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Li Q, Jiang M, Hong S, Yang J, Wu X, Pang J, Chen Y, Zhao X, Ding X. Comprehensive genomic and clinical analyses identify APOBEC mutational signatures as a brain metastasis risk factor in lung adenocarcinoma patients. Transl Oncol 2024; 43:101921. [PMID: 38402722 PMCID: PMC10904272 DOI: 10.1016/j.tranon.2024.101921] [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: 11/20/2023] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Lung adenocarcinoma is the most common source of brain metastasis (BM), resulting in significant morbidity and mortality. We aimed to identify patients with high BM risk who possibly benefit from brain-penetrant drugs, prophylactic cranial irradiation, or close brain magnetic resonance imaging surveillance. METHODS Metastatic lung adenocarcinoma patients with extracranial tumor samples profiled by a next-generation sequencing panel targeting 425 tumor-related genes were retrospectively enrolled between February 2008 and July 2021. We compared BM and non-BM patients' genomic and clinical features and studied their associations with BM risk. Two external cohorts were used for result validation and molecular mechanisms investigation, respectively. RESULTS We included 174 eligible patients, including 90 having developed BM by the end of follow-up. Age≤60, EGFR activating mutations, and high-level apolipoprotein B mRNA editing enzyme, catalytic polypeptide-like (APOBEC) mutational signatures were associated with elevated BM risk. Similar findings in BM-free survival were obtained by fitting Fine-Gray subdistribution hazard models addressing competing risks. Increased BM risk related to APOBEC mutational signatures was validated in an external cohort (N = 440). RNA sequencing data analyses performed in another external cohort (N = 230) revealed that expressions of metastasis-related pathways such as transforming growth factor (TGF)β and epithelial-mesenchymal transition (EMT) were upregulated in the patients with high-level APOBEC mutational signatures. CONCLUSION APOBEC mutational signatures related to upregulated TGFβ and EMT, could serve as an independent risk factor for BM and BM-free survival in metastatic lung adenocarcinoma patients. Further investigations are warranted to tailor personalized treatments to improve the susceptible patient's outcomes.
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Affiliation(s)
- Qiang Li
- Cancer Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China; Cancer Center, Shandong Provincial Hospital, Shandong University, Jinan, 250021, China
| | - Meng Jiang
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China; Department of Neurosurgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021, China
| | - Shiqiang Hong
- Cancer Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China; Cancer Center, Shandong Provincial Hospital, Shandong University, Jinan, 250021, China
| | - Jing Yang
- Cancer Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China; Cancer Center, Shandong Provincial Hospital, Shandong University, Jinan, 250021, China
| | - Xiaoying Wu
- Nanjing Geneseeq Technology Inc., Nanjing, 210032, China
| | - Jiaohui Pang
- Nanjing Geneseeq Technology Inc., Nanjing, 210032, China
| | - Yedan Chen
- Nanjing Geneseeq Technology Inc., Nanjing, 210032, China
| | - Xiaotian Zhao
- Nanjing Geneseeq Technology Inc., Nanjing, 210032, China
| | - Xiao Ding
- Cancer Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China; Cancer Center, Shandong Provincial Hospital, Shandong University, Jinan, 250021, China.
