1
|
Predicting EGFR mutational status from pathology images using a real-world dataset. Sci Rep 2023; 13:4404. [PMID: 36927889 PMCID: PMC10020556 DOI: 10.1038/s41598-023-31284-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
Treatment of non-small cell lung cancer is increasingly biomarker driven with multiple genomic alterations, including those in the epidermal growth factor receptor (EGFR) gene, that benefit from targeted therapies. We developed a set of algorithms to assess EGFR status and morphology using a real-world advanced lung adenocarcinoma cohort of 2099 patients with hematoxylin and eosin (H&E) images exhibiting high morphological diversity and low tumor content relative to public datasets. The best performing EGFR algorithm was attention-based and achieved an area under the curve (AUC) of 0.870, a negative predictive value (NPV) of 0.954 and a positive predictive value (PPV) of 0.410 in a validation cohort reflecting the 15% prevalence of EGFR mutations in lung adenocarcinoma. The attention model outperformed a heuristic-based model focused exclusively on tumor regions, and we show that although the attention model also extracts signal primarily from tumor morphology, it extracts additional signal from non-tumor tissue regions. Further analysis of high-attention regions by pathologists showed associations of predicted EGFR negativity with solid growth patterns and higher peritumoral immune presence. This algorithm highlights the potential of deep learning tools to provide instantaneous rule-out screening for biomarker alterations and may help prioritize the use of scarce tissue for biomarker testing.
Collapse
|
2
|
Lee J, Han YB, Kwon HJ, Lee SK, Kim H, Chung JH. Landscape of EGFR mutations in lung adenocarcinoma: a single institute experience with comparison of PANAMutyper testing and targeted next-generation sequencing. J Pathol Transl Med 2022; 56:249-259. [PMID: 36128861 PMCID: PMC9510045 DOI: 10.4132/jptm.2022.06.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background Activating mutations in the tyrosine kinase domain of epidermal growth factor receptor (EGFR) are predictive biomarkers for response to EGFR–tyrosine kinase inhibitor (TKI) therapy in lung adenocarcinoma (LUAD). Here, we characterized the clinicopathologic features associated with EGFR mutations via peptide nucleic acid clamping-assisted fluorescence melting curve analysis (PANAMutyper) and evaluated the feasibility of targeted deep sequencing for detecting the mutations. Methods We examined EGFR mutations in exons 18 through 21 for 2,088 LUADs from July 2017 to April 2020 using PANAMutyper. Of these, we performed targeted deep sequencing in 73 patients and evaluated EGFR-mutation status and TKI clinical response. Results EGFR mutation was identified in 55.7% of LUADs by PANAMutyper, with mutation rates higher in females (69.3%) and never smokers (67.1%) and highest in the age range of 50 to 59 years (64.9%). For the 73 patients evaluated using both methods, next-generation sequencing (NGS) identified EGFR mutation–positive results in 14 of 61 patients (23.0%) who were EGFR-negative according to PANAMutyper testing. Of the 10 patients reportedly harboring a sensitizing mutation according to NGS, seven received TKI treatment, with all showing partial response or stable disease. In the 12 PANAMutyper-positive cases, NGS identified two additional mutations in exon 18, whereas a discordant negative result was observed in two cases. Conclusions Although PANAMutyper identified high frequencies of EGFR mutations, targeted deep sequencing revealed additional uncommon EGFR mutations. These findings suggested that appropriate use of NGS may benefit LUAD patients with otherwise negative screening test results.
Collapse
Affiliation(s)
- Jeonghyo Lee
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Yeon Bi Han
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jung Kwon
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Song Kook Lee
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyojin Kim
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Haeng Chung
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
- Artificial Intelligence Institute, Seoul National University, Seoul, Korea
| |
Collapse
|
3
|
Abstract
This overview of the molecular pathology of lung cancer includes a review of the most salient molecular alterations of the genome, transcriptome, and the epigenome. The insights provided by the growing use of next-generation sequencing (NGS) in lung cancer will be discussed, and interrelated concepts such as intertumor heterogeneity, intratumor heterogeneity, tumor mutational burden, and the advent of liquid biopsy will be explored. Moreover, this work describes how the evolving field of molecular pathology refines the understanding of different histologic phenotypes of non-small-cell lung cancer (NSCLC) and the underlying biology of small-cell lung cancer. This review will provide an appreciation for how ongoing scientific findings and technologic advances in molecular pathology are crucial for development of biomarkers, therapeutic agents, clinical trials, and ultimately improved patient care.
