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Taylor M, Evison M, Michael S, Obale E, Fritsch NC, Abah U, Smith M, Martin GP, Shackcloth M, Granato F, Grant SW. Pre-Operative Measures of Systemic Inflammation Predict Survival After Surgery for Primary Lung Cancer. Clin Lung Cancer 2024; 25:460-467.e7. [PMID: 38796323 DOI: 10.1016/j.cllc.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/22/2024] [Accepted: 04/28/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Measures of systemic inflammation (MSIs) have been developed and shown to help predict prognosis in patients with lung cancer. However, studies investigating the impact of MSIs on outcomes solely in cohorts of patients undergoing curative-intent resection of NSCLC are lacking. In the era of individualized therapies, targeting inflammatory pathways could represent a novel addition to the armamentarium of lung cancer treatment. METHODS A multicentre retrospective review of patients who underwent primary lung cancer resection between 2012 and 2018 was undertaken. MSIs assessed were neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic immune inflammation index (SII), advanced lung cancer inflammation index (ALI), prognostic nutritional index (PNI) and haemoglobin albumin lymphocyte platelet (HALP) score. Cox regression analysis was performed to assess the impact of MSIs on overall survival. RESULTS A total of 5029 patients were included in the study. Overall 90-day mortality was 3.7% (n = 185). All MSIs were significantly associated with overall survival on univariable analysis. After multivariable Cox regression analyses, lower ALI (expressed as a continuous variable) (HR 1.000, 95% CI 1.000-1.000, P = .049) and ALI <366.43 (expressed as a dichotomous variable) (HR 1.362, 95% CI 1.137-1.631, P < .001) remained independently associated with reduced overall survival. CONCLUSIONS MSIs have emerged in this study as potentially important factors associated with survival following lung resection for NSCLC with curative intent. In particular, ALI has emerged as independently associated with long-term outcomes. The role of MSIs in the clinical management of patients with primary lung cancer requires further investigation.
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Affiliation(s)
- Marcus Taylor
- Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, M23 9LT, UK.
| | - Matt Evison
- Department of Thoracic Oncology, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Sarah Michael
- Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, M23 9LT, UK
| | - Emmanuel Obale
- Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, M23 9LT, UK
| | - Nils C Fritsch
- Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, M23 9LT, UK
| | - Udo Abah
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, L14 3PE, UK
| | - Matthew Smith
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, L14 3PE, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK
| | - Michael Shackcloth
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, L14 3PE, UK
| | - Felice Granato
- Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, M23 9LT, UK
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospitals Foundation Trust, Manchester, M23 9LT, UK
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2
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Richlitzki C, Wiesweg M, Metzenmacher M, Guberina N, Pöttgen C, Hautzel H, Eberhardt WEE, Darwiche K, Theegarten D, Aigner C, Bölükbas S, Schuler M, Stuschke M, Guberina M. C-reactive protein as robust laboratory value associated with prognosis in patients with stage III non-small cell lung cancer (NSCLC) treated with definitive radiochemotherapy. Sci Rep 2024; 14:13765. [PMID: 38877146 PMCID: PMC11178931 DOI: 10.1038/s41598-024-64302-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024] Open
Abstract
To evaluate the prognostic value of biomarkers from peripheral blood obtained as routine laboratory assessment for overall survival in a cohort of stage III non-small cell lung cancer (NSCLC) patients treated with definitive radiochemotherapy at a high-volume cancer center. Seven blood biomarkers from 160 patients treated with definitive radiochemotherapy for stage III NSCLC were analyzed throughout the course treatment. Parameters were preselected using univariable and multivariable proportional hazards analysis and were assessed for internal validity using leave-one-out cross validation. Cross validated classifiers including biomarkers in addition to important clinical parameters were compared with classifiers containing the clinical parameters alone. An increased C-reactive protein (CRP) value in the final week of radiotherapy was found as a prognostic factor for overall survival, both as a continuous (HR 1.099 (1.038-1.164), p < 0.0012) as well as categorical variable splitting data at the median value of 1.2 mg/dl (HR 2.214 (1.388-3.531), p < 0.0008). In the multivariable analysis, the CRP value-maintained significance with an HR of 1.105 (1.040-1.173) and p-value of 0.0012. The cross validated classifier using CRP at the end of radiotherapy in addition to clinical parameters separated equally sized high and low risk groups more distinctly than a classifier containing the clinical parameters alone (HR = 2.786 (95% CI 1.686-4.605) vs. HR = 2.287 (95% CI 1.407-3.718)). Thus, the CRP value at the end of radiation therapy has successfully passed the crucial cross-validation test. The presented data on CRP levels suggests that inflammatory markers may become increasingly important during definitive radiochemotherapy, particularly with the growing utilization of immunotherapy as a consolidation therapy for stage III NSCLC.
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Affiliation(s)
- Cedric Richlitzki
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Essen, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Marcel Wiesweg
- National Center for Tumor Diseases (NCT) West, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Thoracic Oncology, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Martin Metzenmacher
- National Center for Tumor Diseases (NCT) West, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Thoracic Oncology, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Essen, Germany
- National Center for Tumor Diseases (NCT) West, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Essen, Germany
- National Center for Tumor Diseases (NCT) West, Essen, Germany
| | - Hubertus Hautzel
- National Center for Tumor Diseases (NCT) West, Essen, Germany
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Wilfried E E Eberhardt
- National Center for Tumor Diseases (NCT) West, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pneumology, West German Lung Transplantation Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Servet Bölükbas
- National Center for Tumor Diseases (NCT) West, Essen, Germany
- Department of Thoracic Surgery, Medical Faculty, West German Cancer Center, University Hospital Essen, Ruhrlandklinik, Tueschner Weg 40, 45239, Essen, Germany
| | - Martin Schuler
- National Center for Tumor Diseases (NCT) West, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Thoracic Oncology, University Medicine Essen - Ruhrlandklinik, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Essen, Germany
- National Center for Tumor Diseases (NCT) West, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Maja Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Essen, Germany.
- National Center for Tumor Diseases (NCT) West, Essen, Germany.
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
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Stares M, Brown LR, Abhi D, Phillips I. Prognostic Biomarkers of Systemic Inflammation in Non-Small Cell Lung Cancer: A Narrative Review of Challenges and Opportunities. Cancers (Basel) 2024; 16:1508. [PMID: 38672590 PMCID: PMC11048253 DOI: 10.3390/cancers16081508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Non-small cell lung cancer (NSCLC) is a common malignancy and is associated with poor survival outcomes. Biomarkers of systemic inflammation derived from blood tests collected as part of routine clinical care offer prognostic information for patients with NSCLC that may assist clinical decision making. They are an attractive tool, as they are inexpensive, easily measured, and reproducible in a variety of healthcare settings. Despite the wealth of evidence available to support them, these inflammatory biomarkers are not yet routinely used in clinical practice. In this narrative review, the key inflammatory indices reported in the literature and their prognostic significance in NSCLC are described. Key challenges limiting their clinical application are highlighted, including the need to define the optimal biomarker of systemic inflammation, a lack of understanding of the systemic inflammatory landscape of NSCLC as a heterogenous disease, and the lack of clinical relevance in reported outcomes. These challenges may be overcome with standardised recording and reporting of inflammatory biomarkers, clinicopathological factors, and survival outcomes. This will require a collaborative approach, to which this field of research lends itself. This work may be aided by the rise of data-driven research, including the potential to utilise modern electronic patient records and advanced data-analysis techniques.
