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Waser NA, Quintana M, Schweikert B, Chaft JE, Berry L, Adam A, Vo L, Penrod JR, Fiore J, Berry DA, Goring S. Pathological response in resectable non-small cell lung cancer: a systematic literature review and meta-analysis. JNCI Cancer Spectr 2024; 8:pkae021. [PMID: 38521542 PMCID: PMC11101053 DOI: 10.1093/jncics/pkae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/06/2023] [Accepted: 03/15/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Surrogate endpoints for overall survival in patients with resectable non-small cell lung cancer receiving neoadjuvant therapy are needed to provide earlier treatment outcome indicators and accelerate drug approval. This study's main objectives were to investigate the association among pathological complete response, major pathological response, event-free survival and overall survival and to determine whether treatment effects on pathological complete response and event-free survival correlate with treatment effects on overall survival. METHODS A comprehensive systematic literature review was conducted to identify neoadjuvant studies in resectable non-small cell lung cancer. Analysis at the patient level using frequentist and Bayesian random effects (hazard ratio [HR] for overall survival or event-free survival by pathological complete response or major pathological response status, yes vs no) and at the trial level using weighted least squares regressions (hazard ratio for overall survival or event-free survival vs pathological complete response, by treatment arm) were performed. RESULTS In both meta-analyses, pathological complete response yielded favorable overall survival compared with no pathological complete response (frequentist, 20 studies and 6530 patients: HR = 0.49, 95% confidence interval = 0.42 to 0.57; Bayesian, 19 studies and 5988 patients: HR = 0.48, 95% probability interval = 0.43 to 0.55) and similarly for major pathological response (frequentist, 12 studies and 1193 patients: HR = 0.36, 95% confidence interval = 0.29 to 0.44; Bayesian, 11 studies and 1018 patients: HR = 0.33, 95% probability interval = 0.26 to 0.42). Across subgroups, estimates consistently showed better overall survival or event-free survival in pathological complete response or major pathological response compared with no pathological complete response or no major pathological response. Trial-level analyses showed a moderate to strong correlation between event-free survival and overall survival hazard ratios (R2 = 0.7159) but did not show a correlation between treatment effects on pathological complete response and overall survival or event-free survival. CONCLUSION There was a strong and consistent association between pathological response and survival and a moderate to strong correlation between event-free survival and overall survival following neoadjuvant therapy for patients with resectable non-small cell lung cancer.
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Affiliation(s)
| | | | | | - Jamie E Chaft
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Ahmed Adam
- Insights, Evidence and Value, ICON plc, Burlington, ON, Canada
| | - Lien Vo
- Health Economics and Outcomes Research, Bristol Myers Squibb, Lawrenceville, NJ, USA
| | - John R Penrod
- Health Economics and Outcomes Research, Bristol Myers Squibb, Lawrenceville, NJ, USA
| | - Joseph Fiore
- Health Economics and Outcomes Research, Bristol Myers Squibb, Lawrenceville, NJ, USA
| | | | - Sarah Goring
- Insights, Evidence and Value, ICON plc, Burlington, ON, Canada
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2
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Cuttano R, Colangelo T, Guarize J, Dama E, Cocomazzi MP, Mazzarelli F, Melocchi V, Palumbo O, Marino E, Belloni E, Montani F, Vecchi M, Barberis M, Graziano P, Pasquier A, Sanz-Ortega J, Montuenga LM, Carbonelli C, Spaggiari L, Bianchi F. miRNome profiling of lung cancer metastases revealed a key role for miRNA-PD-L1 axis in the modulation of chemotherapy response. J Hematol Oncol 2022; 15:178. [PMID: 36587234 PMCID: PMC9805174 DOI: 10.1186/s13045-022-01394-1] [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: 05/10/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023] Open
Abstract
Locally advanced non-small cell lung cancer (NSCLC) is frequent at diagnosis and requires multimodal treatment approaches. Neoadjuvant chemotherapy (NACT) followed by surgery is the treatment of choice for operable locally advanced NSCLC (Stage IIIA). However, the majority of patients are NACT-resistant and show persistent lymph nodal metastases (LNmets) and an adverse outcome. Therefore, the identification of mechanisms and biomarkers of NACT resistance is paramount for ameliorating the prognosis of patients with Stage IIIA NSCLC. Here, we investigated the miRNome and transcriptome of chemo-naïve LNmets collected from patients with Stage IIIA NSCLC (N = 64). We found that a microRNA signature accurately predicts NACT response. Mechanistically, we discovered a miR-455-5p/PD-L1 regulatory axis which drives chemotherapy resistance, hallmarks metastases with active IFN-γ response pathway (an inducer of PD-L1 expression), and impacts T cells viability and relative abundances in tumor microenvironment (TME). Our data provide new biomarkers to predict NACT response and add molecular insights relevant for improving the management of patients with locally advanced NSCLC.