Collapse
Affiliation(s)
- James J Saller
- Departments of Pathology and Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
| | - Theresa A Boyle
- Departments of Pathology and Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
| |
Collapse
|
4
|
Liu L, Xiong X. Clinicopathologic Features and Molecular Biomarkers as Predictors of Epidermal Growth Factor Receptor Gene Mutation in Non-Small Cell Lung Cancer Patients. Curr Oncol 2021; 29:77-93. [PMID: 35049681 PMCID: PMC8774362 DOI: 10.3390/curroncol29010007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022] Open
Abstract
Lung cancer ranks first in the incidence and mortality of cancer in the world, of which more than 80% are non-small cell lung cancer (NSCLC). The majority of NSCLC patients are in stage IIIB~IV when they are admitted to hospital and have no opportunity for surgery. Compared with traditional chemotherapy, specific targeted therapy has a higher selectivity and fewer adverse reactions, providing a new treatment direction for advanced NSCLC patients. Tyrosine kinase inhibitors of epidermal growth factor receptor (EGFR-TKIs) are the widely used targeted therapy for NSCLC patients. Their efficacy and prognosis are closely related to the mutation status of the EGFR gene. Clinically, detecting EGFR gene mutation is often limited by difficulty obtaining tissue specimens, limited detecting technology, and economic conditions, so it is of great clinical significance to find indicators to predict EGFR gene mutation status. Clinicopathological characteristics, tumor markers, liquid biopsy, and other predictors are less invasive, economical, and easier to obtain. They can be monitored in real-time, which is supposed to predict EGFR mutation status and provide guidance for the accurate, individualized diagnosis and therapy of NSCLC patients. This article reviewed the correlation between the clinical indicators and EGFR gene mutation status in NSCLC patients.
Collapse
|
5
|
Wang L, Wang X, Huang M, Yan S, Li S, Lv C, Wu N, Yang Y. High-risk-pattern lung adenocarcinoma with epidermal growth factor receptor mutation is associated with distant metastasis risk and may benefit from adjuvant targeted therapy. Interact Cardiovasc Thorac Surg 2021; 33:395-401. [PMID: 33880525 DOI: 10.1093/icvts/ivab099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/19/2021] [Accepted: 03/10/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the value of the high-risk-pattern histology (micropapillary and solid components) for predicting distant metastasis in lung adenocarcinoma and to determine the survival benefit with adjuvant targeted therapy for resected non-small cell lung cancer with high-risk-pattern histology. METHODS Patients receiving surgery for non-small cell lung cancer were included in this retrospective study. Histological classification was performed according to 2015 World Health Organization classification. Tumours with micropapillary and solid components were defined as high-risk-pattern tumours. Univariable and multivariable Cox regression analyses were used for survival analysis. Adjuvant targeted therapy was alternative for patients with epidermal growth factor receptor (EGFR)-mutation and refusing adjuvant chemotherapy, and outcome was evaluated between 2 groups. RESULTS The 514 patients (78 in high-risk group and 436 in low-risk group) were followed up for a median of 64 months. High-risk-pattern adenocarcinoma was significantly more common in male patients (P < 0.001) and in smokers (P < 0.001). Among patients with EGFR mutation (n = 164), the high-risk pattern was significantly associated with distant metastasis (P = 0.028) including brain metastasis (P = 0.022). In the 42 patients with high-risk pattern plus EGFR mutation, survival was significantly better after treatment with adjuvant targeted therapy than with chemotherapy (5-year overall survival: 56.4 ± 2.6 vs 44.7 ± 3.7 months, P = 0.011; 5-year disease-free survival: 54.0 ± 3.3 vs 41.9 ± 4.5 months, P = 0.006). CONCLUSIONS High-risk pattern is associated with distant metastasis in non-small cell lung cancer after surgery. Adjuvant targeted therapy may be superior to chemotherapy for treatment of patients with high-risk pattern and EGFR mutation.
