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Kilickap S, Ozturk A, Karadurmus N, Korkmaz T, Yumuk PF, Cicin I, Paydas S, Cilbir E, Sakalar T, Uysal M, Yesil Cinkir H, Uskent N, Demir N, Sakin A, Dursun OU, Aver B, Turhal NS, Keskin S, Tural D, Eralp Y, Bugdayci Basal F, Yasar HA, Sendur MAN, Demirci U, Cubukcu E, Karaagac M, Cakar B, Tatli AM, Yetisyigit T, Urvay S, Gursoy P, Oyan B, Turna ZH, Isikdogan A, Olmez OF, Yazici O, Cabuk D, Seker MM, Unal OU, Meydan N, Okutur SK, Tunali D, Erman M. A multicenter, retrospective archive study of radiological and clinical features of ALK-positive non-small cell lung cancer patients and crizotinib efficacy. Medicine (Baltimore) 2024; 103:e37972. [PMID: 38787994 PMCID: PMC11124701 DOI: 10.1097/md.0000000000037972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/29/2024] [Indexed: 05/26/2024] Open
Abstract
To evaluate radiological and clinical features in metastatic anaplastic lymphoma kinase+ non-small cell lung cancer patients and crizotinib efficacy in different lines. This national, non-interventional, multicenter, retrospective archive screening study evaluated demographic, clinical, and radiological imaging features, and treatment approaches in patients treated between 2013-2017. Totally 367 patients (54.8% males, median age at diagnosis 54 years) were included. Of them, 45.4% were smokers, and 8.7% had a family history of lung cancer. On radiological findings, 55.9% of the tumors were located peripherally, 7.7% of the patients had cavitary lesions, and 42.9% presented with pleural effusion. Pleural effusion was higher in nonsmokers than in smokers (37.3% vs. 25.3%, P = .018). About 47.4% of cases developed distant metastases during treatment, most frequently to the brain (26.2%). Chemotherapy was the first line treatment in 55.0%. Objective response rate was 61.9% (complete response: 7.6%; partial response: 54.2%). The highest complete and partial response rates were observed in patients who received crizotinib as the 2nd line treatment. The median progression-free survival was 14 months (standard error: 1.4, 95% confidence interval: 11.2-16.8 months). Crizotinib treatment lines yielded similar progression-free survival (P = .078). The most frequent treatment-related adverse event was fatigue (14.7%). Adrenal gland metastasis was significantly higher in males and smokers, and pleural involvement and effusion were significantly higher in nonsmokers-a novel finding that has not been reported previously. The radiological and histological characteristics were consistent with the literature data, but several differences in clinical characteristics might be related to population characteristics.
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Affiliation(s)
- Saadettin Kilickap
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
- Department of Medical Oncology, Istinye University Faculty of Medicine, Istanbul, Turkey
- Ankara Liv Hospital, Medical Oncology, Ankara, Turkey
| | - Akin Ozturk
- Department of Medical Oncology, Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey
| | - Nuri Karadurmus
- Department of Medical Oncology, University of Health Sciences Gulhane Training and Research Hospital, Ankara, Turkey
| | - Taner Korkmaz
- Department of Medical Oncology, Acibadem University, School of Medicine, Istanbul, Turkey
| | - Perran Fulden Yumuk
- Division of Medical Oncology, Marmara University School of Medicine, Istanbul, Turkey
- Medical Oncology Division, Koc University, School of Medicine, Istanbul, Turkey
| | - Irfan Cicin
- Department of Medical Oncology, Trakya University Medical Faculty, Edirne, Turkey
- Istinye University Medical Center, Istanbul, Turkey
| | - Semra Paydas
- Department of Internal Diseases, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ebru Cilbir
- Department of Medical Oncology, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Teoman Sakalar
- Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Mukremin Uysal
- Department of Medical Oncology, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey
- Medstar Antalya Hospital, Medical Oncology Cancer Center, Antalya, Turkey
- Antalya Bilim University, Institute of Health Sciences, Antalya, Turkey
| | - Havva Yesil Cinkir
- Department of Internal Diseases, Gaziantep University Faculty of Medicine, Division of Medical Oncology, Gaziantep, Turkey
| | - Necdet Uskent
- Department of Medical Oncology, Anadolu Medical Center, Kocaeli, Turkey
| | - Necla Demir
- Sivas Numune Training and Research Hospital, Medical Oncology, Sivas, Turkey
- Acibadem Health Group, Kayseri Hospital, Unit of Medical Oncology, Kayseri, Turkey
| | - Abdullah Sakin
- Department of Medical Oncology, Istanbul Prof. Dr. Cemil Tascioglu City Hospital (University of Health Sciences Okmeydani Training and Research Hospital), Istanbul, Turkey
- Division of Medical Oncology, Medipol University, Medipol Bahcelievler Hospital, Istanbul, Turkey
| | | | | | | | - Serkan Keskin