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Affiliation(s)
- Mark Stares
- Edinburgh Cancer Centre, NHS Lothian, Edinburgh EH4 2XU, UK
- Cancer Research UK Scotland Centre, University of Edinburgh, Edinburgh EH4 2XR, UK
| | - Leo R. Brown
- Cancer Research UK Scotland Centre, University of Edinburgh, Edinburgh EH4 2XR, UK
| | - Dhruv Abhi
- Edinburgh Cancer Centre, NHS Lothian, Edinburgh EH4 2XU, UK
| | - Iain Phillips
- Edinburgh Cancer Centre, NHS Lothian, Edinburgh EH4 2XU, UK
- Cancer Research UK Scotland Centre, University of Edinburgh, Edinburgh EH4 2XR, UK
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4
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Tan DSW, Felip E, de Castro G, Solomon BJ, Greystoke A, Cho BC, Cobo M, Kim TM, Ganguly S, Carcereny E, Paz-Ares L, Bennouna J, Garassino MC, Schenker M, Kim SW, Brase JC, Bury-Maynard D, Passos VQ, Deudon S, Dharan B, Song Y, Caparica R, Johnson BE. Canakinumab Versus Placebo in Combination With First-Line Pembrolizumab Plus Chemotherapy for Advanced Non-Small-Cell Lung Cancer: Results From the CANOPY-1 Trial. J Clin Oncol 2024; 42:192-204. [PMID: 38039427 DOI: 10.1200/jco.23.00980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/14/2023] [Accepted: 10/03/2023] [Indexed: 12/03/2023] Open
Abstract
PURPOSE The addition of checkpoint inhibitors to first-line treatment has prolonged survival of patients with non-small-cell lung cancer (NSCLC), but prognosis remains poor, with new treatment options needed. Canakinumab, a human, monoclonal anti-interleukin (IL)-1β antibody, has potential to enhance the activity of PD-L1 inhibitors and chemotherapy (CT) by inhibiting protumor inflammation. METHODS CANOPY-1 was a phase III, randomized, double-blind study comparing canakinumab (200 mg subcutaneously once every 3 weeks) versus placebo, both combined with pembrolizumab (200 mg intravenously once every 3 weeks) and platinum-based doublet CT, as first-line treatment for advanced/metastatic NSCLC without EGFR or ALK mutations. The primary end points were progression-free survival (PFS) and overall survival (OS). The secondary endpoints included overall response rate, safety, and patient-reported outcomes. RESULTS Overall, 643 patients were randomly assigned to canakinumab (n = 320) or placebo (n = 323). With a median study follow-up of 6.5 months, the median PFS was 6.8 months with canakinumab versus 6.8 months with placebo (hazard ratio [HR], 0.85; 95% CI, 0.67 to 1.09; P = .102). With a median study follow-up of 21.2 months, the median OS was 20.8 months with canakinumab versus 20.2 months with placebo (HR, 0.87; 95% CI, 0.70 to 1.10; P = .123). No unexpected safety signals were observed for canakinumab combination. Infection rates were comparable between treatment and control arms. A higher frequency of neutropenia and ALT increase (grade ≤2) were reported in the treatment arm. Higher baseline C-reactive protein and IL-6 levels were associated with shorter PFS and OS. Patients treated with canakinumab had clinically meaningful delays in deterioration of lung cancer symptoms, including chest pain and coughing per LC13 and dyspnea per LC13 and C30. CONCLUSION The addition of canakinumab to first-line pembrolizumab and CT did not prolong PFS or OS in patients with NSCLC.
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Affiliation(s)
- Daniel S W Tan
- National Cancer Centre Singapore, Duke-NUS Medical School, Singapore, Singapore
| | - Enriqueta Felip
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Alastair Greystoke
- Northern Centre for Cancer Care, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Manuel Cobo
- Medical Oncology Intercenter Unit, Regional University Hospital and Virgen de la Victoria University Hospital, IBIMA, Málaga, Spain
| | - Tae Min Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Enric Carcereny
- Catalan Institute of Oncology, Badalona Applied Research Group in Oncology (B-ARGO), Barcelona, Spain
| | | | - Jaafar Bennouna
- Department of Medical Oncology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Marina Chiara Garassino
- Department of Medicine, Section Hematology Oncology, Thoracic Oncology program, The University of Chicago, Chicago, IL
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michael Schenker
- Sf Nectarie Oncology Center Craiova and the University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Sang-We Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | | - Yuanbo Song
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
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5
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Nassar YM, Ojara FW, Pérez-Pitarch A, Geiger K, Huisinga W, Hartung N, Michelet R, Holdenrieder S, Joerger M, Kloft C. C-Reactive Protein as an Early Predictor of Efficacy in Advanced Non-Small-Cell Lung Cancer Patients: A Tumor Dynamics-Biomarker Modeling Framework. Cancers (Basel) 2023; 15:5429. [PMID: 38001689 PMCID: PMC10670607 DOI: 10.3390/cancers15225429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
In oncology, longitudinal biomarkers reflecting the patient's status and disease evolution can offer reliable predictions of the patient's response to treatment and prognosis. By leveraging clinical data in patients with advanced non-small-cell lung cancer receiving first-line chemotherapy, we aimed to develop a framework combining anticancer drug exposure, tumor dynamics (RECIST criteria), and C-reactive protein (CRP) concentrations, using nonlinear mixed-effects models, to evaluate and quantify by means of parametric time-to-event models the significance of early longitudinal predictors of progression-free survival (PFS) and overall survival (OS). Tumor dynamics was characterized by a tumor size (TS) model accounting for anticancer drug exposure and development of drug resistance. CRP concentrations over time were characterized by a turnover model. An x-fold change in TS from baseline linearly affected CRP production. CRP concentration at treatment cycle 3 (day 42) and the difference between CRP concentration at treatment cycles 3 and 2 were the strongest predictors of PFS and OS. Measuring longitudinal CRP allows for the monitoring of inflammatory levels and, along with its reduction across treatment cycles, presents a promising prognostic marker. This framework could be applied to other treatment modalities such as immunotherapies or targeted therapies allowing the timely identification of patients at risk of early progression and/or short survival to spare them unnecessary toxicities and provide alternative treatment decisions.
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Affiliation(s)
- Yomna M. Nassar
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universität Berlin, 12169 Berlin, Germany; (Y.M.N.)
- Graduate Research Training Program PharMetrX, Berlin/Potsdam, Germany
| | - Francis Williams Ojara
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universität Berlin, 12169 Berlin, Germany; (Y.M.N.)
- Graduate Research Training Program PharMetrX, Berlin/Potsdam, Germany
- Department of Pharmacology, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
| | - Alejandro Pérez-Pitarch
- Translational Medicine & Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, 55216 Ingelheim am Rhein, Germany
| | - Kimberly Geiger
- Institute of Laboratory Medicine, German Heart Centre Munich of the Free State of Bavaria, Technical University Munich, 80636 Munich, Germany
| | - Wilhelm Huisinga
- Institute of Mathematics, University of Potsdam, 14476 Potsdam, Germany; (W.H.); (N.H.)
| | - Niklas Hartung
- Institute of Mathematics, University of Potsdam, 14476 Potsdam, Germany; (W.H.); (N.H.)
| | - Robin Michelet
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universität Berlin, 12169 Berlin, Germany; (Y.M.N.)
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, German Heart Centre Munich of the Free State of Bavaria, Technical University Munich, 80636 Munich, Germany
| | - Markus Joerger
- Department of Medical Oncology and Hematology, Cantonal Hospital, CH-9007 St. Gallen, Switzerland
| | - Charlotte Kloft
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universität Berlin, 12169 Berlin, Germany; (Y.M.N.)
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Hsu WL, Hsieh YT, Chen WM, Chien MH, Luo WJ, Chang JH, Devlin K, Su KY. High-fat diet induces C-reactive protein secretion, promoting lung adenocarcinoma via immune microenvironment modulation. Dis Model Mech 2023; 16:dmm050360. [PMID: 37929799 PMCID: PMC10651111 DOI: 10.1242/dmm.050360] [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: 06/26/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
To understand the effects of a high-fat diet (HFD) on lung cancer progression and biomarkers, we here used an inducible mutant epidermal growth factor receptor (EGFR)-driven lung cancer transgenic mouse model fed a regular diet (RD) or HFD. The HFD lung cancer (LC-HFD) group exhibited significant tumor formation and deterioration, such as higher EGFR activity and proliferation marker expression, compared with the RD lung cancer (LC-RD) group. Transcriptomic analysis of the lung tissues revealed that the significantly changed genes in the LC-HFD group were highly enriched in immune-related signaling pathways, suggesting that an HFD alters the immune microenvironment to promote tumor growth. Cytokine and adipokine arrays combined with a comprehensive analysis using meta-database software indicated upregulation of C-reactive protein (CRP) in the LC-HFD group, which presented with increased lung cancer proliferation and metastasis; this was confirmed experimentally. Our results imply that an HFD can turn the tumor growth environment into an immune-related pro-tumorigenic microenvironment and demonstrate that CRP has a role in promoting lung cancer development in this microenvironment.
