STIM1 and Orai1.
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Affiliation(s)
- Wu Lele
- Department of General Medicine, First People's Hospital of Yuhang, Hangzhou, Zhejiang 311100, P.R. China.,Department of Radiotherapy, Anhui Provincial Hospital, Hefei, Anhui 230031, P.R. China
| | - Lv Lei
- Department of Radiotherapy, Anhui Provincial Hospital, Hefei, Anhui 230031, P.R. China.,Epigenetic Laboratory, Anhui Provincial Hospital, Hefei, Anhui 230031, P.R. China
| | - Qian Liting
- Department of Radiotherapy, Anhui Provincial Hospital, Hefei, Anhui 230031, P.R. China.,Epigenetic Laboratory, Anhui Provincial Hospital, Hefei, Anhui 230031, P.R. China
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Łazar-Poniatowska M, Bandura A, Dziadziuszko R, Jassem J. Concurrent chemoradiotherapy for stage III non-small-cell lung cancer: recent progress and future perspectives (a narrative review). Transl Lung Cancer Res 2021; 10:2018-2031. [PMID: 34012811 PMCID: PMC8107727 DOI: 10.21037/tlcr-20-704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Concurrent chemoradiotherapy (CHRT) remains the therapeutic standard for locally advanced inoperable non-small-cell lung cancer (NSCLC). The median overall survival (OS) with this approach is in the range of 20–30 months, with five-year survival of approximately 30%. These outcomes have recently been further improved by supplementing CHRT with maintenance durvalumab, a monoclonal anti-PD-L1 agent. The progress in treatment outcomes of locally advanced NSCLC before the era of immunotherapy has been achieved mainly by virtue of developments in diagnostics and radiotherapy techniques. Routine implementation of endoscopic and endobronchial ultrasonography for mediastinal lymph nodes assessment, positron emission tomography/computed tomography and magnetic resonance imaging of the brain allows for more accurate staging of NSCLC and for optimizing treatment strategy. Thorough staging and respiratory motion control allows for higher conformity of radiotherapy and reduction of radiotherapy related toxicity. Dose escalation with prolonged overall treatment time does not improve treatment outcomes of CHRT. In consequence, 60 Gy in 2 Gy fractions or equivalent biological dose remains the standard dose for definitive CHRT in locally advanced NSCLC. However, owing to increased toxicity of CHRT, this option may not be applicable in a proportion of elderly or frail patients. This article summarizes recent developments in curative CHRT for inoperable stage III NSCLC, and presents perspectives for further improvements of this strategy
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Affiliation(s)
| | - Artur Bandura
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Rafał Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
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Mielgo-Rubio X, Rojo F, Mezquita-Pérez L, Casas F, Wals A, Juan M, Aguado C, Garde-Noguera J, Vicente D, Couñago F. Deep diving in the PACIFIC: Practical issues in stage III non-small cell lung cancer to avoid shipwreck. World J Clin Oncol 2020; 11:898-917. [PMID: 33312885 PMCID: PMC7701908 DOI: 10.5306/wjco.v11.i11.898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/30/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023] Open
Abstract
After publication of the PACIFIC trial results, immune checkpoint inhibitor-based immunotherapy was included in the treatment algorithm of locally advanced non-small cell lung cancer (NSCLC). The PACIFIC trial demonstrated that 12 mo of durvalumab consolidation therapy after radical-intent platinum doublet chemotherapy with concomitant radiotherapy improved both progression-free survival and overall survival in patients with unresectable stage III NSCLC. This is the first treatment in decades to successfully improve survival in this clinical setting, with manageable toxicity and without deterioration in quality of life. The integration of durvalumab in the management of locally advanced NSCLC accentuates the need for multidisciplinary, coordinated decision-making among lung cancer specialists, bringing new challenges and controversies as well as important changes in clinical work routines. The aim of the present article is to review-from a practical, multidisciplinary perspective-the findings and implications of the PACIFIC trial. We evaluate the immunobiological basis of durvalumab as well as practical aspects related to programmed cell death ligand 1 determination. In addition, we comprehensively assess the efficacy and toxicity data from the PACIFIC trial and discuss the controversies and practical aspects of incorporating durvalumab into routine clinical practice. Finally, we discuss unresolved questions and future challenges. In short, the present document aims to provide clinicians with a practical guide for the application of the PACIFIC regimen in routine clinical practice.