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Affiliation(s)
- Roberto Cuttano
- grid.413503.00000 0004 1757 9135Unit of Cancer Biomarkers, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Padre Pio 7, 71013 San Giovanni Rotondo, FG Italy
| | - Tommaso Colangelo
- grid.413503.00000 0004 1757 9135Unit of Cancer Biomarkers, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Padre Pio 7, 71013 San Giovanni Rotondo, FG Italy
| | - Juliana Guarize
- grid.15667.330000 0004 1757 0843Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Elisa Dama
- grid.413503.00000 0004 1757 9135Unit of Cancer Biomarkers, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Padre Pio 7, 71013 San Giovanni Rotondo, FG Italy
| | - Maria Pia Cocomazzi
- grid.413503.00000 0004 1757 9135Unit of Cancer Biomarkers, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Padre Pio 7, 71013 San Giovanni Rotondo, FG Italy
| | - Francesco Mazzarelli
- grid.413503.00000 0004 1757 9135Unit of Cancer Biomarkers, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Padre Pio 7, 71013 San Giovanni Rotondo, FG Italy
| | - Valentina Melocchi
- grid.413503.00000 0004 1757 9135Unit of Cancer Biomarkers, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Padre Pio 7, 71013 San Giovanni Rotondo, FG Italy
| | - Orazio Palumbo
- grid.413503.00000 0004 1757 9135Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini Snc, 71013 San Giovanni Rotondo, FG Italy
| | - Elena Marino
- grid.15667.330000 0004 1757 0843Clinical Genomics Unit, European Institute of Oncology, Milan, Italy
| | - Elena Belloni
- grid.15667.330000 0004 1757 0843Department of Experimental Oncology, European Institute of Oncology, Milan, Italy
| | - Francesca Montani
- grid.15667.330000 0004 1757 0843Department of Experimental Oncology, European Institute of Oncology, Milan, Italy
| | - Manuela Vecchi
- grid.15667.330000 0004 1757 0843European Institute of Oncology IRCCS, Milan, Italy ,grid.7678.e0000 0004 1757 7797IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Via Adamello 16, 20139 Milan, Italy ,grid.25786.3e0000 0004 1764 2907Present Address: Non-Coding RNAs and RNA-Based Therapeutics, Istituto Italiano Di Tecnologia, CMP3VdA, Via Lavoratori Vittime del Col du Mont 28, 11100 Aosta, Italy
| | - Massimo Barberis
- grid.15667.330000 0004 1757 0843Division of Pathology, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Paolo Graziano
- grid.413503.00000 0004 1757 9135Unit of Pathology, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini Snc, 71013 San Giovanni Rotondo, FG Italy
| | - Andrea Pasquier
- grid.5924.a0000000419370271Solid Tumors Program, Center of Applied Medical Research (CIMA), University of Navarra and IDISNA, Pamplona, Spain
| | - Julian Sanz-Ortega
- grid.411730.00000 0001 2191 685XDepartment of Pathology, Clínica Universidad de Navarra, Madrid, Spain
| | - Luis M. Montuenga
- grid.5924.a0000000419370271Solid Tumors Program, Center of Applied Medical Research (CIMA), University of Navarra and IDISNA, Pamplona, Spain ,grid.510933.d0000 0004 8339 0058CIBERONC, Madrid, Spain
| | - Cristiano Carbonelli
- grid.413503.00000 0004 1757 9135Pneumology Unit, Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG Italy
| | - Lorenzo Spaggiari
- grid.15667.330000 0004 1757 0843Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Fabrizio Bianchi
- grid.413503.00000 0004 1757 9135Unit of Cancer Biomarkers, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Padre Pio 7, 71013 San Giovanni Rotondo, FG Italy