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Arrieta O, Bolaño-Guerra LM, Caballé-Pérez E, Lara-Mejía L, Turcott JG, Gutiérrez S, Lozano-Ruiz F, Cabrera-Miranda L, Arroyave-Ramírez AM, Maldonado-Magos F, Corrales L, Martín C, Gómez-García AP, Cacho-Díaz B, Cardona AF. Perilesional edema diameter associated with brain metastases as a predictive factor of response to radiotherapy in non-small cell lung cancer. Front Oncol 2023; 13:1251620. [PMID: 37916162 PMCID: PMC10616784 DOI: 10.3389/fonc.2023.1251620] [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: 07/31/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023] Open
Abstract
Background Different prognostic scales exist in patients with brain metastasis, particularly in lung cancer. The Graded Prognostic Assessment for lung cancer using molecular markers (Lung-molGPA index) for brain metastases is a powerful prognostic tool that effectively identifies patients at different risks. However, these scales do not include perilesional edema diameter (PED) associated with brain metastasis. Current evidence suggests that PED might compromise the delivery and efficacy of radiotherapy to treat BM. This study explored the association between radiotherapy efficacy, PED extent, and gross tumor diameter (GTD). Aim The aim of this study was to evaluate the intracranial response (iORR), intracranial progression-free survival (iPFS), and overall survival (OS) according to the extent of PED and GT. Methods Out of 114 patients with BM at baseline or throughout the disease, 65 were eligible for the response assessment. The GTD and PED sum were measured at BM diagnosis and after radiotherapy treatment. According to a receiver operating characteristic (ROC) curve analysis, cutoff values were set at 27 mm and 17 mm for PED and GT, respectively. Results Minor PED was independently associated with a better iORR [78.8% vs. 50%, OR 3.71 (95% CI 1.26-10.99); p = 0.018] to brain radiotherapy. Median iPFS was significantly shorter in patients with major PED [6.9 vs. 11.8 months, HR 2.9 (95% CI 1.7-4.4); p < 0.001] independently of other prognostic variables like the Lung-molGPA and GTD. A major PED also negatively impacted the median OS [18.4 vs. 7.9 months, HR 2.1 (95% CI 1.4-3.3); p = 0.001]. Conclusion Higher PED was associated with an increased risk of intracranial progression and a lesser probability of responding to brain radiotherapy in patients with metastatic lung cancer. We encourage prospective studies to confirm our findings.
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Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Laura Margarita Bolaño-Guerra
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Enrique Caballé-Pérez
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Luis Lara-Mejía
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Jenny G. Turcott
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Salvador Gutiérrez
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | | | - Luis Cabrera-Miranda
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | | | | | - Luis Corrales
- Oncology Department, Hospital San Juan de Dios, San José, Costa Rica
| | - Claudio Martín
- Thoracic Oncology Unit, Alexander Fleming Institute, Buenos Aires, Argentina
| | - Ana Pamela Gómez-García
- Thoracic Oncology Unit, Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Bernardo Cacho-Díaz
- Neuro-oncology Unit, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Andrés F. Cardona
- Direction of Research and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center - Cancer Treatment and Research Cente (CTIC), Bogotá, Colombia
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Wang Y, Song W, Wang X, Che G. Does the presence of a micropapillary component predict worse prognosis in pathological stage IA lung adenocarcinoma? Pathol Res Pract 2023; 242:154314. [PMID: 36706587 DOI: 10.1016/j.prp.2023.154314] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/04/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
Considerable evidence has verified that the micropapillary pattern is significantly associated with worse prognosis in pulmonary adenocarcinoma. However, whether the presence of a micropapillary component in pathological stage IA lung adenocarcinoma is also related to worse prognosis remains unclear up to now. The aim of this meta-analysis was to identify the prognostic role of presence of a micropapillary component in pathological stage IA lung adenocarcinoma patients. Relevant studies were searched from the PubMed, EMBASE, Web of Science and CNKI databases and reviewed. The primary and secondary outcomes were the recurrence risk and long-term survival including the overall survival (OS) and disease-free survival (DFS), respectively. All statistical analysis were conducted by STATA 12.0 software. A total of 5257 lung adenocarcinoma patients at the pathological stage IA from ten retrospective studies were enrolled. The recurrence rates in pathological stage IA lung adenocarcinoma patients with and without the a micropapillary component were 32% [95% confidence interval (CI): 20%- 44%] and 7% (95% CI: 4%-10%) separately and pooled results indicated that presence of a micropapillary component was an obvious risk factor for recurrence [odds ratio (OR)= 3.41, 95% CI: 2.80-4.16, P<0.001]. Besides, the presence of a micropapillary component was significantly related to poorer OS [hazard ratio (HR)= 2.44, 95% CI: 1.28-4.68, P = 0.007] and DFS (HR=2.60, 95% CI: 1.63-4.16, P<0.001). Subgroup analysis focusing on invasive adenocarcinoma manifested consistent results. In pathological stage IA lung adenocarcinoma, the presence of a micropapillary component predicts obviously higher recurrence risk and worse prognosis even after focusing on invasive adenocarcinoma. However, more prospective high-quality studies are still needed to verify our findings.