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Affiliation(s)
- Xabier Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Madrid 28922, Spain
| | - Federico Rojo
- Department of Pathology, IIS-Jiménez Díaz-CIBERONC Foundation, Madrid 28040, Spain
| | - Laura Mezquita-Pérez
- Department of Medical Oncology, Hospital Clinic, Laboratory of Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona 08036, Spain
| | - Francesc Casas
- Department of Radiation Oncology, Hospital Clinic, Barcelona 08036, Spain
| | - Amadeo Wals
- Department of Radiation Oncology, Hospital Universitario Virgen Macarena, Sevilla 41009, Spain
| | - Manel Juan
- Department of Immunology Service, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | - Carlos Aguado
- Department of Medical Oncology, Hospital Universitario Clínico San Carlos, Madrid 28040, Spain
| | - Javier Garde-Noguera
- Department of Medical Oncology, Hospital Arnau de Vilanova, Valencia 46015, Spain
| | - David Vicente
- Department of Medical Oncology, Hospital Universitario Virgen Macarena, Sevilla 49001, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Hospital La Luz, Universidad Europea de Madrid, Madrid 28028, Spain
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Abstract
Anatomic staging is a critical step in evaluation of patients with lung cancer. Accurate identification of stage based on features of primary tumor (T), regional nodes (N), and metastatic disease (M) is fundamental to determining appropriate care. In this article, the TNM components of the anatomic staging system and a framework for description of lung cancer with multiple pulmonary sites of involvement are discussed. TNM combinations are grouped according to prognosis, with patient-level, tumor-level, and environment-level factors also influencing survival outcomes. Although the staging system does not include molecular and immunologic information, anatomic staging remains the common language for communicating extent of disease.
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Affiliation(s)
- Lynn T Tanoue
- Yale School of Medicine, 333 Cedar Street, PO Box 208057, New Haven, CT 06520, USA.
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7
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Wilshire CL, Rayburn JR, Chang SC, Gilbert CR, Louie BE, Aye RW, Farivar AS, Bograd AJ, Vallières E, Gorden JA. Not Following the Rules in Guideline Care for Lung Cancer Diagnosis and Staging Has Negative Impact. Ann Thorac Surg 2020; 110:1730-1738. [PMID: 32492435 DOI: 10.1016/j.athoracsur.2020.04.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/30/2020] [Accepted: 04/10/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Recent studies have identified poor adherence to recommended guidelines in diagnosing and staging patients with non-small cell lung cancer (NSCLC), and this practice has been associated with numerous negative downstream effects. However, these reports consist predominantly of large administrative databases with inherent limitations. We aimed to describe guideline-inconsistent care and identify any associated factors within the Swedish Cancer Institute health care system. METHODS A review of patients with a diagnosis of primary NSCLC between January 1, 2014 and December 31, 2014 within our community hospital network was performed. Univariate and multivariable logistic regression analyses were performed to identify factors associated with guideline-inconsistent care. RESULTS Guideline-inconsistent care was identified in 24% (98 of 406) of patients: 58% (46 of 81) in clinical stage III and 29% (52 of 179) in stage IV. Of the 46 clinical stage III patients with guideline-inconsistent care, 43% (20) had no invasive mediastinal lymph node sampling before treatment initiation. Patients with guideline-inconsistent care more frequently underwent additional invasive procedures and had a delay in management. Regression analyses identified clinical stage III disease, stage IV with distant metastases, and specialty ordering the diagnostic test to be associated with guideline-inconsistent care. CONCLUSIONS Guideline-inconsistent diagnosis and staging of patients with NSCLC, particularly patients with stage III disease, are highly prevalent. This finding is associated with incomplete staging, a higher number of additional procedures, and a delay in management. The identification of this vulnerable population may serve as a target for quality improvement interventions aimed to increase adherence to guidelines while decreasing unnecessary procedures and time to treatment.
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Affiliation(s)
- Candice L Wilshire
- Division of Interventional Pulmonology and Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Joshua R Rayburn
- Division of Interventional Pulmonology and Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Shu-Ching Chang
- Medical Data Research Center, Providence St. Joseph Health, Portland, Oregon
| | - Christopher R Gilbert
- Division of Interventional Pulmonology and Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Brian E Louie
- Division of Interventional Pulmonology and Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Ralph W Aye
- Division of Interventional Pulmonology and Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Alexander S Farivar
- Division of Interventional Pulmonology and Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Adam J Bograd
- Division of Interventional Pulmonology and Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Eric Vallières
- Division of Interventional Pulmonology and Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Jed A Gorden
- Division of Interventional Pulmonology and Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington.
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The need of a clinically oriented reporting of 18F-FDG PET/CT in non-small cell lung cancer (NSCLC). Clin Transl Imaging 2020. [DOI: 10.1007/s40336-019-00354-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bade BC, Silvestri GA. Setting the Stage for Success in Lung Cancer: The Importance of Remembering Your (Guide)Lines. Chest 2019; 155:456-457. [PMID: 30846061 DOI: 10.1016/j.chest.2018.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Brett C Bade
- Department of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT
| | - Gerard A Silvestri
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC.
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Radiation Therapy in Non-small-Cell Lung Cancer. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-52619-5_34-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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