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Affiliation(s)
- Wei-Lun Hsu
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei 10055, Taiwan
| | - Yun-Ting Hsieh
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei 10055, Taiwan
| | - Wei-Ming Chen
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei 10055, Taiwan
| | - Min-Hui Chien
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei 10055, Taiwan
| | - Wei-Jia Luo
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei 10055, Taiwan
| | - Jung-Hsuan Chang
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei 10055, Taiwan
| | - Kevin Devlin
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei 10055, Taiwan
| | - Kang-Yi Su
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei 10055, Taiwan
- Genome and Systems Biology Degree Program, National Taiwan University and Academia Sinica, Taipei 10617, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei 10055, Taiwan
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7
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Ojara FW, Henrich A, Frances N, Nassar YM, Huisinga W, Hartung N, Geiger K, Holdenrieder S, Joerger M, Kloft C. A prognostic baseline blood biomarker and tumor growth kinetics integrated model in paclitaxel/platinum treated advanced non-small cell lung cancer patients. CPT Pharmacometrics Syst Pharmacol 2023; 12:1714-1725. [PMID: 36782356 PMCID: PMC10681433 DOI: 10.1002/psp4.12937] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/11/2023] [Indexed: 02/15/2023] Open
Abstract
Paclitaxel/platinum chemotherapy, the backbone of standard first-line treatment of advanced non-small cell lung cancer (NSCLC), exhibits high interpatient variability in treatment response and high toxicity burden. Baseline blood biomarker concentrations and tumor size (sum of diameters) at week 8 relative to baseline (RS8) are widely investigated prognostic factors. However, joint analysis of data on demographic/clinical characteristics, blood biomarker levels, and chemotherapy exposure-driven early tumor response for improved prediction of overall survival (OS) is clinically not established. We developed a Weibull time-to-event model to predict OS, leveraging data from 365 patients receiving paclitaxel/platinum combination chemotherapy once every three weeks for ≤six cycles. A developed tumor growth inhibition model, combining linear tumor growth and first-order paclitaxel area under the concentration-time curve-induced tumor decay, was used to derive individual RS8. The median model-derived RS8 in all patients was a 20.0% tumor size reduction (range from -78% to +15%). Whereas baseline carcinoembryonic antigen, cytokeratin fragments, and thyroid stimulating hormone levels were not significantly associated with OS in a subset of 221 patients, and lactate dehydrogenase, interleukin-6 and neutrophil-to-lymphocyte ratio levels were significant only in univariate analyses (p value < 0.05); C-reactive protein (CRP) in combination with RS8 most significantly affected OS (p value < 0.01). Compared to the median population OS of 11.3 months, OS was 128% longer at the 5th percentile levels of both covariates and 60% shorter at their 95th percentiles levels. The combined paclitaxel exposure-driven RS8 and baseline blood CRP concentrations enables early individual prognostic predictions for different paclitaxel dosing regimens, forming the basis for treatment decision and optimizing paclitaxel/platinum-based advanced NSCLC chemotherapy.
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Affiliation(s)
- Francis Williams Ojara
- Department of Clinical Pharmacy and Biochemistry, Institute of PharmacyFreie Universitaet BerlinBerlinGermany
- Graduate Research Training Program PharMetrXBerlin/PotsdamGermany
| | - Andrea Henrich
- Department of Clinical Pharmacy and Biochemistry, Institute of PharmacyFreie Universitaet BerlinBerlinGermany
- Graduate Research Training Program PharMetrXBerlin/PotsdamGermany
| | - Nicolas Frances
- Department of Translational Modeling and Simulation, Roche Pharma Research and Early Development, Roche Innovation Center BaselF. Hoffmann‐La Roche LtdBaselSwitzerland
| | - Yomna M. Nassar
- Department of Clinical Pharmacy and Biochemistry, Institute of PharmacyFreie Universitaet BerlinBerlinGermany
- Graduate Research Training Program PharMetrXBerlin/PotsdamGermany
| | | | - Niklas Hartung
- Institute of MathematicsUniversity of PotsdamPotsdamGermany
| | - Kimberly Geiger
- Munich Biomarker Research Center, Institute of Laboratory Medicine, German Heart CenterTechnical University of MunichMunichGermany
| | - Stefan Holdenrieder
- Munich Biomarker Research Center, Institute of Laboratory Medicine, German Heart CenterTechnical University of MunichMunichGermany
| | - Markus Joerger
- Department of Oncology and HematologyCantonal Hospital St. GallenSt. GallenSwitzerland
| | - Charlotte Kloft
- Department of Clinical Pharmacy and Biochemistry, Institute of PharmacyFreie Universitaet BerlinBerlinGermany
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8
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Rocco D, Della Gravara L, Ragone A, Sapio L, Naviglio S, Gridelli C. Prognostic Factors in Advanced Non-Small Cell Lung Cancer Patients Treated with Immunotherapy. Cancers (Basel) 2023; 15:4684. [PMID: 37835378 PMCID: PMC10571734 DOI: 10.3390/cancers15194684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Taking into account the huge epidemiologic impact of lung cancer (in 2020, lung cancer accounted for 2,206,771 of the cases and for 1,796,144 of the cancer-related deaths, representing the second most common cancer in female patients, the most common cancer in male patients, and the second most common cancer in male and female patients) and the current lack of recommendations in terms of prognostic factors for patients selection and management, this article aims to provide an overview of the current landscape in terms of currently available immunotherapy treatments and the most promising assessed prognostic biomarkers, highlighting the current state-of-the-art and hinting at future challenges.
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Affiliation(s)
- Danilo Rocco
- Department of Pulmonary Oncology, AORN dei Colli Monaldi, 80131 Naples, Italy;
| | - Luigi Della Gravara
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.D.G.); (L.S.); (S.N.)
| | - Angela Ragone
- Max-Planck Institute of Molecular Physiology, 44227 Dortmund, Germany;
| | - Luigi Sapio
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.D.G.); (L.S.); (S.N.)
| | - Silvio Naviglio
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.D.G.); (L.S.); (S.N.)
