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Jiang M, Guo X, Chen P, Zhang X, Gao Q, Zhang J, Zheng J. Prognostic significance of integrating total metabolic tumor volume and EGFR mutation status in patients with lung adenocarcinoma. PeerJ 2024; 12:e16807. [PMID: 38250731 PMCID: PMC10799611 DOI: 10.7717/peerj.16807] [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: 09/18/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Background The objective of this study was to investigate the prognostic significance of total metabolic tumor volume (TMTV) derived from baseline 18F-2-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), in conjunction with epidermal growth factor receptor (EGFR) mutation status, among patients with lung adenocarcinoma (LUAD). Methods We performed a retrospective analysis on 141 patients with LUAD (74 males, 67 females, median age 67 (range 34-86)) who underwent 18F-FDG PET/CT and had their EGFR mutation status determined. Optimal cutoff points for TMTV were determined using time-dependent receiver operating characteristic curve analysis. The survival difference was compared using Cox regression analysis and Kaplan‒Meier curves. Results The EGFR mutant patients (n = 79, 56.0%) exhibited significantly higher 2-year progression-free survival (PFS) and overall survival (OS) rates compared to those with EGFR wild-type (n = 62, 44.0%), with rates of 74.2% vs 69.2% (P = 0.029) and 86.1% vs 67.7% (P = 0.009), respectively. The optimal cutoff values of TMTV were 36.42 cm3 for PFS and 37.51 cm3 for OS. Patients with high TMTV exhibited significantly inferior 2-year PFS and OS, with rates of 22.4% and 38.1%, respectively, compared to those with low TMTV, who had rates of 85.8% and 95.0% (both P < 0.001). In both the EGFR mutant and wild-type groups, patients exhibiting high TMTV demonstrated significantly inferior 2-year PFS and OS compared to those with low TMTV. In multivariate analysis, EGFR mutation status (hazard ratio, HR, 0.41, 95% confidence interval, CI [0.18-0.94], P = 0.034) and TMTV (HR 8.08, 95% CI [2.34-28.0], P < 0.001) were independent prognostic factors of OS, whereas TMTV was also an independent prognosticator of PFS (HR 2.59, 95% CI [1.30-5.13], P = 0.007). Conclusion Our study demonstrates that the integration of TMTV on baseline 18F-FDG PET/CT with EGFR mutation status improves the accuracy of prognostic evaluation for patients with LUAD.
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Affiliation(s)
- Maoqing Jiang
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
- Department of Nuclear Medicine, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
| | - Xiuyu Guo
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
| | - Ping Chen
- Department of Nephrology, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
| | - Xiaohui Zhang
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
| | - Qiaoling Gao
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
| | - Jingfeng Zhang
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
| | - Jianjun Zheng
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
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Wankhede D, Bontoux C, Grover S, Hofman P. Prognostic Role of KRAS G12C Mutation in Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:3043. [PMID: 37835787 PMCID: PMC10572143 DOI: 10.3390/diagnostics13193043] [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: 08/17/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
KRAS G12C mutation (mKRAS G12C) is the most frequent KRAS point mutation in non-small cell lung cancer (NSCLC) and has been proven to be a predictive biomarker for direct KRAS G12C inhibitors in advanced solid cancers. We sought to determine the prognostic significance of mKRAS G12C in patients with NSCLC using the meta-analytic approach. A protocol is registered at the International Prospective Register for systematic reviews (CRD42022345868). PubMed, EMBASE, The Cochrane Library, and Clinicaltrials.gov.in were searched for prospective or retrospective studies reporting survival data for tumors with mKRAS G12C compared with either other KRAS mutations or wild-type KRAS (KRAS-WT). The hazard ratios (HRs) for overall survival (OS) or Disease-free survival (DFS) of tumors were pooled according to fixed or random-effects models. Sixteen studies enrolling 10,153 participants were included in the final analysis. mKRAS G12C tumors had poor OS [HR, 1.42; 95% CI, 1.10-1.84, p = 0.007] but similar DFS [HR 2.36, 95% CI 0.64-8.16] compared to KRAS-WT tumors. Compared to other KRAS mutations, mKRAS G12C tumors had poor DFS [HR, 1.49; 95% CI, 1.07-2.09, p < 0.0001] but similar OS [HR, 1.03; 95% CI, 0.84-1.26]. Compared to other KRAS mutations, high PD-L1 expression (>50%) [OR 1.37 95% CI 1.11-1.70, p = 0.004] was associated with mKRAS G12C tumors. mKRAS G12C is a promising prognostic factor for patients with NSCLC, negatively impacting survival. Prevailing significant heterogeneity and selection bias might reduce the validity of these findings. Concomitant high PD-L1 expression in these tumors opens doors for exciting therapeutic potential.
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Affiliation(s)
- Durgesh Wankhede
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Christophe Bontoux
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Centre Hospitalier, Université Côte d’Azur, 06002 Nice, France;
| | - Sandeep Grover
- Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, 72076 Tübingen, Germany;
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Centre Hospitalier, Université Côte d’Azur, 06002 Nice, France;
- Institute for Research on Cancer and Ageing, Nice (IRCAN), INSERM U1081 and UMR CNRS 7284, Team 4, 06107 Nice, France;
- Hospital-Integrated Biobank BB-0033-00025, Pasteur Hospital, 06000 Nice, France
- University Hospital Federation OncoAge, CHU de Nice, University Côte d’Azur, 06000 Nice, France
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Joshi J, Pandit A, Tarapara B, Patel H, Bhavnagari H, Panchal H, Shah FD. An association of epidermal growth factor receptor mutation subtypes with prognostic prediction and site-specific recurrence in advanced stage lung cancer patients. Mol Biol Rep 2023; 50:5105-5115. [PMID: 37099232 DOI: 10.1007/s11033-023-08432-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/05/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Concerning the different clinical behavior of epidermal growth factor receptor (EGFR) subtypes in advanced-stage lung cancer patients, the current study aimed to evaluate the clinical, pathological, and prognostic significance of EGFR mutation subtypes, and treatment response in patients with advanced-stage lung cancer. METHODS AND RESULTS A retrospective study enrolled a total of 346 patients with advanced-stage lung cancer tested for EGFR mutation. EGFR mutation was analyzed by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). Statistical analysis was performed using SPSS version 20.0. EGFR mutation was evident in 38% of patients with the highest prevalence of exon 19 deletions. A higher incidence of 19-deletions and 20-insertions were observed in young patients, while a higher incidence of L858R was noted in old age patients. Patients with de-novo T790M failed to improve their OS by any of the treatment modalities. Patients with de-novo T790M mutation have a higher risk of developing lung, liver, and multiple site metastases while patients with L858R mutation have a higher risk of developing brain metastasis. Additionally, patients with 19 deletion mutation did not improve their OS after receiving conventional chemotherapy hence, they demonstrate better survival only after EGFR-TKIs. Multivariate survival analysis predicted chemotherapy as an independent predictor of OS. CONCLUSION Besides clinicopathological and prognostic consequences of EGFR mutation and mutation subtypes, patients harboring TKI sensitive, or insensitive mutations reveal different secondary disease development and hence should be treated accordingly for better survival. Current findings may provide the basis for a better treatment strategy.
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Affiliation(s)
- Jigna Joshi
- Molecular Diagnostic and Research Lab-3, Department of Cancer Biology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, 380016, India
| | - Apexa Pandit
- Molecular Diagnostic and Research Lab-3, Department of Cancer Biology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, 380016, India
| | - Bhoomi Tarapara
- Molecular Diagnostic and Research Lab-3, Department of Cancer Biology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, 380016, India
| | - Hitarth Patel
- Molecular Diagnostic and Research Lab-3, Department of Cancer Biology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, 380016, India
| | - Hunayna Bhavnagari
- Molecular Diagnostic and Research Lab-3, Department of Cancer Biology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, 380016, India
| | - Harsha Panchal
- Department of Medical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Franky D Shah
- Molecular Diagnostic and Research Lab-3, Department of Cancer Biology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, 380016, India.
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Gallina FT, Bertolaccini L, Forcella D, Mohamed S, Ceddia S, Melis E, Fusco F, Bardoni C, Marinelli D, Buglioni S, Visca P, Cappuzzo F, Spaggiari L, Facciolo F. Analysis of Molecular Biomarkers in Resected Early-Stage Non-Small Cells Lung Cancer: A Narrative Review. Cancers (Basel) 2022; 14:cancers14081949. [PMID: 35454856 PMCID: PMC9024905 DOI: 10.3390/cancers14081949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary In the last few years, the treatment of advanced NSCLC has radically changed after the development of new drugs against specific molecular targets. Moreover, multiple tumour biopsies have become mandatory in order to better select the appropriate targeted therapy. Molecular analysis using NGS in the early stage of NSCLC is still relatively widespread. The recent clinical trials that use targeted therapies in neoadjuvant and adjuvant settings also require molecular characterisation for early-stage patients. Due to the widespread use of molecular analysis in patients with early-stage NSCLC, the prognostic role of molecular biomarkers needs to be fully understood. This paper aimed to review the most recent studies associating the molecular expressions of early-stage NSCLC with survival. Abstract Next-generation sequencing has become a cornerstone in clinical oncology practice and is recommended for the appropriate use of tailored therapies in NSCLC. While NGS has already been standardised in advanced-stage NSCLC, its use is still uncommon in the early stages. The recent approval of Osimertinib for resected EGFR-mutated NSCLC in an adjuvant setting has launched the hypothesis that other targeted therapies used in metastatic patients can also lead to improved early-stage outcomes of NSCLC. The impact of molecular biomarkers on the prognosis of patients undergoing radical surgery for NSCLC is still unclear. Notably, the heterogeneous populations included in the studies that analysed surgical patients could be the main reason for these results. In this review, we report the most important studies that analysed the impact of principal molecular biomarkers on the survival outcomes of patients who underwent radical surgery for NSCLC.
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Affiliation(s)
- Filippo Tommaso Gallina
- Thoracic Surgery Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (D.F.); (E.M.); (F.F.)
- Correspondence: ; Tel.: +39-06-5266-5832; Fax: +39-06-5266-6993
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20100 Milan, Italy; (L.B.); (S.M.); (C.B.); (L.S.)
| | - Daniele Forcella
- Thoracic Surgery Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (D.F.); (E.M.); (F.F.)
| | - Shehab Mohamed
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20100 Milan, Italy; (L.B.); (S.M.); (C.B.); (L.S.)
| | - Serena Ceddia
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (S.C.); (F.F.); (F.C.)
| | - Enrico Melis
- Thoracic Surgery Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (D.F.); (E.M.); (F.F.)
| | - Francesca Fusco
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (S.C.); (F.F.); (F.C.)
| | - Claudia Bardoni
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20100 Milan, Italy; (L.B.); (S.M.); (C.B.); (L.S.)
| | - Daniele Marinelli
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy;
| | - Simonetta Buglioni
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (S.B.); (P.V.)
| | - Paolo Visca
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (S.B.); (P.V.)
| | - Federico Cappuzzo
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (S.C.); (F.F.); (F.C.)
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20100 Milan, Italy; (L.B.); (S.M.); (C.B.); (L.S.)
| | - Francesco Facciolo
- Thoracic Surgery Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (D.F.); (E.M.); (F.F.)
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Yang XN, Yan HH, Wang J, Chu XY, Liu ZD, Shen Y, Ma HT, Fu XN, Hu J, Zhou NK, Liu YY, Zhou XM, Li JS, Yang K, Li J, Xu L, Wang SY, Wang Q, Liu LX, Xu S, Chen ZY, Lou HH, Wang CL, Cheng Y, Liu SY, Zhang XC, Zhong WZ, Wu YL. Real-World Survival Outcomes Based on EGFR Mutation Status in Chinese Patients With Lung Adenocarcinoma After Complete Resection: Results From the ICAN Study. JTO Clin Res Rep 2022; 3:100257. [PMID: 34977823 PMCID: PMC8683612 DOI: 10.1016/j.jtocrr.2021.100257] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction The adjuvant treatment of patients with resected lung adenocarcinoma (LUAD) remains unstandardized. We analyzed the survival outcomes of these patients based on EGFR mutation status and adjuvant chemotherapy treatment. Methods This noninterventional real-world study (ICAN) enrolled Chinese patients with resected stages I to III LUAD from April 8, 2010, to December 31, 2010. Tumor EGFR mutation status and 3-year disease-free survival (DFS) were determined. The extension phase provided long-term follow-up with overall survival (OS) as the primary end point. Secondary end points included DFS and prognostic factors of survival. Survival outcomes based on adjuvant chemotherapy treatment, EGFR mutation status, and postoperative stage were analyzed post hoc. Results Among 568 patients in the ICAN cohort, 472 continued to the extension phase and remained eligible. The 3-year DFS rate was 58.8%. In the extension cohort, 260 patients (55.1%) had EGFR-mutant disease and 207 (43.9%) received adjuvant chemotherapy. At a median follow-up of 109.0 (95% confidence interval [CI]: 106.6–111.4) months, median OS and DFS were 103.3 (95% CI: 101.7–104.9) and 67.4 (95% CI: 49.7–85.2) months, respectively. The 5-year OS and DFS rates were 68.9% (95% CI: 64.3–73.6) and 52.9% (95% CI: 48.2–57.7), respectively. EGFR wild-type disease was a significant independent predictor of worse OS (HR = 1.24, 95% CI: 1.07–1.44, p= 0.004) based on the Cox regression analysis of common factors. Post hoc subgroup analysis revealed that survival outcomes were not significantly different with adjuvant chemotherapy regardless of EGFR mutation status across all postoperative stages. Conclusions EGFR mutations are common in operable LUAD, and recurrence and mortality after resection were considerable. Adjuvant chemotherapy did not improve survival outcomes, regardless of EGFR mutation status and postoperative stage.