- Department of Oncology, Memorial Sisli Hospital, Istanbul, Turkey
| | - Deniz Tural
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Clinic of Medical Oncology, Istanbul, Turkey
| | - Yesim Eralp
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
- Acibadem Mehmet Ali Aydinlar University, Institute of Senology, Istanbul, Turkey
- Acibadem Healthcare Group, Maslak Hospital, Unit of Medical Oncology, Istanbul, Turkey
| | - Fatma Bugdayci Basal
- Department of Medical Oncology, Ankara Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
- Department of Medical Oncology, Lösante Children’s and Adult Hospital, Ankara, Turkey
| | - Hatime Arzu Yasar
- Department of Medical Oncology, Lösante Children’s and Adult Hospital, Ankara, Turkey
- Department of Medical Oncology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Mehmet Ali Nahit Sendur
- Ankara Atatürk Training and Research Hospital, Clinic of Medical Oncology, Ankara, Turkey
- Department of Internal Medicine, Medical Oncology Division, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Umut Demirci
- Department of Medical Oncology, Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
- Department of Medical Oncology, Memorial Hospital, Ankara, Turkey
- Department of Internal Medicine and Medical Oncology, Medical Sciences Division, Uskudar University, Faculty of Medicine, Istanbul, Turkey
| | - Erdem Cubukcu
- Department of Internal Diseases, Medical Oncology, Bursa Uludag University, Faculty of Medicine, Bursa, Turkey
- Medicana Health Group-Bursa Hospital, Medical Oncology, Bursa, Turkey
| | - Mustafa Karaagac
- Department of Internal Diseases, Division of Medical Oncology, Necmettin Erbakan University, Meram Medical Faculty, Konya, Turkey
| | - Burcu Cakar
- Department of Internal Diseases, Ege University Faculty of Medicine Tulay Aktas Oncology Hospital, Izmir, Turkey
| | - Ali Murat Tatli
- Department of Internal Diseases, Division of Medical Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Tarkan Yetisyigit
- Department of Medical Oncology, Tekirdag Namik Kemal University, Faculty of Medicine, Tekirdag, Turkey
- Department of Medical Oncology, King Hamad University Hospital, Bahrain Oncology Center, Manama, Kingdom of Bahrain
| | - Semiha Urvay
- Department of Internal Diseases, Kayseri Acibadem Hospital, Medical Oncology, Kayseri, Turkey
| | - Pinar Gursoy
- Department of Medical Oncology, University of Health Sciences Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey
- Department of Internal Diseases, Medical Oncology Division, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Basak Oyan
- Department of Medical Oncology, Acibadem University, School of Medicine, Istanbul, Turkey
| | - Zeynep Hande Turna
- Department of Internal Diseases, Division of Medical Oncology, Istanbul University Cerrahpasa, Faculty of Medicine, Istanbul, Turkey
| | - Abdurrahman Isikdogan
- Department of Medical Oncology, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Omer Fatih Olmez
- Department of Medical Oncology, Medipol University, Faculty of Medicine, Istanbul, Turkey
| | - Ozan Yazici
- University of Health Sciences, Ankara Numune Training and Research Hospital, Clinic of Medical Oncology, Ankara, Turkey
- Department of Internal Diseases, Medical Oncology Division, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Devrim Cabuk
- Department of Internal Diseases, Medical Oncology, Kocaeli University Faculty of Medicine, Kocaeli, Istanbul, Turkey
| | - Mehmet Metin Seker
- Department of Medical Oncology, Bayindir Hospital Sogutozu, Ankara, Turkey
- Department of Medical Oncology, Koru Health Group, Ankara, Turkey
| | - Olcun Umit Unal
- Department of Medical Oncology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
- Department of Medical Oncology-Chemotherapy, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Nezih Meydan
- Department of Medical Oncology, Adnan Menderes University, Faculty of Medicine, Aydin, Turkey
- Department of Medical Oncology, Medicana Health Group, Istanbul, Turkey
| | - Sadi Kerem Okutur
- Department of Medical Oncology, Medical Park Bahcelievler Hospital, Istanbul, Turkey
- Department of Medical Oncology, Memorial Hospital, Istanbul, Turkey
- Department of Medical Oncology, Istanbul Arel University, Istanbul, Turkey
| | - Didem Tunali
- Department of Medical Oncology, Koc University, Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Erman
- Departments of Preventive and Medical Oncology, Hacettepe University, Cancer Institute, Ankara, Turkey
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Sasaki T, Kuno H, Hiyama T, Oda S, Masuoka S, Miyasaka Y, Taki T, Nagasaki Y, Ohtani-Kim SJY, Ishii G, Kaku S, Shroff GS, Kobayashi T. 2021 WHO Classification of Lung Cancer: Molecular Biology Research and Radiologic-Pathologic Correlation. Radiographics 2024; 44:e230136. [PMID: 38358935 DOI: 10.1148/rg.230136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