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Affiliation(s)
- Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Wenpeng Song
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xin Wang
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, People's Republic of China.
| | - Guowei Che
- Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Liu B, Qian JY, Wu LL, Zeng JQ, Xu SQ, Yuan JH, Zheng YL, Xie D, Chen X, Yu HH. A long waiting time from diagnosis to treatment decreases the survival of non-small cell lung cancer patients with stage IA1: A retrospective study. Front Surg 2022; 9:987075. [PMID: 36157427 PMCID: PMC9489994 DOI: 10.3389/fsurg.2022.987075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe prognostic effect of delayed treatment on stage IA1 non-small cell lung cancer (NSCLC) patients is still unclear. This study aimed to explore the association between the waiting time before treatment and the prognosis in stage IA1 NSCLC patients.MethodsEligible patients diagnosed with pathological stage IA1 NSCLC were included in this study. The clinical endpoints were overall survival (OS) and cancer-specific survival (CSS). The Kaplan-Meier method, the Log-rank test, univariable, and multivariable Cox regression analyses were used in this study. Propensity score matching was used to reduce the bias of data distribution.ResultsThere were eligible 957 patients in the study. The length of waiting time before treatment stratified the survival in patients [<3 months vs. ≥3-months, unadjusted hazard ratio (HR) = 0.481, P = 0.007; <2 months vs. ≥2-months, unadjusted HR = 0.564, P = 0.006; <1 month vs. ≥1-month, unadjusted HR = 0.537, P = 0.001]. The 5-year CSS rates were 95.0% and 77.0% in patients of waiting time within 3 months and over 3 months, respectively. After adjusting for other confounders, the waiting time was identified as an independent prognostic factor.ConclusionsA long waiting time before treatment may decrease the survival of stage IA1 NSCLC patients. We propose that the waiting time for those patients preferably is less than one month and should not exceed two months.
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Affiliation(s)
- Bin Liu
- Department of Oncology, The Affiliated Hospital of Jinggangshan University, Ji’an, China
| | - Jia-Yi Qian
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei-Lei Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jun-Quan Zeng
- Department of Oncology, The Affiliated Hospital of Jinggangshan University, Ji’an, China
| | - Shu-Quan Xu
- School of Medicine, Tongji University, Shanghai, China
| | - Jin-Hua Yuan
- Department of Oncology, The Affiliated Hospital of Jinggangshan University, Ji’an, China
| | - Yong-Liang Zheng
- Department of Oncology, The Affiliated Hospital of Jinggangshan University, Ji’an, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Correspondence: Hai-Hong Yu Xiaolu Chen Dong Xie
| | - Xiaolu Chen
- Department of Respiratory and Critical Care, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
- Correspondence: Hai-Hong Yu Xiaolu Chen Dong Xie
| | - Hai-Hong Yu
- School of Medicine, Tongji University, Shanghai, China
- School of Medicine, Jinggangshan University, Ji'an, China
- Correspondence: Hai-Hong Yu Xiaolu Chen Dong Xie
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Feng S, Liu X, Huang B, Shi J, Zhang H. The Effect of Examined Lymph Nodes and Lymph Node Ratio on Pathological Nodal Classification in the Lung Adenosquamous Carcinoma After Lobectomy. Front Surg 2022; 9:909810. [PMID: 35756483 PMCID: PMC9218197 DOI: 10.3389/fsurg.2022.909810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The effects of examined lymph nodes (LNs) and lymph node ratio (LNR) on pN classification and the prognosis are unclear in lung adenosquamous carcinoma (ASC) patients. Thus, this study aimed to investigate the significance of LNs and LNR in the prognosis of ASC and the impact of the abovementioned factors on the pN classification. Methods Patients diagnosed with pathological stage T1-4N0-2M0 ASC from the Surveillance Epidemiology and End Results database were included in the study. The primary clinical endpoint was cancer-specific survival (CSS). The optimal cutoff values of the LNs and LNR were determined. An LN indicator, including pN0 #LNs ≤9, pN0 #LNs >9, pN+ #LNR ≤0.53, and pN+ #LNR > 0.53, was developed. Concordance index (C-index) was used to compare the prognostic predictive ability between N classification and LN indicator. The univariable and multivariable Cox regression analyses were used in this study. Results The cohort of 1,416 patients were included in the study. The level of LNs stratified the patients without metastasis of lymph nodes (pN0 #LNs ≤9 vs. pN0 #LNs >9, unadjusted hazard ratio [HR] = 1.255, P = 0.037). Two groups based on the cutoff value of LNR differentiated prognosis of patients with metastasis of lymph nodes (pN+ #LNR >0.53 vs. pN+ #LNR ≤0.53, unadjusted HR = 1.703, P = 0.001). The LN indicator had a much better predictive ability over N classification in this cohort (LN indicator: C-index = 0.615; N classification: C-index = 0.602, P = 0.001). Conclusions We explored clinicopathological factors affecting prognosis in resected lung ASC patients. Besides, the LN indicator was confirmed to be played an essential role in affecting the survival rate in ASC patients. The high-level LNs or low-level LNR might be corelated to improved survival outcomes.