| | - Cesare Gridelli
- Division of Medical Oncology, “S.G. Moscati” Hospital, Contrada Amoretta, 83100 Avellino, Italy
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9
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Lv X, Xu B, Zou Q, Han S, Feng Y. Clinical application of common inflammatory and nutritional indicators before treatment in prognosis evaluation of non-small cell lung cancer: a retrospective real-world study. Front Med (Lausanne) 2023; 10:1183886. [PMID: 37521341 PMCID: PMC10373868 DOI: 10.3389/fmed.2023.1183886] [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: 03/10/2023] [Accepted: 06/05/2023] [Indexed: 08/01/2023] Open
Abstract
Objective To evaluate the prognostic value of common clinical inflammatory and nutritional indicators before treatment in patients with non-small cell lung cancer in the real world. Method A total of 5,239 patients with pathologically confirmed non-small cell lung cancer from 2011 to 2018 in the Affiliated Cancer Hospital of Xinjiang Medical University were selected. Their inflammatory and nutritional indicators (RDW, PDW, NLR, LMR, NMR, PLR, SII, PNI, TP, ALB, CYRFA21-1, CEA, CA125, NSE, α1-globulin, α2-globulin, β1-globulin, β2-globulin, and γ-globulin) before treatment were collected. From the total number, 1,049 patients were randomly sampled (18 to 20% of patients each year) and used as the validation set; the remaining 4,190 patients were used as the training set. According to the eighth edition of the guidelines for the diagnosis, treatment, and stage risk stratification of lung cancer, the patients were divided into four groups: stage I/II operable, stage III operable, stage III inoperable, and stage IV. We used the X-tile software to intercept and classify the cut-off values of each index in the validation set. Univariate and multivariate Cox proportional-hazard regression were used to screen the independent risk factors affecting the prognosis of non-small cell lung cancer and establish a prognostic model for 1, 3, and 5 years. The validation set was used to verify its performance. Finally, the Kaplan-Meier curve was used to assess the survival rate, and the corresponding nomogram was established for clinical use. Results After screening, no effective indicators were found in the stage I/II operable group. RDW and CA125 were effective indicators for the stage III operable group (cut-off values were 14.1 and 9.21, respectively, compared with the low-value group; univariate HR was 2.145 and 1.612, and multivariate HR was 1.491 and 1.691, respectively). CYRFA21-1 and CA125 were effective prognostic indicators for the stage III inoperable group (cut-off values were 10.62 and 44.10, respectively, compared with the low-value group; univariate HR was 1.744 and 1.342, and multivariate HR was 1.284 and 1.304, respectively). CYRFA21-1, CA125, NLR, and α1-globulin were effective indicators of prognosis in stage IV (cut-off values were 3.07, 69.60, 4.08, and 5.30, respectively, compared with the low-value group; univariate HR was 1.713, 1.339, 1.388, and 1.539; and multivariate HR was 1.407, 1.119, 1.191, and 1.110, respectively). The model was constructed with the best validation power in stage IV patients (C-index = 0.733, 0.749, and 0.75 at 1, 3, and 5 years, respectively). Conclusion For patients with stage III and IV non-small cell lung cancer, some inflammatory markers, serum tumor markers, and nutritional indicators are independent prognostic factors. Combined with the general data of patients, the constructed prognostic evaluation model has the best efficacy in patients with stage IV and can be widely used in clinical practice.
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Affiliation(s)
- Xiang Lv
- Clinical Laboratory Center, Cancer Hospital Affiliated to Xinjiang Medical University, Ürümqi, China
- Department of Laboratory Medicine, Jianyang People's Hospital, Jianyang, China
| | - Bin Xu
- Clinical Laboratory Center, Cancer Hospital Affiliated to Xinjiang Medical University, Ürümqi, China
- Medical Laboratory Center, Affiliated to Traditional Chinese Medicine Hospital of Xinjiang Medical University, Ürümqi, China
| | - Qingxia Zou
- Clinical Laboratory Center, Cancer Hospital Affiliated to Xinjiang Medical University, Ürümqi, China
| | - Songtao Han
- Clinical Laboratory Center, Cancer Hospital Affiliated to Xinjiang Medical University, Ürümqi, China
- Medical Laboratory Center, Affiliated to Traditional Chinese Medicine Hospital of Xinjiang Medical University, Ürümqi, China
| | - Yangchun Feng
- Clinical Laboratory Center, Cancer Hospital Affiliated to Xinjiang Medical University, Ürümqi, China
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Langberg CW, Horndalsveen H, Helland Å, Haakensen VD. Factors associated with failure to start consolidation durvalumab after definitive chemoradiation for locally advanced NSCLC. Front Oncol 2023; 13:1217424. [PMID: 37476372 PMCID: PMC10354813 DOI: 10.3389/fonc.2023.1217424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Introduction The introduction of consolidation immunotherapy after chemoradiotherapy has improved outcome for patients with locally advanced non-small cell lung cancer. However, not all patients receive this treatment. This study identifies factors associated with failure to start durvalumab as consolidation therapy with the aim of optimizing treatment, supportive care and prehabilitation to ensure that more patients complete the planned treatment. Materials and methods Patients from two clinical trials and a named patient use program, were included in this study. All patients received platinum-doublet chemotherapy concomitant with radiotherapy to a total dose of 60-66 gray. Patient characteristics, cancer treatment, toxicity, performance status and laboratory data before and after chemoradiotherapy were recorded and patients who never started durvalumab were compared with those who did. Results A total of 101 patients were included, of which 83 started treatments with durvalumab after chemoradiotherapy. The 18 patients who did not start durvalumab had significantly higher lactate dehydrogenase at baseline and a worse performance status, cumulative toxicity and higher c-reactive protein after completed chemoradiotherapy. Data also suggest that pre-treatment diabetes and reduced hemoglobin and/or diffusion capacity of the lungs for carbon monoxide contribute to the risk of treatment abruption. Conclusion Treatment plan disruption rate was 18%. Systemic inflammation and performance status were associated with failure to receive durvalumab after chemoradiation. Further studies are needed to confirm findings and prospective trials should investigate whether prehabilitation and supportive treatment could help more patients finishing the planned treatment. Clinical Trial Registration clinicaltrials.gov, identifier NCT03798535; NCT04392505.
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Affiliation(s)
| | - Henrik Horndalsveen
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Åslaug Helland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vilde Drageset Haakensen
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
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11
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Schweppe JA, Potthoff AL, Heimann M, Ehrentraut SF, Borger V, Lehmann F, Schaub C, Bode C, Putensen C, Herrlinger U, Vatter H, Schäfer N, Schuss P, Schneider M. Incurring detriments of unplanned readmission to the intensive care unit following surgery for brain metastasis. Neurosurg Rev 2023; 46:155. [PMID: 37382699 PMCID: PMC10310600 DOI: 10.1007/s10143-023-02066-5] [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: 01/14/2023] [Revised: 05/21/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
OBJECT Postoperative intensive care unit (ICU) monitoring is a common regime after neurosurgical resection of brain metastasis (BM). In comparison, unplanned secondary readmission to the ICU after initial postoperative treatment course occurs in response to adverse events and might significantly impact patient prognosis. In the present study, we analyzed the potential prognostic implications of unplanned readmission to the ICU and aimed at identifying preoperatively collectable risk factors for the development of such adverse events. METHODS Between 2013 and 2018, 353 patients with BM had undergone BM resection at the authors' institution. Secondary ICU admission was defined as any unplanned admission to the ICU during the initial hospital stay. A multivariable logistic regression analysis was performed to identify preoperatively identifiable risk factors for unplanned ICU readmission. RESULTS A total of 19 patients (5%) were readmitted to the ICU. Median overall survival (mOS) of patients with unplanned ICU readmission was 2 months (mo) compared to 13 mo for patients without secondary ICU admission (p<0.0001). Multivariable analysis identified "multiple BM" (p=0.02) and "preoperative CRP levels > 10 mg/dl" (p=0.01) as significant and independent predictors of secondary ICU admission. CONCLUSIONS Unplanned ICU readmission following surgical therapy for BM is significantly related to poor OS. Furthermore, the present study identifies routinely collectable risk factors indicating patients that are at a high risk for unplanned ICU readmission after BM surgery.