The 2021 World Health Organization (WHO) classification system for thoracic tumors (including lung cancer) contains several updates to the 2015 edition. Revisions for lung cancer include a new grading system for invasive nonmucinous adenocarcinoma that better reflects prognosis, reorganization of squamous cell carcinomas and neuroendocrine neoplasms, and description of some new entities. Moreover, remarkable advancements in our knowledge of genetic mutations and targeted therapies have led to a much greater emphasis on genetic testing than that in 2015. In 2015, guidelines recommended evaluation of only two driver mutations, ie, epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) fusions, in patients with nonsquamous non-small cell lung cancer. The 2021 guidelines recommend testing for numerous additional gene mutations for which targeted therapies are now available including ROS1, RET, NTRK1-3, KRAS, BRAF, and MET. The correlation of imaging features and genetic mutations is being studied. Testing for the immune biomarker programmed death ligand 1 is now recommended before starting first-line therapy in patients with metastatic non-small cell lung cancer. Because 70% of lung cancers are unresectable at patient presentation, diagnosis of lung cancer is usually based on small diagnostic samples (ie, biopsy specimens) rather than surgical resection specimens. The 2021 version emphasizes differences in the histopathologic interpretation of small diagnostic samples and resection specimens. Radiologists play a key role not only in evaluation of tumor and metastatic disease but also in identification of optimal biopsy targets. ©RSNA, 2024 Test Your Knowledge questions in the supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Tomoaki Sasaki
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Hirofumi Kuno
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Takashi Hiyama
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Shioto Oda
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Sota Masuoka
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Yusuke Miyasaka
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Tetsuro Taki
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Yusuke Nagasaki
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Seiyu Jeong-Yoo Ohtani-Kim
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Genichiro Ishii
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Sawako Kaku
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Girish S Shroff
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Tatsushi Kobayashi
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
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Hou X, Chen H, Liu Y, Gong S, Zhudai M, Shen L. Clinicopathological and computed tomography features of patients with early-stage non-small-cell lung cancer harboring ALK rearrangement. Cancer Imaging 2023; 23:20. [PMID: 36823653 PMCID: PMC9951448 DOI: 10.1186/s40644-023-00537-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Although some studies have assessed the correlation between computed tomography (CT) features and anaplastic lymphoma kinase (ALK) rearrangement in patients with non-small-cell lung cancer (NSCLC), few have focused on early-stage patients. The results of some previous studies are inconsistent and contradictory. Therefore, this study aimed to analyze the clinicopathological and CT features of patients with early-stage NSCLC harboring ALK rearrangement. METHODS This retrospective analysis included 65 patients with ALK rearrangement and 629 ALK-negative patients. All patients had surgically resected NSCLC and were diagnosed with stage IA or stage IIB NSCLC. Clinicopathological features and CT signs, including tumor size and density, consolidation tumor ratio (CTR), lesion location, round or irregular shape, lobulated or spiculated margins, air bronchograms, bubble-like lucency or cavities, and pleural retraction, were investigated according to different genotypes. RESULTS The prevalence of ALK rearrangement in patients with early-stage NSCLC was 9.3% (65/694). Patients with ALK rearrangement were significantly younger than those without ALK rearrangement (P = 0.033). The frequency of moderate cell differentiation was significantly lower in tumors with ALK rearrangement than in those without ALK rearrangement (46.2% vs. 59.8%, P = 0.034). The frequency of the mucinous subtype was significantly higher in the ALK-positive group than in the ALK-negative group (13.8% vs. 5.4%, P = 0.007). No significant differences were found in any CT signs between the ALK-positive and ALK-negative groups. CONCLUSIONS Patients with ALK-positive lung cancer may have specific clinicopathological features, including younger age, lower frequency of moderate cell differentiation, and higher frequency of the mucinous type. CT features may not correlate with ALK rearrangement in early-stage lung cancer. Immunohistochemistry or next-generation sequencing is needed to further clarify the genomic mutation status.