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Affiliation(s)
- Xue-Ning Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Hong-Hong Yan
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Jun Wang
- Thoracic Surgery Department, Peking University People's Hospital, Beijing, People's Republic of China
| | - Xiang-Yang Chu
- Thoracic Surgery Department, 301 Hospital, Beijing, People's Republic of China
| | - Zhi-Dong Liu
- Thoracic Surgery Department II, Beijing Chest Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yi Shen
- Thoracic Surgery Department, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, People's Republic of China
| | - Hai-Tao Ma
- Thoracic Surgery Department, the First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Xiang-Ning Fu
- Thoracic Surgery Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jian Hu
- Thoracic Surgery Department, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, People's Republic of China
| | - Nai-Kang Zhou
- Thoracic Surgery Department, 309 Hospital, Beijing, People's Republic of China
| | - Yong-Yu Liu
- Thoracic Surgery Department, Liaoning Cancer Hospital & Institute, Shenyang, People's Republic of China
| | - Xin-Ming Zhou
- Thoracic Surgery Department, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Jing-Song Li
- Thoracic Surgery Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Kang Yang
- Thoracic Surgery Department, The First Affiliated Hospital of Third Military Medical University, Chongqing, People's Republic of China
| | - Jian Li
- Thoracic Surgery Department, Peking University First Hospital, Beijing, People's Republic of China
| | - Lin Xu
- Thoracic Surgery Department, Jiangsu Cancer Hospital, Nanjing, People's Republic of China
| | - Si-Yu Wang
- Thoracic Surgery Department, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Qun Wang
- Thoracic Surgery Department, Zhongshan Hospital Fudan University, Shanghai, People's Republic of China
| | - Lun-Xu Liu
- Thoracic Surgery Department, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Shun Xu
- Thoracic Surgery Department, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Zhong-Yuan Chen
- Thoracic Surgery Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Hong-He Lou
- Thoracic Surgery Department, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Chang-Li Wang
- Lung Cancer Center, Tianjin Medical University Cancer Institute & Hospital, Tianjin, People's Republic of China
| | - Ying Cheng
- Medical Oncology, Jilin Cancer Hospital, Changchun, People's Republic of China
| | - Si-Yang Liu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Xu-Chao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
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Kondo Y, Ichinose J, Ninomiya H, Hashimoto K, Matsuura Y, Nakao M, Ishikawa Y, Okumura S, Satoh Y, Mun M. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6546235. [PMID: 35266536 PMCID: PMC9297517 DOI: 10.1093/icvts/ivac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/19/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Yasuto Kondo
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Junji Ichinose
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
- Corresponding author. Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan. Tel: +81-3-3520-0111; e-mail: (J. Ichinose)
| | - Hironori Ninomiya
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kohei Hashimoto
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuichi Ishikawa
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Pathology, Mita Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukitoshi Satoh
- Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Wang Y, Lin X, Sun D. A narrative review of prognosis prediction models for non-small cell lung cancer: what kind of predictors should be selected and how to improve models? ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1597. [PMID: 34790803 PMCID: PMC8576716 DOI: 10.21037/atm-21-4733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/02/2021] [Indexed: 12/18/2022]
Abstract
Objective To discover potential predictors and explore how to build better models by summarizing the existing prognostic prediction models of non-small cell lung cancer (NSCLC). Background Research on clinical prediction models of NSCLC has experienced explosive growth in recent years. As more predictors of prognosis are discovered, the choice of predictors to build models is particularly important, and in the background of more applications of next-generation sequencing technology, gene-related predictors are widely used. As it is more convenient to obtain samples and follow-up data, the prognostic model is preferred by researchers. Methods PubMed and the Cochrane Library were searched using the items “NSCLC”, “prognostic model”, “prognosis prediction”, and “survival prediction” from 1 January 1980 to 5 May 2021. Reference lists from articles were reviewed and relevant articles were identified. Conclusions The performance of gene-related models has not obviously improved. Relative to the innovation and diversity of predictors, it is more important to establish a highly stable model that is convenient for clinical application. Most of the prevalent models are highly biased and referring to PROBAST at the beginning of the study may be able to significantly control the bias. Existing models should be validated in a large external dataset to make a meaningful comparison.
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Affiliation(s)
- Yuhang Wang
- Graduate School, Tianjin Medical University, Tianjin, China
| | | | - Daqiang Sun
- Graduate School, Tianjin Medical University, Tianjin, China.,Department of Thoracic Surgery, Tianjin Chest Hospital of Nankai University, Tianjin, China
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Isaka T, Ito H, Nakayama H, Yokose T, Saito H, Adachi H, Miura J, Shigefuku S, Kikuchi A, Rino Y. Effect of epidermal growth factor receptor gene mutation on the prognosis of pathological stage II-IIIA (8th edition TNM classification) primary lung cancer after curative surgery. Lung Cancer 2021; 162:128-134. [PMID: 34775216 DOI: 10.1016/j.lungcan.2021.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/21/2021] [Accepted: 11/03/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This retrospective study aimed to elucidate the effect of epidermal growth factor receptor (EGFR) gene mutations on the prognosis of patients with pathological stage II-IIIA primary lung cancer after curative surgery. MATERIALS AND METHODS We enrolled 539 patients with p-stage II-IIIA (8th edition tumor-node-metastasis [TNM] classification) lung cancer who underwent curative resection at Kanagawa Cancer Center between January 2010 and December 2020 and whose tumors were tested for EGFR mutations. Relapse-free survival (RFS) and overall survival (OS) of patients with EGFR-mutant lung cancer (Mt, n = 126) including EGFR exon 21 L858R point mutation and EGFR exon 19 deletion mutation and EGFR mutation-wild lung cancer (Wt, n = 413) were analyzed using Kaplan-Meier curves and compared using a log-rank test. Cox regression analysis was performed to evaluate the effects of EGFR gene mutations on RFS and OS at each stage. RESULTS There were 56/256 patients with p-stage II EGFR-Mt/Wt and 70/157 patients with p-stage IIIA EGFR-Mt/Wt. The 5-year RFS rate of patients with EGFR-Mt/Wt was 46.6%/52.0% (p = 0.787) for p-stage II and 17.4%/29.7% (p = 0.929) for p-stage IIIA. The 5-year OS rate was 92.0%/65.7% (p = 0.001) for p-stage II and 56.0%/39.3% (p = 0.016) for p-stage IIIA. EGFR-Mt was not an independent prognostic factor for OS of patients with p-stage IIIA lung cancer (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.51-1.76; p = 0.872); however, EGFR-Mt was an independent favorable prognostic factor for OS of patients with p-stage II lung cancer (HR, 0.59; 95% CI, 0.36-0.96; p = 0.034). CONCLUSION The OS of lung cancer patients with p-stage II or IIIA, classified according to the 8th edition TNM classification, was remarkably favorable. Incorporating EGFR mutations to the anatomical TNM classification may lead to a more accurate prognosis prediction.
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Affiliation(s)
- Tetsuya Isaka
- Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan; Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan
| | - Haruhiro Saito
- Department of Thoracic Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan
| | - Hiroyuki Adachi
- Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan
| | - Jun Miura
- Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan
| | - Shunsuke Shigefuku
- Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan
| | - Akitomo Kikuchi
- Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan
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9
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Hattori A, Matsunaga T, Fukui M, Takamochi K, Suzuki K. Prognosis of epidermal growth factor receptor-mutated stage I lung adenocarcinoma with radiologically solid features. Eur J Cardiothorac Surg 2021; 61:769-777. [PMID: 34791156 DOI: 10.1093/ejcts/ezab481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/17/2021] [Accepted: 08/28/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES The prognostic role of the epidermal growth factor receptor (EGFR) mutation remains controversial, especially in early-stage lung adenocarcinoma with a solid appearance. We evaluated the oncological outcomes of clinical stage I (c-stage I) radiologically invasive lung adenocarcinoma by EGFR mutation status. METHODS Between 2008 and 2013, the data from 463 surgically resected c-stage I radiologically invasive, i.e. solid-dominant lung adenocarcinomas subjected to EGFR mutant analysis, were evaluated. Oncological outcomes were assessed using multivariable Cox regression analysis. Recurrence-free survival (RFS) was estimated using Kaplan-Meier analysis and the log-rank test. RESULTS A total of 229 (49%) samples harboured the EGFR-mutant adenocarcinoma. Overall, the 5-year RFS did not differ significantly between the EGFR-mutant and EGFR wild-type groups (67.3% vs 64.9%; P = 0.639). However, among the clinical T1c/T2a tumour subset (n = 177), a multivariable Cox hazard model revealed that radiologically pure-solid tumour (P = 0.024), EGFR-mutant (P = 0.027) and pathological stage II/III (P < 0.001) were significant predictors of a poor RFS. Furthermore, in the c-T1c/T2a radiologically pure-solid lung adenocarcinoma subset, the EGFR-mutant group showed marginally lower 5-year RFS compared to that with the EGFR wild-type group (n = 134; 34.9% vs 53.0%; P = 0.062). Among them, multivariable Cox regression analysis revealed that EGFR mutant (P = 0.037) and pathological stage II/III (P = 0.011) were independently and significantly prognostic for worse RFS. CONCLUSIONS Among the c-stage I radiologically invasive lung adenocarcinomas, the EGFR mutation-positive type was correlated with an increased risk of recurrence in the c-T1c/T2a radiologically pure-solid tumour subset. When considering the prognostic value of EGFR mutations in early-stage lung adenocarcinoma, it is necessary to stratify them based on the presence of a ground-glass opacity component.
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Affiliation(s)
- Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Mariko Fukui
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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10
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Saw SPL, Zhou S, Chen J, Lai G, Ang MK, Chua K, Kanesvaran R, Ng QS, Jain A, Tan WL, Rajasekaran T, Lim DWT, Tan A, Fong KW, Takano A, Cheng XM, Lim KH, Koh T, Ong BH, Tan EH, Toh CK, Skanderup AJ, Tan SH, Tan DSW. Association of Clinicopathologic and Molecular Tumor Features With Recurrence in Resected Early-Stage Epidermal Growth Factor Receptor-Positive Non-Small Cell Lung Cancer. JAMA Netw Open 2021; 4:e2131892. [PMID: 34739062 PMCID: PMC8571655 DOI: 10.1001/jamanetworkopen.2021.31892] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE The recently published ADAURA study has posed a significant dilemma for clinicians in selecting patients for adjuvant osimertinib. Risk factors for recurrence in early-stage epidermal growth factor receptor (EGFR)-positive non-small cell lung cancer (NSCLC) also remain undefined. OBJECTIVE To determine clinicopathologic characteristics and recurrence patterns of resected early-stage EGFR-positive NSCLC, using wildtype EGFR as a comparator cohort, and identify features associated with recurrence. DESIGN, SETTING, AND PARTICIPANTS This is a cohort study including patients diagnosed with AJCC7 Stage IA to IIIA NSCLC between January 1, 2010, and June 30, 2018, who underwent curative surgical procedures at a specialist cancer center in Singapore. The cutoff for data analysis was October 15, 2020. Patient demographic characteristics, treatment history, and survival data were collated. In exploratory analysis, whole-exome sequencing was performed in a subset of 86 patients. Data were analyzed from September 3, 2020, to June 6, 2021. EXPOSURES Adjuvant treatment was administered per investigator's discretion. MAIN OUTCOMES AND MEASURES The main outcome was 2-year disease-free survival (DFS). RESULTS A total of 723 patients were included (389 patients with EGFR-positive NSCLC; 334 patients with wildtype EGFR NSCLC). There were 366 women (50.6%) and 357 men (49.4%), and the median (range) age was 64 (22-88) years. A total of 299 patients (41.4%) had stage IA NSCLC, 155 patients (21.4%) had stage IB NSCLC, 141 patients (19.5%) had stage II NSCLC, and 125 patients (17.3%) had stage IIIA NSCLC. Compared with patients with wildtype EGFR NSCLC, patients with EGFR-positive NSCLC were more likely to be women (106 women [31.7%] vs 251 women [64.5%]) and never smokers (121 never smokers [36.2%] vs 317 never smokers [81.5%]). At median (range) follow up of 46 (0-123) months, 299 patients (41.4%) had cancer recurrence. There was no statistically significant difference in 2-year DFS for EGFR-positive and wildtype EGFR NSCLC (70.2% [95% CI, 65.3%-74.5%] vs 67.6% [95% CI, 62.2%-72.4%]; P = .70), although patients with EGFR-positive NSCLC had significantly better 5-year overall survival (77.7% [95% CI, 72.4%-82.1%] vs 66.6% [95% CI, 60.5%-72.0%]; P = .004). Among patients with EGFR-positive NSCLC, 2-year DFS was 81.0% (95% CI, 74.0%-86.3%) for stage IA, 78.4% (95% CI, 68.2%-85.6%) for stage IB, 57.1% (95% CI, 43.7%-68.4%) for stage II, and 46.6% (95% CI, 34.7%-57.7%) for stage IIIA. Overall, 5-year DFS among patients with stage IB through IIIA was 37.2% (95% CI, 30.1%-44.3%). Sites of disease at recurrence were similar between EGFR-positive and wildtype EGFR NSCLC, with locoregional (64 patients [16.5%] vs 56 patients [16.8%]), lung (41 patients [10.5%] vs 40 patients [12.0%]), and intracranial (37 patients [9.5%] vs 22 patients [6.6%]) metastases being the most common. A risk estimation model incorporating genomic data and an individual patient nomogram using clinicopathologic features for stage I EGFR-positive NSCLC was developed to improve risk stratification. CONCLUSIONS AND RELEVANCE This cohort study found that recurrence rates were high in early-stage EGFR-positive NSCLC including stage IA, yet 37.2% of patients with stage IB through IIIA were cured without adjuvant osimertinib. Further studies are needed to elucidate individualized surveillance and adjuvant treatment strategies for early-stage EGFR-positive NSCLC.