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Association of Pathologic Complete Response and Long-Term Survival Outcomes Among Patients Treated With Neoadjuvant Chemotherapy or Chemoradiotherapy for NSCLC: A Meta-Analysis. JTO Clin Res Rep 2022; 3:100384. [PMID: 36118131 PMCID: PMC9472066 DOI: 10.1016/j.jtocrr.2022.100384] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/30/2022] [Accepted: 07/18/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Increased efforts to optimize outcomes for early stage NSCLC through the investigation of novel perioperative treatment strategies are ongoing. An emerging question is the role of pathologic response and its association with long-term clinical outcomes after neoadjuvant therapy. Methods To investigate the association of pathologic complete response (pCR) and event-free survival (EFS) and overall survival (OS), we performed a systematic review and meta-analysis identifying studies reporting on the prognostic impact of pCR after neoadjuvant chemotherapy or chemoradiotherapy. To evaluate this prognostic value, an aggregated data (AD) meta-analyses was conducted to estimate the pooled hazard ratios (HRs) of EFS and OS for pCR. Using reconstructed individual patient data (IPD), pooled Kaplan-Meier curves were obtained to estimate this association in a more granular fashion. Subgroup analyses were conducted to further explore the impacts of study-level characteristics. Results A total of 28 studies comprising 7011 patients were included in the AD meta-analysis, of which, IPD was available for 6274 patients from 24 studies. Results from our AD meta-analysis revealed a pooled pCR rate of 18% (95% confidence interval [CI]: 15%–21%), including significant improvements in OS (HR = 0.50, 95% CI: 0.45–0.56) and EFS (HR = 0.46, 95% CI: 0.37–0.57) on the basis of pCR status. Our IPD analysis revealed a 5-year OS rate of 63% (95% CI: 59.6–67.4) for patients with a pCR compared with 39% (95% CI: 34.5–44.5) for those without a pCR. Conclusions pCR after neoadjuvant chemotherapy plus or minus radiotherapy is associated with significant improvements in EFS and survival for patients with resectable NSCLC.
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Bertolaccini L, Prisciandaro E, Guarize J, Girelli L, Sedda G, Filippi N, de Marinis F, Spaggiari L. Long-term clinical outcomes and prognostic factors of upfront surgery as a first-line therapy in biopsy-proven clinical N2 non-small cell lung cancer. Front Oncol 2022; 12:933278. [PMID: 35965495 PMCID: PMC9366141 DOI: 10.3389/fonc.2022.933278] [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: 04/30/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMultimodality therapy offers the best opportunity to improve pathological N2 non-small cell lung cancer (NSCLC) prognosis. This paper aimed to evaluate the long-term clinical outcomes and the prognostic factors of upfront surgery as first-line therapy in biopsy-proven clinical N2.MethodsRetrospective review of biopsy-proven cN2 NSCLC patients operated between 2007 and 2017. Upfront surgery was considered if the primary tumour was deemed completely resectable, with mediastinal nodal involvement confined to a single station and no preoperative evidence of extranodal tumour invasion.ResultsTwo hundred eighty-five patients who underwent radical resections were included. One hundred fifty-nine patients (55.8%) received induction chemotherapy. At follow-up completion, 127 (44.6%) patients had died. For the induction chemotherapy