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Affiliation(s)
- Xiaoming Hou
- Department of Radiology, Hainan Hospital of PLA General Hospital, Sanya, 572013 China
| | - Han Chen
- Department of Information, Hainan Hospital of PLA General Hospital, Sanya, 572013 China
| | - You Liu
- Department of Pathology, Hainan Hospital of PLA General Hospital, Sanya, 572013 China
| | - Sandong Gong
- Department of Gastroenterology, Hainan Hospital of PLA General Hospital, Sanya, 572013 China
| | - Meizi Zhudai
- Department of Thoracic Surgery, Hainan Hospital of PLA General Hospital, Jiang-Lin Road, Hai Tang District, Sanya, 572013 China
| | - Leilei Shen
- Department of Thoracic Surgery, Hainan Hospital of PLA General Hospital, Jiang-Lin Road, Hai Tang District, Sanya, 572013, China.
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Xu Z, Ren H, Zhou W, Liu Z. ISANET: Non-small cell lung cancer classification and detection based on CNN and attention mechanism. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103773] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Random Walk Algorithm-Based Computer Tomography (CT) Image Segmentation Analysis Effect of Spiriva Combined with Symbicort on Immunologic Function of Non-Small-Cell Lung Cancer. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1986647. [PMID: 35693265 PMCID: PMC9187478 DOI: 10.1155/2022/1986647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022]
Abstract
The objective of this research was to explore the effect of the treatment regimen of Spiriva combined with Symbicort on the immune function of non-small-cell lung cancer (NSCLC) based on computed tomography (CT) imaging features. An automatic CT image segmentation algorithm (RW-CT) was constructed based on random walk (RW) and image segmentation technology. The image segmentation algorithm based on the Toboggan method (C-CT) was introduced to compare with the traditional RW algorithm. 60 subjects were divided into four groups: a Chinese combined with Western medicine group (treated with Spiriva combined with Symbicort, group C+W), a Chinese medicine group (treated with Spiriva, group C), a Western medicine group (treated with Symbicort, group W), and a model group for control (group M). The results show that the Dice coefficient of the RW-CT algorithm was obviously larger than that of the C-CT algorithm and the RW algorithm, while the Hausdorff distance (HD) of the RW-CT algorithm was much smaller than that of the other two algorithms (
). The proportion of positive cells of hypoxia-inducible factor-1α (HIF-1α) in group C+W was the least (15%-23%), followed by the group W (21%-29%) and the group C (28%-37%), and that in the group M was the highest (39%-49%). There was a remarkable difference in the immunohistochemical scores (HIS) of vascular endothelial growth factor (VEGF) in the tumor tissues between group C+W and the group M (
,
), but there was no great difference from the group C and the group W (
). There was a notable difference in the IHS of vascular endothelial factor recepto-2 (VEGFR-2) between the group C+W medication group and the group M (
,
), and there was no statistical difference between the group C and W (
). In short, the RW-CT constructed based on RW was better than the traditional algorithms for CT image segmentation. The Spiriva combined with Symbicort could effectively inhibit the expression of VEGF, VEGFR-2, and HIF-1α in NSCLC and promote the immunologic function of the body.