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Affiliation(s)
| | - Siqin Zhou
- Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | | | - Gillianne Lai
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Mei-Kim Ang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Kevin Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | | | - Quan Sing Ng
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Amit Jain
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Wan Ling Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | | - Darren W. T. Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Aaron Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Kam Weng Fong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Angela Takano
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Xin Ming Cheng
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Kiat Hon Lim
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Tina Koh
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Boon-Hean Ong
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Eng Huat Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | | | | - Sze Huey Tan
- Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - Daniel S. W. Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
- Genome Institute of Singapore, Singapore
- Duke-NUS Medical School, Singapore
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11
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Chen S, Yang S, Zhang Y, Xiang J, Zhang Y, Hu H, Sun Y, Fu F, Deng C, Wang S, Li Q, Gu Y, Li Y, Shen X, Ye T. Clinicopathologic features and prognostic value of epidermal growth factor receptor mutation in patients with pT1a and pT1b invasive lung adenocarcinoma after surgical resection. J Thorac Dis 2021; 13:5496-5507. [PMID: 34659816 PMCID: PMC8482337 DOI: 10.21037/jtd-21-924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/30/2021] [Indexed: 11/15/2022]
Abstract
Background Previous studies have evaluated the prognostic value of epidermal growth factor receptor (EGFR) mutation in different subgroups of lung adenocarcinoma, but there remains controversial on this issue. We conduct this study aimed to reveal the prognostic value of EGFR mutation in patients with pT1a and pT1b invasive lung adenocarcinoma. Methods From August 2009 to February 2015, 338 patients with pT1a and pT1b invasive lung adenocarcinoma who underwent EGFR mutation analysis were enrolled into this study. According to clinicopathologic and radiologic characteristics, survival analysis was conducted in different subgroups using Kaplan-Meier methods and Cox regression models. Results EGFR mutation was detected in 216 (63.9%) patients. In the entire cohort, EGFR mutation was significantly frequent in female (P=0.011), never smoking (P=0.014) patients, patients with part-solid nodules (P=0.005) and patients with lepidic pattern-predominant adenocarcinoma (LPA)/acinar pattern-predominant adenocarcinoma (APA)/papillary pattern-predominant adenocarcinoma (PPA) (P=0.005). No difference in recurrence-free survival (RFS) was seen between patients harboring EGFR mutation and patients without EGFR mutation in the entire cohort (P=0.664) and the subgroup cohorts. Patients with EGFR mutation had a longer overall survival (OS) compared with patients without EGFR mutation in the entire cohort (P=0.005) and the subgroups of N0 stage cohort (P=0.013), N1–2 stage cohort (P=0.033), APA/PPA/invasive mucinous adenocarcinoma (IMA) cohort (P=0.011) and pT1b cohort (P=0.002). Tyrosine kinase inhibitors (TKIs) could significantly prolong the OS in patients with EGFR mutation after recurrence (P=0.04). Conclusions EGFR mutation was not a risk factor for recurrence of patients with pT1a and pT1b invasive lung adenocarcinoma.
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Affiliation(s)
- Shiqi Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Siqian Yang
- School of Life Sciences, Fudan University, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiaqing Xiang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yawei Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hong Hu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yihua Sun
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangqiu Fu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chaoqiang Deng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shengping Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qiao Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yajia Gu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuan Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xuxia Shen
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ting Ye
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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12
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Saito G, Oya Y, Taniguchi Y, Kawachi H, Daichi F, Matsumoto H, Iwasawa S, Suzuki H, Niitsu T, Miyauchi E, Yokoi T, Yokoyama T, Uenami T, Sakata Y, Arai D, Okada A, Nagata K, Teraoka S, Kokubo M. Real-world survey of pneumonitis and its impact on durvalumab consolidation therapy in patients with non-small cell lung cancer who received chemoradiotherapy after durvalumab approval (HOPE-005/CRIMSON). Lung Cancer 2021; 161:86-93. [PMID: 34543942 DOI: 10.1016/j.lungcan.2021.08.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The incidence of real-world pneumonitis and durvalumab rechallenge during chemoradiotherapy and durvalumab consolidation for non-small cell lung cancer is unknown. MATERIALS AND METHODS We retrospectively evaluated the medical records of 302 consecutive patients diagnosed with non-small cell lung cancer who started chemoradiotherapy between May 2018 and May 2019. RESULTS Median age was 70 (range: 40-87) years. Volume of lung parenchyma that received 20 Gy (V20) exceeded 35% in 2% and mean lung dose exceeded 20 Gy in 1% of patients. Durvalumab consolidation was delivered to 225 patients (75%). Overall, 83% (n = 251), 34% (n = 103), 7% (n = 21), and 1% (n = 4) of the patients developed any grade of pneumonitis, symptomatic pneumonitis, ≥grade 3 pneumonitis, and fatal (grade 5) pneumonitis, respectively. Corticosteroids were administered to 25% of the patients to treat pneumonitis. Multivariate analysis identified the predictive factors for the development of symptomatic pneumonitis: V20 Gy or more ≥ 25% (odds ratio [OR]: 2.37, P = 0.008) and mean lung dose (MLD) ≥ 10 Gy (OR: 1.93, P < 0.0047). Of the 52 patients who received corticosteroids for pneumonitis after durvalumab initiation, 21 were rechallenged with durvalumab. Overall, 81% of patients met the PACIFIC study's rechallenge criteria and did not experience a severe pneumonitis relapse. CONCLUSION High V20 and MLD were independent risk factors of symptomatic pneumonitis. More than 80% of the patients who were rechallenged with durvalumab after pneumonitis met the PACIFIC study's rechallenge criteria. Consequently, severe relapse did not occur. Cooperation between radiation and medical oncologists is important for safe chemoradiotherapy and the safe completion of durvalumab consolidation therapy.
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Affiliation(s)
- Go Saito
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuko Oya
- Department of Thoracic Oncology, Aichi Cancer Center, Aichi, Japan.
| | - Yoshihiko Taniguchi
- Department of Internal Medicine, Kinki-chuo Chest Medical Center, Osaka, Japan
| | - Hayato Kawachi
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Fujimoto Daichi
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Hirotaka Matsumoto
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Shunichiro Iwasawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan; Medical Sciences Department, Medical Affairs Division, Chugai Pharmaceutical Co., Ltd, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Takayuki Niitsu
- Department of Respiratory Medicine, Osaka General Medical Center, Osaka, Japan
| | - Eisaku Miyauchi
- Department of Respiratory Medicine, Tohoku University Hospital, Miyagi, Japan
| | - Takashi Yokoi
- Department of Thoracic Oncology, Hyogo College of Medicine, Hyogo, Japan
| | - Toshihide Yokoyama
- Department of Respiratory Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Takeshi Uenami
- Department of Thoracic Oncology, National Hospital Organization, Toneyama National Hospital, Osaka, Japan
| | - Yoshihiko Sakata
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Daisuke Arai
- Pulmonary Division, Department Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Asuka Okada
- Department of Respiratory Medicine, Saiseikai Suita Hospital, Osaka, Japan
| | - Kenji Nagata
- Department of Respiratory Medicine, Itami City Hospital, Hyogo, Japan
| | - Shunsuke Teraoka
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masaki Kokubo
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Hyogo, Japan
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13
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Tsuboi M, Weder W, Escriu C, Blakely C, He J, Dacic S, Yatabe Y, Zeng L, Walding A, Chaft JE. Neoadjuvant osimertinib with/without chemotherapy versus chemotherapy alone for EGFR-mutated resectable non-small-cell lung cancer: NeoADAURA. Future Oncol 2021; 17:4045-4055. [PMID: 34278827 PMCID: PMC8530153 DOI: 10.2217/fon-2021-0549] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Osimertinib is a third-generation, irreversible oral EGFR-tyrosine kinase inhibitor), that potently inhibits EGFR-tyrosine kinase inhibitor-sensitizing mutations and T790M resistance mutations together with efficacy in CNS metastases in patients with non-small-cell lung cancer (NSCLC). Here we describe the rationale and design for the Phase III NeoADAURA study (NCT04351555), which will evaluate neoadjuvant osimertinib with or without chemotherapy versus chemotherapy alone prior to surgery, in patients with resectable stage II-IIIB N2 EGFR mutation-positive NSCLC. The primary end point is centrally assessed major pathological response at the time of resection. Secondary end points include event-free survival, pathological complete response, nodal downstaging at the time of surgery, disease-free survival, overall survival and health-related quality of life. Safety and tolerability will also be assessed. Trial Registration number: NCT04351555 (ClinicalTrials.gov).
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Affiliation(s)
- Masahiro Tsuboi
- National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan
| | - Walter Weder
- Thoraxchirurgie Klinik Bethanien, Zürich, 8044, Switzerland
| | - Carles Escriu
- The Clatterbridge Cancer Centre, Bebington, Wirral, CH63 4JY, UK
| | - Collin Blakely
- Department of Medicine, University of California, San Francisco, CA 94158-2140, USA
| | - Jianxing He
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Sanja Dacic
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | | | | | | | - Jamie E Chaft
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center & Weill Cornell Medical College, New York, NY 10021, USA
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14
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Prognostic Value of Combing Primary Tumor and Nodal Glycolytic-Volumetric Parameters of 18F-FDG PET in Patients with Non-Small Cell Lung Cancer and Regional Lymph Node Metastasis. Diagnostics (Basel) 2021; 11:diagnostics11061065. [PMID: 34207763 PMCID: PMC8228685 DOI: 10.3390/diagnostics11061065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 12/19/2022] Open
Abstract
We investigated whether the combination of primary tumor and nodal 18F-FDG PET parameters predict survival outcomes in patients with nodal metastatic non-small cell lung cancer (NSCLC) without distant metastasis. We retrospectively extracted pre-treatment 18F-FDG PET parameters from 89 nodal-positive NSCLC patients (stage IIB–IIIC). The Cox proportional hazard model was used to identify independent prognosticators of overall survival (OS) and progression-free survival (PFS). We devised survival stratification models based on the independent prognosticators and compared the model to the American Joint Committee on Cancer (AJCC) staging system using Harrell’s concordance index (c-index). Our results demonstrated that total TLG (the combination of primary tumor and nodal total lesion glycolysis) and age were independent risk factors for unfavorable OS (p < 0.001 and p = 0.001) and PFS (both p < 0.001), while the Eastern Cooperative Oncology Group scale independently predicted poor OS (p = 0.022). Our models based on the independent prognosticators outperformed the AJCC staging system (c-index = 0.732 versus 0.544 for OS and c-index = 0.672 versus 0.521 for PFS, both p < 0.001). Our results indicate that incorporating total TLG with clinical factors may refine risk stratification in nodal metastatic NSCLC patients and may facilitate tailored therapeutic strategies in this patient group.
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15
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Cai L, Wang J, Yan J, Zeng J, Zhu L, Liang J, Pan C, Huang X, Jin J, Xu Y, Wang F, Shao Y, Xu Q, Xia G, Xing M, Xu X, Jiang Y. Genomic Profiling and Prognostic Value Analysis of Genetic Alterations in Chinese Resected Lung Cancer With Invasive Mucinous Adenocarcinoma. Front Oncol 2021; 10:603671. [PMID: 33505917 PMCID: PMC7829865 DOI: 10.3389/fonc.2020.603671] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/23/2020] [Indexed: 12/21/2022] Open
Abstract
Background Invasive mucinous adenocarcinoma (IMA) of the lung is a distinct histological subtype with unique clinical and pathological features. Despite previous genomic studies on lung IMA, the genetic characteristics and the prognosis-related biomarkers in Chinese surgically resected lung IMA remain unclear. Methods We collected 76 surgically resected primary tumors of invasive lung adenocarcinoma, including 51 IMA and 25 non-mucinous adenocarcinomas (non-IMA). IMA was further divided into pure-IMA (mucinous features≥90%) and mixed-IMA subgroups. Comprehensive genomic profiling based on targeted next-generation sequencing (NGS) of 425 genes was explored and genomic characteristics were evaluated for the correlation with postoperative disease-free survival (DFS). Results IMA had a unique genetic profile, with more diverse driver mutations and more tumor drivers/suppressors co-occurrence than that of non-IMA. The frequency of EGFR (72.0% vs. 40.0% vs. 23.1%, p=0.002) and ALK (undetected vs. 20.0% vs. 26.9%, p=0.015) alterations showed a trend of gradual decrease and increase from non-IMA to mixed-IMA to pure-IMA, respectively. The frequency of KRAS mutations in pure-IMA was higher than that in mixed-IMA, albeit statistically insignificant (23.1% vs. 4.0%, p=0.10). TP53 mutation was significantly less in pure-IMA compared to mixed-IMA and non-IMA (23.1% vs. 52.0% vs. 56.0%, p=0.03). Besides, IMA exhibited less arm-level amplifications (p=0.04) and more arm-level deletions (p=0.004) than non-IMA, and the frequency of amplification and deletion also showed a trend of gradual decrease and increase from non-IMA to mixed-IMA to pure-IMA, respectively. Furthermore, prognosis analysis in stage III IMA patients showed that patients harboring alterations in EGFR (mDFS=30.3 vs. 16.0 months, HR=0.19, P=0.027) and PI3K pathway (mDFS=36.0 vs. 16.0 months, HR=0.12, P=0.023) achieved prolonged DFS, while patients with poorly differentiated tumors (mDFS=14.1 vs. 28.0 months, HR=3.75, p=0.037) or with KRAS mutations (mDFS=13.0 vs. 20.0 months, HR=6.95, p=0.027) had shorter DFS. Multivariate analysis showed that KRAS mutations, PI3K pathway alterations, and tumor differentiation status were independent factors that have statistically significant influences on clinical outcomes of IMA patients. Conclusion Our study provided genomic insights into Chinese surgically resected lung IMA. We also identified several genomic features that may serve as potential biomarkers on postoperative recurrence in IMA patients with stage III disease.
