1
|
Hueman M, Wang H, Liu Z, Henson D, Nguyen C, Park D, Sheng L, Chen D. Expanding TNM for lung cancer through machine learning. Thorac Cancer 2021; 12:1423-1430. [PMID: 33713568 PMCID: PMC8088955 DOI: 10.1111/1759-7714.13926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 01/05/2023] Open
Abstract
Background Expanding the tumor, lymph node, metastasis (TNM) staging system by accommodating new prognostic and predictive factors for cancer will improve patient stratification and survival prediction. Here, we introduce machine learning for incorporating additional prognostic factors into the conventional TNM for stratifying patients with lung cancer and evaluating survival. Methods Data were extracted from SEER. A total of 77 953 patients were analyzed using factors including primary tumor (T), regional lymph node (N), distant metastasis (M), age, and histology type. Ensemble algorithm for clustering cancer data (EACCD) and C‐index were applied to generate prognostic groups and expand the current staging system. Results With T, N, and M, EACCD stratified patients into 11 groups, resulting in a significantly higher accuracy in survival prediction than the 10 AJCC stages (C‐index = 0.7346 vs. 0.7247, increase in C‐index = 0.0099, 95% CI: 0.0091–0.0106, p‐value = 9.2 × 10−147). There nevertheless remained a strong association between the EACCD grouping and AJCC staging (rank correlation = 0.9289; p‐value = 6.7 × 10−22). A further analysis demonstrated that age and histological tumor could be integrated with the TNM. Data were stratified into 12 prognostic groups with an even higher prediction accuracy (C‐index = 0.7468 vs. 0.7247, increase in C‐index = 0.0221, 95% CI: 0.0212–0.0231, p‐value <5 × 10−324). Conclusions EACCD can be successfully applied to integrate additional factors with T, N, M for lung cancer patients.
Collapse
Affiliation(s)
- Matthew Hueman
- Department of Surgical Oncology, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Huan Wang
- Department of Biostatistics, George Washington University, Washington, District of Columbia, USA
| | - Zhenqiu Liu
- Department of Public Health Sciences, Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Donald Henson
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Cuong Nguyen
- Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Dean Park
- Department of Hematology-Oncology, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Li Sheng
- Department of Mathematics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Dechang Chen
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| |
Collapse
|
2
|
Tantraworasin A, Siwachat S, Tanatip N, Lertprasertsuke N, Kongkarnka S, Euathrongchit J, Wannasopha Y, Suksombooncharoen T, Chewaskulyong B, Taioli E, Saeteng S. Outcomes of pulmonary resection in non-small cell lung cancer patients older than 70 years old. Asian J Surg 2019; 43:154-165. [PMID: 30898491 DOI: 10.1016/j.asjsur.2019.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/23/2019] [Accepted: 03/05/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND An appropriate treatment of older lung cancer patients has become an important issue. The aim of this study is to evaluate the short and long-term surgical outcomes in lung cancer patients using 70 years as a cut-point, and to identify prognostic factors of cancer-specific mortality in patients older than 70 years. METHODS Medical records of non-small cell lung cancer (NSCLC) patients who underwent pulmonary resection at Chiang Mai University Hospital from January 2002 through December 2016 were retrospectively reviewed. Patients were divided into age less than 70 years (control group) and 70 years or more (study group). Primary outcomes were major post-operative complications and in-hospital death (POM); secondary outcome was long-term survival. Multivariable regression analysis was used. RESULTS This study included 583 patients, 167 for study group, and 416 for control group. There were no differences in POM, both at univariable and multivariable analyses, however, for long-term cancer-specific mortality, the study group was more likely to die (HRadj = 1.40, 95%CI = 1.03-1.89). Adverse prognostic factors for long-term mortality in study group were having universal coverage scheme (HRadj = 1.70, 95%CI = 1.03-2.79), the presence of intratumoral lymphatic invasion (HRadj = 2.83, 95%CI = 1.28-6.29), perineural invasion (HRadj = 2.80, 95%CI = 1.13-6.94), underwent lymph node sampling (HRadj = 2.23, 95%CI = 1.16-4.30) and higher stage of disease (HRadj = 2.02, 95%CI = 1.06-3.85 for stage III, HRadj = 3.40, 95%CI = 1.29-8.94 for stage IV). CONCLUSIONS In-hospital mortality and composite post-operative complications are acceptable in pulmonary resection for NSCLC patients older than 70 years. However, these patients had shorter long-term survival, especially who have some adverse prognostic factors. Further studies with larger sample size are warranted.