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[Relationship between EGFR, ALK Gene Mutation and Imaging
and Pathological Features in Invasive Lung Adenocarcinoma]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:147-155. [PMID: 35340157 PMCID: PMC8976203 DOI: 10.3779/j.issn.1009-3419.2022.101.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND At present, the research progress of targeted therapy for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) gene mutations in lung adenocarcinoma is very rapid, which brings new hope for the treatment of advanced lung adenocarcinoma patients. However, the specific imaging and pathological features of EGFR and ALK gene mutations in adenocarcinoma are still controversial. This study will further explore the correlation between EGFR, ALK gene mutations and imaging and pathological features in invasive lung adenocarcinoma. METHODS A total of 525 patients with lung adenocarcinoma who underwent surgery in our center from January 2018 to December 2019 were included. According to the results of postoperative gene detection, the patients were divided into EGFR gene mutation group, ALK gene mutation group and wild group, and the EGFR gene mutation group was divided into exon 19 and exon 21 subtypes. The pathological features of the mutation group and wild group, such as histological subtype, lymph node metastasis, visceral pleural invasion (VPI) and imaging features such as tumor diameter, consolidation tumor ratio (CTR), lobulation sign, spiculation sign, pleural retraction sign, air bronchus sign and vacuole sign were analyzed by univariate analysis and multivariate Logistic regression analysis to explore whether the gene mutation group had specific manifestations. RESULTS EGFR gene mutation group was common in women (OR=2.041, P=0.001), with more pleural traction sign (OR=1.506, P=0.042), and had little correlation with lymph node metastasis and VPI (P>0.05). Among them, exon 21 subtype was more common in older (OR=1.022, P=0.036), women (OR=2.010, P=0.007), and was associated with larger tumor diameter (OR=1.360, P=0.039) and pleural traction sign (OR=1.754, P=0.029). Exon 19 subtype was common in women (OR=2.230, P=0.009), with a high proportion of solid components (OR=1.589, P=0.047) and more lobulation sign (OR=2.762, P=0.026). ALK gene mutations were likely to occur in younger patients (OR=2.950, P=0.045), with somking history (OR=1.070, P=0.002), and there were more micropapillary components (OR=4.184, P=0.019) and VPI (OR=2.986, P=0.034) in pathology. CONCLUSIONS The EGFR and ALK genes mutated adenocarcinomas have specific imaging and clinicopathological features, and the mutations in exon 19 or exon 21 subtype have different imaging features, which is of great significance in guiding the clinical diagnosis and treatment of pulmonary nodules.
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Xie X, Li X, Tang W, Xie P, Tan X. Primary tumor location in lung cancer: the evaluation and administration. Chin Med J (Engl) 2021; 135:127-136. [PMID: 34784305 PMCID: PMC8769119 DOI: 10.1097/cm9.0000000000001802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Lung cancer continues to be the leading cause of cancer-related death in the world, which is classically subgrouped into two major histological types: Non-small cell lung cancer (NSCLC) (85% of patients) and small-cell lung cancer (SCLC) (15%). Tumor location has been reported to be associated with the prognosis of various solid tumors. Several types of cancer often occur in a specific region and are more prone to spread to predilection locations, including colorectal cancer, prostate cancer, gastric cancer, ovarian cancer, cervical cancer, bladder cancer, lung tumor, and so on. Besides, tumor location is also considered as a risk factor for lung neoplasm with chronic obstructive pulmonary disease/emphysema. Additionally, the primary lung cancer location is associated with specific lymph node metastasis. And the recent analysis has shown that the primary location may affect metastasis pattern in metastatic NSCLC based on a large population. Numerous studies have enrolled the "location" factor in the risk model. Anatomy location and lobe-specific location are both important in prognosis. Therefore, it is important for us to clarify the characteristics about tumor location according to various definitions. However, the inconsistent definitions about tumor location among different articles are controversial. It is also a significant guidance in multimode therapy in the present time. In this review, we mainly aim to provide a new insight about tumor location, including anatomy, clinicopathology, and prognosis in patients with lung neoplasm.
