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Takahara T, Satou A, Tsuyuki T, Ito T, Taniguchi N, Yamamoto Y, Ohashi A, Takahashi E, Kadota K, Tsuzuki T. Histology of Bronchiolar Tumor Spread Through Air Spaces. Am J Surg Pathol 2024; 48:1052-1059. [PMID: 38757408 DOI: 10.1097/pas.0000000000002246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
The clinical significance of lung tumor spread through air spaces (STAS) has been extensively studied, and is recognized as a unique pattern of invasion. Previous studies of STAS have focused primarily on STAS in alveolar spaces, whereas STAS in the bronchiolar spaces (bronchiolar STAS) has been described in only a few case reports only. Here, we examined 306 cases of primary lung adenocarcinoma and found that bronchiolar STAS was present in 18%. Bronchiolar STAS was associated with an inferior prognosis, more advanced stage, and higher histologic grade. No significant difference in clinicopathological factors or prognosis was observed between cases with bronchiolar STAS and those with alveolar STAS alone. Notably, bronchiolar STAS often occurred simultaneously with alveolar STAS and endobronchial spread of adenocarcinoma, particularly when bronchiolar STAS was present outside the main tumor. We also identified cases where bronchiolar STAS and endobronchial spread of adenocarcinoma occurred simultaneously in the same bronchi or bronchioles located outside the main tumor, as well as cases with bronchiolar STAS adjacent to intrapulmonary metastatic nodules. Our results highlight the significant role of bronchiolar STAS in the aerogenous spread of adenocarcinoma cells. Bronchiolar STAS can be regarded as a histologic variant of alveolar STAS. This study also supports the idea that STAS is not a tissue processing artifact, but a true biological process with clinical implications, offering histologic evidence of aerogenous spread in lung adenocarcinoma.
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Affiliation(s)
- Taishi Takahara
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute
| | - Takuji Tsuyuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute
| | - Takanori Ito
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute
| | - Natsuki Taniguchi
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute
| | - Yuki Yamamoto
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute
| | - Akiko Ohashi
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute
| | - Emiko Takahashi
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute
| | - Kyuichi Kadota
- Department of Molecular Oncologic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute
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Winter H, Eichhorn M, Eichhorn F, Grott M. [Modern individualized diagnostics and treatment of non-small cell lung cancer]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:280-287. [PMID: 38376521 DOI: 10.1007/s00104-024-02037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 02/21/2024]
Abstract
Approximately one half of patients with non-small cell lung cancer (NSCLC) are diagnosed at resectable tumor stages (I-IIIA), which can potentially be curatively treated. In the early tumor stages (tumor diameter ≤2 cm) sublobar resection (segmentectomy or atypical wedge resection) leads to a 5‑year long-term survival comparable to lobectomy. The use of immunotherapy, especially within the framework of neoadjuvant treatment, is anticipated to change the surgical treatment of NSCLC in the future. With the introduction of lung cancer screening for certain risk groups in Germany planned for 2024, lung tumors can be expected to be diagnosed at earlier stages and more frequently curatively treated. This article provides an overview of the potential impact of lung cancer screening, modern minimally invasive surgical techniques and neoadjuvant treatment concepts for the surgical treatment of NSCLC.
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Affiliation(s)
- Hauke Winter
- Thoraxchirurgie, Thoraxklinik Heidelberg, Roentgenstraße 1, 69126, Heidelberg, Deutschland.
| | - Martin Eichhorn
- Thoraxchirurgie, Thoraxklinik Heidelberg, Roentgenstraße 1, 69126, Heidelberg, Deutschland
| | - Florian Eichhorn
- Thoraxchirurgie, Thoraxklinik Heidelberg, Roentgenstraße 1, 69126, Heidelberg, Deutschland
| | - Matthias Grott
- Thoraxchirurgie, Thoraxklinik Heidelberg, Roentgenstraße 1, 69126, Heidelberg, Deutschland
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Wang H, Chen A, Wang K, Yang H, Wen W, Ren Q, Chen L, Xu X, Zhu Q. CT imaging features of lung ground-glass nodule patients with upgraded intraoperative frozen pathology. Discov Oncol 2024; 15:29. [PMID: 38310621 PMCID: PMC10838864 DOI: 10.1007/s12672-024-00872-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/23/2024] [Indexed: 02/06/2024] Open
Abstract
PURPOSE Intraoperative frozen section pathology (FS) is widely used to guide surgical strategies while the accuracy is relatively low. Underestimating the pathological condition may result in inadequate surgical margins. This study aims to identify CT imaging features related to upgraded FS and develop a predictive model. METHODS Collected data from 860 patients who underwent lung surgery from January to December 2019. We analyzed the consistency rate of FS and categorized the patients into three groups: Group 1 (n = 360) had both FS and Formalin-fixed Paraffin-embedded section (FP) as non-invasive adenocarcinoma (IAC); Group 2 (n = 128) had FS as non-IAC but FP as IAC; Group 3 (n = 372) had both FS and FP as IAC. Clinical baseline characteristics were compared and propensity score adjustment was used to mitigate the effects of these characteristics. Univariate analyses identified imaging features with inter-group differences. A multivariate analysis was conducted to screen independent risk factors for FS upgrade, after which a logistic regression prediction model was established and a receiver operating characteristic (ROC) curve was plotted. RESULTS The consistency rate of FS with FP was 84.19%. 26.67% of the patients with non-IAC FS diagnosis were upgraded to IAC. The predictive model's Area Under Curve (AUC) is 0.785. Consolidation tumor ratio (CTR) ≤ 0.5 and smaller nodule diameter are associated with the underestimation of IAC in FS. CONCLUSION CT imaging has the capacity to effectively detect patients at risk of upstaging during FS.
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Affiliation(s)
- Hongya Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Aiping Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Kun Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - He Yang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Wei Wen
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qianrui Ren
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Liang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xinfeng Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Quan Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Zhang S, Dong P, Pan Z, Chen Q, Zhu J, Mao Z. Comparison of gene mutation profile in different lung adenocarcinoma subtypes by targeted next-generation sequencing. Med Oncol 2023; 40:349. [PMID: 37935925 DOI: 10.1007/s12032-023-02206-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/28/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Disease prognosis after resection of lung cancer could be affected by pathological subtypes. In this study, we investigated the difference of gene variation and significantly altered pathways between adenocarcinoma in situ (AIS)/microinvasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) subtypes to reveal the molecular mechanism of prognosis differences. METHODS Sixty one tumor tissues were subjected to DNA extraction and customized 136 gene targeted next-generation sequencing. Comparisons between groups were performed with two-sided Fisher's exact test for categorical variables and two-tailed unpaired t test for numerical variables. RESULTS A total of 402 somatic mutations involved in 70 genes were detected in all these samples, and 74.29% of these genes were mutated in at least two samples. PMS2, ARID1A, EGFR, and POLE were the most frequently mutated genes. ALK_EML4 fusion was observed in one IAC patient and RET_ KIF5B fusion in one AIS patient. A significant higher proportion of patients with TP53 gene mutation was observed in the IAC group (P = 0.0057). The average onset age in IAC group is 62.48 years, which is greater than other subtypes (P = 0.0166). It revealed that mutations in genes involved in the mTOR signaling pathway (56.52% vs 26.32%, P = 0.0288) and Hippo signaling pathway (34.78% vs 10.53%, P = 0.0427) were significantly enriched in IAC subtypes, suggesting the key involvement of mTOR and Hippo signaling pathways in lung tumor development and malignant progression. CONCLUSIONS This study revealed the heterogeneity of gene mutations and significantly altered pathways between different lung cancer subtypes, suggesting the potential mechanism of different prognosis.