Collapse
Affiliation(s)
- Apichat Tantraworasin
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Sophon Siwachat
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narumon Tanatip
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nirush Lertprasertsuke
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sarawut Kongkarnka
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Juntima Euathrongchit
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yutthaphan Wannasopha
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Busayamas Chewaskulyong
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Emanuela Taioli
- Tisch Cancer Institute, Institute for Translational Epidemiology, Department of Population Health Science and Policy, Icahn Medical School at Mount Sinai, New York, NY, USA
| | - Somcharoen Saeteng
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
3
|
Hu R, Wang X, Zhan X. Multi-parameter systematic strategies for predictive, preventive and personalised medicine in cancer. EPMA J 2013; 4:2. [PMID: 23339750 PMCID: PMC3564825 DOI: 10.1186/1878-5085-4-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/09/2013] [Indexed: 12/11/2022]
Abstract
Cancer is a complex disease that causes the alterations in the levels of gene, RNA, protein and metabolite. With the development of genomics, transcriptomics, proteomics and metabolomic techniques, the characterisation of key mutations and molecular pathways responsible for tumour progression has led to the identification of a large number of potential targets. The increasing understanding of molecular carcinogenesis has begun to change paradigms in oncology from traditional single-factor strategy to multi-parameter systematic strategy. The therapeutic model of cancer has changed from adopting the general radiotherapy and chemotherapy to personalised strategy. The development of predictive, preventive and personalised medicine (PPPM) will allow prediction of response with substantially increased accuracy, stratification of particular patient groups and eventual personalisation of medicine. The PPPM will change the approach to tumour diseases from a systematic and comprehensive point of view in the future. Patients will be treated according to the specific molecular profiles that are found in the individual tumour tissue and preferentially with targeted substances, if available.
Collapse
Affiliation(s)
- Rong Hu
- Key Laboratory of Cancer Proteomics of Chinese Ministry of Health, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, People's Republic of China.
| | | | | |
Collapse
|
4
|
Brodowicz T, Ciuleanu T, Crawford J, Filipits M, Fischer JR, Georgoulias V, Gridelli C, Hirsch FR, Jassem J, Kosmidis P, Krzakowski M, Manegold C, Pujol JL, Stahel R, Thatcher N, Vansteenkiste J, Minichsdorfer C, Zöchbauer-Müller S, Pirker R, Zielinski CC. Third CECOG consensus on the systemic treatment of non-small-cell lung cancer. Ann Oncol 2012; 23:1223-1229. [PMID: 21940784 DOI: 10.1093/annonc/mdr381] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The current third consensus on the systemic treatment of non-small-cell lung cancer (NSCLC) builds upon and updates similar publications on the subject by the Central European Cooperative Oncology Group (CECOG), which has published such consensus statements in the years 2002 and 2005 (Zielinski CC, Beinert T, Crawford J et al. Consensus on medical treatment of non-small-cell lung cancer--update 2004. Lung Cancer 2005; 50: 129-137). The principle of all CECOG consensus is such that evidence-based recommendations for state-of-the-art treatment are given upon which all participants and authors of the manuscript have to agree (Beslija S, Bonneterre J, Burstein HJ et al. Third consensus on medical treatment of metastatic breast cancer. Ann Oncol 2009; 20 (11): 1771-1785). This is of particular importance in diseases in which treatment options depend on very particular clinical and biologic variables (Zielinski CC, Beinert T, Crawford J et al. Consensus on medical treatment of non-small-cell lung cancer--update 2004. Lung Cancer 2005; 50: 129-137; Beslija S, Bonneterre J, Burstein HJ et al. Third consensus on medical treatment of metastatic breast cancer. Ann Oncol 2009; 20 (11): 1771-1785). Since the publication of the last CECOG consensus on the medical treatment of NSCLC, a series of diagnostic tools for the characterization of biomarkers for personalized therapy for NSCLC as well as therapeutic options including adjuvant treatment, targeted therapy, and maintenance treatment have emerged and strongly influenced the field. Thus, the present third consensus was generated that not only readdresses previous disease-related issues but also expands toward recent developments in the management of NSCLC. It is the aim of the present consensus to summarize minimal quality-oriented requirements for individual patients with NSCLC in its various stages based upon levels of evidence in the light of a rapidly expanding array of individual therapeutic options.
