How close are we to customizing chemotherapy in early non-small cell lung cancer?

[Effect of Adjuvant Chemotherapy on DFS for Patients with Stage I NSCLC]

背景与目的

手术是早期肺癌的首选治疗方法，但早期肺癌术后的预后仍有很大差异，术后是否应用辅助化疗也有争议。本研究探讨术后辅助化疗在Ⅰ期非小细胞肺癌患者中的作用，尤其是在高危人群中的作用。

方法

选择北京大学人民医院2009年1月-2013年6月接受手术的Ⅰa期、Ⅰb期肺癌患者，分别以是否行术后化疗分为两组，用Kaplan-Meier法进行生存分析，比较两组术后无瘤生存时间（disease-free survival, DFS）的差异；并按危险因素个数进行评分，分为0分、1分、≥2分三组，比较三组术后DFS的差异；单独比较术后化疗对≥2分的高危组患者的作用。

结果

经过筛选后共有465例患者纳入研究，Ⅰa期284例，Ⅰb期181例。Ⅰa期化疗组和对照组术后DFS并无明显差异（P=0.171），但化疗组生存曲线位于对照组下方，Ⅰb期两组术后DFS也无明显差异（P=0.630）。危险因素评分后的三组患者DFS有明显差异（P < 0.001），危险因素越多，术后DFS越差，可看作是高危患者。但单独分析显示，术后化疗与否对这部分高危患者的DFS并无显著影响（P=0.763）。

结论

术后化疗对早期非小细胞肺癌的DFS并无积极作用，即使是对于具有多个高危因素的Ⅰ期非小细胞肺癌患者，术后化疗也许也不适用。

Fusion of Quantitative Image and Genomic Biomarkers to Improve Prognosis Assessment of Early Stage Lung Cancer Patients

OBJECTIVE

This study aims to develop a new quantitative image feature analysis scheme and investigate its role along with two genomic biomarkers, namely protein expression of the excision repair cross-complementing 1 genes and a regulatory subunit of ribonucleotide reductase (RRM1), in predicting cancer recurrence risk of stage I nonsmall-cell lung cancer (NSCLC) patients after surgery.

METHODS

By using chest computed tomography images, we developed a computer-aided detection scheme to segment lung tumors and computed tumor-related image features. After feature selection, we trained a Naïve Bayesian network-based classifier using eight image features and a multilayer perceptron classifier using two genomic biomarkers to predict cancer recurrence risk, respectively. Two classifiers were trained and tested using a dataset with 79 stage I NSCLC cases, a synthetic minority oversampling technique and a leave-one-case-out validation method. A fusion method was also applied to combine prediction scores of two classifiers.

RESULTS

Areas under ROC curves (AUC) values are 0.78 ± 0.06 and 0.68 ± 0.07 when using the image feature and genomic biomarker-based classifiers, respectively. AUC value significantly increased to 0.84 ± 0.05 ( ) when fusion of two classifier-generated prediction scores using an equal weighting factor.

CONCLUSION

A quantitative image feature-based classifier yielded significantly higher discriminatory power than a genomic biomarker-based classifier in predicting cancer recurrence risk. Fusion of prediction scores generated by the two classifiers further improved prediction performance.

SIGNIFICANCE

We demonstrated a new approach that has potential to assist clinicians in more effectively managing stage I NSCLC patients to reduce cancer recurrence risk.

Predictive and prognostic effect of CD133 and cancer-testis antigens in stage Ib-IIIA non-small cell lung cancer