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Affiliation(s)
- Shaowen Zhang
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China
| | - Ping Dong
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China
| | - Zongwei Pan
- Department of Medical Equipment, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China
| | - Qian Chen
- Thorgene Co., Ltd, Beijing, 100176, China
| | - Junqi Zhu
- Thorgene Co., Ltd, Beijing, 100176, China
| | - Zhangfan Mao
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China.
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Liu J, Ji Y, Weng X, Shao W, Zhao J, Chen H, Shen L, Wang F, Meng Q, Wu X, Wang X, Ou Q, Ke H. Immune microenvironment analysis and novel biomarkers of early-stage lung adenocarcinoma evolution. Front Oncol 2023; 13:1150098. [PMID: 37427097 PMCID: PMC10328385 DOI: 10.3389/fonc.2023.1150098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Background Lung cancer is the deadliest and most diagnosed type of cancer worldwide. The 5-year survival rate of lung adenocarcinoma (LUAD) dropped significantly when tumor stages advanced. Patients who received surgically resecting at the pre-invasive stage had a 5-year survival rate of nearly 100%. However, the study on the differences in gene expression profiles and immune microenvironment among pre-invasive LUAD patients is still lacking. Methods In this study, the gene expression profiles of three pre-invasive LUAD stages were compared using the RNA-sequencing data of 10 adenocarcinoma in situ (AIS) samples, 12 minimally invasive adenocarcinoma (MIA) samples, and 10 invasive adenocarcinoma (IAC) samples. Results The high expression levels of PTGFRN (Hazard Ratio [HR] = 1.45; 95% Confidence Interval [CI]: 1.08-1.94; log-rank P = 0.013) and SPP1 (HR = 1.44; 95% CI: 1.07-1.93; log-rank P = 0.015) were identified to be associated with LUAD prognosis. Moreover, the early LUAD invasion was accompanied by the enhancement of antigen presentation ability, reflected by the increase of myeloid dendritic cells infiltration rate (Cuzick test P < 0.01) and the upregulation of seven important genes participating in the antigen presentation, including HLA-A (Cuzick test P = 0.03), MICA (Cuzick test P = 0.01), MICB (Cuzick test P = 0.01), HLA-DPA1 (Cuzick test P = 0.04), HLA-DQA2 (Cuzick test P < 0.01), HLA-DQB1 (Cuzick test P = 0.03), and HLA-DQB2 (Cuzick test P < 0.01). However, the tumor-killing ability of the immune system was inhibited during this process, as there were no rising cytotoxic T cell activity (Cuzick test P = 0.20) and no increasing expression in genes encoding cytotoxic proteins. Conclusion In all, our research elucidated the changes in the immune microenvironment during early-stage LUAD evolution and may provide a theoretical basis for developing novel early-stage lung cancer therapeutic targets.
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Affiliation(s)
- Jun Liu
- Department of Chemotherapy, Affiliated Hospital of Nantong University, Nantong, China
| | - Yaxin Ji
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Xiaodan Weng
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Wei Shao
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Jiaping Zhao
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Hanlin Chen
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Lu Shen
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Fufeng Wang
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Qi Meng
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Xue Wu
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Xiaonan Wang
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Qiuxiang Ou
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Honggang Ke
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, China
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Perez Holguin RA, Olecki EJ, Wong WG, Stahl KA, Go PH, Taylor MD, Reed MF, Shen C. Outcomes after sublobar resection versus lobectomy in non-small cell carcinoma in situ. J Thorac Cardiovasc Surg 2023; 165:853-861.e3. [PMID: 35760619 DOI: 10.1016/j.jtcvs.2022.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/13/2022] [Accepted: 05/07/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Guidelines for treatment of non-small cell lung cancer identify patients with tumors ≤2 cm and pure carcinoma in situ histology as candidates for sublobar resection. Although the merits of lobectomy, sublobar resection, and lymphoid (LN) sampling, have been investigated in early-stage non-small cell lung cancer, evaluation of these modalities in patients with IS disease can provide meaningful clinical information. This study aims to compare these operations and their relationship with regional LN sampling in this population. METHODS The National Cancer Database was used to identify patients diagnosed with non-small cell lung cancer clinical Tis N0 M0 with a tumor size ≤2 cm from 2004 to 2017. The χ2 tests were used to examine subgroup differences by type of surgery. Kaplan-Meier method and Cox proportional hazard model were used to compare overall survival. RESULTS Of 707 patients, 56.7% (401 out of 707) underwent sublobar resection and 43.3% (306 out of 707) underwent lobectomy. There was no difference in 5-year overall survival in the sublobar resection group (85.1%) compared with the lobectomy group (88.9%; P = .341). Multivariable survival analyses showed no difference in overall survival (hazard ratio, 1.044; P = .885) in the treatment groups. LN sampling was performed in 50.9% of patients treated with sublobar resection. In this group, LN sampling was not associated with improved survival (84.9% vs 85.0%; P = .741). CONCLUSIONS We observed no difference in overall survival between sublobar resection and lobectomy in patients with cTis N0 M0 non-small cell lung cancer with tumors ≤2 cm. Sublobar resection may be an appropriate surgical option for this population. LN sampling was not associated with improved survival in patients treated with sublobar resection.
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Affiliation(s)
- Rolfy A Perez Holguin
- Division of Outcomes Research Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa
| | - Elizabeth J Olecki
- Division of Outcomes Research Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa
| | - William G Wong
- Division of Outcomes Research Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa
| | - Kelly A Stahl
- Division of Outcomes Research Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa
| | - Pauline H Go
- Division of Thoracic Surgery, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa; Penn State Cancer Institute, Hershey, Pa
| | - Matthew D Taylor
- Division of Thoracic Surgery, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa; Penn State Cancer Institute, Hershey, Pa
| | - Michael F Reed
- Division of Thoracic Surgery, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa; Penn State Cancer Institute, Hershey, Pa
| | - Chan Shen
- Division of Outcomes Research Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa; Penn State Cancer Institute, Hershey, Pa; Division of Health Services and Behavioral Research, Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pa.