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Affiliation(s)
- Justus August Schweppe
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Anna-Laura Potthoff
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Muriel Heimann
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Stefan Felix Ehrentraut
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Felix Lehmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Christian Bode
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Current address: Department of Neurosurgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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12
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Promises and Challenges of Predictive Blood Biomarkers for Locally Advanced Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy. Cells 2023; 12:cells12030413. [PMID: 36766755 PMCID: PMC9913546 DOI: 10.3390/cells12030413] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
The treatment of locally advanced rectal cancer (LARC) requires a multimodal approach combining neoadjuvant radiotherapy or chemoradiotherapy (CRT) and surgery. Predicting tumor response to CRT can guide clinical decision making and improve patient care while avoiding unnecessary toxicity and morbidity. Circulating biomarkers offer both the advantage to be easily accessed and followed over time. In recent years, biomarkers such as proteins, blood cells, or nucleic acids have been investigated for their predictive value in oncology. We conducted a comprehensive literature review with the aim to summarize the status of circulating biomarkers predicting response to CRT in LARC. Forty-nine publications, of which forty-seven full-text articles, one review and one systematic review, were retrieved. These studies evaluated circulating markers (CEA and CA 19-9), inflammatory biomarkers (CRP, albumin, and lymphocytes), hematologic markers (hemoglobin and thrombocytes), lipids and circulating nucleic acids (cell-free DNA [cfDNA], circulating tumor DNA [ctDNA], and microRNA [miRNA]). Post-CRT CEA levels had the most consistent association with tumor response, while cfDNA integrity index, MGMT promoter methylation, ERCC-1, miRNAs, and miRNA-related SNPs were identified as potential predictive markers. Although circulating biomarkers hold great promise, inconsistent results, low statistical power, and low specificity and sensibility prevent them from reliably predicting tumor response following CRT. Validation and standardization of methods and technologies are further required to confirm results.
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13
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He D, Yang Y, Yang Y, Tang X, Huang K. Prognostic significance of preoperative C-reactive protein to albumin ratio in non-small cell lung cancer patients: A meta-analysis. Front Surg 2023; 9:1056795. [PMID: 36684183 PMCID: PMC9852518 DOI: 10.3389/fsurg.2022.1056795] [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: 09/29/2022] [Accepted: 11/09/2022] [Indexed: 01/09/2023] Open
Abstract
Objective We aimed to assess whether C-reactive protein to albumin ratio (CAR) is associated with the clinicopathology and prognosis of patients with non-small cell lung cancer (NSCLC) after surgery. Methods Several literature databases were searched for eligible studies in English and Chinese published before September 1, 2022, according to the inclusion and exclusion criteria. The pooled odds ratios (ORs) with 95% confidence interval (CI) were calculated to assess the association of CAR in lung cancer with clinicopathological characteristics including age, sex, smoking status, lymph node metastasis, and American Association of Cancer (AJCC) stage. The pooled hazard ratios (HRs) with 95% CI were calculated to assess the association of CAR with prognosis in lung cancer. Publication bias was assessed using Egger's test. Results Overall, 9 studies involving 3,359 NSCLC patients were included in this meta-analysis. The CAR was observed to be higher in males, smokers, and patients with lymph node metastasis and correlated with advanced AJCC stage but not with age. Moreover, a high CAR correlated with poor survival. No publication bias was observed in this meta-analysis. Conclusions CAR was observed to be a significant biomarker for prognosis and associated with clinicopathological characteristics in patients with NSCLC after surgery.
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Affiliation(s)
- Dingxiu He
- Department of Emergency, Deyang People's Hospital, Sichuan, China
| | - Yong Yang
- Department of Emergency, Deyang People's Hospital, Sichuan, China
| | - Yi Yang
- Department of Emergency, Deyang People's Hospital, Sichuan, China
| | - Xiaoqu Tang
- Department of Emergency, Deyang People's Hospital, Sichuan, China
| | - Kaisen Huang
- Department of Cardiology, Deyang People's Hospital, Sichuan, China,Correspondence: Kaisen Huang
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14
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Miki M, Lee L, Hisano T, Sugimoto R, Furukawa M. Loss of adipose tissue or skeletal muscle during first-line gemcitabine/nab-paclitaxel therapy is associated with worse survival after second-line therapy of advanced pancreatic cancer. Asia Pac J Clin Oncol 2022; 18:e297-e305. [PMID: 34818466 PMCID: PMC9541259 DOI: 10.1111/ajco.13669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/17/2021] [Indexed: 12/18/2022]
Abstract
AIM Progression of cachexia indicated by decreased body weight and composition is associated with poor survival of advanced pancreatic cancer (APC). There are limited data concerning the prognostic effect of cachexia on second-line chemotherapy (L2). We aimed to assess the impact of cachexia progression during first-line therapy (L1) on survival after L2. METHODS We reviewed patients with gemcitabine/nab-paclitaxel (GEM/nabPTX)-refractory APC who underwent L2 with modified FOLFIRINOX or S-1 between 2015 and 2019 in our institution. We determined clinicopathological data including body composition parameters: subcutaneous fat area (SFA), visceral fat area (VFA), and skeletal muscle index (SMI). Correlations of changes in these parameters, as well as their effect on overall survival after L2 (OS2), were examined. RESULTS Median rates of change in SMI, SFA, and VFA were 0.19%, -4.17%, and -18.39%, respectively, in 59 patients during L1. Although there was moderate correlation in rate of change between SFA and VFA, there was no correlation between SMI and other parameters. We defined loss of SFA, VFA, and SMI as decreases greater than 8.5%, 34.1%, and 8.7%, respectively. Median OS2 of patients with loss in any of these parameters was significantly shorter than in patients without loss (3.83 vs. 8.73 months). Multivariate analysis revealed that loss in any parameters, performance status, and C-reactive protein/albumin ratio were independent negative prognostic factors. CONCLUSION Loss of adipose tissue or skeletal muscle during L1 had a considerable impact on OS2 in APC refractory to GEM/nabPTX.
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Affiliation(s)
- Masami Miki
- Department of Hepato‐Biliary‐PancreatologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Lingaku Lee
- Department of Hepato‐Biliary‐PancreatologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Terumasa Hisano
- Department of Hepato‐Biliary‐PancreatologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Rie Sugimoto
- Department of Hepato‐Biliary‐PancreatologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Masayuki Furukawa
- Department of Hepato‐Biliary‐PancreatologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
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15
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The Treatment Combining Antiangiogenesis with Chemoradiotherapy Impinges on the Peripheral Circulation Vascular Endothelial Cells and Therapeutic Effect in the Patients with Locally Advanced Nasopharyngeal Carcinoma. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1787854. [PMID: 35872851 PMCID: PMC9307343 DOI: 10.1155/2022/1787854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 12/24/2022]
Abstract
This study was implemented for the evaluation on the circulating endothelial cells' (CECs) clinical significance in the locally advanced nasopharyngeal carcinoma treatment with endostatin-combined chemoradiotherapy. This study enrolled 47 patients with locally advanced nasopharyngeal carcinoma who were hospitalized from May 9, 2012 to March 10, 2013. These patients were split up into the observation group (25 patients) and control group (22 patients). Patients in the observation group received the endostatin combined with induction chemotherapy and subsequently with concurrent chemoradiotherapy with endostatin. Patients in the control group were treated with inductive chemotherapy followed by concurrent chemoradiotherapy. CECs in peripheral blood were conducted separately before or after inductive chemotherapy and additionally in the end of concurrent chemoradiotherapy. The CEC values of the observation group showed significant statistical differences (p < 0.05) before or after different therapies, whereas those data in the control group were not statistically different. And, the mostly importantly, the CEC values in the observation group and control group turned out a statistical difference. The combination of endostatin and chemoradiotherapy significantly reduced parameters of peripheral blood CECs in these patients. According to the CEC parameters' variety that we observed in the combined therapies, this study demonstrated that the CECs might be a clinical clue to evaluate this antiangiogenic chemoradiotherapy. And the clinical value of CECs will be further determined along with increasing comparative studies and clinical long-term efficacy observation.