group, the median overall survival (OS) was 49 months [95% confidence interval (CI): 38–70 months], and the 5-year OS was 44.4%. The median and 5-year OS for the up front surgery group was 66 months (95% CI: 40–119 months) and 66.3%, respectively. There were no statistically significant differences between treatment approaches (p = 0.48). One hundred thirty-four patients (47.0%) developed recurrence. The recurrence-free survival (RFS) at 5 years was 17% (95% CI: 11–25%) for induction chemotherapy and 22% (95% CI: 9–32%) for upfront surgery; there were no statistically significant differences between groups (p = 0.93). No significant differences were observed based on the clinical N status (OS, p = 0.36; RFS, p = 0.65).ConclusionsUpfront surgery as first-line therapy for biopsy-proven cN2 NSCLC showed favourable clinical outcomes, similar to those obtained after induction chemotherapy followed by surgery. Therefore, it should be considered one of the multimodality treatment options in resectable N2 NSCLC.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- *Correspondence: Luca Bertolaccini,
| | - Elena Prisciandaro
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Juliana Guarize
- Unit of Interventional Pneumology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lara Girelli
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Niccolò Filippi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Filippo de Marinis
- Department of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Maliarchuk K, Ganul AV, Borisyuk BO, Bororov LV, Shevchenko AI, Sovenko VM. PROSPECTS OF NEOADJUVANT CHEMORADIOTHERAPY IN PATIENTS WITH STAGE III A NON-SMALL CELL LUNG CANCER AS A METHOD OF IMPROVING SURVIVAL. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2098-2102. [PMID: 36256935 DOI: 10.36740/wlek202209109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The aim: To study the survival rate and count the number of complications in groups with NCRT, NCT and NCT + adjuvant radiotherapy. PATIENTS AND METHODS Materials and methods: The studied patients were divided into three groups with a total number of 304 people, Patients who received neoadjuvant chemotherapy-149 people, who received neoadjuvant chemotherapy and adjuvant radiation therapy-90 people. Neoadjuvant chemoradiotherapy was performed in accordance with Cisplatin/Docetaxel or Carboplatin/Paclitaxel 4 Mg and simultaneous radiation therapy with a total radiation dose 30 gray with a single dose of 2 Mg. After neoadjuvant treatment, patients of all groups underwent radical surgery. It consisted of lobectomy, bilobectomy and pneumonectomy. Postoperative complications and the duration of stay in the clinic after surgery were studied. Survival was assessed on the Kaplan and Mayer scale. RESULTS Results: The study analyzed the main results of treatment, which showed that the 5 years survival in the main group was 28.1±5.9 %, in the control groups-the first control group (neoadjuvant chemotherapy) - 10.4±3.8 % and the second control group (neoadjuvant chemotherapy and adjuvant radiation therapy) - 5.8±2.0 %, respectively. CONCLUSION Conclusions: 1. The overall survival rate of patients receiving NCT compared to patients receiving neoadjuvant chemotherapy is higher than in the neoadjuvant chemotherapy group and 13 months higher than in the adjuvant radiation therapy group. 2. Patients who had the phenomenon of a complete morphological response have a significantly higher survival rate (45 and 39 months, respectively).