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Affiliation(s)
- Lei Cai
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Jiangfeng Wang
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Junrong Yan
- Medical Department, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Jian Zeng
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Liang Zhu
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China.,Department of Pathology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Jinxiao Liang
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Chao Pan
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xiancong Huang
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Ju Jin
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China.,Department of Pathology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Yang Xu
- Medical Department, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Fufeng Wang
- Medical Department, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Yang Shao
- Medical Department, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Qinqin Xu
- Medical Department, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Guojie Xia
- Department of Medical Oncology, Traditional Chinese Medical Hospital of Huzhou, Huzhou, China
| | - Minyan Xing
- Department of Medical Oncology, Haining People's Hospital, Haining Branch, The First Affiliated Hospital, Zhejiang University, Haining, China
| | - Xiaoling Xu
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Youhua Jiang
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
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16
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Hung YP, Chirieac LR. How should molecular findings be integrated in the classification for lung cancer? Transl Lung Cancer Res 2020; 9:2245-2254. [PMID: 33209647 PMCID: PMC7653151 DOI: 10.21037/tlcr-20-153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The use of molecular diagnostics in the diagnosis and management of patients with advanced lung cancer has become widespread. Although molecular classification has increasingly been incorporated in the pathologic classification of certain types of human tumors (particularly within the hematologic, glial, and bone/soft tissue malignancies), genetic findings have not been formally incorporated into the pathologic classification of lung cancer, which presently relies solely on the assessment of histologic and immunophenotypic characteristics. Whether molecular classification should be adopted in lung cancer would depend on the diagnostic, prognostic, and predictive impacts of such classification-and whether these impacts confer significant values additive to those derived from the routine histologic and immunophenotypic assessment. We provide a brief overview on the genetics of lung cancer, including adenocarcinoma, squamous cell carcinoma, and neuroendocrine tumors (small cell carcinoma, large cell neuroendocrine carcinoma, and carcinoid tumors). We consider the values of molecular information with some examples, in terms of the current diagnostic, prognostic, and predictive impacts. Finally, we discuss the conceptual and technical challenges of adopting a molecular classification for lung cancer in clinical management for patients. While there are conceptual and technical hurdles to tackle in implementing molecular classification in the pathologic classification of lung cancer, such integrated histologic-molecular diagnosis may allow one to personalize and optimize therapy for patients with advanced lung cancer.
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Affiliation(s)
- Yin P Hung
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Lucian R Chirieac
- Departments of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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17
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Deng C, Zhang Y, Ma Z, Fu F, Deng L, Li Y, Chen H. Prognostic value of epidermal growth factor receptor gene mutation in resected lung adenocarcinoma. J Thorac Cardiovasc Surg 2020; 162:664-674.e7. [PMID: 32747123 DOI: 10.1016/j.jtcvs.2020.05.099] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Mutation of the EGFR gene is known as a predictor for the response to EGFR tyrosine kinase inhibitor. Although EGFR mutation status is proposed to be incorporated in the Ninth Edition of the Lung Cancer Staging system, its prognostic value for surgically resected lung adenocarcinoma remains controversial. METHODS Data on 1512 patients with completely resected lung adenocarcinoma who underwent EGFR mutation analysis between 2008 and 2015 were collected. The prognostic value of EGFR mutations was determined in patients with lung adenocarcinoma stratified by clinicopathologic and radiologic characteristics. Independent prognostic factors were identified by multivariate analysis using the Cox proportional hazards model. Competing risk model was used to estimate the cumulative incidence. RESULTS EGFR mutations were identified in 935 patients (61.8%). In the entire cohort, there was no difference in recurrence-free survival between the EGFR-mutated group and the wild-type group (P = .266). However, Cox multivariate analyses revealed that EGFR mutation was a strong independent prognostic factor for worse recurrence-free survival in patients with radiologic solid tumors (hazard ratio, 1.485; 95% confidence interval, 1.208-1.826; P < .001), histologic acinar pattern-predominant adenocarcinoma/papillary pattern-predominant adenocarcinoma/invasive mucinous adenocarcinoma (hazard ratio, 1.684; 95% confidence interval, 1.330-2.132; P < .001), and pathologic stage II and III (hazard ratio, 1.417; 95% confidence interval, 1.115-1.801; P = .004). Patients with EGFR mutations developed significantly more brain (hazard ratio, 1.827; 95% confidence interval, 1.213-2.766; P = .004) and bone (hazard ratio, 1.724; 95% confidence interval, 1.131-2.631; P = .011) metastases compared with the wild-type cohort. CONCLUSIONS EGFR mutation was a strong poor prognostic factor in patients with radiologic solid, histologic acinar pattern-predominant adenocarcinoma/papillary pattern-predominant adenocarcinoma/invasive mucinous adenocarcinoma, and pathologic stage II and III lung adenocarcinomas. After surgery, distinct metastatic patterns were revealed according to EGFR mutation status. These findings have implications for the upcoming new lung cancer staging system.
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Affiliation(s)
- Chaoqiang Deng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zelin Ma
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangqiu Fu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lin Deng
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuan Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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18
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Yang L, Zhang J, Yang G, Xu H, Lin J, Shao L, Li J, Guo C, Du Y, Guo L, Li X, Han-Zhang H, Wang C, Chuai S, Ye J, Kang Q, Liu H, Ying J, Wang Y. The prognostic value of a Methylome-based Malignancy Density Scoring System to predict recurrence risk in early-stage Lung Adenocarcinoma. Theranostics 2020; 10:7635-7644. [PMID: 32685009 PMCID: PMC7359091 DOI: 10.7150/thno.44229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022] Open
Abstract
Current NCCN guidelines do not recommend the use of adjuvant chemotherapy for stage IA lung adenocarcinoma patients with R0 surgery. However, 25% to 40% of patients with stage IA disease experience recurrence. Stratifying patients according to the recurrence risk may tailor adjuvant therapy and surveillance imaging for those with a higher risk. However, prognostic markers are often identified by comparing high-risk and low-risk cases which might introduce bias due to the widespread interpatient heterogeneity. Here, we developed a scoring system quantifying the degree of field cancerization in adjacent normal tissues and revealed its association with disease-free survival (DFS). Methods: We recruited a cohort of 44 patients with resected stage IA lung adenocarcinoma who did not receive adjuvant therapy. Both tumor and adjacent normal tissues were obtained from each patient and subjected to capture-based targeted genomic and epigenomic profiling. A novel methylome-based scoring system namely malignancy density ratio (MD ratio) was developed based on 39 patients by comparing tumor and corresponding adjacent normal tissues of each patient. A MD score was then obtained by Wald statistics. The correlations of MD ratio, MD score, and genomic features with clinical outcome were investigated. Results: Patients with a high-risk MD ratio showed a significantly shorter postsurgical DFS compared with those with a low-risk MD ratio (HR=4.47, P=0.01). The MD ratio was not associated with T stage (P=1), tumor cell fraction (P=0.748) nor inflammatory status (p=0.548). Patients with a high-risk MD score also demonstrated an inferior DFS (HR=4.69, P=0.039). In addition, multivariate analysis revealed EGFR 19 del (HR=5.39, P=0.012) and MD score (HR= 7.90, P=0.01) were independent prognostic markers. Conclusion: The novel methylome-based scoring system, developed by comparing the signatures between tumor and corresponding adjacent normal tissues of individual patients, largely minimizes the bias of interpatient heterogeneity and reveals a robust prognostic value in patients with resected lung adenocarcinoma.
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19
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Wang S, Qu X, Cao L, Hu X, Hou K, Liu Y, Che X. Assessment of Nine Driver Gene Mutations in Surgically Resected Samples from Patients with Non-Small-Cell Lung Cancer. Cancer Manag Res 2020; 12:4029-4038. [PMID: 32581578 PMCID: PMC7269179 DOI: 10.2147/cmar.s250822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/13/2020] [Indexed: 12/30/2022] Open
Abstract
Background The mutational profile of oncogenic driver genes play an important role in non-small-cell lung cancer (NSCLC). The need of a testing panel capable of comprehensively determining patient genotypes in limited amounts of material has increased since the recent association of nine core oncogenic driver genes as tumor predictive biomarkers. Methods Surgically resected samples from 214 NSCLC patients (168 patients with adenocarcinomas and 46 with squamous cell cancers) were included. A multiplexed PCR-based assay was developed to simultaneously test 118 hotspot mutations and fusions in nine driver genes. Results The sensitivity of the kit was 1% for gene mutation and 450 copies for gene fusion. Genetic alterations were detected in 143 (66.8%) patients by the assay. The three most common alterations identified were EGFR mutations (50.9%), KRAS mutations (8.4%) and ALK fusions (4.7%). Eight (3.7%) patients harbored concurrent mutations, and the most common partners were EGFR mutations which were observed in the eight patients. No associations between survival and EGFR, KRAS, and ALK status were observed. Patients with two or more alterations exhibited shorter DFS compared to those with single mutations (P=0.032), whilst had no significant difference in OS (P=0.245). However, only TNM stage was an independent predictor of OS (HR=2.905, P<0.001) as well as DFS (HR=2.114, P<0.001) in our cohort in multivariate analysis. Furthermore, patients with the L858R mutation had longer DFS (P=0.014) compared to other sensitizing mutations and tended to have better OS but the differences were not significant (P=0.06). Conclusion These findings suggest this multiplex gene panel testing technique can be efficiently used to detect nine driver genes in a limited number of specimens. This methodology would have the potential to save both specimens and time compared to the combination of all assays by other methods.
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Affiliation(s)
- Shuo Wang
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang 110001, People's Republic of China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang 110001, People's Republic of China.,Liaoning Province Clinical Research Center for Cancer, Shenyang 110001, People's Republic of China
| | - Xiujuan Qu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang 110001, People's Republic of China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang 110001, People's Republic of China.,Liaoning Province Clinical Research Center for Cancer, Shenyang 110001, People's Republic of China
| | - Lili Cao
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang 110001, People's Republic of China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang 110001, People's Republic of China.,Liaoning Province Clinical Research Center for Cancer, Shenyang 110001, People's Republic of China
| | - Xuejun Hu
- Department of Respiratory Medicine, The First Hospital of China Medical University, Shenyang 110001, People's Republic of China
| | - Kezuo Hou
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang 110001, People's Republic of China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang 110001, People's Republic of China.,Liaoning Province Clinical Research Center for Cancer, Shenyang 110001, People's Republic of China
| | - Yunpeng Liu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang 110001, People's Republic of China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang 110001, People's Republic of China.,Liaoning Province Clinical Research Center for Cancer, Shenyang 110001, People's Republic of China
| | - Xiaofang Che
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang 110001, People's Republic of China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang 110001, People's Republic of China.,Liaoning Province Clinical Research Center for Cancer, Shenyang 110001, People's Republic of China
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20
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Isaka T, Ito H, Nakayama H, Yokose T, Yamada K, Masuda M. Effect of epidermal growth factor receptor mutation on early-stage non-small cell lung cancer according to the 8th TNM classification. Lung Cancer 2020; 145:111-118. [PMID: 32428800 DOI: 10.1016/j.lungcan.2020.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/06/2020] [Accepted: 04/12/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study evaluated the effect of EGFR mutation on early-stage non-small cell lung cancer (NSCLC) based on the 8th TNM classification. MATERIALS AND METHODS The study retrospectively examined 1231 patients who underwent curative resection for pathological stage 0-I (8th TNM classification) NSCLC and EGFR mutation analysis from January 2006 to December 2018 at Kanagawa Cancer Center. The disease-free survival (DFS), overall survival (OS) and disease-specific survival (DSS) of EGFR-mutant lung cancer (Mt) and EGFR wild-type lung cancer (Wt) patients at each stage were compared between two patient groups using the log-rank test. Cox regression analyses were performed to identify prognostic factors. RESULTS The number of stage 0, IA1, IA2, IA3, and IB Mt/Wt patients was 79/92, 202/189, 145/144, 45/75, and 74/186, respectively. There was no statistically significant difference in DFS between Mt and Wt patients at any pathological stage. The 5-year OS of Mt/Wt patients was 96.9 %/98.5 % for stage 0 (p = 0.671), 92.2 %/92.2 % for stage IA1 (p = 0.997), 93.9 %/82.6 % for stage IA2 (p = 0.039), 87.3 %/91.4 % for stage IA3 (p = 0.768), and 85.3 %/69.3 % for stage IB (p = 0.017). The 5-year DSS of Mt/Wt patients was 95.7 %/95.4 % for stage IA2 (p = 0.684) and 93.2 %/77.5 % for stage IB (p = 0.016). In Cox regression analyses, Mt was not identified as a prognostic factor for OS among stage IA2 NSCLC patients (HR, 0.62; 95 % CI, 0.20-1.93; p = 0.413). However, Mt was a favorable prognostic factor for OS (HR, 0.44; 95 % CI, 0.19-1.00; p = 0.049) and DSS (HR, 0.38; 95 % CI, 0.17-0.87; p = 0.022) among stage IB NSCLC patients. CONCLUSION EGFR mutation had no effect on the prognosis of stage 0-IA NSCLC but significantly affected the OS and DSS of stage IB NSCLC. Effect of EGFR mutations on postoperative prognosis of patients with stage 0-I NSCLC differed with each stage.
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Affiliation(s)
- Tetsuya Isaka
- Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan; Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan.
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan
| | - Kouzo Yamada
- Department of Thoracic Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan
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21
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Linardou H, Kotoula V, Kouvatseas G, Mountzios G, Karavasilis V, Samantas E, Kalogera-Fountzila A, Televantou D, Papadopoulou K, Mavropoulou X, Daskalaki E, Zaramboukas T, Efstratiou I, Lampaki S, Rallis G, Res E, Syrigos KN, Kosmidis PA, Pectasides D, Fountzilas G. Genotyping KRAS and EGFR Mutations in Greek Patients With Non-small-cell Lung Cancer: Incidence, Significance and Implications for Treatment. Cancer Genomics Proteomics 2020; 16:531-541. [PMID: 31659106 DOI: 10.21873/cgp.20155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/15/2019] [Accepted: 09/18/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND/AIM KRAS mutations are reported in 20-25% of non-small cell lung cancer (NSCLC) and their prognostic role is unclear. We studied KRAS and EGFR genotyping in Greek NSCLC patients. PATIENTS AND METHODS KRAS and EGFR genotypes were centrally evaluated in 421 NSCLC patients (diagnosed September 1998 -June 2013) and associated with clinicopathological parameters. Outcome comparisons were performed in 288 patients receiving first line treatment. RESULTS Most patients were male (78.6%), >60 years old (63.9%), current smokers (51.1%), with adenocarcinoma histology (63.9%). EGFR and KRAS mutations were found in 10.7% and 16.6% of all histologies, respectively, and in 14.9% and 21.9% of adenocarcinomas. At 4.5 years median follow-up, KRAS status was an independent negative prognostic factor for overall survival (OS, p=0.016). KRAS mutations conferred 80% increased risk of death in patients receiving first-line treatment (p=0.002). CONCLUSION The presence of KRAS mutations is an independent negative prognosticator among Greek NSCLC patients and an independent response predictor to first line treatment.