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16
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Kgokolo MCM, Anderson K, Siwele SC, Steel HC, Kwofie LLI, Sathekge MM, Meyer PWA, Rapoport BL, Anderson R. Elevated Levels of Soluble CTLA-4, PD-1, PD-L1, LAG-3 and TIM-3 and Systemic Inflammatory Stress as Potential Contributors to Immune Suppression and Generalized Tumorigenesis in a Cohort of South African Xeroderma Pigmentosum Patients. Front Oncol 2022; 12:819790. [PMID: 35223501 PMCID: PMC8874270 DOI: 10.3389/fonc.2022.819790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/20/2022] [Indexed: 12/03/2022] Open
Abstract
Xeroderma Pigmentosum (XP), an autosomal recessive disorder characterized by ultraviolet radiation-induced abnormalities of DNA excision and repair pathways is associated with early development of cutaneous cancers. Intracellular oxidative stress has also been proposed as a contributor to the occurrence of skin cancers. However, little is known about the possible augmentative contributions of chronic inflammation, immune suppression and oxidative stress to the pathogenesis of malignancies associated with other subtypes of XP. This has been addressed in the current study, focused on the measurement of systemic biomarkers of inflammation, immune dysfunction and oxidative damage in XP patients, consisting of XP-C, XP-D and XP-E cases, including those XP-C cases who had already developed multiple skin malignancies. The inflammatory biomarker profile measured in XP patients and healthy control subjects included the cytokines, interleukins (ILs)-2, -4, -6, -10, interferon-γ (IFN- γ) and tumor-necrosis factor-α (TNF-α), the acute phase reactant, C-reactive protein (CRP), and cotinine (as an objective indicator of smoking status). Immune suppression was detected according to the levels of five soluble inhibitory immune checkpoint proteins (CTLA-4, PD-1, PD-L1, LAG-3 and TIM-3), as well as those of vitamin D, while oxidative stress was determined according to the circulating levels of the DNA adduct, 8-hydroxy-2-deoxyguanosine (8-OH-dG). These various biomarkers were measured in plasma using immunofluorimetric, nephelometric and ELISA procedures. Significant elevations in IL-6 (P<0.01) and TNF-α (P<0.0001), but none of the other cytokines, as well as increased levels of all five soluble inhibitory immune checkpoints (P=0.032-P=0.0001) were detected in the plasma of the XP patients. C-reactive protein and vitamin D were increased and decreased, respectively (both P<0.0001), while only one participant had an elevated level of plasma cotinine. Surprisingly, the levels of 8-OH-dG were significantly (P=0.0001) lower in the group of XP patients relative to a group of healthy control subjects. The findings of increased levels of pro-inflammatory cytokines and, in particular, those of the soluble immune checkpoints, in the setting of decreased vitamin D and moderately elevated levels of CRP in XP patients suggest a possible secondary role of ongoing, inflammatory stress and immune suppression in the pathogenesis of XP-associated malignancies.
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Affiliation(s)
- Mahlatse C M Kgokolo
- Department of Dermatology, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Katherine Anderson
- Department of Dermatology, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Shalate C Siwele
- Department of Dermatology, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Helen C Steel
- Department of Immunology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Luyanda L I Kwofie
- Department of Immunology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Tshwane Academic Division of the National Health Laboratory Service, Pretoria, South Africa
| | - Mike M Sathekge
- Department of Nuclear Medicine, Faculty of Nuclear Medicine, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Pieter W A Meyer
- Department of Immunology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Tshwane Academic Division of the National Health Laboratory Service, Pretoria, South Africa
| | - Bernardo L Rapoport
- Department of Immunology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,The Medical Oncology Centre of Rosebank, Johannesburg, South Africa
| | - Ronald Anderson
- Department of Immunology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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17
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Yang T, Hao L, Yang X, Luo C, Wang G, Lin Cai C, Qi S, Li Z. Prognostic value of derived neutrophil-to-lymphocyte ratio (dNLR) in patients with non-small cell lung cancer receiving immune checkpoint inhibitors: a meta-analysis. BMJ Open 2021; 11:e049123. [PMID: 34475167 PMCID: PMC8413941 DOI: 10.1136/bmjopen-2021-049123] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Derived neutrophil-to-lymphocytes ratio (dNLR) has recently been reported as a novel potential biomarker associated with prognosis of non-small cell lung cancer (NSCLC). However, evidence for the prognostic utility of dNLR in patients with NSCLC treated with immune checkpoint inhibitors (ICIs) remains inconsistent. The objective of this work was to evaluate the association between pretreatment dNLR and prognosis of patients with NSCLC treated with ICIs. DESIGN This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES PubMed, EMBASE, Web of Science and the Cochrane Library were searched for eligible studies up to 16 October 2020. ELIGIBILITY CRITERIA: (1) Human subjects receiving ICIs therapy and who had been diagnosed with NSCLC; (2) the baseline values of dNLR were obtained; (3) the objective of the study was to investigate the relationships between dNLR and overall survival (OS) or progression-free survival (PFS) in NSCLC and (4) HR and 95% CI were displayed in the original article or could be extracted from Kaplan-Meier curves. DATA EXTRACTION AND SYNTHESIS Two investigators extracted data independently. Data synthesis was performed via systematic review and meta-analysis of eligible cohort studies. Meta-analysis was performed with Cochran's Q test and I2 statistics. Publication bias of studies was assessed by Begg's test and Egger's test. We used V.12.0 of the Stata statistical software. RESULTS This analysis included eight studies (2456 cases) on the prognostic utility of dNLR in ICI therapy for NSCLC. The results indicate that higher dNLR significantly predicted poor OS (HR=1.65, 95% CI 1.46 to 1.88; p<0.001) and PFS (HR=1.38, 95% CI 1.23 to 1.55; p<0.001). Subgroup analyses of OS-related studies indicated that there were similar results in stratifications by ethnicity, sample size, type of HR and dNLR cut-off value. As for PFS-related studies, subgroup analyses showed no significant difference in Asian populations. Publication biases were not detected using Begg's test and Egger's linear regression test. CONCLUSIONS This meta-analysis indicated that elevated pretreatment dNLR may be a negative prognostic predictor for patients with NSCLC treated with ICIs. More large-sample and higher-quality studies are warranted to support our findings. PROSPERO REGISTRATION NUMBER CRD42021214034.
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Affiliation(s)
- Tao Yang
- Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
- Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Lizheng Hao
- Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
| | - Xinyu Yang
- Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
| | - Changyong Luo
- Beijing University of Chinese Medicine, Beijing, China
| | - Guomi Wang
- Beijing University of Chinese Medicine, Beijing, China
| | | | - Shuo Qi
- Department of Thyroid, Sun Simiao hospital, Beijing University of Chinese Medicine, Tongchuan, China
| | - Zhong Li
- Department of Hematology and Oncology, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
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18
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Meng Y, Long C, Huang X, Huang L, Liao L, Tang W, Liu J. Prognostic role and clinical significance of C-reactive protein-lymphocyte ratio in colorectal cancer. Bioengineered 2021; 12:5138-5148. [PMID: 34436973 PMCID: PMC8806856 DOI: 10.1080/21655979.2021.1960768] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Systemic inflammatory response (SIRS) can be used as a potential prognostic marker in patients with colorectal cancer (CRC). The purpose of this study was to examine the predictive role of the C-reactive protein (CRP)-lymphocyte ratio (CLR) in the prognosis of CRC. We retrospectively analyzed the data of CRC patients who underwent surgery from 2004 to 2019. The clinicopathological characteristics and follow-up records were analyzed. According to a cutoff value of CLR, the patients were divided into the high and low groups. Kaplan–Meier curves and Cox proportional hazards regression model were applied to assess the overall survival (OS). Clinicopathological characteristics analysis showed that gender, age, BMI, lymphocyte count, tumor location, left- and right-sided CRC, differentiation, T stage, M stage, TNM stage, carcinoembryonic antigen (CEA), CLR, CRP, and microsatellite status were found to differ significantly between the high and low CLR groups. Kaplan–Meier curves revealed that the high CLR group had a shorter OS, and the elderly or right-sided CRC patients faced a worse prognosis. Multivariate analysis suggested that age (hazard ratio [HR]:1.011, P = 0.003), differentiation (HR:1.331, P = 0.000), TNM stage (HR:2.425, P = 0.000), CEA (HR:1.001, P = 0.025), CLR (HR:1.261, P = 0.014) were significant independent prognostic factors for OS. Subgroup analysis demonstrated that females or patients not receiving postoperative adjuvant chemotherapy with high CLR might suffer a worse prognosis. Overall, CLR can be applied as a promising prognostic marker in CRC patients and has great potential in guiding clinical work.