CD133 and cancer-testis antigens (CTAs) may be potential predicted markers of adjuvant chemotherapy or immune therapy, and they may be the independent prognostic factor of NSCLC. Nowadays, there is still no predictive biomarker identified for the use of adjuvant chemotherapy in non-small cell lung cancer (NSCLC) patients. To clarify the role of CD133 and CTAs as a predictive marker for adjuvant chemotherapy or prognostic factors of overall survival, we performed a retrospective study in 159 stage Ib-IIIA NSCLC patients receiving adjuvant chemotherapy or observe from April 2003 to March 2004 in our institute. Clinical data and gene anaylisis results were collected, while CD133 and three CTAs (MAGE-A4, NY-ESO-1, MAGE-A10) were determined according to their monoclonal antibodies such as CD133, 57B, D8.38 and 3GA11 by immunohistochemistry. All CTAs were more frequently expressed in squamous cell carcinoma (SCC) (50.0%, 26.9%, 34.6%) than in adenocarcinoma (16.2%, 16.2%, 16.2%). CD133 was more frequently found in patients with adenocarcinoma (P=0.044). Negative expression of CD133 was associated with a significantly longer overall survival compared to positive expression of CD133 (62.5 vs. 48.5 months, P=0.035). When combined with MAGEA4, NY-ESO-1or MAGE-A10, patients' OS showed significantly difference among different combination. (CD133-MAGEA4-/CD133-MAGEA4+/CD133+MAGEA4-/CD133+MAGEA4+: 65.6 months vs.51.5 months vs.32.2 months vs.19.8 months, P=0.000, CD133-NY-ESO-1-/ CD133+NY-ESO-1-/CD133-NY-ESO-1+/ CD133+NY-ESO-1+: 57.8 months vs. 55.7 months vs. 44.6 months vs. 28.5 months, P=0.000, CD133-MAGEA10-/CD133+ MAGEA10-/CD133-MAGEA10-/CD133+MAGEA10+: 66.2 months vs. 57.2 months vs. 48.8 months vs. 41.4 months, P=0.001). There is no difference between patients received adjuvant chemotherapy or not, but subgroup analysis showed that the patients with CD133+NY-ESO-1+ expression who received chemotherapy will survive longer than not receive adjuvant chemotherapy (received vs. not received, 52.1 vs. 27.1 months, P=0.020). In the subgroup with EGFR mutation/ALK translocation/Ros1 translocation/Ret fusion, the trend remained but without a statistically significant difference. Multivariate COX regression analysis showed that stage, CD133, CD133-MAGEA4- and CD133-NY-ESO-1- are independent prognostic factors. In conclusion, CTAs (MAGE-A4, NY-ESO-1, MAGE-A10) were more likely expressed in patients with squamous cell carcinoma and when CTAs combined with CD133, they can be better prognostic factors. Patients with CD133+NY-ESO-1+ expression may survive longer when treated with adjuvant chemotherapy, which indicates that the CD133 and CTAs might be a potential marker to guide adjuvant chemotherapy in this population.

[High risk indication of postoperative chemotherapy in early stage non-small cell lung cancer]

背景与目的

Ⅰb期肺癌患者术后2年内转移和复发率超过35%，预后仍较差，而该期患者术后是否需要辅助化疗依然存在争议。本探索研究影响早期非小细胞肺癌手术预后的相关临床病理学因素，探讨术后辅助化疗的高风险指征。

方法

281例接受完全性切除的Ⅰb期非小细胞肺癌患者，依据Cox回归模型进行预后多因素分析，采用Kaplan-Meier方法进行生存分析。

结果

单因素分析显示：①存在淋巴管或血管内癌栓、低分化肿瘤、肿瘤位于中下叶者预后较差（P < 0.05）；②患者的年龄、性别、病理类型、肿瘤侵犯胸膜、术后辅助化疗与术后生存无明显关系（P > 0.05）。多因素分析显示：血管内癌栓和肿瘤低分化是影响患者生存率的主要因素。

结论

Ⅰb期非小细胞肺癌患者肿瘤细胞分化程度及脉管内癌栓是影响手术预后及生存率的重要因素，低分化肿瘤和脉管癌栓可作为术后辅助化疗的指征之一。

Matrine induction of reactive oxygen species activates p38 leading to caspase-dependent cell apoptosis in non-small cell lung cancer cells