Collapse
Affiliation(s)
- T Brodowicz
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria; Central European Cooperative Oncology Group
| | - T Ciuleanu
- Medical Oncology Department, Institute of Oncology, Cluj-Napoca, Romania
| | - J Crawford
- Department of Medicine, Duke Medical Center, Durham, USA
| | - M Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria
| | - J R Fischer
- Department of Medicine II, Onkology, Klinik Löwenstein, Löwenstein, Germany
| | - V Georgoulias
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - C Gridelli
- Division of Medical Oncology, S.G. Moscati Hospital, Contrada Amoretta, Italy
| | - F R Hirsch
- Department of Pathology, University of Colorado, Aurora, USA
| | - J Jassem
- Central European Cooperative Oncology Group; Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - P Kosmidis
- Department of Medical Oncology, Hygeia Hospital, Athens, Greece
| | - M Krzakowski
- Central European Cooperative Oncology Group; Department of Lung and Thoracic Tumours, Maria Sklodowska Curie Memorial Cancer Center, Warsaw, Poland
| | - Ch Manegold
- Department of Surgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - J L Pujol
- Department of Oncology Lung, Hopital Arnaud de Villeneuve, Montpellier, France
| | - R Stahel
- Laboratory for Molecular Oncology, Department of Thoracic Oncology, Clinic and Policlinic for Oncology, University Hospital Zurich, Zurich, Switzerland
| | - N Thatcher
- Department of Medical Oncology, Christie Hospital NHS Trust, Manchester, UK
| | - J Vansteenkiste
- Respiratory Oncology Unit (Pulmonology), University Hospital Gasthuisberg, Leuven, Belgium
| | - C Minichsdorfer
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria
| | - S Zöchbauer-Müller
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria
| | - R Pirker
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria
| | - C C Zielinski
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria; Central European Cooperative Oncology Group.
| |
Collapse
|
5
|
Gridelli C, Maione P, Castaldo V, Rossi A. Gefitinib in elderly and unfit patients affected by advanced non-small-cell lung cancer. Br J Cancer 2004; 89:1827-9. [PMID: 14612886 PMCID: PMC2394460 DOI: 10.1038/sj.bjc.6601387] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Elderly and poor performance status advanced non-small-cell lung cancer (NSCLC) patients often tolerate chemotherapy poorly. Special approaches are needed for these patient populations. Gefitinib (Iressa) was used in 59 elderly and/or unfit NSCLC pretreated patients participating in a compassionate use programme showing some activity and good tolerability.
Collapse
Affiliation(s)
- C Gridelli
- Division of Medical Oncology, 'SG Moscati' Hospital Via Circumvallazione, Avellino 83100, Italy.
| | | | | | | |
Collapse
|
6
|
Gridelli C, Rossi A, Maione P. Treatment of non-small-cell lung cancer: state of the art and development of new biologic agents. Oncogene 2003; 22:6629-38. [PMID: 14528288 DOI: 10.1038/sj.onc.1206957] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Conventional treatment of non-small-cell lung cancer (NSCLC) has apparently reached a plateau of effectiveness in improving the survival of NSCLC patients. Although neoadjuvant and adjuvant therapies in early stages are under investigation and some progress has been achieved in the management of locally advanced and advanced disease, treatment outcomes for NSCLC are still to be considered dismal. The majority of patients affected from NSCLC experience metastatic disease and optimization of chemotherapy is unlikely to produce further substantial survival improvement, with symptom relief and quality of life still being the primary goal of treatment. Based on this background, clinical investigation of novel treatment strategies is mandatory. As our understanding of tumor cell biology has increased and several molecular targets for NSCLC have been identified, a number of new biologic agents have been developed. Targeted therapy describes treatment strategies that focus on cell signaling and other biologic pathways involved in tumorigenesis. Several targeted agents have been introduced in clinical trials in NSCLC, the majority in advanced disease, and some phase III studies have already produced definitive results. Currently, the minority of these new agents offer promise of improved outcomes and negative results are more common to be reported than positive ones. However, important lessons can be learned from this first generation of clinical trials that should be considered the first step of clinical research in this field.