Collapse
Affiliation(s)
- Liang Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xing Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Miao Huang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shi Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shaolei Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chao Lv
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing, China
| | | | - Yue Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing, China
| |
Collapse
|
6
|
Li Y, Tan Y, Hu S, Xie J, Yan Z, Zhang X, Zong Y, Han-Zhang H, Li Q, Li C. Targeted Sequencing Analysis of Predominant Histological Subtypes in Resected Stage I Invasive Lung Adenocarcinoma. J Cancer 2021; 12:3222-3229. [PMID: 33976731 PMCID: PMC8100815 DOI: 10.7150/jca.51405] [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: 08/02/2020] [Accepted: 03/15/2021] [Indexed: 01/11/2023] Open
Abstract
Objective: Lung adenocarcinoma (LADC) is classified into five main histological subtypes with distinct clinicopathologic characteristics: lepidic-predominant adenocarcinoma (LPA), acinar-predominant adenocarcinoma (APA), papillary-predominant adenocarcinoma (PPA), micropapillary-predominant adenocarcinoma (MPA) and solid-predominant adenocarcinoma (SPA). However, the mutational profiles of predominant histological subtypes have not been well defined. In this study, we aimed to reveal the genomic landscape of 5 main histological subtypes. Patients and Methods: We performed next-generation sequencing (NGS) in a cohort of 86 stage I invasive adenocarcinoma (IAC) patients, using a customized panel including 168 cancer-associated genes. Results: Our analysis identified a total of 302 genomic alterations. Five subtypes showed different mutation profiles with LPA, APA, PPA, MPA and SPA had an average mutation rate of 1.95 (range: 0-5), 2.56 (range: 1-6), 3.5 (range: 1-7), 3.75 (range: 1-8) and 6.05 (range: 2-12), respectively (p=4.17e-06). Driver mutations occurred in 96.55% (83/86) of all patients. EGFR (73.3%), KRAS (9.3%), ALK (4.7%) and MET (4.7%) are the most commonly mutated lung cancer driver genes, TP53 is the top mutated tumor suppressor gene. SPA patients harbored more driver mutations and higher frequency of TP53 than LPA patients. Interestingly, LRP1B mutations, which has been reported to be associated with high tumor mutation burden and better response to immunotherapy, were only detected from 5 SPA patients (p=0.001). No patients from other four cohorts harbored LRP1B mutations. Conclusions: We revealed distinctive mutation landscape of the 5 major histological subtypes of LADC, evident by distinctive average mutation rate with SPA and LPA having the highest and lowest average mutation rate, respectively. SPA patients showed higher mutation rate of LRP1B and higher rates for PD-L1 positivity, indicating that SPA patients may have better response to immunotherapy.
Collapse
Affiliation(s)
- Yan Li
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
- Department of Respiratory Medicine, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, China
| | - Yan Tan
- Department of Pathology, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
| | - Song Hu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
| | - Jun Xie
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
| | - Zhantao Yan
- Department of Pathology, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
| | - Xian Zhang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
| | - Yun Zong
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
| | - Han Han-Zhang
- Burning Rock Biotech, Guangzhou, Guangdong, 510300, China
| | - Qing Li
- Department of Pathology, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
| | - Chong Li
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, China
| |
Collapse
|
7
|
Fang C, Xu D, Su J, Dry JR, Linghu B. DeePaN: deep patient graph convolutional network integrating clinico-genomic evidence to stratify lung cancers for immunotherapy. NPJ Digit Med 2021; 4:14. [PMID: 33531613 PMCID: PMC7854753 DOI: 10.1038/s41746-021-00381-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 01/05/2021] [Indexed: 01/30/2023] Open
Abstract
Immuno-oncology (IO) therapies have transformed the therapeutic landscape of non-small cell lung cancer (NSCLC). However, patient responses to IO are variable and influenced by a heterogeneous combination of health, immune, and tumor factors. There is a pressing need to discover the distinct NSCLC subgroups that influence response. We have developed a deep patient graph convolutional network, we call "DeePaN", to discover NSCLC complexity across data modalities impacting IO benefit. DeePaN employs high-dimensional data derived from both real-world evidence (RWE)-based electronic health records (EHRs) and genomics across 1937 IO-treated NSCLC patients. DeePaN demonstrated effectiveness to stratify patients into subgroups with significantly different (P-value of 2.2 × 10-11) overall median survival of 20.35 months and 9.42 months post-IO therapy. Significant differences in IO outcome were not seen from multiple non-graph-based unsupervised methods. Furthermore, we demonstrate that patient stratification from DeePaN has the potential to augment the emerging IO biomarker of tumor mutation burden (TMB). Characterization of the subgroups discovered by DeePaN indicates potential to inform IO therapeutic insight, including the enrichment of mutated KRAS and high blood monocyte count in the IO beneficial and IO non-beneficial subgroups, respectively. Our work has proven the concept that graph-based AI is feasible and can effectively integrate high-dimensional genomic and EHR data to meaningfully stratify cancer patients on distinct clinical outcomes, with potential to inform precision oncology.
