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Li Z, Lv H, Zhang F, Zhu Z, Guo Q, Wang M, Huang C, Guo L, Meng F, Tian Z. Using molecular characteristics to distinguish multiple primary lung cancers and intrapulmonary metastases. PeerJ 2024; 12:e16808. [PMID: 38313018 PMCID: PMC10838092 DOI: 10.7717/peerj.16808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024] Open
Abstract
Objectives Multiple lung cancers may present as multiple primary lung cancers (MPLC) or intrapulmonary metastasis (IPM) with variations in clinical stage, treatment, and prognosis. However, the existing differentiation criteria based on histology do not fully meet the clinical needs. Next-generation sequencing (NGS) may play an important role in assisting the identification of different pathologies. Here, we extended the relevant data by combining histology and NGS to develop detailed identification criteria for MPLC and IPM. Materials and Methods Patients with lung cancer (each patient had ≥2 tumors) were enrolled in the training (n = 22) and validation (n = 13) cohorts. Genomic profiles obtained from 450-gene-targeted NGS were analyzed, and the new criteria were developed based on our findings and pre-existing Martini & Melamed criteria and molecular benchmarks. Results The analysis of the training cohort indicated that patients identified with MPLC had no (or <2) trunk or shared mutations. However, 98.02% of mutations were branch mutations, and 69.23% of MPLC had no common mutations. In contrast, a higher percentage of trunk (33.08%) or shared (9.02%) mutations were identified in IPM, suggesting significant differences among mutated components. Subsequently, eight MPLC and five IPM cases were identified in the validation cohort, aligning with the independent imaging and pathologic distinction. Overall, the percentage of trunk and shared mutations was higher in patients with IPM than in patients with MPLC. Based on these results and the establishment of new determination criteria for MPLC and IPM, we emphasize that the type and number of shared variants based on histologic consistency assist in identification. Conclusion Determining genetic alterations may be an effective method for differentiating MPLC and IPM, and NGS can be used as a valuable assisting tool.
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Affiliation(s)
- Zhenhua Li
- Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huilai Lv
- Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fan Zhang
- Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ziming Zhu
- Department of Thoracic Surgery, The First Hospital of Xingtai, Xingtai, China
| | - Qiang Guo
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Mingbo Wang
- Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chao Huang
- Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | | | | | - Ziqiang Tian
- Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Wang Z, Yuan X, Jiang G, Li Y, Yang F, Wang J, Chen K. Towards the molecular era of discriminating multiple lung cancers. EBioMedicine 2023; 90:104508. [PMID: 36958271 PMCID: PMC10040518 DOI: 10.1016/j.ebiom.2023.104508] [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: 10/22/2022] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/25/2023] Open
Abstract
In the era of histopathology-based diagnosis, the discrimination between multiple lung cancers (MLCs) poses significant uncertainties and has thus become a clinical dilemma. However, recent significant advances and increased application of molecular technologies in clonal relatedness assessment have led to more precision in distinguishing between multiple primary lung cancers (MPLCs) and intrapulmonary metastasis (IPMs). This review summarizes recent advances in the molecular identification of MLCs and compares various methods based on somatic mutations, chromosome alterations, microRNAs, and tumor microenvironment markers. The paper also discusses current challenges at the forefront of genomics-based discrimination, including the selection of detection technology, application of next-generation sequencing, and intratumoral heterogeneity (ITH). In summary, this paper highlights an entrance into the primary stage of molecule-based diagnostics.
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Affiliation(s)
- Ziyang Wang
- Thoracic Oncology Institute and Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Xiaoqiu Yuan
- Peking University Health Science Center, Beijing, 100191, China
| | - Guanchao Jiang
- Thoracic Oncology Institute and Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Yun Li
- Thoracic Oncology Institute and Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Fan Yang
- Thoracic Oncology Institute and Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Jun Wang
- Thoracic Oncology Institute and Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Kezhong Chen
- Thoracic Oncology Institute and Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, China.
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Ezer N, Wang H, Corredor AG, Fiset PO, Baig A, van Kempen LC, Chong G, Issac MSM, Fraser R, Spatz A, Riviere JB, Broët P, Spicer J, Camilleri-Broët S. Integrating NGS-derived mutational profiling in the diagnosis of multiple lung adenocarcinomas. Cancer Treat Res Commun 2021; 29:100484. [PMID: 34773797 DOI: 10.1016/j.ctarc.2021.100484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022]
Abstract
MICROABSTRACT Integration of Next Generation Sequencing (NGS) information for use in distinguishing between Multiple Primary Lung Cancer and intrapulmonary metastasis was evaluated. We used a probabilistic model, comprehensive histologic assessment and NGS to classify patients. Integrating NGS data confirmed initial diagnosis (n = 41), revised the diagnosis (n = 12), while resulted in non-informative data (n = 8). Accuracy of diagnosis can be significantly improved with integration of NGS data. BACKGROUND Distinguishing between multiple primary lung cancers (MPLC) and intrapulmonary metastases (IPM) is challenging. The goal of this study was to evaluate how Next Generation Sequencing (NGS) information may be integrated in the diagnostic strategy. PATIENTS AND METHODS Patients with multiple lung adenocarcinomas were classified using both the comprehensive histologic assessment and NGS. We computed the joint probability of each pair having independent mutations by chance (thus being classified as MPLC). These probabilities were computed using the marginal mutation rates of each mutation, and the known negative dependencies between driver genes and different gene loci. With these NGS-driven data, cases were re-classified as MPLC or IPM. RESULTS We analyzed 61 patients with a total of 131 tumors. The most frequent mutation was KRAS (57.3%) which occured at a rate higher than expected (p < 0.001) in lung cancer. No mutation was detected in 25/131 tumors (19.1%). Discordant molecular findings between tumor sites were found in 46 patients (75.4%); 11 patients (18.0%) had concordant molecular findings, and 4 patients (6.6%) had concordant molecular findings at 2 of the 3 sites. After integration of the NGS data, the initial diagnosis was confirmed for 41 patients (67.2%), the diagnosis was revised for 12 patients (19.7%) or was considered as non-informative for 8 patients (13.1%). CONCLUSION Integrating the information of NGS data may significantly improve accuracy of diagnosis and staging.