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Affiliation(s)
- Yongsheng Meng
- Division of Colorectal & Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, The People's Republic of China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, The People's Republic of China
| | - Chenyan Long
- 2nd Department of General Surgery, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Hunan, The People's Republic of China
| | - Xiaoliang Huang
- Division of Colorectal & Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, The People's Republic of China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, The People's Republic of China
| | - Lihaoyun Huang
- Division of Colorectal & Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, The People's Republic of China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, The People's Republic of China
| | - Lixian Liao
- Division of Colorectal & Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, The People's Republic of China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, The People's Republic of China
| | - Weizhong Tang
- Division of Colorectal & Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, The People's Republic of China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, The People's Republic of China
| | - Jungang Liu
- Division of Colorectal & Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, The People's Republic of China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, The People's Republic of China
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19
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Chan P, Marchand M, Yoshida K, Vadhavkar S, Wang N, Lin A, Wu B, Ballinger M, Sternheim N, Jin JY, Bruno R. Prediction of overall survival in patients across solid tumors following atezolizumab treatments: A tumor growth inhibition-overall survival modeling framework. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2021; 10:1171-1182. [PMID: 34270868 PMCID: PMC8520743 DOI: 10.1002/psp4.12686] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/18/2021] [Accepted: 07/02/2021] [Indexed: 12/23/2022]
Abstract
The objectives of the study were to use tumor size data from 10 phase II/III atezolizumab studies across five solid tumor types to estimate tumor growth inhibition (TGI) metrics and assess the impact of TGI metrics and baseline prognostic factors on overall survival (OS) for each tumor type. TGI metrics were estimated from biexponential models and posttreatment longitudinal data of 6699 patients. TGI‐OS full models were built using parametric survival regression by including all significant baseline covariates from the Cox univariate analysis followed by a backward elimination step. The model performance was evaluated for each trial by 1000 simulations of the OS distributions and hazard ratios (HR) of the atezolizumab‐containing arms versus the respective controls. The tumor growth rate estimate was the most significant predictor of OS across all tumor types. Several baseline prognostic factors, such as inflammatory status (C‐reactive protein, albumin, and/or neutrophil‐to‐lymphocyte ratio), tumor burden (sum of longest diameters, number of metastatic sites, and/or presence of liver metastases), Eastern Cooperative Oncology Group performance status, and lactate dehydrogenase were also highly significant across multiple studies in the final multivariate models. TGI‐OS models adequately described the OS distribution. The model‐predicted HRs indicated good model performance across the 10 studies, with observed HRs within the 95% prediction intervals for all study arms versus controls. Multivariate TGI‐OS models developed for different solid tumor types were able to predict treatment effect with various atezolizumab monotherapy or combination regimens and could be used to support design and analysis of future studies.
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Affiliation(s)
- Phyllis Chan
- Department of Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | | | - Kenta Yoshida
- Department of Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - Shweta Vadhavkar
- Department of Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - Nina Wang
- Department of Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - Alyse Lin
- Department of Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - Benjamin Wu
- Department of Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - Marcus Ballinger
- Department of Clinical Science, Genentech, Inc., South San Francisco, California, USA
| | - Nitzan Sternheim
- Department of Product Development, Genentech, Inc., South San Francisco, California, USA
| | - Jin Y Jin
- Department of Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - René Bruno
- Department of Clinical Pharmacology, Genentech/Roche, Marseille, France
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20
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Saito K, Sugawara H, Ichihara K, Watanabe T, Ishii A, Fukuchi T. Prediction of 72-hour mortality in patients with extremely high serum C-reactive protein levels using a novel weighted average of risk scores. PLoS One 2021; 16:e0246259. [PMID: 33606735 PMCID: PMC7894915 DOI: 10.1371/journal.pone.0246259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 01/18/2021] [Indexed: 01/10/2023] Open
Abstract
The risk factors associated with mortality in patients with extremely high serum C-reactive protein (CRP) levels are controversial. In this retrospective single-center cross-sectional study, the clinical and laboratory data of patients with CRP levels ≥40 mg/dL treated in Saitama Medical Center, Japan from 2004 to 2017 were retrieved from medical records. The primary outcome was defined as 72-hour mortality after the final CRP test. Forty-four mortal cases were identified from the 275 enrolled cases. Multivariate logistic regression analysis (MLRA) was performed to explore the parameters relevant for predicting mortality. As an alternative method of prediction, we devised a novel risk predictor, “weighted average of risk scores” (WARS). WARS features the following: (1) selection of candidate risk variables for 72-hour mortality by univariate analyses, (2) determination of C-statistics and cutoff value for each variable in predicting mortality, (3) 0–1 scoring of each risk variable at the cutoff value, and (4) calculation of WARS by weighted addition of the scores with weights assigned according to the C-statistic of each variable. MLRA revealed four risk variables associated with 72-hour mortality—age, albumin, inorganic phosphate, and cardiovascular disease—with a predictability of 0.829 in C-statistics. However, validation by repeated resampling of the 275 records showed that a set of predictive variables selected by MLRA fluctuated occasionally because of the presence of closely associated risk variables and missing data regarding some variables. WARS attained a comparable level of predictability (0.837) by combining the scores for 10 risk variables, including age, albumin, electrolytes, urea, lactate dehydrogenase, and fibrinogen. Several mutually related risk variables are relevant in predicting 72-hour mortality in patients with extremely high CRP levels. Compared to conventional MLRA, WARS exhibited a favorable performance with flexible coverage of many risk variables while allowing for missing data.
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Affiliation(s)
- Kai Saito
- Nara Medical University, Kashihara, Nara, Japan
| | - Hitoshi Sugawara
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Saitama, Japan
- * E-mail:
| | - Kiyoshi Ichihara
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Tamami Watanabe
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Akira Ishii
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takahiko Fukuchi
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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21
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Jørgensen IF, Brunak S. Time-ordered comorbidity correlations identify patients at risk of mis- and overdiagnosis. NPJ Digit Med 2021; 4:12. [PMID: 33514862 PMCID: PMC7846731 DOI: 10.1038/s41746-021-00382-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/05/2021] [Indexed: 11/08/2022] Open
Abstract
Diagnostic errors are common and can lead to harmful treatments. We present a data-driven, generic approach for identifying patients at risk of being mis- or overdiagnosed, here exemplified by chronic obstructive pulmonary disease (COPD). It has been estimated that 5-60% of all COPD cases are misdiagnosed. High-throughput methods are therefore needed in this domain. We have used a national patient registry, which contains hospital diagnoses for 6.9 million patients across the entire Danish population for 21 years and identified statistically significant disease trajectories for COPD patients. Using 284,154 patients diagnosed with COPD, we identified frequent disease trajectories comprising time-ordered comorbidities. Interestingly, as many as 42,459 patients did not present with these time-ordered, common comorbidities. Comparison of the individual disease history for each non-follower to the COPD trajectories, demonstrated that 9597 patients were unusual. Survival analysis showed that this group died significantly earlier than COPD patients following a trajectory. Out of the 9597 patients, we identified one subgroup comprising 2185 patients at risk of misdiagnosed COPD without the typical events of COPD patients. In all, 10% of these patients were diagnosed with lung cancer, and it seems likely that they are underdiagnosed for lung cancer as their laboratory test values and survival pattern are similar to such patients. Furthermore, only 4% had a lung function test to confirm the COPD diagnosis. Another subgroup with 2368 patients were found to be at risk of "classically" overdiagnosed COPD that survive >5.5 years after the COPD diagnosis, but without the typical complications of COPD.