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Affiliation(s)
| | - Vassiliki Kotoula
- Department of Pathology, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.,Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Giannis Mountzios
- Second Oncology Department, Henry Dunant Hospital Center, Athens, Greece
| | - Vasilios Karavasilis
- Department of Medical Oncology, Papageorgiou Hospital, Faculty of Medicine, Aristotle University of Thessaloniki, School of Health Sciences, Thessaloniki, Greece
| | - Epaminondas Samantas
- Third Department of Medical Oncology, Agii Anargiri Cancer Hospital, Athens, Greece
| | - Anna Kalogera-Fountzila
- Department of Radiology, AHEPA Hospital, School of Health Sciences, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despina Televantou
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriaki Papadopoulou
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Xanthipi Mavropoulou
- Department of Radiology, AHEPA Hospital, School of Health Sciences, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emily Daskalaki
- Department of Pathology, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece
| | - Thomas Zaramboukas
- Department of Pathology, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece
| | | | - Sofia Lampaki
- Department of Medical Oncology, Papageorgiou Hospital, Faculty of Medicine, Aristotle University of Thessaloniki, School of Health Sciences, Thessaloniki, Greece
| | - Grigorios Rallis
- Department of Medical Oncology, Papageorgiou Hospital, Faculty of Medicine, Aristotle University of Thessaloniki, School of Health Sciences, Thessaloniki, Greece
| | - Eleni Res
- Third Department of Medical Oncology, Agii Anargiri Cancer Hospital, Athens, Greece
| | - Konstantinos N Syrigos
- Oncology Unit GPP, Sotiria General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Paris A Kosmidis
- Second Department of Medical Oncology, Hygeia Hospital, Athens, Greece
| | - Dimitrios Pectasides
- Oncology Section, Second Department of Internal Medicine, Hippokration Hospital, Athens, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece.,Aristotle University of Thessaloniki, Thessaloniki, Greece
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22
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Tamiya A, Koh Y, Isa SI, Kubo A, Ando M, Saka H, Yoshimoto N, Takeo S, Adachi H, Tagawa T, Kawashima O, Yamashita M, Kataoka K, Takenoyama M, Takeuchi Y, Watanabe K, Matsumura A, Kawaguchi T. Impact of somatic mutations on prognosis in resected non-small-cell lung cancer: The Japan Molecular Epidemiology for lung cancer study. Cancer Med 2020; 9:2343-2351. [PMID: 32022477 PMCID: PMC7131842 DOI: 10.1002/cam4.2897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/17/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To report the follow up data and clinical outcomes of the JME study (UMIN 000008177), a prospective, multicenter, molecular epidemiology examination of 876 surgically resected non-small-cell lung cancer (NSCLC) cases, and the impact of somatic mutations (72 cancer-associated genes) on recurrence-free survival (RFS) and overall survival (OS). METHODS Patients were enrolled between July 2012 and December 2013, with follow up to 30th November 2017. A Cox proportional hazards model was used to assess the impact of gene mutations on RFS and OS, considering sex, smoking history, age, stage, histology, EGFR, KRAS, TP53, and number of coexisting mutations. RESULTS Of 876 patients, 172 had ≥2 somatic mutations. Median follow-up was 48.4 months. On multivariate analysis, number of coexisting mutations (≥2 vs 0 or 1, HR = 2.012, 95% CI: 1.488-2.695), age (≥70 vs <70 years, HR = 1.583, 95% CI: 1.229-2.049), gender (male vs female, HR = 1.503, 95% CI: 1.045-2.170) and pathological stage (II vs I, HR = 3.386, 95% CI: 2.447-4.646; ≥III vs I, HR = 6.307, 95% CI: 4.680-8.476) were significantly associated with RFS, while EGFR mutation (yes vs no, HR = 0.482, 95% CI: 0.309-0.736), number of coexisting mutations (≥2 vs 0 or 1, HR = 1.695, 95% CI: 1.143-2.467), age (≥70 vs <70 years, HR = 1.932, 95% CI: 1.385-2.726), and pathological stage (II vs I, HR = 2.209, 95% CI: 1.431-3.347; ≥III vs I, HR = 5.286, 95% CI: 3.682-7.566) were also significant for OS. CONCLUSION A smaller number of coexisting mutations, earlier stage, and younger age were associated with longer RFS and OS, while EGFR mutations were significantly associated with improved OS.
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Affiliation(s)
- Akihiro Tamiya
- National Hospital Organization (NHO) Kinki-Chuo Chest Medical Center, Sakai, Japan
| | | | - Shun-Ichi Isa
- National Hospital Organization (NHO) Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Akihito Kubo
- Aichi Medical University School of Medicine, Nagakute, Japan
| | | | - Hideo Saka
- NHO Nagoya Medical Center, Nagoya, Japan
| | | | | | | | | | | | | | | | | | | | | | - Akihide Matsumura
- National Hospital Organization (NHO) Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Tomoya Kawaguchi
- Graduate School of Medicine, Osaka City University, Osaka, Japan
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Ito M, Miyata Y, Tsutani Y, Ito H, Nakayama H, Imai K, Ikeda N, Okada M. Positive EGFR mutation status is a risk of recurrence in pN0-1 lung adenocarcinoma when combined with pathological stage and histological subtype: A retrospective multi-center analysis. Lung Cancer 2020; 141:107-113. [PMID: 32035371 DOI: 10.1016/j.lungcan.2020.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/27/2019] [Accepted: 01/27/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Recurrence risk of resected lung adenocarcinoma is represented by pathological stage (pStage), histological subtype, and potentially by EGFR mutation. However, the relationship among these factors and their combined impact on prognosis are unclear. MATERIALS AND METHODS Using a multicenter database, we retrospectively investigated the prognostic impact of EGFR mutation status in relation to pStage and histological subtype in resected pN0-1M0 lung adenocarcinoma. RESULTS Among 1155 pN0-1M0 adenocarcinoma cases, pStage 0 and IA1-IB were confirmed predominantly in EGFR-positive cases. AIS, MIA, and lepidic predominant adenocarcinoma were also more frequently found in EGFR-positive cases and showed no/little recurrence regardless of EGFR mutation status. The 5-year recurrence-free survival (RFS) of papillary, acinar, solid, and micropapillary predominant adenocarcinoma was stratified by pStage (IA1-IB, IIA-IIIA) or histological malignant subtype (intermediate or high malignant subtype), and more finely subdivided by EGFR mutation status. Positive EGFR mutation cases showed worse RFS in both classifications. Low malignant subtype and pStage IA1-IB intermediate malignant subtype showed low frequency of recurrence. Whereas, in pStage IA1-IB high malignant subtype and pStage IIA-IIIA cases, EGFR-positive cases showed poorer 5-year RFS than EGFR-negative (49.6% and 75.6%, respectively, hazard ratio [HR] = 1.84, 95% CI = 1.38-7.42, p < 0.01) and multivariate analysis indicated positive EGFR mutation status was significantly related to poorer PRF (HR = 2.005, 95% CI = 1.029-3.906, p = 0.041). CONCLUSION EGFR mutation harbored primarily in early-stage or low-malignant histological subtypes with no/little recurrence. In pN0-1M0 adenocarcinoma with higher risk of recurrence, positive EGFR mutation cases showed worse RFS. EGFR mutation status enables better stratification of recurrence risk when considering pStage and histological malignant subtype.
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Affiliation(s)
- Masaoki Ito
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.
| | - Kentaro Imai
- Department of Thoracic Surgery, Tokyo Medical School, Shinjuku-ku, Tokyo, Japan.
| | - Norihiko Ikeda
- Department of Thoracic Surgery, Tokyo Medical School, Shinjuku-ku, Tokyo, Japan.
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
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Lu Y, Ma T, Wang L, Xue T. [Advances in Lymph Node Metastasis and Lymph Node Dissection
in Early Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 22:520-525. [PMID: 31451143 PMCID: PMC6717872 DOI: 10.3779/j.issn.1009-3419.2019.08.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
肺癌是目前我国发病率和死亡率均居首位的恶性肿瘤,其中以非小细胞肺癌为主要病理类型。淋巴结转移是非小细胞肺癌最常见和最主要的转移途径,也是影响肺癌分期和预后最重要的因素。由于目前通过现有手段术前很难准确判断早期非小细胞肺癌患者的淋巴结受累情况。因此,在早期非小细胞肺癌中,尤其是在临床Ⅰ期非小细胞肺癌患者中,淋巴结清扫方式一直存在很大争议。本文就非小细胞肺癌淋巴结转移的规律及清扫方式进行综述。
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Affiliation(s)
- Yun Lu
- Department of Cardiothoracic Surgery, the Affiliated Zhongda Hospital of Southeast University, Nanjing 210000, China
| | - Teng Ma
- Department of Cardiothoracic Surgery, the Affiliated Zhongda Hospital of Southeast University, Nanjing 210000, China
| | - Lei Wang
- Department of Cardiothoracic Surgery, the Affiliated Zhongda Hospital of Southeast University, Nanjing 210000, China
| | - Tao Xue
- Department of Cardiothoracic Surgery, the Affiliated Zhongda Hospital of Southeast University, Nanjing 210000, China
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Tang W, Li X, Xie X, Sun X, Liu J, Zhang J, Wang C, Yu J, Xie P. EGFR inhibitors as adjuvant therapy for resected non-small cell lung cancer harboring EGFR mutations. Lung Cancer 2019; 136:6-14. [DOI: 10.1016/j.lungcan.2019.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/27/2019] [Accepted: 08/01/2019] [Indexed: 12/30/2022]
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26
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Kim H, Lee HJ, Hong H, Kim YJ, Kim KG, Jeon YK, Kim YT. The prognostic implications of EGFR mutation and ALK rearrangement for the long-term outcomes of patients with resected lung adenocarcinomas. Thorac Cancer 2019; 10:1619-1627. [PMID: 31215177 PMCID: PMC6610284 DOI: 10.1111/1759-7714.13128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 12/14/2022] Open
Abstract
Background To investigate the prognostic impact of epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement for the overall survival (OS) of patients with surgically treated lung adenocarcinomas. Methods A total of 689 patients with stage I–III lung adenocarcinomas (male:female = 334:355; median age, 64 years) underwent complete surgical resection between 2007 and 2013. The prognostic impact of EGFR mutation and ALK rearrangement on OS was analyzed using Cox regression analysis. Certain clinicopathological prognostic factors (i.e., age, sex, smoking status, nodule type, solid portion size, pathologic stage, adenocarcinoma subtype, and history of adjuvant chemotherapy) were included for adjustments of the hazard ratio (HR). Results EGFR mutation was observed in 438 patients (64%) and ALK rearrangement was seen in 28 patients (4%). Multivariable‐adjusted Cox regression demonstrated that the prognostic effect of EGFR mutation on OS differed by age (HR, exp.[−5.199 + 0.064*age]). The adjusted HR for EGFR mutation was 0.14 (95% CI: 0.05–0.36; P < 0.001) at 50 years, 0.26 (95% CI: 0.15–0.46; P < 0.001) at 60 years, and 0.50 (95% CI: 0.31–0.81; P = 0.005) at 70 years. However, the effect of ALK rearrangement on OS was without statistical significance (P > 0.05). Conclusions EGFR mutation was independently prognostic of the long‐term outcomes of patients with surgically treated lung adenocarcinomas. A more favorable prognostic effect was seen in younger than in older patients. ALK rearrangement was not associated with OS.
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Affiliation(s)
- Hyungjin Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Hyun-Ju Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Young Jae Kim
- Department of Biomedical Engineering, Gachon University College of Medicine, Incheon, Korea
| | - Kwang Gi Kim
- Department of Biomedical Engineering, Gachon University College of Medicine, Incheon, Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
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27
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He Q, Xin P, Zhang M, Jiang S, Zhang J, Zhong S, Liu Y, Guo M, Chen X, Xia X, Pan Z, Guo C, Cai X, Liang W, He J. The impact of epidermal growth factor receptor mutations on the prognosis of resected non-small cell lung cancer: a meta-analysis of literatures. Transl Lung Cancer Res 2019; 8:124-134. [PMID: 31106123 PMCID: PMC6504652 DOI: 10.21037/tlcr.2019.03.14] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 03/20/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) mutation represents a good response to EGFR-tyrosine kinase inhibitor and an advantageous prognostic factor in advanced-stage non-small cell lung cancer (NSCLC). However, the predictive value of EGFR mutation for prognosis in NSCLC patients after complete surgery, which more reflective of natural process, remains controversial. We sought to examine the predictive value of EGFR mutation in NSCLC. Several studies with small sample sizes have been reported but small studies bring bias especially in a postoperative setting. Therefore, we sought to pool all current evidence to show the true effects. METHODS Electronic databases were used to search the relevant articles. Disease-free survival (DFS), which will be less effected by subsequent treatments after recurrence, was the primary endpoint. The DFS between EGFR mutated and wild-type patients were compared focus on stage I patients who are rarely received adjuvant therapy. Besides, the DFS of patients with 19 exon deletion (19del) and 21 exon L858R mutation (L858R) were compared. A random effects model was used. RESULTS A total of 19 relevant studies which involved 4,872 cases were enrolled and 2,086 patients were EGFR-mutated. The majority of studies used PCR-based methods to detect EGFR mutations. Through meta-analysis, we observed the DFS of EGFR-mutated patients were similar to wild type patients in overall population (HR 0.93, 95% CI: 0.74 to 1.17). Similar results were observed in stage I subgroup (HR 0.82, 95% CI: 0.50 to 1.33). DFS of 19 del patients were potentially inferior to L858R patients but the difference was not significant (HR 1.38, 95% CI: 0.76 to 2.52). CONCLUSIONS There was no significant difference in postoperative DFS between EGFR-mutant patients and wild-type with resected NSCLC. In addition, there is still insufficient evidence to support different postoperative treatment strategies (especially for stage I) for both mutated and wild-type patients. However, 19 del may be a negative factor, which may require more strict management. Thus, we strongly encourage reporting specific prognostic impacts of different mutation types.