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Zhu J, Wang W, Xiong Y, Xu S, Chen J, Wen M, Zhao Y, Lei J, Jiang T. Evolution of lung adenocarcinoma from preneoplasia to invasive adenocarcinoma. Cancer Med 2023; 12:5545-5557. [PMID: 36325966 PMCID: PMC10028051 DOI: 10.1002/cam4.5393] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/16/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Mutations in driver genes contribute to the development and progression of lung adenocarcinoma (LUAD). However, in the dynamic evolutionary process from adenocarcinoma in situ (AIS) to minimally invasive adenocarcinoma (MIA) and eventually to invasive adenocarcinoma (IAC), the role of driver genes is currently unclear. This study aimed to analyse the role of driver gene status in the progression of LUAD from preneoplasia to IAC. METHODS Patients with LUAD who underwent surgery in our centre from March 2015 to December 2019 were retrospectively analysed, and LUAD patients with tumour sizes ≤3.0 cm and pN0 were included in the final analysis. The mutation status of common driver genes, including EGFR, ALK and ROS1, was detected. According to the pathological characteristics, the patients were divided into three stages: AIS, MIA and IAC. We analysed the distribution of driver gene mutation frequencies across three stages of LUAD. In addition, we performed univariate and multivariate analyses of IAC patients to screen for relevant variables (driver genes and clinicopathological features) affecting their prognosis. RESULTS Ultimately, 759 patients with LUAD were enrolled, including 135, 130, and 494 cases of AIS, MIA, and IAC, respectively. EGFR mutations were identified in 359 (61.8%) patients, and with the transition from AIS to MIA, the frequency of EGFR mutations increased from 33.3% to 50.8%, p = 0.004, whereas the frequency of EGFR mutations was comparable for MIA and IAC (50.8% vs. 50.2%, p = 0.922). Moreover, ALK and ROS1 gene fusions were identified in 17 cases (2.2%) and 2 cases (3.0‰) respectively. For AIS, neither ALK gene nor ROS1 gene fusions were observed. When the tumour progressed to MIA, the ALK fusion frequency was 2.3% (3/130), which was basically consistent with the ALK fusion frequency of 2.8% in IAC, p = 0.143. For IAC, fusions of ROS1 fell into this category. In addition, we found that 40 patients (5.3%) developed metastasis/recurrence, and 14 patients (1.8%) died of cancer-specific related diseases. Notably, for AIS, there were no recurrences and no deaths, and for MIA, only 1 patient died with LUAD. Finally, survival analysis was performed in patients with stage IA invasive adenocarcinoma, and EGFR-mutant patients showed better DFS than EGFR-wild-type patients (p = 0.036). Conversely, patients with ALK fusions showed worse DFS than those with ALK wild-type (p = 0.004), and the same results were found in OS analysis. CONCLUSIONS The accumulation of EGFR driver gene mutation frequencies mediates the progression of LUAD from AIS to MIA. When the tumour progresses to stage IA invasive adenocarcinoma, multivariate analysis based on driver gene status can be used as a pivotal prognostic factor.
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Affiliation(s)
- Jianfei Zhu
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
- Department of Thoracic Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Wenchen Wang
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yanlu Xiong
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Shuonan Xu
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jiankuan Chen
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Miaomiao Wen
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yabo Zhao
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jie Lei
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Tao Jiang
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
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Luo Z, Xiao Y, Luo C, Zhang L, Zhou R, Zhao Z, Sun C, Wu D, Wang T. Molecular characteristics of multiple primary pulmonary nodules under a three-dimensional reconstruction model and relevant multi-omics analyses: a case report. Front Oncol 2023; 13:1064475. [PMID: 37205198 PMCID: PMC10185815 DOI: 10.3389/fonc.2023.1064475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Background In addition to CT images and pathological features, many other molecular characteristics remain unknown about multiple primary lung cancer (MPLC) from intrapulmonary metastatic lung cancer. Case presentation In this study, we reported a patient with an early-stage MPLC with both adenocarcinoma in situ (AIS) subtype and minimally invasive adenocarcinoma (MIA) subtype. The patient was diagnosed with more than 10 nodules and underwent precise surgery assisted by three-dimensional (3D) reconstruction at the left upper lung lobe. Whole-exome sequencing (WES) and multiple immunohistochemistry (mIHC) were performed to reveal the genomic profiling and tumor microenvironments of multiple nodules in this patient with MPLC. Based on 3D reconstruction location information, we found that the genomic and pathological results of adjacent lymph nodes were quite different. On the other hand, PD-L1 expression and the proportion of infiltrating lymphocytes in tumor microenvironments were all at a low status and did not vary in adjacent lymph nodes. Additionally, maximum diameter and tumor mutational burden levels were found to be significantly associated with CD8+ T cell proportion (p<0.05). Besides, CD163+ macrophages and CD4+ T cell proportion were higher in MIA nodules than in AIS nodules (p<0.05). This patient reached a recurrence-free survival of 39 months. Conclusion Generally, in addition to CT imaging and pathological results, genomic profiling and tumor microenvironments may facilitate identifying the potential molecular mechanisms and clinical outcomes in patients with early-stage MPLC.
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Affiliation(s)
- Zhilin Luo
- Department of Thoracic Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yajie Xiao
- Department of Medicine, YuceBio Technology Co. Ltd., Shenzhen, China
| | - Chengwen Luo
- Department of Thoracic Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liping Zhang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Runquan Zhou
- Department of Thoracic Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhikun Zhao
- Department of Medicine, YuceBio Technology Co. Ltd., Shenzhen, China
| | - Chao Sun
- Department of Medicine, YuceBio Technology Co. Ltd., Shenzhen, China
| | - Dongfang Wu
- Department of Medicine, YuceBio Technology Co. Ltd., Shenzhen, China
| | - Tianhu Wang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Tianhu Wang,
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Chen K, Liu S, Lu C, Gu X. A prognostic and therapeutic hallmark developed by the integrated profile of basement membrane and immune infiltrative landscape in lung adenocarcinoma. Front Immunol 2022; 13:1058493. [PMID: 36532024 PMCID: PMC9748099 DOI: 10.3389/fimmu.2022.1058493] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Abstract
Basement membranes (BMs) are specialised extracellular matrices that maintain cellular integrity and resist the breaching of carcinoma cells for metastases while regulating tumour immunity. The tumour immune microenvironment (TME) is essential for tumour growth and the response to and benefits from immunotherapy. In this study, the BM score and TME score were constructed based on the expression signatures of BM-related genes and the presence of immune cells in lung adenocarcinoma (LUAD), respectively. Subsequently, the BM-TME classifier was developed with the combination of BM score and TME score for accurate prognostic prediction. Further, Kaplan-Meier survival estimation, univariate Cox regression analysis and receiver operating characteristic curves were used to cross-validate and elucidate the prognostic prediction value of the BM-TME classifier in several cohorts. Findings from functional annotation analysis suggested that the potential molecular regulatory mechanisms of the BM-TME classifier were closely related to the cell cycle, mitosis and DNA replication pathways. Additionally, the guiding value of the treatment strategy of the BM-TME classifier for LUAD was determined. Future clinical disease management may benefit from the findings of our research.
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Affiliation(s)
- Kaijie Chen
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China,Shanghai Key Laboratory of Molecular Imaging, Zhoupu Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Shuang Liu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China,Shanghai Key Laboratory of Molecular Imaging, Zhoupu Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Changlian Lu
- School of Pharmacy, Shanghai University of Medicine and Health Sciences, Shanghai, China,*Correspondence: Xuefeng Gu, ; Changlian Lu,
| | - Xuefeng Gu
- Shanghai Key Laboratory of Molecular Imaging, Zhoupu Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, China,School of Pharmacy, Shanghai University of Medicine and Health Sciences, Shanghai, China,*Correspondence: Xuefeng Gu, ; Changlian Lu,
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Li Z, Cai J, Zhao Y, Cai J, Zhao X. Folate receptor-positive circulating tumor cells in the preoperative diagnosis of indeterminate pulmonary nodules. J Clin Lab Anal 2022; 36:e24654. [PMID: 36217263 PMCID: PMC9550973 DOI: 10.1002/jcla.24654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/17/2022] [Accepted: 07/30/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The use of FR + CTC to distinguish lung cancer from benign lung disease has been well studied. However, the effective method to differentiate precursor glandular lesions from benign/malignant pulmonary diseases is rare. METHODS 380 patients with indeterminate pulmonary nodules were prospectively recruited. Peripheral blood samples were collected from all participants before surgery for analyzing FR + CTC levels. The performance of FR + CTC to identify lung precursor lesions were analyzed by receiver operating characteristic (ROC) curve. RESULTS FR + CTC can effectively differentiate precursor from benign pulmonary diseases in all included patients (cutoff: 9.22 FU/3 ml, AUC = 0.807, (p < 0.0001, sensitivity: 69.17%, specificity: 82.46%) and patients with single pulmonary lesion (cutoff: 9.03 FU/3 ml, AUC = 0.842, p = 0.0001, sensitivity: 75.20%, specificity: 83.00%). However, FR + CTC cannot differentiate precursor from benign pulmonary diseases in multiple lesions patients (p = 0.110). FR + CTC neither differentiate precursor from malignant pulmonary lesions in all included patients (p = 0.715), single nor multiple lesions patients (p = 0.867, p = 0.692, respectively). Total number of pulmonary nodules, MTD, location (lower vs upper) were independent risk factors for malignancy (AOR, 95% CI: 3.104 (1.525, 6.316), 3.148 (1.722, 5.754), 2.098 (1.132, 3.888), respectively. CONCLUSION Preoperative FR + CTC can be identified in precursor glandular lesions and utilized to differentiate from benign pulmonary diseases. Total number of pulmonary nodules, MTD, location (lower vs upper) were independent risk factors for malignancy.