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Affiliation(s)
- Isabella Friis Jørgensen
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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22
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Moik F, Zöchbauer-Müller S, Posch F, Pabinger I, Ay C. Systemic Inflammation and Activation of Haemostasis Predict Poor Prognosis and Response to Chemotherapy in Patients with Advanced Lung Cancer. Cancers (Basel) 2020; 12:cancers12061619. [PMID: 32570944 PMCID: PMC7352812 DOI: 10.3390/cancers12061619] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 12/25/2022] Open
Abstract
Systemic inflammation and activation of haemostasis are common in patients with lung cancer. Both conditions support tumour growth and metastasis. Therefore, inflammatory and haemostatic biomarkers might be useful for prediction of survival and therapy response. Patients with unresectable/metastatic lung cancer initiating 1st-line chemotherapy (n = 277, 83% non-small cell lung cancer) were followed in a prospective observational cohort study. A comprehensive panel of haemostatic biomarkers (D-dimer, prothrombin fragment 1+2, soluble P-selectin, fibrinogen, coagulation factor VIII, peak thrombin generation), blood count parameters (haemoglobin, leucocytes, thrombocytes) and inflammatory markers (neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, C-reactive protein) were measured at baseline. We assessed the association of biomarkers with mortality, progression-free-survival (PFS) and disease-control-rate (DCR). A biomarker-based prognostic model was derived. Selected inflammatory and haemostatic biomarkers were strong and independent predictors of mortality and therapy response. The strongest predictors (D-dimer, LMR, CRP) were incorporated in a unified biomarker-based prognostic model (1-year overall-survival (OS) by risk-quartiles: 79%, 69%, 51%, 24%; 2-year-OS: 53%, 36%, 23%, 8%; log-rank p < 0.001). The biomarker-based model further predicted shorter PFS and lower DCR. In conclusion, inflammatory and haemostatic biomarkers predict poor prognosis and treatment-response in patients with advanced lung cancer. A biomarker-based prognostic score efficiently predicts mortality and disease progression beyond clinical characteristics.
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Affiliation(s)
- Florian Moik
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1190 Vienna, Austria; (F.M.); (I.P.)
| | - Sabine Zöchbauer-Müller
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1190 Vienna, Austria;
| | - Florian Posch
- Clinical Division of Oncology, Department of Internal Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8036 Graz, Austria;
| | - Ingrid Pabinger
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1190 Vienna, Austria; (F.M.); (I.P.)
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1190 Vienna, Austria; (F.M.); (I.P.)
- I. M. Sechenov First Moscow State Medical University, 119146 Moscow, Russia
- Correspondence:
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23
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Joobeur S, Ben Saad A, Migaou A, Fahem N, Mhamed SC, Rouatbi N. [Survival and prognostic factors of non-small-cell lung cancer among young people in central Tunisia]. Pan Afr Med J 2020; 35:19. [PMID: 32341740 PMCID: PMC7170746 DOI: 10.11604/pamj.2020.35.19.21100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Non-small cell lung cancer (NSCLC) is a public health problem that usually affects the elderly. Currently and for some years now, this disease is increasingly affecting the young population. The purpose of this study was to analyze the features of NSCLC in young subjects and to assess survival as well as the various prognostic factors. Methods We conducted a retrospective study of all patients under the age of 50 years treated in the Department of Pneumology at the Fattouma Bourguiba University Hospital, Monastir for NSCLC. Survival and prognostic factors have been analyzed according to Kaplan Meier method. Results The average age of patients was 43.8 ± 5.29 years. The most common histological type was lung adenocarcinoma (66.1%). NSCLC was discovered at an advanced or metastatic stage in 79.7% of cases. The median overall survival was 8 ± 0.72 months. Univariate analysis showed that survival was significantly influenced by patients' general status, assessed according to the "Performance Status (PS)" index of the World Health Organization on admission, tumor stage and CRP concentrations. Multivariate analysis was performed, which enabled us to use PS index ≥ 2 and high CRP concentrations as factors of poor prognosis. Conclusion Despite the therapeutic progress, prognosis in young subjects with NSCLC is poor. Early diagnosis and management can improve survival in these patients.
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Affiliation(s)
- Samah Joobeur
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue du 1 Juin 1955, Monastir 5000, Tunisie
| | - Ahmed Ben Saad
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue du 1 Juin 1955, Monastir 5000, Tunisie
| | - Asma Migaou
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue du 1 Juin 1955, Monastir 5000, Tunisie
| | - Nesrine Fahem
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue du 1 Juin 1955, Monastir 5000, Tunisie
| | - Saousen Cheikh Mhamed
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue du 1 Juin 1955, Monastir 5000, Tunisie
| | - Naceur Rouatbi
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue du 1 Juin 1955, Monastir 5000, Tunisie
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24
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Kumar S, Chmura S, Robinson C, Lin SH, Gadgeel SM, Donington J, Feliciano J, Stinchcombe TE, Werner-Wasik M, Edelman MJ, Moghanaki D. Alternative Multidisciplinary Management Options for Locally Advanced NSCLC During the Coronavirus Disease 2019 Global Pandemic. J Thorac Oncol 2020; 15:1137-1146. [PMID: 32360578 PMCID: PMC7194660 DOI: 10.1016/j.jtho.2020.04.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is currently accelerating. Patients with locally advanced NSCLC (LA-NSCLC) may require treatment in locations where resources are limited, and the prevalence of infection is high. Patients with LA-NSCLC frequently present with comorbidities that increase the risk of severe morbidity and mortality from COVID-19. These risks may be further increased by treatments for LA-NSCLC. Although guiding data is scarce, we present an expert thoracic oncology multidisciplinary (radiation oncology, medical oncology, surgical oncology) consensus of alternative strategies for the treatment of LA-NSCLC during a pandemic. The overarching goals of these approaches are the following: (1) reduce the number of visits to a health care facility, (2) reduce the risk of exposure to severe acute respiratory syndrome–coronavirus-2, (3) attenuate the immunocompromising effects of lung cancer therapies, and (4) provide effective oncologic therapy. Patients with resectable disease can be treated with definitive nonoperative management if surgical resources are limited or the risks of perioperative care are high. Nonoperative options include chemotherapy, chemoimmunotherapy, and radiation therapy with sequential schedules that may or may not affect long-term outcomes in an era in which immunotherapy is available. The order of treatments may be on the basis of patient factors and clinical resources. Whenever radiation therapy is delivered without concurrent chemotherapy, hypofractionated schedules are appropriate. For patients who are confirmed to have COVID-19, usually, cancer therapies may be withheld until symptoms have resolved with negative viral test results. The risk of severe treatment-related morbidity and mortality is increased for patients undergoing treatment for LA-NSCLC during the COVID-19 pandemic. Adapting alternative treatment strategies as quickly as possible may save lives and should be implemented through communication with the multidisciplinary cancer team.
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Affiliation(s)
- Sameera Kumar
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
| | - Steven Chmura
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Steven H Lin
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Shirish M Gadgeel
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Josephine Feliciano
- Department of Medical Oncology, Johns Hopkins University, Baltimore, Maryland
| | | | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Martin J Edelman
- Department of Hematology and Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Drew Moghanaki
- Department of Radiation Oncology, Emory University, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia
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25
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Koyama N, Aoshiba K, Nakamura H. Serum C-Reactive Protein Level Predicts Clinical Outcomes in Patients With Non-Small Cell Lung Cancer Harboring EGFR Mutations. Cancer Invest 2020; 38:122-129. [PMID: 31985315 DOI: 10.1080/07357907.2020.1721522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to assess the association of serum C-reactive protein (CRP) levels with outcomes in 81 patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC). Patients with high serum CRP levels had lower therapeutic responses to EGFR-tyrosine kinase inhibitors (43.8%), and shorter time to treatment failure (TTF; 5.8 months) and overall survival (OS; 14.2 months) than those with low CRP levels. In multivariate analysis, serum CRP level was associated with TTF (hazard ratio [HR] 4.86) and OS (HR 49.42). High serum CRP levels may predict poor outcomes in patients with EGFR-mutated NSCLC.
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Affiliation(s)
- Nobuyuki Koyama
- Department of Clinical Oncology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Kazutetsu Aoshiba
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Hiroyuki Nakamura
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
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