Non-small cell lung carcinoma (NSCLC) is one of the most refractory cancers in the clinic; it is insensitive to chemotherapy and is usually excised. However, screening natural compounds from herbs is also considered a possible method for its therapy. In the present study, we investigated whether matrine, a natural compound isolated from Sophora flavescens Ait. and exerting an inhibitory effect on lung cancer cells, also indicates inhibition on NSCLC cells and elucidated its molecular mechanism. Firstly, it is confirmed that matrine induces apoptosis of human NSCLC cells with anti-apoptotic factors inhibited and dependent on caspase activity. In addition, we found that matrine increases the phosphorylation of p38 but not its total protein, and inhibition of the p38 pathway with SB202190 partially prevents matrine-induced apoptosis. Furthermore, matrine generates reactive oxygen species (ROS) in a dose- and time-dependent manner, which is reversed by pretreatment with N-acetyl-L-cysteine (NAC). Additionally, inhibition of cell proliferation and increase of phosphorylation of p38 was also partially reversed by NAC. Collectively, matrine activates p38 pathway leading to a caspase-dependent apoptosis by inducing generation of ROS in NSCLC cells and may be a potential chemical for NSCLC.

Prognostic significance of MCM7 expression in the bronchial brushings of patients with non-small cell lung cancer (NSCLC)

PURPOSE

To identify potential biomarkers for the prognosis of non-small cell lung cancer (NSCLC) patients by using bronchial brushing specimens.

METHODS

The expression of MCM7, Ki67 and EGFR was evaluated in 494 NSCLC tissues and 174 bronchial brushings using immunohistochemical and immunocytochemical techniques. Associations between protein expression and clinico-pathologic parameters were assessed, and the impact on overall survival (OS) was analyzed.

RESULTS

High expression of MCM7, Ki67 and EGFR was detected in 33.3%, 23.5% and 12.7% of tissues and in 52.4%, 52.7% and 20.6% of bronchial brushings, respectively. Expression of MCM7 and Ki67 was associated with squamous cell carcinoma (SCC) in both tissues and bronchial brushings (MCM7: P = 0.0007, 0.00003; Ki67: P < 0.00001, 0.00001). Overexpression of MCM7 in tumor tissues was detected more frequently in poorly differentiated tumors (P = 0.0120) and non-bronchioloalveolar carcinomas (non-BACs) (P = 0.0238). EGFR overexpression was observed in tissues of larger tumors (P = 0.00004) and in bronchial brushings at later stage (P = 0.0262). Kaplan-Meier curves indicated that patients with overexpression of MCM7 or Ki67 had a poorer OS compared to those with low expression for all stages (P < 0.00001, 0.0233) and early-stages (P < 0.00001, 0.0032). In particular, the patients with MCM7 overexpression in bronchial brushings had a poorer prognosis (P = 0.0045). Multivariate Cox regression analysis showed that MCM7 was an independent prognostic indicator both in tissue samples and bronchial brushings.

CONCLUSIONS

Our data suggest that MCM7 and Ki67 in tumor tissues may be potential markers of a poor prognosis for NSCLC patients. MCM7 in bronchial brushings also showed an independent prognostic value, which may be useful when biopsies are unavailable.

Prohibitin in squamous cell carcinoma of the lung: its expression and possible clinical significance

rohibitin is localized to mitochondria where it might have a role in the maintenance of mitochondrial function and protection against senescence. In this study, we show that prohibitin is up-regulated in lung squamous cell carcinoma tissues compared with adjacent normal tissues using agarose 2-dimensional differential gel electrophoresis and immunoblotting. Prohibitin expression was further evaluated by immunohistochemistry. We statistically analyzed the association of prohibitin expression with clinicopathologic indicators in 78 patients with lung squamous cell carcinoma. Our data suggested that prohibitin expression was positively correlated with the International Union Against Cancer (UICC) classification of tumor grade (P < .001), pathologic stage (P < .001), tumor size (P = .01), and lymph node metastasis (P = .004). Furthermore, we found that prohibitin expression was an independent prognostic indicator (P = .037) for overall survival of patients with lung squamous cell carcinoma by multivariate analysis using the Cox regression method. These findings may encourage further studies investigating prohibitin function in lung squamous cell carcinoma.