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Affiliation(s)
- Xueqi Xie
- School of Medicine and Life Sciences, Shandong First Medical University, Jinan, Shandong 250117, China Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, China
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Han X, Fan J, Liu T, Li N, Alwalid O, Gu J, Shi H. Differentiating synchronous double primary lung adenocarcinomas from intrapulmonary metastasis by CT features, EGFR mutations and ALK rearrangement status. J Thorac Dis 2020; 12:5505-5516. [PMID: 33209384 PMCID: PMC7656436 DOI: 10.21037/jtd-19-3570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Differentiating synchronous double primary lung adenocarcinoma (SDPLA) from interpulmonary metastasis (IPM) has significant therapeutic and prognostic implications. This retrospective study aimed to investigate the potential of computed tomography (CT) features and two known oncogenic driver mutations [epidermal growth factor receptor (EGFR) and anaplastic large-cell lymphoma kinase (ALK)] to discriminate synchronous double primary lung adenocarcinoma from one primary pulmonary adenocarcinoma with intrapulmonary metastasis. Methods Patients with SDPLA were selected at our hospital, and those with IPM served as the control group. All 60 patients (40 with SDPLA and 20 with IPM) were tested for EGFR mutations and ALK status, and they underwent chest CT prior to any treatment. Independent-sample Student's t-test was used for comparisons between two groups of normally distributed variables, and the Chi-square test was used to compare categorical variables. Results The discordance rate of EGFR mutations was significantly higher in patients with SDPLA than in patients with IPM (40% vs. 5%, P<0.001). The incidence of ALK-positive status was 15%, and patients with IPM were more likely to be ALK-positive than patients with SDPLA (35% vs. 5%, P<0.001). Compared to IPM, SDPLA more frequently occurred in different lobes (P=0.024), presented with less lymphadenopathy (P=0.014), showed a smaller difference in diameter (Äd) between tumors (P=0.001) and more commonly presented as lobulated tumors (P<0.001), spiculated masses (P<0.001), ground-glass opacities (GGOs) (P=0.001) and air bronchograms (P=0.020). Conclusion Patients with SDPLA showed higher discordance with EGFR mutations and were less frequently ALK-positive than those with IPM. Thus, the CT characteristics are significantly different between SDPLA and IPM.
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Affiliation(s)
- Xiaoyu Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jun Fan
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tong Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Na Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Osamah Alwalid
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jin Gu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Preoperative CT features for prediction of ALK gene rearrangement in lung adenocarcinomas. Clin Radiol 2020; 75:562.e21-562.e29. [PMID: 32307109 DOI: 10.1016/j.crad.2020.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 03/11/2020] [Indexed: 11/20/2022]
Abstract
AIM To identify preoperative features on computed tomography (CT) associated with ALK rearrangement in lung adenocarcinomas presenting as a nodule. MATERIALS AND METHODS This retrospective analysis included 56 patients with ALK rearrangement and 57 that were ALK-negative. All patients had surgically resected lung adenocarcinomas <3 cm. Univariate and multivariate analyses were conducted to analyse clinicopathological and CT features associated with ALK rearrangement. Receiver operating characteristic (ROC) analyses were performed to quantify the performance status of the model. RESULTS ALK rearrangement was associated with lymph node metastases (p=0.004), later pathological stage (p=0.005), lower lobe (p=0.019), lobulation (p=0.006), thickened adjacent bronchovascular bundles (p=0.006), homogeneous tumour (p=0.008), absence of ground-glass opacity (GGO; p<0.001), absence of air bronchogram (p=0.010), smaller relative enhancement (p=0.019), and larger short axis of the largest lymph node (p=0.012). Cavity larger than 1 cm was found in 3 ALK-positive tumours while not in ALK-negative tumours. Multivariate analysis revealed a single predictive model with an AUC of 0.794 that lobulation (OR=4.50, p=0.026), GGO (OR=0.19, p=0.003), and short axis of the largest lymph node (OR=12.49, p=0.047) were independent predictors of ALK rearrangement status. CONCLUSIONS This study identified a modestly predictive radiological model to identify ALK rearrangement in small lung adenocarcinomas.
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