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Affiliation(s)
- Qihua He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Peiling Xin
- Department of Radiation Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, China
| | - Mingzhe Zhang
- Department of Cardiology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, China
| | - Si Jiang
- Department of Ultrasound, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
| | - Jianrong Zhang
- George Warren Brown School, Washington University in St. Louis, St. Louis, USA
| | - Shengyi Zhong
- Department of Cardiothoracic Surgery, Xianning Central Hospital, Xianning 437000, China
| | - Yang Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Minzhang Guo
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Xuewei Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Xiaojun Xia
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Zhenkui Pan
- Department of Oncology, Qingdao Municipal Hospital, Qingdao 266000, China
| | - Chenye Guo
- Department of Oncology, Qingdao Municipal Hospital, Qingdao 266000, China
| | - Xiuyu Cai
- Department of General Medicine, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510000, China
| | - Wenhua Liang
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
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Cruz Castellanos P, Gutiérrez Sainz L, Esteban I, de Castro J. Uso de inhibidores del receptor del factor de crecimiento epidérmico en estadio precoz: nuestra experiencia clínica. OPEN RESPIRATORY ARCHIVES 2019. [DOI: 10.1016/j.opresp.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Park IK, Hyun K, Kim ER, Park S, Kang CH, Kim YT. The prognostic effect of the epidermal growth factor receptor gene mutation on recurrence dynamics of lung adenocarcinoma. Eur J Cardiothorac Surg 2018; 54:1022-1027. [PMID: 29878144 DOI: 10.1093/ejcts/ezy220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/09/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The prognostic effects of epidermal growth factor receptor (EGFR) gene mutation on lung adenocarcinoma recurrence have not been well established. The relationship between EGFR gene mutation and recurrence dynamics of lung adenocarcinoma was investigated. METHODS A total of 527 patients with complete resection for adenocarcinoma were reviewed retrospectively. EGFR gene mutation was analysed by polymerase chain reaction followed by bidirectional direct sequencing in recurred patients. Patients were divided into the EGFR gene mutation group (M) or the wild-type EGFR gene group (W). Recurrence types and disease-free intervals (DFIs) of the 2 groups were compared. DFIs were calculated by the Kaplan-Meier method and compared using the log-rank test and Cox proportional hazard model. RESULTS EGFR gene sequencing was performed in 115 recurrent adenocarcinoma patients. Sixty-six patients had EGFR mutations and 49 patients had wild-type EGFR. The median DFI of the 2 groups were significantly different (M: 20.3 months, W: 15.1 months, P = 0.012). EGFR gene mutation was the only prognostic factor for DFI [hazard ratio (HR) = 0.639, 95% confidence interval (CI) = 0.428-0.954, P = 0.029]. The proportion of loco-regional recurrences and distant metastases of both groups were similar (P = 0.50). In subgroup analysis, EGFR gene mutation (HR = 0.534, 95% CI = 0.339-0.839, P = 0.007) was a significant prognostic factor for DFI of distant metastases. CONCLUSIONS Lung adenocarcinoma with EGFR gene mutations had longer DFI than those with wild-type EGFR gene, especially with regard to distant metastasis. EGFR gene mutation was a prognostic factor for lung adenocarcinoma.
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Affiliation(s)
- In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Eung Re Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea.,Seoul National University Cancer Research Institute, Seoul, Korea
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30
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Ito M, Miyata Y, Kushitani K, Yoshiya T, Kai Y, Tsutani Y, Mimura T, Konishi K, Takeshima Y, Okada M. Increased risk of recurrence in resected EGFR-positive pN0M0 invasive lung adenocarcinoma. Thorac Cancer 2018; 9:1594-1602. [PMID: 30298562 PMCID: PMC6275825 DOI: 10.1111/1759-7714.12866] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study was conducted to evaluate the prognostic and recurrent impact of EGFR mutation status in resected pN0M0 lung adenocarcinoma with consideration of the histological subtype. METHODS Following retrospective analysis of whole 474 consecutive pathological N0M0 lung adenocarcinoma patients, the prognostic significance of EGFR mutation status was evaluated in limited 394 subjects. Overall survival and recurrence-free interval (RFI) were estimated using the Kaplan-Meier method and compared using a log-rank test. Univariate and multivariate analyses were performed using Cox proportional hazard models. RESULTS The five-year RFI was 85.7% and 93.3% for EGFR positive (n = 176) and negative (n = 218) cases, respectively (hazard ratio [HR] 1.992, 95% confidence interval [CI] 1.005-3.982; P = 0.048). Following the exclusion of specific subtypes free from recurrence or EGFR mutation (adenocarcinoma in situ, minimally invasive adenocarcinoma, and invasive mucinous adenocarcinoma), the five-year RFI was obviously poorer in EGFR positive compared to negative cases (80.7% and 92.1%, respectively; HR 2.163, 95% CI 1.055-4.341; P = 0.035). Multivariate analysis excluding the specific subtypes confirmed that male sex, age, current or Ex-smoking status, pleural invasion, and EGFR-positive status were independently associated with shorter RFI. No significant differences in five-year overall survival were found between the EGFR mutation positive and negative groups (88.7% and 93.7%, respectively; HR 1.630, 95% CI 0.787-3.432; P = 0.2). CONCLUSION EGFR mutations are associated with recurrence in pN0M0 lung adenocarcinoma. EGFR mutation status and histological subtype should be considered when evaluating the risk of recurrence in resected lung adenocarcinoma patients.
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Affiliation(s)
- Masaoki Ito
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Kei Kushitani
- Department of Pathology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoharu Yoshiya
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yuichiro Kai
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Takeshi Mimura
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Kazuo Konishi
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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31
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Zhang SM, Zhu QG, Ding XX, Lin S, Zhao J, Guan L, Li T, He B, Zhang HQ. Prognostic value of EGFR and KRAS in resected non-small cell lung cancer: a systematic review and meta-analysis. Cancer Manag Res 2018; 10:3393-3404. [PMID: 30237741 PMCID: PMC6138965 DOI: 10.2147/cmar.s167578] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The prognostic value of EGFR and KRAS mutations in resected non-small cell lung cancer (NSCLC) has been reported. However, conflicting results were reported in these studies. The effect of mutations in these two genes in resected NSCLC remains controversial. Methods We searched Internet databases for studies reporting disease-free survival (DFS) and overall survival (OS) in resected NSCLC patients with EGFR or KRAS mutations. A meta-analysis calculating the pooled hazard ratio (HR) for DFS and OS was used to measure the association of EGFR or KRAS mutations with the prognosis of patients after surgery. Results A total of 9,635 patients from 32 studies were included in this analysis. The combined HR for EGFR mutations on DFS was 0.77 (95% CI 0.66–0.90, p=0.001) and on OS was 0.72 (95% CI 0.66–0.80, p<0.00001). In addition, the combined HR for KRAS mutations on DFS was 1.5 (95% CI 1.15–1.96, p=0.002) and on OS was 1.49 (95% CI 1.28–1.73, p<0.00001). Sensitivity analysis, subgroup analysis, and bias analysis proved the stability of the results. Conclusion The analysis showed that EGFR mutations were significantly associated with DFS and OS. These findings indicated that surgically treated NSCLC patients with EGFR mutations were inclined to exhibit a prolonged DFS and OS. In addition, the results indicated that KRAS mutations predicted worse DFS and OS in patients with resected NSCLC.
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Affiliation(s)
- Shi-Ming Zhang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an JiaoTong University, Xi'an, 710049, China, ;
| | - Qing-Ge Zhu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an JiaoTong University, Xi'an, 710049, China, ;
| | - Xiao-Xiao Ding
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an JiaoTong University, Xi'an, 710049, China, ;
| | - Song Lin
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an JiaoTong University, Xi'an, 710049, China, ;
| | - Jing Zhao
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an JiaoTong University, Xi'an, 710049, China, ;
| | - Lei Guan
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an JiaoTong University, Xi'an, 710049, China, ;
| | - Ting Li
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an JiaoTong University, Xi'an, 710049, China, ;
| | - Bing He
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an JiaoTong University, Xi'an, 710049, China, ;
| | - Hu-Qin Zhang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an JiaoTong University, Xi'an, 710049, China, ;
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32
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McKeage M, Elwood M, Tin Tin S, Khwaounjoo P, Aye P, Li A, Sheath K, Shepherd P, Laking G, Kingston N, Lewis C, Love D. EGFR Mutation Testing of non-squamous NSCLC: Impact and Uptake during Implementation of Testing Guidelines in a Population-Based Registry Cohort from Northern New Zealand. Target Oncol 2018; 12:663-675. [PMID: 28699084 DOI: 10.1007/s11523-017-0515-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Since 2013, clinical practice guidelines recommend EGFR mutation testing of non-squamous NSCLC to select advanced-stage patients for first-line treatment using EGFR-TKIs. OBJECTIVE We aimed to determine population-based trends in the real-world uptake and impact in routine practice of these recently updated testing guidelines. PATIENTS AND METHODS A population-based observational study was conducted of notifications to the New Zealand Cancer Registry of patients eligible for EGFR testing diagnosed in northern New Zealand between January 2010 and April 2014. The main study variable was EGFR mutation testing. Main outcome measures (overall survival and dispensing of EGFR-TKIs) were extracted from prospectively archived electronic databases until October 2015. RESULTS The population-based cohort of 1857 patients had an average age of 70 years. Most had adenocarcinoma and metastatic disease at diagnosis. EGFR testing was undertaken in 500 patients (27%) with mutations detected in 109 patients (22%). EGFR testing increased during the period of study from <5% to 67% of patients (P < 0.0001). Full uptake of testing by all eligible patients was limited by a lack of availability of specimens for testing and variable testing referral practices. The proportion of patients treated with EGFR-TKIs decreased during the same time period, both among untested patients (from 12.2% to 2.8% (P < 0.0001)) and in the population as a whole (from 13.7% to 10.6% (P < 0.05)). EGFR testing was associated with prolonged overall survival (Adjusted HR = 0.76 (95% CI, 0.65-0.89) Log-rank P < 0.0001) due at least in part to the much longer overall survival achieved by mutation-positive patients, of whom 79% received EGFR-TKIs. Compared to untested EGFR-TKI-treated patients, mutation-positive EGFR-TKI-treated patients received EGFR-TKIs for longer, and survived longer both from the start of EGFR-TKI treatment and date of their diagnosis. CONCLUSIONS In this real world setting, high uptake of EGFR testing was achieved and associated with major changes in EGFR-TKI prescribing and improved health outcomes. Modifiable factors determined testing uptake. Study registration ACTRN12615000998549.
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Affiliation(s)
- Mark McKeage
- University of Auckland, Auckland, New Zealand. .,Auckland City Hospital, Auckland, New Zealand. .,Department of Pharmacology and Clinical Pharmacology and Auckland Cancer Society Research Centre, School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road Grafton, Room 504-236A, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Mark Elwood
- University of Auckland, Auckland, New Zealand
| | | | | | - Phyu Aye
- University of Auckland, Auckland, New Zealand
| | - Angie Li
- University of Auckland, Auckland, New Zealand.,Auckland City Hospital, Auckland, New Zealand
| | - Karen Sheath
- LabPlus, Auckland City Hospital, Auckland, New Zealand
| | | | | | | | | | - Donald Love
- LabPlus, Auckland City Hospital, Auckland, New Zealand
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33
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Li R, Li Q, Lin S, Li W, Yu L, Wang L, Dong X, Yu L, Li S, Liu W, Li B. Prognostic implication of EGFR mutation status and subtype in resected lung adenocarcinoma patients irrespective of therapy. Clin Transl Oncol 2018; 21:298-303. [PMID: 30022385 DOI: 10.1007/s12094-018-1922-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/11/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to investigate the pure prognostic role of epidermal growth factor receptor (EGFR) mutation status and subtype in lung adenocarcinoma patients irrespective of therapy. MATERIALS AND METHODS We retrospectively enrolled 119 cases of completely resected pathological stage I lung adenocarcinoma patients who received no postoperative chemotherapy or tyrosine kinase inhibitors. EGFR gene mutations from 18 to 21 exons were tested for all the patients. Disease-free survival (DFS) and overall survival (OS) were compared between patients with different EGFR mutation status and subtype using Kaplan-Meier methods. RESULTS EGFR mutations were detected in 54 (45.4%) patients including two common mutation subtypes: 32 in-frame deletion within exon 19 (19del) and 19 point mutation within exon 21 (L858R). The frequency of EGFR mutations was much greater for patients of non-smokers versus current or ever smokers (58.1 versus 24.4%, P = 0.000), and a little greater for females versus males (53.8 versus 35.2%, P = 0.042). The median follow-up duration was 43.5 months, and there were no differences on DFS (P = 0.461) and OS (P = 0.989) between patients with EGFR mutations and those without in univariate analysis. The patients harboring 19del mutation had a better DFS (P = 0.028) and OS (P = 0.001) than the patients harboring L858R mutation with significant statistical difference. CONCLUSIONS This study suggests that there is no difference on survival between patients with EGFR mutations and those without, but the patients harboring EGFR 19del mutation have survival advantage compared to those harboring EGFR L858R mutation.
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Affiliation(s)
- R Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute Affiliated to Shandong University, No 440, Jiyan Road, Jinan, Shandong, China
| | - Q Li
- Department of Oncology II, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - S Lin
- Department of Oncology II, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - W Li
- Department of Oncology II, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - L Yu
- Department of Oncology II, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - L Wang
- Department of Oncology II, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - X Dong
- Department of Oncology II, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - L Yu
- Department of Oncology II, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - S Li
- Department of Oncology II, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - W Liu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - B Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute Affiliated to Shandong University, No 440, Jiyan Road, Jinan, Shandong, China.