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Affiliation(s)
- Nicole Ezer
- Department of Medicine, Division of Respirology, McGill University Health Center, 1001 Decarie Blvd., Montreal, QC, Canada; Centre for Outcomes Research and Evaluation - Research Institute of the McGill University Health Center, Montreal, 1001 Decarie Blvd., QC, Canada
| | - Hangjun Wang
- Division of Pathology, McGill University Health Center, 1001 Decarie Blvd., Montreal, QC, Canada; OPTILAB-MUHC & Department of Laboratory Medicine, 1001 Decarie Blvd., Montreal, QC, Canada; Research Molecular Pathology Center, Lady Davis Institute, 3755 Côte Ste-Catherine Road, Montreal, QC, Canada
| | - Andrea Gomez Corredor
- OPTILAB-MUHC & Department of Laboratory Medicine, 1001 Decarie Blvd., Montreal, QC, Canada; Division of Molecular Genetics, McGill University Health Center, 1001 Decarie Blvd., Montreal, QC, Canada
| | - Pierre Olivier Fiset
- Division of Pathology, McGill University Health Center, 1001 Decarie Blvd., Montreal, QC, Canada; OPTILAB-MUHC & Department of Laboratory Medicine, 1001 Decarie Blvd., Montreal, QC, Canada
| | - Ayesha Baig
- Division of Pathology, McGill University Health Center, 1001 Decarie Blvd., Montreal, QC, Canada; OPTILAB-MUHC & Department of Laboratory Medicine, 1001 Decarie Blvd., Montreal, QC, Canada
| | - Léon C van Kempen
- OPTILAB-MUHC & Department of Laboratory Medicine, 1001 Decarie Blvd., Montreal, QC, Canada; Division of Molecular Genetics, McGill University Health Center, 1001 Decarie Blvd., Montreal, QC, Canada; University Medical Center of Groningen, PO box 30.001, 9700 RB, Groningen, Netherlands
| | - George Chong
- OPTILAB-MUHC & Department of Laboratory Medicine, 1001 Decarie Blvd., Montreal, QC, Canada; Division of Molecular Genetics, McGill University Health Center, 1001 Decarie Blvd., Montreal, QC, Canada
| | - Marianne S M Issac
- Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada; Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, El Saray St., El Manial, Postal Code 11956, Cairo, Egypt
| | - Richard Fraser
- Division of Pathology, McGill University Health Center, 1001 Decarie Blvd., Montreal, QC, Canada; OPTILAB-MUHC & Department of Laboratory Medicine, 1001 Decarie Blvd., Montreal, QC, Canada
| | - Alan Spatz
- Division of Pathology, McGill University Health Center, 1001 Decarie Blvd., Montreal, QC, Canada; OPTILAB-MUHC & Department of Laboratory Medicine, 1001 Decarie Blvd., Montreal, QC, Canada; Research Molecular Pathology Center, Lady Davis Institute, 3755 Côte Ste-Catherine Road, Montreal, QC, Canada
| | - Jean-Baptiste Riviere
- OPTILAB-MUHC & Department of Laboratory Medicine, 1001 Decarie Blvd., Montreal, QC, Canada; Division of Molecular Genetics, McGill University Health Center, 1001 Decarie Blvd., Montreal, QC, Canada
| | - Philippe Broët
- UMR 1018, INSERM, CESP, Paris-Saclay University, Faculty of Medicine, Paul-Brousse Hospital AP-AP, Villejuif, France; Research Center, CHU Ste-Justine, University of Montreal, 3175 Côte-Sainte-Catherine Road, H3T 1C5, Montreal, QC, Canada
| | - Jonathan Spicer
- Division of Thoracic and Upper GI Surgery, McGill University Health Center, 1650 Cedar Avenue Montreal, H3G 1A4, Montreal, QC, Canada
| | - Sophie Camilleri-Broët
- Division of Pathology, McGill University Health Center, 1001 Decarie Blvd., Montreal, QC, Canada; OPTILAB-MUHC & Department of Laboratory Medicine, 1001 Decarie Blvd., Montreal, QC, Canada.
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