Collapse
Affiliation(s)
- Chao Fang
- Translational Medicine, Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA, USA
| | - Dong Xu
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
- Christopher S Bond Life Sciences Center, University of Missouri, Columbia, MO, USA
| | - Jing Su
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA.
| | - Jonathan R Dry
- Translational Medicine, Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA, USA.
| | - Bolan Linghu
- Translational Medicine, Research and Early Development, Oncology R&D, AstraZeneca, Boston, MA, USA.
| |
Collapse
|
8
|
Osawa J, Shimada Y, Maehara S, Hagiwara M, Kakihana M, Kajiwara N, Ohira T, Matsubayashi J, Ikeda N. Clinical usefulness of the 3-tier classification according to the proportion of morphological patterns for patients with pathological stage I invasive lung adenocarcinoma. Gen Thorac Cardiovasc Surg 2021; 69:943-949. [PMID: 33385289 DOI: 10.1007/s11748-020-01559-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We classified pathological stage I invasive lung adenocarcinomas according to our 3-tier classification, which was based on the proportion of invasive morphological patterns as follows: (1) patients with each predominant subtype, (2) those with a minor histological subtype, even not the predominant subtype and (3) those without each invasive component. We aimed to evaluate the classification's clinical impact in survival, recurrence, malignant grade, and epidermal growth factor receptor (EGFR) mutational status. MATERIALS AND METHODS A total of 1,269 patients with p-stage I lung adenocarcinoma underwent curative surgical resection between January 2008 and December 2017. Of these, 620 patients (48.9%) met the inclusion criteria of this study. RESULTS Postoperative recurrence was observed in 81 patients (13.1%). Multivariate analysis showed that vascular invasion (hazard ratio, 2.61; p < 0.001) and p-stage IB (hazard ratio, 2.19; p = 0.001) were significantly associated with an unfavorable RFS, while the presence of acinar component (hazard ratio, 1.64; p = 0.052) or solid component (hazard ratio, 1.60; p = 0.074) were marginally significant. The presence of lepidic or papillary component and the absence of acinar or solid component significantly correlated with an increased proportion of lung adenocarcinomas harboring EGFR mutations. CONCLUSION In patients with p-stage I invasive lung adenocarcinoma, it is beneficial to use not only the predominant subtype but analyzing the extent of each histological component based on our classification to predict patient prognoses and form appropriate postoperative follow-up methods.