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Jao K, Tomasini P, Kamel-Reid S, Korpanty GJ, Mascaux C, Sakashita S, Labbé C, Leighl NB, Liu G, Feld R, Bradbury PA, Hwang DM, Pintilie M, Tsao MS, Shepherd FA. The prognostic effect of single and multiple cancer-related somatic mutations in resected non-small-cell lung cancer. Lung Cancer 2018; 123:22-29. [PMID: 30089591 DOI: 10.1016/j.lungcan.2018.06.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 03/20/2018] [Accepted: 06/18/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Somatic mutations are becoming increasingly important biomarkers for treatment selection and outcome in patients with non-small-cell lung cancer (NSCLC). The role of multiple somatic mutations in early-stage NSCLC is unclear. METHODS Tissue from 214 patients with resected NSCLC at the Princess Margaret Cancer Centre was analyzed by next-generation sequencing by Mi-SEQ or Sequenom multiplex platforms. Associations between mutation status, baseline patient characteristics and outcomes (disease-free survival (DFS) after surgical resection and overall survival (OS)) were investigated. RESULTS Somatic mutations were identified in 184 patients with resected stage I-III NSCLC: None (n = 30), single (n = 101) and multiple (≥2, n = 83). Multiple mutations were significantly associated with younger age (p = 0.0006), female sex (p = 0.012), smoking status (p = 0.002) and adenocarcinoma histology (p = 0.0001).TP53, KRAS and EGFR were the most common mutations. TP53 mutation was the most frequent co-mutation occurring in 72% of patients with multiple mutations. In resected stage I-III patients, multiple mutations were significantly associated with worse DFS (HR = 2.56, p = 0.003) but not OS on univariate analysis. Patients with KRAS and EGFR mutations were also associated with shorter DFS (HR = 2.52, p = 0.016 and HR = 4.37, p = 0.001 respectively) but no OS difference. TP53 mutation was associated with both shorter DFS (HR = 2.21, p = 0.02) and OS (HR = 3.08, p = 0.02). In subgroup univariate analysis, poorer DFS was associated with multiple mutations (p = 0.0015), EGFR (HR = 3.14, p = 0.006), and TP53 (HR = 2.46, p = 0.018) in patients with stage I disease. CONCLUSION The presence of known somatic mutations is associated with worse DFS in resected NSCLC. The differences are both statistically significant and clinically relevant. The presence of EGFR, KRAS and TP53 mutations was also associated with adverse outcomes. Larger datasets are required to validate whether mutational status is an independent prognostic factor in early stage NSCLC.
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Affiliation(s)
- Kevin Jao
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada.
| | - Pascale Tomasini
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille. Multidisciplinary Oncology and Therapeutic Innovations department, Marseille, 13015, France
| | - Suzanne Kamel-Reid
- Laboratory Genetics, University Health Network, Toronto, Ontario, Canada
| | - Gregorz J Korpanty
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Céline Mascaux
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille. Multidisciplinary Oncology and Therapeutic Innovations department, Marseille, 13015, France
| | - Shingo Sakashita
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibraraki, Japan
| | - Catherine Labbé
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Natasha B Leighl
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Ronald Feld
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Penelope A Bradbury
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - David M Hwang
- Laboratory Medicine and Pathobiology, University Health Network, Toronto, Ontario, Canada
| | - Melania Pintilie
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ming-Sound Tsao
- Laboratory Medicine and Pathobiology, University Health Network, Toronto, Ontario, Canada
| | - Frances A Shepherd
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
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Renaud S, Seitlinger J, Guerrera F, Reeb J, Beau-Faller M, Voegeli AC, Siat J, Clément-Duchêne C, Tiotiu A, Santelmo N, Costardi L, Ruffini E, Falcoz PE, Vignaud JM, Massard G. Prognostic Value of Exon 19 Versus 21 EGFR Mutations Varies According to Disease Stage in Surgically Resected Non-small Cell Lung Cancer Adenocarcinoma. Ann Surg Oncol 2018; 25:1069-1078. [DOI: 10.1245/s10434-018-6347-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Prognostic value of tumor mutations in radically treated locally advanced non-small cell lung cancer patients. Oncotarget 2018; 8:25189-25199. [PMID: 28445990 PMCID: PMC5421921 DOI: 10.18632/oncotarget.15966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 02/15/2017] [Indexed: 12/25/2022] Open
Abstract
Introduction Chemo-radiation is standard treatment in locally advanced non-small cell lung cancers (NSCLC). The prognostic value of mutations has been poorly explored in this population. RESULTS Clinical data were collected from 190 patients and mutational profiles were obtained in 78 of them; 58 (74%) were males, 31 (40%) current smokers, 47/31 stage IIIA/IIIB and 40 (51%) adenocarcinoma. The following mutations were identified: EGFR 12% (9/78), KRAS 15% (12/78), BRAF 5% (3/65), PI3KCA 2% (1/57), NRAS 3% (1/32), and ALK+ (FISH) 4% (2/51). HER2 was not detected. Median follow-up was 3.1 years. Overall survival was evaluated by group; no significant differences were identified in median overall survival (p = 0.21), with 29.4 months for the EGFR/ALK group (n = 11), 12.8 months for other mutations (n = 17), and 23.4 months for wild-type (n = 50). The EGFR/ALK and other mutations groups had poorer median progression-free survival (9.6 and 6.0 months) compared to the wild-type group (12.0 months; multivariate hazard ratio 2.0 [95% CI, 0.9–4.2] and 2.8 [95% CI, 1.5–5.2] respectively, p = 0.003). Materials and Methods We retrospectively reviewed all patients receiving radical treatment for locally advanced NSCLC in a single institution between January 2002 and June 2013. Next generation sequencing was performed on DNA from paraffin-embedded tissue. ALK rearrangements were detected by immunohistochemistry and/or FISH. Mutational prognostic value for Kaplan-Meier survival parameters was determined by log-rank tests and Cox proportional hazards models. Conclusions Selected gene alterations may be associated with poorer progression-free survival in locally advanced radically treated NSCLC and their prognostic and/or predictive value merits further evaluation in a larger population.
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Hayasaka K, Shiono S, Matsumura Y, Yanagawa N, Suzuki H, Abe J, Sagawa M, Sakurada A, Katahira M, Takahashi S, Endoh M, Okada Y. Epidermal Growth Factor Receptor Mutation as a Risk Factor for Recurrence in Lung Adenocarcinoma. Ann Thorac Surg 2018; 105:1648-1654. [PMID: 29486179 DOI: 10.1016/j.athoracsur.2018.01.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The presence of epidermal growth factor receptor (EGFR) mutations is an established prognostic factor for patients with advanced lung adenocarcinoma. Here, we examined whether EGFR mutation status is a prognostic factor for patients who had undergone surgery. METHODS Clinicopathologic data from 1,463 patients who underwent complete surgical resection for lung adenocarcinoma between 2005 and 2012 were collected. Differences in postoperative recurrence-free survival and overall survival according to EGFR mutation status were evaluated. RESULTS Of 835 eligible patients, the numbers of patients with wild-type EGFR (WT), exon 19 deletion (Ex19), and exon 21 L858R (Ex21) were 426, 175, and 234, respectively. Patients with Ex19 had a significantly higher incidence of extrathoracic recurrence than patients with Ex21 (p = 0.004). The 5-year recurrence-free survival rates for patients with WT, Ex19, and Ex21 were 63.0%, 67.5%, and 78.2%, respectively. The Ex21 group had a significantly longer recurrence-free survival than the WT group (p < 0.001) and the Ex19 group (p = 0.016). The 5-year overall survival for patients with WT, Ex19, and Ex21 were 76.9%, 86.5%, and 87.5%, respectively. Patients with Ex19 and Ex21 had a significantly longer overall survival than patients with WT (Ex19, p = 0.009; Ex21, p < 0.001). Multivariate analysis for recurrence-free survival showed that Ex19 was significantly associated with a worse prognosis than Ex21 (p = 0.019). CONCLUSIONS Patients with Ex19 had significantly shorter recurrence-free survival and had extrathoracic recurrence more frequently than patients with Ex21 among patients with resected lung adenocarcinoma, implying that Ex19 could be a worse prognostic factor.
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Affiliation(s)
- Kazuki Hayasaka
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
| | - Yuki Matsumura
- Department of Regenerative Surgery, Fukushima Medical University, Fukushima, Japan
| | - Naoki Yanagawa
- Department of Pathology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Hiroyuki Suzuki
- Department of Regenerative Surgery, Fukushima Medical University, Fukushima, Japan
| | - Jiro Abe
- Department of Thoracic Surgery, Miyagi Cancer Center, Miyagi, Japan
| | - Motoyasu Sagawa
- Department of Endoscopy, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Akira Sakurada
- Department of Thoracic Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Masato Katahira
- Department of Thoracic Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Satomi Takahashi
- Department of Thoracic Surgery, Miyagi Cancer Center, Miyagi, Japan
| | - Makoto Endoh
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Soon YY, Vellayappan B, Tey JCS, Leong CN, Koh WY, Tham IWK. Impact of epidermal growth factor receptor sensitizing mutations on outcomes of patients with non-small cell lung cancer treated with definitive thoracic radiation therapy: a systematic review and meta-analysis. Oncotarget 2017; 8:109712-109722. [PMID: 29312641 PMCID: PMC5752554 DOI: 10.18632/oncotarget.21019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/29/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To determine if the presence of epidermal growth factor receptor (EGFR) sensitizing mutations improves tumor control and survival outcomes in patients with non-metastatic non-small cell lung cancer (NSCLC) who received definitive thoracic radiation therapy (TRT) with or without chemotherapy. MATERIALS AND METHODS We searched MEDLINE for eligible comparative studies which compared the outcomes of patients treated with definitive TRT according to EGFR mutation status. Meta-analysis was performed using random effects model. Outcomes of interest were tumor overall response rate (ORR), loco-regional (LRR), distant recurrence rates (DRR), relapse-free survival (RFS), overall survival (OS) and adverse events (AE). RESULTS We found seven studies including 537 patients with stage III NSCLC. Up to 45% of patients in the studies had mutations in exon 19 and 21. Patients harbouring EGFR sensitizing mutations had a trend towards improvement in ORR (risk ratio 1.17, 95% confidence interval 0.99-1.37, P = 0.06) compared to EGFR wild type status. There were no significant differences in LRR, DRR, RFS, OS and AE outcomes between the EGFR mutant and EGFR wild type groups. CONCLUSIONS The presence of EGFR sensitizing mutations may improve tumour response rate but not survival in patients with localized NSCLC treated with definitive thoracic radiation therapy with or without chemotherapy.
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Affiliation(s)
- Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore
- National University Hospital, Singapore
- National University of Singapore, Singapore
| | - Balamurugan Vellayappan
- Department of Radiation Oncology, National University Cancer Institute, Singapore
- National University Hospital, Singapore
- National University of Singapore, Singapore
| | - Jeremy Chee Seong Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore
- National University Hospital, Singapore
- National University of Singapore, Singapore
| | - Cheng Nang Leong
- Department of Radiation Oncology, National University Cancer Institute, Singapore
- National University Hospital, Singapore
- National University of Singapore, Singapore
| | - Wee Yao Koh
- Department of Radiation Oncology, National University Cancer Institute, Singapore
- National University Hospital, Singapore
- National University of Singapore, Singapore
| | - Ivan Weng Keong Tham
- Department of Radiation Oncology, National University Cancer Institute, Singapore
- National University Hospital, Singapore
- National University of Singapore, Singapore
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Lo WM, Ripley RT. EGFR mutational status in lung adenocarcinoma: Staging implications or continuous evolution? J Thorac Cardiovasc Surg 2017; 154:1766-1767. [DOI: 10.1016/j.jtcvs.2017.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 07/31/2017] [Indexed: 12/09/2022]
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Prognostic implication of EGFR gene mutations and histological classification in patients with resected stage I lung adenocarcinoma. PLoS One 2017; 12:e0186567. [PMID: 29065153 PMCID: PMC5655534 DOI: 10.1371/journal.pone.0186567] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/03/2017] [Indexed: 01/12/2023] Open
Abstract
Introduction The prognostic value of epidermal growth factor receptor (EGFR) mutations and the correlation between EGFR mutations and the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) histological classification remain controversial. The current study aimed to investigate the pure prognostic role of EGFR mutations in treatment-naïve patients with resected stage I lung adenocarcinoma. Methods We retrospectively reviewed 373 patients with stage I pulmonary non-small-cell lung cancer who underwent complete surgical resection between January 2010 and May 2014. The tumors were classified according to IASLC/ATS/ERS criteria. EGFR mutation status was determined by established methods. Results A total of 120 patients were included for analysis; 87 had tumors with EGFR mutations and 33 had wild-type tumors. More low- and intermediate-grade tumors had EGFR mutations, and nearly half of the high-grade tumors were wild-type (75.7% versus 46.2%, p = 0.041). Patients with low-grade tumors had significantly greater median disease-free survival (DFS) (76.8 versus 13 months, p < 0.0001) and better overall survival (OS) (median OS not reached, p = 0.0003) than those with intermediate- and high-grade tumors. Tumor recurrence was 41.4% and 30.3% in mutant and wild-type patients. The 5-years survival rate was 54% and 71.2%. Multivariate analysis revealed that the new histological classification and the pathologic stage were independent predictors of both DFS and OS. EGFR mutation status had no prognostic implications. Conclusion Low grade tumors according to IASLC/ATS/ERS histological classification and the pathologic stage IA tumors of resected stage I lung adenocarcinomas independently predict better DFS and OS. EGFR mutations were frequently seen in histologically low- and intermediate-grade tumors but not a prognostic factor.