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Affiliation(s)
- Zhixin Li
- Department of Thoracic Surgery, Shanghai Pulmonary HospitalSchool of Medicine, Tongji UniversityShanghaiChina
| | - Jianqiao Cai
- Department of Thoracic Surgery, Shanghai Pulmonary HospitalSchool of Medicine, Tongji UniversityShanghaiChina
| | - Yongqiang Zhao
- Department of Thoracic SurgeryLinqu County People's hospitalWeifangChina
| | - Jie Cai
- Department of Thoracic Surgery, Shanghai Pulmonary HospitalSchool of Medicine, Tongji UniversityShanghaiChina
| | - Xiaogang Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary HospitalSchool of Medicine, Tongji UniversityShanghaiChina
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11
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Lee J, Han YB, Kwon HJ, Lee SK, Kim H, Chung JH. Landscape of EGFR mutations in lung adenocarcinoma: a single institute experience with comparison of PANAMutyper testing and targeted next-generation sequencing. J Pathol Transl Med 2022; 56:249-259. [PMID: 36128861 PMCID: PMC9510045 DOI: 10.4132/jptm.2022.06.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background Activating mutations in the tyrosine kinase domain of epidermal growth factor receptor (EGFR) are predictive biomarkers for response to EGFR–tyrosine kinase inhibitor (TKI) therapy in lung adenocarcinoma (LUAD). Here, we characterized the clinicopathologic features associated with EGFR mutations via peptide nucleic acid clamping-assisted fluorescence melting curve analysis (PANAMutyper) and evaluated the feasibility of targeted deep sequencing for detecting the mutations. Methods We examined EGFR mutations in exons 18 through 21 for 2,088 LUADs from July 2017 to April 2020 using PANAMutyper. Of these, we performed targeted deep sequencing in 73 patients and evaluated EGFR-mutation status and TKI clinical response. Results EGFR mutation was identified in 55.7% of LUADs by PANAMutyper, with mutation rates higher in females (69.3%) and never smokers (67.1%) and highest in the age range of 50 to 59 years (64.9%). For the 73 patients evaluated using both methods, next-generation sequencing (NGS) identified EGFR mutation–positive results in 14 of 61 patients (23.0%) who were EGFR-negative according to PANAMutyper testing. Of the 10 patients reportedly harboring a sensitizing mutation according to NGS, seven received TKI treatment, with all showing partial response or stable disease. In the 12 PANAMutyper-positive cases, NGS identified two additional mutations in exon 18, whereas a discordant negative result was observed in two cases. Conclusions Although PANAMutyper identified high frequencies of EGFR mutations, targeted deep sequencing revealed additional uncommon EGFR mutations. These findings suggested that appropriate use of NGS may benefit LUAD patients with otherwise negative screening test results.
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Affiliation(s)
- Jeonghyo Lee
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Yeon Bi Han
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jung Kwon
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Song Kook Lee
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyojin Kim
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Haeng Chung
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
- Artificial Intelligence Institute, Seoul National University, Seoul, Korea
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12
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Cai YS, Dong HH, Li XY, Ye X, Chen S, Hu B, Li H, Miao JB, Chen QR. Incidence of venous thromboembolism after surgery for adenocarcinoma in situ and the validity of the modified Caprini score: A propensity score-matched study. Front Oncol 2022; 12:976988. [PMID: 36119540 PMCID: PMC9478866 DOI: 10.3389/fonc.2022.976988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/12/2022] [Indexed: 12/05/2022] Open
Abstract
Background Recently, the new World Health Organization (WHO) tumor classification removed adenocarcinoma in situ (AIS) from the diagnosis of lung cancer. However, it remains unclear whether the “malignancy” item should be assessed when the modified Caprini Risk Assessment Model (RAM) is used to assess venous thromboembolism (VTE) risk in AIS. The purpose of our study is to assess differences between AIS and stage IA adenocarcinoma (AD) from a VTE perspective. Methods A retrospective study was performed on AIS and IA adenocarcinoma in our hospital from January 2018 to December 2021, and divided into AIS group and AD group. Propensity score matching (PSM) was used to compare the incidence of VTE and coagulation function, and to analyze whether the RAM is more effective when the “malignancy” item is not evaluated in AIS. Results 491 patients were included after screening, including 104 patients in the AIS group and 387 patients in the AD group. After PSM, 83 patients were matched. The incidence of VTE and D-dimer in the AIS group was significantly lower than that in the AD group (P<0.05).When using the RAM to score AIS, compared with retaining the “malignancy” item, the incidence of VTE in the intermediate-high-risk group was significantly higher after removing the item (7.9% vs. 36.4%, P=0.018), which significantly improved the stratification effect of the model. Conclusions The incidence of postoperative VTE in AIS was significantly lower than that in stage IA adenocarcinoma. The stratification effect was more favorable when the “malignancy” item was not evaluated in AIS using the RAM.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Qi-rui Chen
- *Correspondence: Jin-bai Miao, ; Qi-rui Chen,
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13
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Parker AL, Toulabi L, Oike T, Kanke Y, Patel D, Tada T, Taylor S, Beck JA, Bowman E, Reyzer ML, Butcher D, Kuhn S, Pauly GT, Krausz KW, Gonzalez FJ, Hussain SP, Ambs S, Ryan BM, Wang XW, Harris CC. Creatine riboside is a cancer cell-derived metabolite associated with arginine auxotrophy. J Clin Invest 2022; 132:157410. [PMID: 35838048 PMCID: PMC9282934 DOI: 10.1172/jci157410] [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: 12/08/2021] [Accepted: 05/25/2022] [Indexed: 12/17/2022] Open
Abstract
The metabolic dependencies of cancer cells have substantial potential to be exploited to improve the diagnosis and treatment of cancer. Creatine riboside (CR) is identified as a urinary metabolite associated with risk and prognosis in lung and liver cancer. However, the source of high CR levels in patients with cancer as well as their implications for the treatment of these aggressive cancers remain unclear. By integrating multiomics data on lung and liver cancer, we have shown that CR is a cancer cell–derived metabolite. Global metabolomics and gene expression analysis of human tumors and matched liquid biopsies, together with functional studies, revealed that dysregulation of the mitochondrial urea cycle and a nucleotide imbalance were associated with high CR levels and indicators of a poor prognosis. This metabolic phenotype was associated with reduced immune infiltration and supported rapid cancer cell proliferation that drove aggressive tumor growth. CRhi cancer cells were auxotrophic for arginine, revealing a metabolic vulnerability that may be exploited therapeutically. This highlights the potential of CR not only as a poor-prognosis biomarker but also as a companion biomarker to inform the administration of arginine-targeted therapies in precision medicine strategies to improve survival for patients with cancer.