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Affiliation(s)
- Shoujie Feng
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Thoracic Surgery Laboratory, Xuzhou Medical University, 84 West Huaihai Road, Xuzhou, China
| | - Xiangming Liu
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Thoracic Surgery Laboratory, Xuzhou Medical University, 84 West Huaihai Road, Xuzhou, China
| | - Bing Huang
- Department of Thoracic Surgery, Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jing Shi
- Department of Radiology, Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, China
| | - Hao Zhang
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Thoracic Surgery Laboratory, Xuzhou Medical University, 84 West Huaihai Road, Xuzhou, China
- Correspondence: Hao Zhang
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Xu Y, Huang Z, Yu X, Chen K, Fan Y. Integrated genomic and DNA methylation analysis of patients with advanced non-small cell lung cancer with brain metastases. Mol Brain 2021; 14:176. [PMID: 34952628 PMCID: PMC8710019 DOI: 10.1186/s13041-021-00886-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brain metastasis is a common and lethal complication of non-small cell lung cancer (NSCLC). It is mostly diagnosed only after symptoms develop, at which point very few treatment options are available. Therefore, patients who have an increased risk of developing brain metastasis need to be identified early. Our study aimed to identify genomic and epigenomic biomarkers for predicting brain metastasis risk in NSCLC patients. METHODS Paired primary lung tumor tissues and either brain metastatic tissues or cerebrospinal fluid (CSF) samples were collected from 29 patients with treatment-naïve advanced NSCLC with central nervous system (CNS) metastases. A control group comprising 31 patients with advanced NSCLC who died without ever developing CNS metastasis was also included. Somatic mutations and DNA methylation levels were examined through capture-based targeted sequencing with a 520-gene panel and targeted bisulfite sequencing with an 80,672 CpG panel. RESULTS Compared to primary lung lesions, brain metastatic tissues harbored numerous unique copy number variations. The tumor mutational burden was comparable between brain metastatic tissue (P = 0.168)/CSF (P = 0.445) and their paired primary lung tumor samples. Kelch-like ECH-associated protein (KEAP1) mutations were detected in primary lung tumor and brain metastatic tissue samples of patients with brain metastasis. KEAP1 mutation rate was significantly higher in patients with brain metastasis than those without (P = 0.031). DNA methylation analysis revealed 15 differentially methylated blocks between primary lung tumors of patients with and without CNS metastasis. A brain metastasis risk prediction model based on these 15 differentially methylated blocks had an area under the curve of 0.94, with 87.1% sensitivity and 82.8% specificity. CONCLUSIONS Our analyses revealed 15 differentially methylated blocks in primary lung tumor tissues, which can differentiate patients with and without CNS metastasis. These differentially methylated blocks may serve as predictive biomarkers for the risk of developing CNS metastasis in NSCLC. Additional larger studies are needed to validate the predictive value of these markers.
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Affiliation(s)
- Yanjun Xu
- Department of Medical Thoracic Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, No. 1 East Banshan Road, Gongshu District, Hangzhou, 310022, China
| | - Zhiyu Huang
- Department of Medical Thoracic Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, No. 1 East Banshan Road, Gongshu District, Hangzhou, 310022, China
| | - Xiaoqing Yu
- Department of Medical Thoracic Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, No. 1 East Banshan Road, Gongshu District, Hangzhou, 310022, China
| | - Kaiyan Chen
- Department of Medical Thoracic Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, No. 1 East Banshan Road, Gongshu District, Hangzhou, 310022, China
| | - Yun Fan
- Department of Medical Thoracic Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, No. 1 East Banshan Road, Gongshu District, Hangzhou, 310022, China.
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The future in the instant: The lung adenocarcinoma classification as a predictor of future adverse events. Lung Cancer 2021; 155:191-192. [PMID: 33757658 DOI: 10.1016/j.lungcan.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/21/2022]
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