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Affiliation(s)
- Katerina Maliarchuk
- NATIONAL INSTITUTE OF HEALTH PROTECTION OF P.L. SHUPIK ESTATE, KYIV, UKRAINE
| | - Andrey V Ganul
- NATIONAL INSTITUTE OF HEALTH PROTECTION OF P.L. SHUPIK ESTATE, KYIV, UKRAINE
| | - Bogdan O Borisyuk
- NATIONAL INSTITUTE OF HEALTH PROTECTION OF P.L. SHUPIK ESTATE, KYIV, UKRAINE
| | - Leonid V Bororov
- NATIONAL INSTITUTE OF HEALTH PROTECTION OF P.L. SHUPIK ESTATE, KYIV, UKRAINE
| | | | - Vladimir M Sovenko
- NATIONAL INSTITUTE OF HEALTH PROTECTION OF P.L. SHUPIK ESTATE, KYIV, UKRAINE
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Preliminary Results of Robotic Lobectomy in Stage IIIA-N2 NSCLC after Induction Treatment: A Case Control Study. J Clin Med 2021; 10:jcm10163465. [PMID: 34441761 PMCID: PMC8396941 DOI: 10.3390/jcm10163465] [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: 06/04/2021] [Revised: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 11/16/2022] Open
Abstract
Despite there already being many studies on robotic surgery as a minimally invasive approach for non-small-cell lung cancer (NSCLC) patients, the use of this technique for stage III disease is still poorly described. These are the preliminary results of our prospective study on the safety and effectiveness of robotic approaches in patients with locally advanced NSCLC in terms of postoperative complications and oncological outcomes. Since 2016, we prospectively investigated 19 consecutive patients with NSCLC stage IIIA-pN2 (diagnosed by EBUS-TBNA) who underwent lobectomy and radical lymph node dissection with robotic approaches after induction treatment. Furthermore, we matched a case-control study with 46 patients treated with open surgery during the same period of time, with similar age, comorbidities, clinical stage and tumor size. The individual matched population was composed of 16 robot-assisted thoracic surgeries and 16 patients who underwent open surgery. The median time range of resection was inferior in the open group compared to robotic lobectomy (243 vs. 161 min; p < 0.001). Lymph node resection and positivity were not significantly different (p = 0.96 and p = 0.57, respectively). Moreover, no difference was observed for PFS (p = 0.16) or OS (p = 0.41). In conclusion, we demonstrated that the early outcomes and oncological results of N2-patients after robotic lobectomy were similar to those who had open surgery. Considering the advantages of minimally invasive surgery, robot-assisted lobectomy appears to be a safe approach to patients with locally advanced diseases.
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7
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Wang YQ, Liu XD, Bai WL, Li SQ. Identification of Resectable N2 in NSCLC: A Single Center Experience and Review of the SEER Database. Front Oncol 2021; 11:647546. [PMID: 33981606 PMCID: PMC8108988 DOI: 10.3389/fonc.2021.647546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/29/2021] [Indexed: 12/25/2022] Open
Abstract
Background Non-small cell lung carcinoma (NSCLC) with ipsilateral and/or subcarinal mediastinal lymphatic spread (N2) is a heterogeneous disease. The role of surgical resection in patients with N2 NSCLC remains controversial and no survival-based definition of “resectable N2” exists. The purpose of this study is to evaluate the factors that potentially affect the survival of N2 NSCLC patients who receive surgical resection and to define “resectable N2” based on the survival benefits. Methods Data from the open Surveillance, Epidemiology, and End Results (SEER) database from the National Cancer Institute in the United States were used to construct a nomogram. Patients who received surgery between 2010 and 2015 for N2 NSCLC were included. Independent prognostic factors for survival identified through Cox regression analysis were used to create the nomogram. The C-index, receiver operating characteristics (ROC) analyses, calibration curves, and risk stratification were used to evaluate the nomogram. The nomogram was also validated using data from 222 patients from Peking Union Medical College Hospital (PUMCH). Furthermore, lung cancer–related deaths were compared using competitive risk analysis. Results In total, 4267 patients were included in the SEER cohort. Male gender, old age, high T stage and grade, adenosquamous and squamous cell carcinoma, lower lobe and overlapping lesions, extended lobe or bilobectomy and pneumonectomy, no chemotherapy, radiation before and after surgery, positive number of lymph nodes, and lymph node ratio (LNR) were identified as independent risk factors for higher mortality. The nomogram was created using these parameters. The C-index was 0.665 (95% confidence interval (CI), 0.651-0.679) and 0.722 (95% CI, 0.620-0.824) in the SEER and PUMCH cohorts, respectively. The calibration curves showed satisfactory consistency between the predicted and actual survival status in both the SEER and PUMCH cohorts. Competitive risk analysis confirmed that the variables in the nomogram, except radiation, are risk factors for prognosis. Conclusions “Resectable N2” should be assessed by a multidisciplinary team. The novel nomogram developed in this study may help with clinical decision-making for this patient population.