Collapse
Affiliation(s)
- Junichiro Osawa
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yoshihisa Shimada
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Sachio Maehara
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Masaru Hagiwara
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Masatoshi Kakihana
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Naohiro Kajiwara
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Tatsuo Ohira
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| |
Collapse
|
9
|
Weng CF, Huang CJ, Huang SH, Wu MH, Tseng AH, Sung YC, Lee HHC, Ling TY. New International Association for the Study of Lung Cancer (IASLC) Pathology Committee Grading System for the Prognostic Outcome of Advanced Lung Adenocarcinoma. Cancers (Basel) 2020; 12:cancers12113426. [PMID: 33218158 PMCID: PMC7698816 DOI: 10.3390/cancers12113426] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022] Open
Abstract
Simple Summary This study investigated the association between survival outcome and the new grading system among advanced stage lung adenocarcinoma (LADC) (stages IIIA, IIIB and IV) patients who were diagnosed as LADC with a pathologic report according to a new grading system by the International Association for the Study of Lung Cancer (IASLC) pathology committee. The results indicate that the poorly differentiated group had a poorer prognosis in PFS, as did patients with wild-type EGFR who were treated with chemotherapy. No survival difference could be found among EGFR mutation patients. Older age and a lower body mass index also led to worse survival. Patients with poorly differentiated adenocarcinoma likewise had worse survival, especially compared to those with moderately differentiated adenocarcinoma. Our findings highlight that the therapeutic regimen should be adjusted for wild-type EGFR patients with poorly differentiated adenocarcinoma treated with chemotherapy to provide better outcomes. No survival difference could be seen among EGFR mutation patients. Abstract The impact of the new International Association for the Study of Lung Cancer pathology committee grading system for advanced lung adenocarcinoma (LADC) on survival is unclear, especially in Asian populations. In this study, we reviewed the prognostic outcomes of patients with late-stage disease according to the new grading system. We reviewed 136 LADC cases who underwent a small biopsy from 2007 to 2018. Tumors were classified according to the new grading system for LADC. Baseline characteristics (age, sex, smoking status, body mass index, and driver gene mutations) were analyzed. Kaplan–Meier and Cox regression analyses were used to determine correlations with the new grading system and prognosis. Patients with poorly differentiated adenocarcinoma were significantly correlated with a poor progression-free survival (PFS) (p = 0.013) but not overall survival (OS) (p = 0.154). Subgroup analysis showed that wild-type EGFR patients with poorly differentiated adenocarcinoma treated with chemotherapy had significantly worse PFS (p = 0.011). There was no significant difference in survival among the patients with epidermal growth factor receptor mutations who were treated with tyrosine kinase inhibitors. Patients aged >70 years and those with a BMI ≤ 25 kg/m2 and wild-type patients had significantly worse OS in both univariate (HR = 1.822, p = 0.006; HR = 2.250, p = 0.004; HR = 1.537, p = 0.046, respectively) and multivariate analyses (HR = 1.984, p = 0.002; HR = 2.383, p = 0.002; HR = 1.632, p = 0.028, respectively). Despite therapy, patients with poorly differentiated tumors still fared worse than those with better differentiated tumors. No differences were found among the EGFR mutations treated with TKI. Our findings highlight that the therapeutic regimen should be adjusted for EGFR Wild-type patients with poorly differentiated adenocarcinoma treated with chemotherapy to provide better outcomes.
Collapse
Affiliation(s)
- Ching-Fu Weng
- Division of Pulmonary Medicine, Department of Internal Medicine, Hsinchu Cathay General Hospital, Hsinchu 300, Taiwan;
- Department and Graduate Institute of Pharmacology, National Taiwan University, Taipei 100, Taiwan
| | - Chi-Jung Huang
- Medical Research Center, Cathay General Hospital, Taipei 106, Taiwan;
- Department of Biochemistry, National Defense Medical Center, Taipei 114, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei 242, Taiwan
| | - Shih-Hung Huang
- Division of Pathology, Cathay General Hospital, Taipei 106, Taiwan;
| | - Mei-Hsuan Wu
- Teaching and Research Center, Hsinchu Cathay General Hospital, Hsinchu 300, Taiwan;
| | - Ailun Heather Tseng
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan 320, Taiwan;
| | - Yung-Chuan Sung
- Division of Hematology/Oncology, Department of Internal Medicine, Cathay General Hospital, Taipei 106, Taiwan;
| | - Henry Hsin-Chung Lee
- School of Medicine, Fu Jen Catholic University, New Taipei 242, Taiwan
- Department of Surgery, Hsinchu Cathay General Hospital, Hsinchu 300, Taiwan
- Graduate Institute of Translational and Interdisciplinary Medicine, College of Health Sciences and Technology, National Central University, Taoyuan 320, Taiwan
- Correspondence: (H.H.-C.L.); (T.-Y.L.); Tel.: +886-3-527-8999 (ext. 61346) (H.H.-C.L.); +886-2-2312-3456 (ext. 88322) (T.-Y.L.)
| | - Thai-Yen Ling
- Department and Graduate Institute of Pharmacology, National Taiwan University, Taipei 100, Taiwan
- Correspondence: (H.H.-C.L.); (T.-Y.L.); Tel.: +886-3-527-8999 (ext. 61346) (H.H.-C.L.); +886-2-2312-3456 (ext. 88322) (T.-Y.L.)
| |
Collapse
|
10
|
Li JX, Huang JM, Jiang ZB, Li RZ, Sun A, Lai-Han Leung E, Yan PY. Current Clinical Progress of PD-1/PD-L1 Immunotherapy and Potential Combination Treatment in Non-Small Cell Lung Cancer. Integr Cancer Ther 2020; 18:1534735419890020. [PMID: 31838881 PMCID: PMC7242804 DOI: 10.1177/1534735419890020] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Conventional methods in treating non–small cell lung cancer contain surgery,
chemotherapy, radiotherapy, and targeted therapy, which have various defects.