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Affiliation(s)
- Amelia L Parker
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Leila Toulabi
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Takahiro Oike
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Yasuyuki Kanke
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Daxeshkumar Patel
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Takeshi Tada
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Sheryse Taylor
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Jessica A Beck
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Elise Bowman
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Michelle L Reyzer
- National Research Resource for Imaging Mass Spectrometry, Vanderbilt University, Nashville, Tennessee, USA
| | - Donna Butcher
- Pathology and Histotechnology Laboratory, Frederick National Laboratory, Frederick, Maryland, USA
| | - Skyler Kuhn
- Center for Cancer Research Collaborative Bioinformatics Resource
| | | | | | | | - S Perwez Hussain
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Bríd M Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Xin Wei Wang
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA.,Liver Cancer Program, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, USA
| | - Curtis C Harris
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
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Detection and treatment of lung adenocarcinoma at pre-/minimally invasive stage: is it lead-time bias? J Cancer Res Clin Oncol 2022; 148:2717-2722. [PMID: 35524781 DOI: 10.1007/s00432-022-04031-z] [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: 03/29/2022] [Accepted: 04/17/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study investigates whether lead-time bias contributes to the excellent survival of AIS and MIA. METHODS We enrolled patients with resected adenocarcinoma from 2008 to 2012. Age, sex, smoke history, surgical approach, radiological features, invasive stage and postoperative follow-up data were documented. 1:1 PSM was performed to balance the influence of sex and smoking status on survival. After matching, the average age of the two groups was compared to calculate the lead time of diagnosis. The gain in life years for adenocarcinoma diagnosed at pre-/minimally invasive stage was estimated by subtracting the "lead time" and "median survival year of IAC" from "the life expectancy of AIS/MIA patients" referring to the Centre for Health and Information. RESULTS There were 124 AIS/MIA patients and 1148 IAC patients. The frequency of female and never-smoking patients in AIS/MIA group was much higher than that in IAC group. PSM analysis identified 124 patient pairs. No cancer-related death and recurrence were observed among AIS/MIA patients 5 years after surgery. For IAC patients, the 5-year disease-specific survival rate was 73.5% and the median survival is 13.5 years. The average age of AIS/MIA group and IAC group are 53.6 years and 58.2 years, respectively. The lead time between diagnosis of AIS/MIA and IAC is 4.6 years. Referring to the Centre for Health and Information, the life expectancy of patients with AIS/MIA diagnosed at 53.6 years old is 28.9 years. With adjustment for the lead time, the gain in life years for adenocarcinoma diagnosed at pre-/minimally invasive stage is 10.8 years. CONCLUSIONS With adjustment for the lead time between diagnosis of AIS/MIA and IAC, resecting lung adenocarcinoma at pre-/minimally invasive stage can improve life expectancy. The excellent survival of AIS/MIA is not lead-time bias.
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15
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Qiu ZB, Zhang C, Chu XP, Cai FY, Yang XN, Wu YL, Zhong WZ. Quantifying invasiveness of clinical stage IA lung adenocarcinoma with computed tomography texture features. J Thorac Cardiovasc Surg 2022; 163:805-815.e3. [PMID: 33541730 DOI: 10.1016/j.jtcvs.2020.12.092] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/21/2020] [Accepted: 12/11/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The study objectives were to establish and validate a nomogram for pathological invasiveness prediction in clinical stage IA lung adenocarcinoma and to help identify those potentially unsuitable for sublobar resection-based computed tomography texture features. METHOD Patients with clinical stage IA lung adenocarcinoma who underwent surgery at Guangdong Provincial People's Hospital between January 2015 and October 2018 were retrospectively reviewed. All surgically resected nodules were pathologically classified into less-invasive and invasive cohorts. Each nodule was manually segmented, and its computerized texture features were extracted. Clinicopathological and computed tomographic texture features were compared between 2 cohorts. A nomogram for distinguishing the pathological invasiveness was established and validated. RESULTS Among 428 enrolled patients, 249 were diagnosed with invasive pathological subtypes. Smoking status (odds ratio, 2.906; 95% confidence interval, 1.285-6.579; P = .011), mean computed tomography attenuation value (odds ratio, 1.005, 95% confidence interval, 1.002-1.007; P < .001), and entropy (odds ratio, 8.536, 95% confidence interval, 3.478-20.951; P < .001) were identified as independent predictors for pathological invasiveness by multivariate logistics regression analysis. The nomogram showed good calibration (P = .182) with an area under the curve of 0.849 when validated with testing set data. Decision curve analysis indicated the potentially clinical usefulness of the model with respect to treat-all or treat-none scenario. Compared with intraoperative frozen-section, the nomogram performed better in pathological invasiveness diagnosis (area under the curve, 0.815 vs 0.670; P = .00095). CONCLUSIONS We established and validated a nomogram to compute the probability of invasiveness of clinical stage IA lung adenocarcinoma with great calibration, which may contribute to decisions related to resection extent.
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Affiliation(s)
- Zhen-Bin Qiu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Shantou University Medical College, Shantou, China
| | - Chao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiang-Peng Chu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; School of Medicine, South China University of Technology, Guangzhou, China
| | - Fei-Yue Cai
- Perception Vision Medical Technologies Co Ltd, Guangzhou, China
| | - Xue-Ning Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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16
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Sugawara H, Watanabe H, Kunimatsu A, Abe O, Watanabe SI, Yatabe Y, Kusumoto M. Adenocarcinoma in situ and minimally invasive adenocarcinoma in lungs of smokers: image feature differences from those in lungs of non-smokers. BMC Med Imaging 2021; 21:172. [PMID: 34798844 PMCID: PMC8603503 DOI: 10.1186/s12880-021-00705-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE We aimed to examine the characteristics of imaging findings of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) in the lungs of smokers compared with those of non-smokers. MATERIALS AND METHODS We included seven cases of AIS and 20 cases of MIA in lungs of smokers (pack-years ≥ 20) and the same number of cases of AIS and MIA in lungs of non-smokers (pack-years = 0). We compared the diameter of the entire lesion and solid component measured on computed tomography (CT) images, pathological size and invasive component diameter measured from pathological specimens, and CT values of the entire lesion and ground-glass opacity (GGO) portions between the smoker and non-smoker groups. RESULTS The diameters of AIS and MIA on CT images and pathological specimens of the smoker group were significantly larger than those of the non-smoker group (p = 0.036 and 0.008, respectively), whereas there was no significant difference in the diameter of the solid component on CT images or invasive component of pathological specimens between the two groups. Additionally, mean CT values of the entire lesion and GGO component of the lesions in the smoker group were significantly lower than those in the non-smoker group (p = 0.036 and 0.040, respectively). CONCLUSION AIS and MIA in smoker's lung tended to have larger lesion diameter and lower internal CT values compared with lesions in non-smoker's lung. This study calls an attention on smoking status in CT-based diagnosis for early stage adenocarcinoma.