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Affiliation(s)
- Yan-Qing Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xu-Dong Liu
- Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wen-Liang Bai
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shan-Qing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Guarize J, Rocco EG, de Marinis F, Sedda G, Bertolaccini L, Donghi SM, Casiraghi M, Tonno CD, Barberis M, Spaggiari L. Prospective evaluation of EBUS-TBNA specimens for programmed death-ligand 1 expression in non-small cell lung cancer patients: a pilot study. J Bras Pneumol 2021; 47:e20200584. [PMID: 34259745 PMCID: PMC8332653 DOI: 10.36416/1806-3756/e20200584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/06/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE EBUS-TBNA cytological sampling is routinely performed for pathological diagnosis, mediastinal staging, and molecular testing in lung cancer patients. EBUS-TBNA samples are not formally accepted for testing programmed death-ligand 1 (PD-L1) expression. The objective of the study was to compare the feasibility, reproducibility, and accuracy of PD-L1 expression assessment in cytological specimens and histological samples. METHODS We prospectively collected histological (transbronchial forceps biopsy) and cytological (EBUS-TBNA) samples from peribronchial neoplastic lesions during an endoscopic procedure at the same target lesion for the pathological diagnosis and molecular assessment of stage IV non-small cell lung cancer (NSCLC). RESULTS Fifteen patients underwent the procedure. Adequate cytological samples (at least 100 neoplastic cells) were obtained in 12 cases (92.3%). Assessment of PD-L1 expression was similar between histological and cytological samples (agreement rate = 92%). Sensitivity and diagnostic accuracy of EBUS-TBNA cytological specimens were 88.9% and 100%, respectively. CONCLUSIONS The evaluation of PD-L1 expression in EBUS-TBNA cytological specimens is feasible and presents good reproducibility when compared with routine histological samples. EBUS-TBNA cytological samples could be used for the assessment of PD-L1 expression in patients with NSCLC as a minimally invasive approach in stage IV NSCLC cancer patients.
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Affiliation(s)
- Juliana Guarize
- . Pneumologia Interventistica, Divisione di Chirurgia Toracica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Elena Guerini Rocco
- . Divisione di Anatomia Patologica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Filippo de Marinis
- . Divisione di Oncologia Toracica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Giulia Sedda
- . Divisione di Chirurgia Toracica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Luca Bertolaccini
- . Divisione di Chirurgia Toracica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Stefano Maria Donghi
- . Pneumologia Interventistica, Divisione di Chirurgia Toracica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Monica Casiraghi
- . Divisione di Chirurgia Toracica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Clementina Di Tonno
- . Divisione di Anatomia Patologica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Massimo Barberis
- . Divisione di Anatomia Patologica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
| | - Lorenzo Spaggiari
- . Divisione di Chirurgia Toracica, Istituto Europeo di Oncologia - IEO - Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Milano, Italia
- . Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milano, Italia
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Brascia D, De Iaco G, Schiavone M, Panza T, Signore F, Geronimo A, Sampietro D, Montrone M, Galetta D, Marulli G. Resectable IIIA-N2 Non-Small-Cell Lung Cancer (NSCLC): In Search for the Proper Treatment. Cancers (Basel) 2020; 12:cancers12082050. [PMID: 32722386 PMCID: PMC7465235 DOI: 10.3390/cancers12082050] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 12/25/2022] Open
Abstract
Locally advanced non-small cell lung cancer accounts for one third of non-small cell lung cancer (NSCLC) at the time of initial diagnosis and presents with a wide range of clinical and pathological heterogeneity. To date, the combined multimodality approach involving both local and systemic control is the gold standard for these patients, since occult distant micrometastatic disease should always be suspected. With the rapid increase in treatment options, the need for an interdisciplinary discussion involving oncologists, surgeons, radiation oncologists and radiologists has become essential. Surgery should be recommended to patients with non-bulky, discrete, or single-level N2 involvement and be included in the multimodality treatment. Resectable stage IIIA patients have been the subject of a number of clinical trials and retrospective analysis, discussing the efficiency and survival benefits on patients treated with the available therapeutic approaches. However, most of them have some limitations due to their retrospective nature, lack of exact pretreatment staging, and the involvement of heterogeneous populations leading to the awareness that each patient should undergo a tailored therapy in light of the nature of his tumor, its extension and his performance status.