Collapse
Affiliation(s)
- Cesare Gridelli
- Division of Medical Oncology, S.G. Moscati Hospital, Via Circumvallazione, Avellino, 83100, Italy.
| | | | | |
Collapse
|
7
|
Danesi R, de Braud F, Fogli S, de Pas TM, Di Paolo A, Curigliano G, Del Tacca M. Pharmacogenetics of anticancer drug sensitivity in non-small cell lung cancer. Pharmacol Rev 2003; 55:57-103. [PMID: 12615954 DOI: 10.1124/pr.55.1.4] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In mammalian cells, the process of malignant transformation is characterized by the loss or down-regulation of tumor-suppressor genes and/or the mutation or overexpression of proto-oncogenes, whose products promote dysregulated proliferation of cells and extend their life span. Deregulation in intracellular transduction pathways generates mitogenic signals that promote abnormal cell growth and the acquisition of an undifferentiated phenotype. Genetic abnormalities in cancer have been widely studied to identify those factors predictive of tumor progression, survival, and response to chemotherapeutic agents. Pharmacogenetics has been founded as a science to examine the genetic basis of interindividual variation in drug metabolism, drug targets, and transporters, which result in differences in the efficacy and safety of many therapeutic agents. The traditional pharmacogenetic approach relies on studying sequence variations in candidate genes suspected of affecting drug response. However, these studies have yielded contradictory results because of the small number of molecular determinants of drug response examined, and in several cases this approach was revealed to be reductionistic. This limitation is now being overcome by the use of novel techniques, i.e., high-density DNA and protein arrays, which allow genome- and proteome-wide tumor profiling. Pharmacogenomics represents the natural evolution of pharmacogenetics since it addresses, on a genome-wide basis, the effect of the sum of genetic variants on drug responses of individuals. Development of pharmacogenomics as a new field has accelerated the progress in drug discovery by the identification of novel therapeutic targets by expression profiling at the genomic or proteomic levels. In addition to this, pharmacogenetics and pharmacogenomics provide an important opportunity to select patients who may benefit from the administration of specific agents that best match the genetic profile of the disease, thus allowing maximum activity.
Collapse
Affiliation(s)
- Romano Danesi
- Division of Pharmacology and Chemotherapy, Department of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy.
| | | | | | | | | | | | | |
Collapse
|
8
|
Curran MP, Plosker GL. Vinorelbine: a review of its use in elderly patients with advanced non-small cell lung cancer. Drugs Aging 2002; 19:695-721. [PMID: 12381238 DOI: 10.2165/00002512-200219090-00006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Vinorelbine is a semisynthetic vinca alkaloid that is effective as monotherapy in elderly patients with advanced non-small cell lung cancer (NSCLC). In the large comparative Elderly Lung Cancer Vinorelbine Italian Study (ELVIS), patients receiving vinorelbine monotherapy achieved an objective response rate of 19.7%. The median survival time and the 1-year survival rate were significantly higher in recipients of vinorelbine plus best supportive care than in recipients of best supportive care alone. Vinorelbine recipients generally scored better than recipients of best supportive care on quality-of-life (QOL) functioning scales and experienced significantly fewer lung cancer-related symptoms; however, QOL scores were worse with vinorelbine for parameters relating to drug tolerability. Comparative phase III trials investigating the efficacy of combination therapy with vinorelbine and other agents specifically in elderly patients with advanced NSCLC have been conducted only for the combination of vinorelbine and gemcitabine [the Southern Italy Cooperative Oncology Group (SICOG) trial and the Multicenter Italian Lung Cancer in the Elderly Study (MILES)]. Objective response rates for vinorelbine/gemcitabine combination therapy in these phase III trials were 22 and 20%, respectively. The SICOG trial was closed early when an interim analysis demonstrated a significant survival advantage for combination therapy with vinorelbine plus gemcitabine over vinorelbine monotherapy. However, a survival advantage for combination therapy versus vinorelbine monotherapy was not demonstrated in the larger MILES trial. The main adverse effect of vinorelbine monotherapy in the elderly is myelosuppression. Adverse events associated with most antineoplastic agents, such as mild alopecia, nausea, vomiting and mucositis, were reported in clinical trials; however, these events were rarely severe. Mild-to-moderate neurotoxicity, including constipation (presumably from autonomic neuropathy), was also reported. The addition of gemcitabine to vinorelbine increased the incidence of both haematological and nonhaematological adverse events. However, there was no significant increase in the incidence of life-threatening toxicity. Vinorelbine as a single agent is effective in elderly patients with NSCLC and is associated with improved survival and at least a trend towards improved QOL parameters compared with best supportive care alone. Vinorelbine was associated with a generally manageable tolerability profile. The benefit of adding gemcitabine to vinorelbine for the treatment of NSCLC in the elderly is equivocal; improved survival was reported in one comparative trial, but not in another larger one. Vinorelbine is an effective and well tolerated palliative treatment option for elderly patients with advanced NSCLC.
Collapse
Affiliation(s)
- Monique P Curran
- Adis International Limited, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, Auckland 10, New Zealand.
| | | |
Collapse
|