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Affiliation(s)
- Haruto Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
- Department of Radiology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
| | - Hirokazu Watanabe
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akira Kunimatsu
- Department of Radiology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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17
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Huang Z, Lyu M, Ai Z, Chen Y, Liang Y, Xiang Z. Pre-operative Prediction of Ki-67 Expression in Various Histological Subtypes of Lung Adenocarcinoma Based on CT Radiomic Features. Front Surg 2021; 8:736737. [PMID: 34733879 PMCID: PMC8558627 DOI: 10.3389/fsurg.2021.736737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/09/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose: The aims of this study were to combine CT images with Ki-67 expression to distinguish various subtypes of lung adenocarcinoma and to pre-operatively predict the Ki-67 expression level based on CT radiomic features. Methods: Data from 215 patients with 237 pathologically proven lung adenocarcinoma lesions who underwent CT and immunohistochemical Ki-67 from January 2019 to April 2021 were retrospectively analyzed. The receiver operating curve (ROC) identified the Ki-67 cut-off value for differentiating subtypes of lung adenocarcinoma. A chi-square test or t-test analyzed the differences in the CT images between the negative expression group (n = 132) and the positive expression group (n = 105), and then the risk factors affecting the expression level of Ki-67 were evaluated. Patients were randomly divided into a training dataset (n = 165) and a validation dataset (n = 72) in a ratio of 7:3. A total of 1,316 quantitative radiomic features were extracted from the Analysis Kinetics (A.K.) software. Radiomic feature selection and radiomic classifier were generated through a least absolute shrinkage and selection operator (LASSO) regression and logistic regression analysis model. The predictive capacity of the radiomic classifiers for the Ki-67 levels was investigated through the ROC curves in the training and testing groups. Results: The cut-off value of the Ki-67 to distinguish subtypes of lung adenocarcinoma was 5%. A comparison of clinical data and imaging features between the two groups showed that histopathological subtypes and air bronchograms could be used as risk factors to evaluate the expression of Ki-67 in lung adenocarcinoma (p = 0.005, p = 0.045, respectively). Through radiomic feature selection, eight top-class features constructed the radiomic model to pre-operatively predict the expression of Ki-67, and the area under the ROC curves of the training group and the testing group were 0.871 and 0.8, respectively. Conclusion: Ki-67 expression level with a cut-off value of 5% could be used to differentiate non-invasive lung adenocarcinomas from invasive lung adenocarcinomas. It is feasible and reliable to pre-operatively predict the expression level of Ki-67 in lung adenocarcinomas based on CT radiomic features, as a non-invasive biomarker to predict the degree of malignant invasion of lung adenocarcinoma, and to evaluate the prognosis of the tumor.
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Affiliation(s)
- Zhiwei Huang
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Mo Lyu
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China.,School of Life Sciences, South China Normal University, Guangzhou, China
| | - Zhu Ai
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Yirong Chen
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Yuying Liang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Zhiming Xiang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
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Zhang T, Wang Y, Sun Y, Yuan M, Zhong Y, Li H, Yu T, Wang J. High-resolution CT image analysis based on 3D convolutional neural network can enhance the classification performance of radiologists in classifying pulmonary non-solid nodules. Eur J Radiol 2021; 141:109810. [PMID: 34102564 DOI: 10.1016/j.ejrad.2021.109810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/19/2021] [Accepted: 05/28/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate whether 3D convolutional neural network (CNN) is able to enhance the classification performance of radiologists in classifying pulmonary non-solid nodules (NSNs). MATERIALS AND METHODS Data of patients with solitary NSNs and diagnosed as adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), or invasive adenocarcinoma (IAC) in pathological after surgical resection were analyzed retrospectively. Ultimately, 532 patients in our institution were included in the study: 427 cases (144 AIS, 167 MIA, 116 IAC) were assigned to training dataset and 105 cases (36 AIS, 41 MIA and 28 IAC) were assigned to validation dataset. For external validation, 177 patients (60 AIS, 69 MIA and 48 IAC) from another hospital were assigned to testing dataset. The clinical and morphological characteristics of NSNs were established as radiologists' model. The trained classification model based on 3D CNN was used to identify NSNs types automatically. The evaluation and comparison on classification performance of the two models and CNN + radiologists' model were performed via receiver operating curve (ROC) analysis and integrated discrimination improvement (IDI) index. The Akaike information criterion (AIC) was calculated to find the best-fit model. RESULTS In external testing dataset, radiologists' model showed inferior classification performance than CNN model both in discriminating AIS from MIA-IAC and AIS-MIA from IAC (the area under the ROC curve (Az value), 0.693 vs 0.820, P = 0.011; 0.746 vs 0.833, P = 0.026, respectively). However, combining CNN significantly enhanced the classification performance of radiologists and exhibited higher Az values than CNN model alone (Az values, 0.893 vs 0.820, P < 0.001; 0.906 vs 0.833, P < 0.001, respectively). The IDI index further confirmed CNN's contribution to radiologists in classifying NSNs (IDI = 25.8 % (18.3-46.1 %), P < 0.001; IDI = 30.1 % (26.1-45.2 %), P < 0.001, respectively). The CNN + radiologists' model also provided the best fit over radiologists' model and CNN model alone (AIC value 63.3 % vs. 29.5 %, 49.5 %, P < 0.001; 69.2 % vs. 34.9 %, 53.6 %, P < 0.001, respectively). CONCLUSION CNN successfully classified NSNs based on CT images and its classification performance were superior to radiologists' model. But the classification performance of radiologists can be significantly enhanced when combined with CNN in classifying NSNs.
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Affiliation(s)
- Teng Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Yida Wang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China.
| | - Yingli Sun
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China.
| | - Mei Yuan
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Yan Zhong
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Hai Li
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Tongfu Yu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Jie Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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Chen T, Zhang X, Campisi A, Ciarrocchi AP, Dell'Amore A, Song L, Yang Y, Chen C, Luo Q. Evaluation of dynamic image progression of minimally invasive and preinvasive lung adenocarcinomas. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:804. [PMID: 34268417 PMCID: PMC8246155 DOI: 10.21037/atm-21-1994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/06/2021] [Indexed: 01/15/2023]
Abstract
Background The target of our study was to investigate if the size (greater than and less than 1 cm) of ground-glass opacities (GGOs) of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) of the lung influences the rate of their evolution. Methods We retrospectively analyzed patients with AIS and MIA who underwent surgery at Shanghai Chest Hospital, Shanghai Jiao Tong University between January 2018 and July 2019, focusing on histopathology, surgical procedure, epidermal growth factor receptor (EGFR) mutations, and computed tomography (CT) images. Results A total of 224 AIS (n=117) and MIA (n=107) tumors were analyzed. The patients with a tumor diameter <1 cm were distinctly younger than those with tumors >1 cm in size (P<0.001). Pure ground-glass opacities (pGGO) occurred significantly more in patients with nodules <1 cm, while part-solid/mixed ground-glass opacities (mGGO) predominated in patients with nodules >1 cm (P=0.047). There was no significant difference in GGO evolution for GGOs of different sizes. Mutations of EGFR were more common in patients with MIA than in those with AIS (P<0.001). Conclusions We found that GGO size and variation (pGGO or mGGO) did not correlate to tumor stability, therefore larger GGOs can undergo standard follow-up protocols to evaluate their evolution over time.
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Affiliation(s)
- Tianxiang Chen
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaocheng Zhang
- Department of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Alessio Campisi
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Angelo Paolo Ciarrocchi
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Andrea Dell'Amore
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, Padua, Italy
| | - Liwei Song
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yunhai Yang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chengshui Chen
- Department of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qingquan Luo
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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20
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Mitzman B. Commentary: Rise of the machines. J Thorac Cardiovasc Surg 2021; 163:1507-1508. [PMID: 33773817 DOI: 10.1016/j.jtcvs.2021.02.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Brian Mitzman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah.