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Affiliation(s)
- Debora Brascia
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Giulia De Iaco
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Marcella Schiavone
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Teodora Panza
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Francesca Signore
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Alessandro Geronimo
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Doroty Sampietro
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Michele Montrone
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70121 Bari, Italy; (M.M.); (D.G.)
| | - Domenico Galetta
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70121 Bari, Italy; (M.M.); (D.G.)
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
- Correspondence: or
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10
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Martinez-Meehan D, Lutfi W, Dhupar R, Christie N, Baker N, Schuchert M, Luketich JD, Okusanya OT. Factors Associated With Survival in Complete Pathologic Response Non-Small Cell Lung Cancer. Clin Lung Cancer 2020; 21:349-356. [PMID: 32299769 DOI: 10.1016/j.cllc.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/30/2019] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES There is a strong association with improved survival for patients with non-small cell lung cancer (NSCLC) who have developed a pathological complete response (pCR) after neoadjuvant therapy. A national database was used to investigate factors associated with long-term survival in this cohort of patients. PATIENTS Retrospective review was completed of the National Cancer Database of patients who obtained pCR and had neoadjuvant therapy for stage I to stage III NSCLC between 2004 and 2014. All patients had neoadjuvant chemotherapy with or without radiation therapy. METHODS Univariate and multivariable analysis was performed on factors associated with overall survival (OS), including gender, clinical stage, and nodal count. Patients were divided into 2 groups based on the Commission on Cancer-recommended median number of lymph nodes (LNs) examined: 0 to 9 LNs and ≥10 LNs. Chi-square and Wilcoxon rank-sum tests were used to compare patient, hospital, and clinical variables between groups. RESULTS Increased age (hazard ratio [HR] 1.02, 95% confidence interval [CI], 1.00-1.03), neoadjuvant radiation therapy (HR 1.48, 95% CI, 1.10-2.00), and pneumonectomy (HR 1.64, 95% CI, 1.22-2.22) were associated with worse survival in the 759-patient cohort. Multivariable regression demonstrated having ≥10 nodes harvested (HR 0.71, 95% CI, 0.56-0.89) was associated with improved survival as was every increase in LN harvest up to 17 LNs. No significant differences in 5-year OS were found between clinical stage I, II, and III, respectively (66.1% vs. 60.9% vs. 58.6%, P = .288). CONCLUSION This study shows that younger age, increasing LN harvest, female sex, the absence of neoadjuvant radiation therapy and non-pneumonectomy resections are all associated with improved OS in patients with NSCLC who have developed pCR.
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Affiliation(s)
- Deirdre Martinez-Meehan
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Waseem Lutfi
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Rajeev Dhupar
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA; Surgical Services Division, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Neil Christie
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Nicholas Baker
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Matthew Schuchert
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Olugbenga T Okusanya
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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11
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Casiraghi M, Guarize J, Sandri A, Maisonneuve P, Brambilla D, Romano R, Galetta D, Petrella F, Gasparri R, Gridelli C, De Marinis F, Spaggiari L. Pneumonectomy in Stage IIIA-N2 NSCLC: Should It Be Considered After Neoadjuvant Chemotherapy? Clin Lung Cancer 2019; 20:97-106.e1. [DOI: 10.1016/j.cllc.2018.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/14/2018] [Indexed: 11/26/2022]
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