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Takamochi K, Oh S, Matsunaga T, Suzuki K. Prognostic impacts of EGFR mutation status and subtype in patients with surgically resected lung adenocarcinoma. J Thorac Cardiovasc Surg 2017; 154:1768-1774.e1. [PMID: 28826599 DOI: 10.1016/j.jtcvs.2017.06.062] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/07/2017] [Accepted: 06/30/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Epidermal growth factor receptor (EGFR) gene mutation status is a well-established predictor of the efficacy of EGFR tyrosine-kinase inhibitor (TKI) therapy in patients with non-small cell lung cancer. Recently, differences in EGFR mutation subtypes have been reported to be associated with the efficacy of EGFR-TKI therapy. The prognostic impact of EGFR mutation status and subtypes remains controversial, however. METHODS We retrospectively reviewed 939 patients with surgically resected adenocarcinomas who underwent EGFR mutation status analysis between January 2010 and December 2014. Overall survival (OS) and recurrence-free survival (RFS) were compared according to pathological stage, EGFR mutation status, and EGFR mutation subtype using the log-rank test. Independent prognostic factors for OS and RFS were identified by multivariate analysis using the Cox proportional hazards model. RESULTS The median duration of follow-up was 48 months. We found that positive EGFR mutation status was significantly associated with longer OS and RFS in all patients and was associated with longer OS in patients in pathological stage I; however, there were no significant differences in OS and RFS between patients with exon 21 L858R mutations and those with exon 19 deletions. In a Cox regression model for OS, EGFR mutation status was a significant prognostic factor that was independent of well-established prognostic factors, including age, pathological stage, vascular invasion, lymphatic permeation, and serum carcinoembryonic antigen level. CONCLUSIONS Positive EGFR mutation status is a favorable prognostic factor in patients with surgically resected lung adenocarcinomas; however, EGFR mutation subtype (exon 21 L858R mutation or exon 19 deletion) exhibits no prognostic impact.
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Affiliation(s)
- Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Shiaki Oh
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Shepherd FA, Lacas B, Le Teuff G, Hainaut P, Jänne PA, Pignon JP, Le Chevalier T, Seymour L, Douillard JY, Graziano S, Brambilla E, Pirker R, Filipits M, Kratzke R, Soria JC, Tsao MS. Pooled Analysis of the Prognostic and Predictive Effects of TP53 Comutation Status Combined With KRAS or EGFR Mutation in Early-Stage Resected Non-Small-Cell Lung Cancer in Four Trials of Adjuvant Chemotherapy. J Clin Oncol 2017; 35:2018-2027. [PMID: 28453411 PMCID: PMC6075828 DOI: 10.1200/jco.2016.71.2893] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose Our previous work evaluated individual prognostic and predictive roles of TP53, KRAS, and EGFR in non-small-cell lung cancer (NSCLC). In this analysis, we explore the prognostic and predictive roles of TP53/KRAS and TP53/EGFR comutations in randomized trials of adjuvant chemotherapy versus observation. Patients and Methods Mutation analyses (wild-type [WT] and mutant) for TP53, KRAS, and EGFR were determined in blinded fashion in multiple laboratories. Primary and secondary end points of pooled analysis were overall survival and disease-free survival. We evaluated the role of TP53/KRAS comutation in all patients and in the adenocarcinoma subgroup as well as the TP53/EGFR comutation in adenocarcinoma only through a multivariable Cox proportional hazards model stratified by trial. Results Of 3,533 patients with NSCLC, 1,181 (557 deaths) and 404 (170 deaths) were used for TP53/KRAS and TP53/EGFR analyses. For TP53/KRAS mutation status, no prognostic effect was observed ( P = .61), whereas a borderline predictive effect ( P = .04) was observed with a deleterious effect of chemotherapy with TP53/KRAS comutations versus WT/WT (hazard ratio, 2.49 [95% CI, 1.10 to 5.64]; P = .03). TP53/EGFR comutation in adenocarcinoma was neither prognostic ( P = .83), nor significantly predictive ( P = .86). Similar results were observed for both groups for disease-free survival. Conclusion We could identify no prognostic effect of the KRAS or EGFR driver and TP53 tumor suppressor comutation. Our observation of a potential negative predictive effect of TP53/KRAS comutation requires validation.
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Affiliation(s)
- Frances A. Shepherd
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - Benjamin Lacas
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - Gwénaël Le Teuff
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - Pierre Hainaut
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - Pasi A. Jänne
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - Jean-Pierre Pignon
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - Thierry Le Chevalier
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - Lesley Seymour
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - Jean-Yves Douillard
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - Stephen Graziano
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - Elizabeth Brambilla
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - Robert Pirker
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - Martin Filipits
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - Robert Kratzke
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - Jean-Charles Soria
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - Ming-Sound Tsao
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
| | - on behalf of the LACE-Bio Collaborative Group
- Frances A. Shepherd and Ming-Sound Tsao, Princess Margaret Cancer Centre; University of Toronto, Toronto; Lesley Seymour, Queen’s University, Kingston, Ontario, Canada; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave-Roussy; Benjamin Lacas, Gwénaël Le Teuff, Jean-Pierre Pignon, Thierry Le Chevalier, and Jean-Charles Soria, University Paris XI, Paris; Pierre Hainaut, International Agency for Research on Cancer, Lyon; Jean-Yves Douillard, R Gauducheau, St Herblain; Elizabeth Brambilla, Inserm U823, Institut Albert Bonniot, Département de Pathologie CHU, Albert Michallon University Joseph Fourrier, Grenoble, France; Pasi A. Jänne, Dana-Farber Cancer Institute, Boston, MA; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN; and Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna, Austria
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Renaud S, Seitlinger J, Massard G. MicroRNAs: a new tool in the complex biology of KRAS mutated non-small cell lung cancer? J Thorac Dis 2017; 9:957-960. [PMID: 28523147 DOI: 10.21037/jtd.2017.03.56] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Stéphane Renaud
- Department of Thoracic Surgery, Institut Lorrain Du Coeur Et Des Vaisseaux Louis Mathieu, Nancy University Hospital, Nancy, France
| | - Joseph Seitlinger
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Gilbert Massard
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
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Genetic susceptibility variants for lung cancer: replication study and assessment as expression quantitative trait loci. Sci Rep 2017; 7:42185. [PMID: 28181565 PMCID: PMC5299838 DOI: 10.1038/srep42185] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/06/2017] [Indexed: 12/13/2022] Open
Abstract
Many single nucleotide polymorphisms (SNPs) have been associated with lung cancer but lack confirmation and functional characterization. We retested the association of 56 candidate SNPs with lung adenocarcinoma risk and overall survival in a cohort of 823 Italian patients and 779 healthy controls, and assessed their function as expression quantitative trait loci (eQTLs). In the replication study, eight SNPs (rs401681, rs3019885, rs732765, rs2568494, rs16969968, rs6495309, rs11634351, and rs4105144) associated with lung adenocarcinoma risk and three (rs9557635, rs4105144, and rs735482) associated with survival. Five of these SNPs acted as cis-eQTLs, being associated with the transcription of IREB2 (rs2568494, rs16969968, rs11634351, rs6495309), PSMA4 (rs6495309) and ERCC1 (rs735482), out of 10,821 genes analyzed in lung. For these three genes, we obtained experimental evidence of differential allelic expression in lung tissue, pointing to the existence of in-cis genomic variants that regulate their transcription. These results suggest that these SNPs exert their effects on cancer risk/outcome through the modulation of mRNA levels of their target genes.
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Guerrera F, Renaud S, Tabbó F, Voegeli’ AC, Filosso PL, Legrain M, Boita M, Schaeffer M, Beau-Faller M, Ruffini E, Falcoz PE, Inghirami G, Oliaro A, Massard G. Epidermal growth factor receptor mutations are linked to skip N2 lymph node metastasis in resected non-small-cell lung cancer adenocarcinomas†. Eur J Cardiothorac Surg 2016; 51:680-688. [DOI: 10.1093/ejcts/ezw362] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/13/2016] [Indexed: 12/25/2022] Open
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Seitlinger J, Renaud S, Falcoz PE, Schaeffer M, Olland A, Reeb J, Santelmo N, Legrain M, Voegeli AC, Weingertner N, Chenard MP, Beau-Faller M, Massard G. Epidermal growth factor receptor and v-Ki-ras2 Kirsten rat sarcoma viral oncogen homologue-specific amino acid substitutions are associated with different histopathological prognostic factors in resected non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2016; 23:902-907. [DOI: 10.1093/icvts/ivw250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Sandfeld-Paulsen B, Folkersen BH, Rasmussen TR, Meldgaard P, Sorensen BS. Gene Expression of the EGF System-a Prognostic Model in Non-Small Cell Lung Cancer Patients Without Activating EGFR Mutations. Transl Oncol 2016; 9:306-12. [PMID: 27567953 PMCID: PMC5006812 DOI: 10.1016/j.tranon.2016.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/09/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES: Contradicting results have been demonstrated for the expression of the epidermal growth factor receptor (EGFR) as a prognostic marker in non–small cell lung cancer (NSCLC). The complexity of the EGF system with four interacting receptors and more than a dozen activating ligands is a likely explanation. The aim of this study is to demonstrate that the combined network of receptors and ligands from the EGF system is a prognostic marker. MATERIAL AND METHODS: Gene expression of the receptors EGFR, HER2, HER3, HER4, and the ligands AREG, HB-EGF, EPI, TGF-α, and EGF was measured by quantitative polymerase chain reaction in tumor samples from 100 NSCLC patients without EGFR activating mutations. Results were dichotomized into high or low levels of target expression. Coexpression of the ligands and receptors was observed, and a score was developed based on the summed effect of receptors and ligands. Akaike’s information criteria selected the optimal score. Results were correlated with age, sex, stage, histology, performance status, and overall survival. RESULTS: Patients were randomly split 1:1 to create test and validation cohorts. In multivariate analyses, the only individual prognostic marker was EPI (hazard ratio [HR] 0.38 [0.20-0.72], P = .003). The optimal score in the test cohort was validated as a marker of inferior survival in the validation cohort and by bootstrapping. Multivariate analysis confirmed the combined score as a prognostic marker of inferior survival (HR 3.75 [2.17-6.47], P < .00001). CONCLUSION: Our study has developed a model that takes the complexity of the EGF system into account and shows that this model is a strong prognostic marker in NSCLC patients.
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Affiliation(s)
| | | | | | - Peter Meldgaard
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Boe S Sorensen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
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Concordant and Discordant EGFR Mutations in Patients With Multifocal Adenocarcinomas: Implications for EGFR-Targeted Therapy. Clin Ther 2016; 38:1567-76. [PMID: 27368115 DOI: 10.1016/j.clinthera.2016.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/04/2016] [Accepted: 06/07/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Adenocarcinoma remains the most common subtype of lung cancer in the United States. Most patients present with tumors that are invasive and often metastatic, but in some patients, multiple precursor in situ or minimally invasive adenocarcinoma tumors develop that can be synchronous and metachronous. These precursor lesions harbor the same spectrum of genetic mutations found in purely invasive adenocarcinomas, such as EGFR, KRAS, and p53 mutations. It is less clear, however, whether separate lesions in patients who present with multifocal disease share common underlying genetic driver mutations. METHODS Here we review the relevant literature on molecular driver alterations in adenocarcinoma precursor lesions. We then report 4 patients with multifocal EGFR mutant adenocarcinomas in whom we performed molecular testing on 2 separate lesions. FINDINGS In 2 of these patients, the mutations are concordant, and in 2 patients, the mutations are discordant. A review of the literature demonstrates increasing evidence that lesions with discordant mutations may confer a more favorable prognosis because they are unlikely to represent metastases. IMPLICATIONS Our findings suggest that the emergence of the dominant EGFR driver alteration is often independent between lesions in patients with multifocal adenocarcinomas, and thus the same targeted therapy may not be effective for all lesions. However, genetic testing of multiple lesions can help to distinguish separate primary tumors from metastatic disease.
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Specific KRAS amino acid substitutions and EGFR mutations predict site-specific recurrence and metastasis following non-small-cell lung cancer surgery. Br J Cancer 2016; 115:346-53. [PMID: 27336603 PMCID: PMC4973154 DOI: 10.1038/bjc.2016.182] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 04/27/2016] [Accepted: 05/17/2016] [Indexed: 12/30/2022] Open
Abstract
Background: We aimed to evaluate whether EGFR mutations (mEGFR) and KRAS amino acid substitutions can predict first site of recurrence or metastasis after non-small-cell lung cancer (NSCLC) surgery. Methods: Data were reviewed from 481 patients who underwent thoracic surgery for NSCLC between 2007 and 2012. Results: Patients with KRAS G12C developed significantly more bone metastases compared with the remainder of the cohort (59% vs 16%, P<0.0001). This was confirmed in multivariate analysis (MA) (odds ratio (OR): 0.113 (95% confidence interval (CI): 0.055–0.231), P<0.0001). Significantly, more patients with mEGFR developed liver and brain metastases compared with the remainder of the cohort (30% vs 10%, P=0.006; 59% vs 1%, P<0.0001, respectively). These were confirmed in MA (OR: 0.333 (95% CI: 0.095–0.998), P=0.05; OR: 0.032 (95% CI: 0.008–0.135), P<0.0001, respectively). Patients with KRAS G12V developed significantly more pleuro-pericardial metastases compared with the remainder of the cohort (94% vs 12%, P<0.0001). This was confirmed in MA (OR: 0.007 (95% CI: 0.001–0.031), P<0.0001). Wild-type patients developed significantly more lung metastases (35% vs 10%, P<0.0001). This was confirmed in MA (OR: 0.383 (95% CI: 0.193–0.762), P=0.006). Conclusion: Epidermal growth factor receptor mutation and KRAS amino acid substitutions seem to predict site-specific recurrence and metastasis after NSCLC surgery.
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Liu SR, Qiu B, Yang H, Liang Y, Wang F, Liu SL, Chen ZL, Zhang L, Liu MZ, Wang SY, Lin LF, Liu H. Epidermal Growth Factor Receptor Mutation Status and Treatment Outcome for R0-Resected Patients with Stage 3 Non-small Cell Lung Cancer. Ann Surg Oncol 2016; 23:2115-22. [DOI: 10.1245/s10434-015-5076-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Indexed: 11/18/2022]
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