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21
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Ashraf SF, Yin K, Meng CX, Wang Q, Wang Q, Pu J, Dhupar R. Predicting benign, preinvasive, and invasive lung nodules on computed tomography scans using machine learning. J Thorac Cardiovasc Surg 2021; 163:1496-1505.e10. [PMID: 33726909 DOI: 10.1016/j.jtcvs.2021.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The study objective was to investigate if machine learning algorithms can predict whether a lung nodule is benign, adenocarcinoma, or its preinvasive subtype from computed tomography images alone. METHODS A dataset of chest computed tomography scans containing lung nodules was collected with their pathologic diagnosis from several sources. The dataset was split randomly into training (70%), internal validation (15%), and independent test sets (15%) at the patient level. Two machine learning algorithms were developed, trained, and validated. The first algorithm used the support vector machine model, and the second used deep learning technology: a convolutional neural network. Receiver operating characteristic analysis was used to evaluate the performance of the classification on the test dataset. RESULTS The support vector machine/convolutional neural network-based models classified nodules into 6 categories resulting in an area under the curve of 0.59/0.65 when differentiating atypical adenomatous hyperplasia versus adenocarcinoma in situ, 0.87/0.86 with minimally invasive adenocarcinoma versus invasive adenocarcinoma, 0.76/0.72 atypical adenomatous hyperplasia + adenocarcinoma in situ versus minimally invasive adenocarcinoma, 0.89/0.87 atypical adenomatous hyperplasia + adenocarcinoma in situ versus minimally invasive adenocarcinoma + invasive adenocarcinoma, and 0.93/0.92 atypical adenomatous hyperplasia + adenocarcinoma in situ + minimally invasive adenocarcinoma versus invasive adenocarcinoma. Classifying benign versus atypical adenomatous hyperplasia + adenocarcinoma in situ + minimally invasive adenocarcinoma versus invasive adenocarcinoma resulted in a micro-average area under the curve of 0.93/0.94 for the support vector machine/convolutional neural network models, respectively. The convolutional neural network-based methods had higher sensitivities than the support vector machine-based methods but lower specificities and accuracies. CONCLUSIONS The machine learning algorithms demonstrated reasonable performance in differentiating benign versus preinvasive versus invasive adenocarcinoma from computed tomography images alone. However, the prediction accuracy varies across its subtypes. This holds the potential for improved diagnostic capabilities with less-invasive means.
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Affiliation(s)
- Syed Faaz Ashraf
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Ke Yin
- Department of Radiology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | | | - Qi Wang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Hebei, China
| | - Qiong Wang
- Department of Radiology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jiantao Pu
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pa; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pa
| | - Rajeev Dhupar
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa; VA Pittsburgh Healthcare System, Pittsburgh, Pa.
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Tumor cell proliferation (Ki-67) expression and its prognostic significance in histological subtypes of lung adenocarcinoma. Lung Cancer 2021; 154:69-75. [PMID: 33626488 DOI: 10.1016/j.lungcan.2021.02.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/22/2021] [Accepted: 02/10/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Ki-67 is a key molecular marker to indicate the proliferative activity of tumor cells in lung cancer. However, Ki-67 expression and its prognostic significance in histological subtypes of lung adenocarcinoma (LUAD) remain unclear. MATERIALS AND METHODS We retrospectively analyzed 1028 invasive LUAD patients who underwent surgery treatment between January 2012 and April 2020 in our department. Associations between Ki-67 expression and histological subtypes of LUAD, as well as other clinicopathological characteristics, were evaluated. The prognostic role of Ki-67 in LUAD subtypes was further assessed using log-rank test and univariate/multivariate Cox proportional hazards regression analyses. RESULTS Ki-67 expression differed across LUAD histological subtypes. The solid-predominant adenocarcinoma (SPA, 46.31 ± 24.72) had the highest expression level of Ki-67, followed by micropapillary (MPA, 31.71 ± 18.14), papillary (PPA, 22.09 ± 19.61), acinar (APA, 19.73 ± 18.71) and lepidic-predominant adenocarcinoma (LPA, 9.86 ± 8.10, P < 0.001). Tumors with solid or micropapillary components also had a higher Ki-67 expression than those without solid or micropapillary components. Besides, males, smokers, larger tumor size, lymph node metastasis and EGFR wild type were correlated with elevated Ki-67 expression. Univariate analysis indicated that increased Ki-67 expression and MPA/SPA subtypes were significantly associated with a poorer prognosis. Notably, the survival differences between LUAD subtypes vanished after adjusting for tumor size and Ki-67 expression in multivariate analysis, while Ki-67 was an independent prognostic factor of LUAD. Patients with MPA/SPA had non-inferior overall and disease-free survival than LPA/APA/PPA patients with a Ki-67 expression comparable to MPA/SPA subjects. CONCLUSION Ki-67 expression varied considerably according to the predominant histological subtypes of LUAD. Ki-67 expression level and tumor size contributed to the survival differences between LUAD histological subtypes.
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Zhang Y, Chen Z, Hu H, Chen H. Surgical Strategies for Pre- and Minimally Invasive Lung Adenocarcinoma 3.0: Lessons Learned From the Optimal Timing of Surgical Intervention. Semin Thorac Cardiovasc Surg 2021; 34:311-314. [PMID: 33444769 DOI: 10.1053/j.semtcvs.2020.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/10/2020] [Indexed: 12/25/2022]
Abstract
We discuss the optimal timing of surgery for lung cancer, and propose 3 surgical strategies for pre- and minimally invasive lung adenocarcinoma to avoid "overdiagnosis" and "overtreatment." Benign disease should not be treated as malignancy, pre- and minimally invasive disease should not be treated as invasive disease, and indolent malignancy should not be treated as aggressive malignancy.
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Affiliation(s)
- Yang Zhang
- Departments 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
| | - Zongwei Chen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Hu
- Departments 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
- Departments 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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Solitary pulmonary nodule and the surgeon. Afr J Thorac Crit Care Med 2020; 26. [PMID: 34240015 PMCID: PMC8203060 DOI: 10.7196/ajtccm.2020.v26i1.053] [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] [Accepted: 01/08/2020] [Indexed: 12/24/2022] Open
Abstract
A solitary pulmonary nodule is a single, well-circumscribed radiographic opacity that will be encountered by every thoracic surgeon, and management is dependent on the malignant potential of the nodule. The nodules are usually first encountered on a chest radiograph. Anatomical characteristics on computed tomography can help to better differentiate the malignant potential of the nodule. These characteristics include nodule size, volume change over time, edge morphology, presence of calcification and nodule attenuation. Other adjuncts to evaluate the malignant potential of the nodule include a functional assessment using positron emission tomography. The role of the thoracic surgeon includes both diagnostic and surgical intervention to assist with management of the malignant nodule.
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25
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Li F, Zhao Y, Yuan L, Wang S, Mao Y. Oncologic outcomes of segmentectomy vs lobectomy in pathologic stage IA (≤2 cm) invasive lung adenocarcinoma: A population-based study. J Surg Oncol 2020; 121:1132-1139. [PMID: 32108349 DOI: 10.1002/jso.25880] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES For early-stage invasive lung adenocarcinoma, it remains unclear whether segmentectomy can yield outcomes equivalent to those of lobectomy. This study aimed to compare survival outcomes after segmentectomy and lobectomy among patients with stage IA invasive lung adenocarcinoma. METHODS We identified patients with stage IA (≤2 cm) invasive lung adenocarcinoma who underwent segmentectomy or lobectomy from the Surveillance, Epidemiology, and End Results database (2004-2015). Propensity score matching (PSM) was used to balance the baseline characteristics. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared using the Kaplan-Meier method and Cox proportional hazards regression. RESULTS A total of 5474 patients were included. Before PSM, the 5-year OS was 78.3% for patients undergoing lobectomy vs 76.5% for patients undergoing segmentectomy (P = .166) while LCSS were 86.8% vs 83.0% (P = .015). After PSM, survival analyses showed that segmentectomy had OS (75.8% vs 76.4%; P = .694) and LCSS (82.7% vs 82.9%; P = .604) equivalent to those of lobectomy. Cox regression demonstrated that segmentectomy was equivalent to lobectomy in terms of OS and LCSS before and after PSM. CONCLUSION For stage IA (≤2 cm) invasive lung adenocarcinoma, segmentectomy may have oncologic outcomes equivalent to those of lobectomy.
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Affiliation(s)
- Feng 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, China
| | - Yue Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ligong Yuan
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuaibo 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, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Jia M, Yu S, Cao L, Sun PL, Gao H. Clinicopathologic Features and Genetic Alterations in Adenocarcinoma In Situ and Minimally Invasive Adenocarcinoma of the Lung: Long-Term Follow-Up Study of 121 Asian Patients. Ann Surg Oncol 2020; 27:3052-3063. [PMID: 32048092 DOI: 10.1245/s10434-020-08241-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) are both small tumors with good prognosis after surgical resection, and most of them present as ground glass opacities (GGOs) on computed tomography (CT) screening. However, the differences in clinicopathologic features and genetic alterations between AIS and MIA are poorly elaborated, and few studies have evaluated the prognosis of MIA with different invasive components. Meanwhile, the histological features of lung lesions presenting as unchanged pure GGOs are barely understood. METHODS Clinicopathologic features and genetic alterations of AIS (n = 59) and MIA (n = 62) presenting as GGOs were analyzed. Long-term preoperative observation (ranging from 2 to 1967 days) and postoperative follow-up (ranging from 0 to 92 months) was conducted. RESULTS The tumor size and consolidation/tumor ratio were significantly larger in the MIA cohort than those in the AIS cohort both on CT and microscopy images. Immunohistochemically, the expression of p53, Ki67, and cyclin D1 was higher in MIA than in AIS. The EGFR mutation rate was significantly higher in MIA, while other genetic alterations showed no differences. Six MIA cases showed recurrence or metachronous adenocarcinoma and all the cases with a predominant micropapillary invasive pattern demonstrated this feature. CONCLUSIONS The current CT measurements may be helpful in distinguishing AIS from MIA, but show limited utility in predicting the histology of unchanged pure GGOs. The invasive pattern may have an influence on the postoperative process of MIA; therefore, further studies are needed to evaluate the current diagnostic criteria and treatment strategy for MIA.
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Affiliation(s)
- Meng Jia
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Shili Yu
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Lanqing Cao
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Ping-Li Sun
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin, China.
| | - Hongwen Gao
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin, China.
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Glycomic Signatures of Plasma IgG Improve Preoperative Prediction of the Invasiveness of Small Lung Nodules. Molecules 2019; 25:molecules25010028. [PMID: 31861777 PMCID: PMC6982969 DOI: 10.3390/molecules25010028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 01/15/2023] Open
Abstract
Preoperative assessment of tumor invasiveness is essential to avoid overtreatment for patients with small-sized ground-glass nodules (GGNs) of 10 mm or less in diameter. However, it is difficult to determine the pathological state by computed tomography (CT) examination alone. Aberrant glycans has emerged as a tool to identify novel potential disease biomarkers. In this study, we used a lectin microarray-based strategy to investigate whether glycosylation changes in plasma immunoglobulin G (IgG) provide additional information about the invasiveness of small GGNs before surgery. Two independent cohorts (discovery set, n = 92; test set, n = 210) of GGN patients were used. Five of 45 lectins (Sambucus nigra agglutinin, SNA; Datura stramonium agglutinin, DSA; Galanthus nivalis agglutinin, GNA; Euonymus europaeus lectin, EEL; and Vicia villosa agglutinin, VVA) were identified as independent factors associated with pathological invasiveness of small GGNs (p < 0.01). Receiver-operating characteristic (ROC) curve analysis indicated the combination of these five lectins could significantly improve the accuracy of CT in diagnosing invasive GGNs, with an area under the curve (AUC) of 0.792 (p < 0.001), a sensitivity of 74.6%, and specificity of 74.4%, which was superior to current clinical biomarkers. These results suggest that the multilectin assay based on plasma IgG glycosylation may be a useful in vitro complementary test to enhance preoperative determination of the invasiveness of GGNs and guide surgeons to select proper clinical management to avoid overtreatment.
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Li F, Yang L, Zhao Y, Yuan L, Wang S, Mao Y. Intraoperative frozen section for identifying the invasion status of lung adenocarcinoma: A systematic review and meta-analysis. Int J Surg 2019; 72:175-184. [DOI: 10.1016/j.ijsu.2019.10.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/15/2019] [Accepted: 10/31/2019] [Indexed: 12/20/2022]
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29
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Shen L, Lin J, Wang B, Xu H, Zhao K, Zhang L. [Computed tomography findings, clinicopathological features, genetic characteristics and prognosis of in situ and minimally invasive lung adenocarcinomas]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:1107-1112. [PMID: 31640952 DOI: 10.12122/j.issn.1673-4254.2019.09.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the computed tomography findings, clinicopathological features, genetic characteristics and prognosis of in situ adenocarcinoma (AIS) and minimally invasive adenocarcinoma (MIA) of the lung. METHODS We retrospectively analyzed the data including computed tomography (CT) images, histopathological findings, Ki-67 immunostaining, and genetic mutations in patients with lung adenocarcinoma undergoing surgery at our hospital between 2014 and 2019. RESULTS Of the total of 480 patients with lung adenocarcinoma we reviewed, 73 (15.2%) had AIS (n=28) or MIA (n=45) tumors. The age of the patients with MIA was significantly younger than that of patients with AIS (P < 0.02). CT scans identified pure ground-glass nodules in 46.4% of AIS cases and in 44.4% of MIA cases. Multiple GGOs were more common in MIA than in AIS cases (P < 0.05), and bluured tumor margins was less frequent in AIS cases (P < 0.05). No significant difference was found in EGFR mutations between MIA and AIS cases. A Ki-67 labeling index (LI) value ≥2.8% did not differentiate MIA from AIS. The follow-up time in MIA group was significantly shorter than that in AIS group, but no recurrence or death occurred. CONCLUSIONS Despite similar surgical outcomes and favorable survival outcomes, the patients with AIS and MIA show differences in terms of age, CT findings, EGFR mutations and Ki-67 LI.
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Affiliation(s)
- Leilei Shen
- Department of Thoracic Surgery, Hainan Hospital of General Hospital of PLA, Sanya 572000, China
| | - Jixing Lin
- Department of Thoracic Surgery, Hainan Hospital of General Hospital of PLA, Sanya 572000, China
| | - Bailin Wang
- Department of Thoracic Surgery, Hainan Hospital of General Hospital of PLA, Sanya 572000, China
| | - Hengliang Xu
- Department of Thoracic Surgery, Hainan Hospital of General Hospital of PLA, Sanya 572000, China
| | - Kai Zhao
- Department of Thoracic Surgery, Hainan Hospital of General Hospital of PLA, Sanya 572000, China
| | - Lianbin Zhang
- Department of Thoracic Surgery, Hainan Hospital of General Hospital of PLA, Sanya 572000, China
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