Recently, with the deeper research on tumor immunity, immunotherapy has made the
breakthrough in the treatment of cancers. Especially developments of programmed
cell death-1/programmed cell death ligand-1 (PD-1/PD-L1) inhibitors bring the
therapy into a new stage. This review mainly focuses on introducing existing
monoclonal antibodies containing nivolumab, pembrolizumab, atezolizumab,
avelumab, and durvalumab, along with 3 ordinary biomarkers such as PD-L1
expression, tumor mutation burden, and microsatellite instability. By
understanding the resistance mechanism of anti-PD-1/L1 blockade, research is
further improving the survival benefit and expanding the benefit population. So,
PD-1/PD-L1 inhibitors begin to be combined with various therapeutic strategies
clinically. Discussion and comparison of their effectiveness and safety are also
comprehensively reviewed. Meanwhile, we explore the potential, the impact, and
mechanisms of combining traditional Chinese medicine with immunotherapy.
Collapse
Affiliation(s)
- Jia-Xin Li
- Macau University of Science and Technology, Macau, People's Republic of China
| | - Ju-Min Huang
- Macau University of Science and Technology, Macau, People's Republic of China
| | - Ze-Bo Jiang
- Macau University of Science and Technology, Macau, People's Republic of China
| | - Run-Ze Li
- Macau University of Science and Technology, Macau, People's Republic of China
| | - Ao Sun
- Macau University of Science and Technology, Macau, People's Republic of China
| | - Elaine Lai-Han Leung
- Macau University of Science and Technology, Macau, People's Republic of China.,Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, People's Republic of China
| | - Pei-Yu Yan
- Macau University of Science and Technology, Macau, People's Republic of China
| |
Collapse
|
11
|
Wang S, Hu C, Xie F, Liu Y. Use of Programmed Death Receptor-1 and/or Programmed Death Ligand 1 Inhibitors for the Treatment of Brain Metastasis of Lung Cancer. Onco Targets Ther 2020; 13:667-683. [PMID: 32158220 PMCID: PMC6986404 DOI: 10.2147/ott.s235714] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/24/2019] [Indexed: 02/05/2023] Open
Abstract
The central nervous system (CNS) is regarded as an immune privileged environment; however, changes in the neuroimmunology paradigm have led to an increased interest in systematic immunotherapy in lung cancer therapy. The presence of the lymphatic system in the CNS as well as the physiological and biochemical changes in the blood–brain barrier in the tumor microenvironment suggests that immunocytes are fully capable of entering and exiting the CNS. Emerging clinical data suggest that inhibitors of programmed death receptor-1/programmed death ligand 1 (PD-1/PD-L1) can stimulate surrounding T cells and thus have antitumor effects in the CNS. For example, PD-1 antibody (pembrolizumab) monotherapy has displayed a 20–30% encephalic response rate in patients with brain metastases from malignant melanoma or non-small cell lung cancer. Combined application of nivolumab and ipilimumab anti-PD-1 and anti-cytotoxic T-lymphocyte-associated protein 4 showed an encephalic response rate of 55% in patients with brain metastases of melanoma. Further evidence is required to verify these response rates and identify the mechanisms of curative effects and drug tolerance. While regional treatments such as whole-brain radiosurgery, stereotactic radiosurgery, and brain surgery remain the mainstream, PD-1/PD-L1 inhibitors display potential decreased neurotoxic effects. To date, five drugs have been approved for use in patients with encephalic metastases of lung carcinoma: the anti-PD-1 drugs, pembrolizumab and nivolumab, and the anti-PD-L1 agents, atezolizumab, durvalumab, and avelumab. In recent years, clinical trials of inhibitors in combination with other drugs to treat brain metastasis have also emerged. This review summarizes the biological principles of PD-1/PD-L1 immunotherapy for brain metastasis of lung cancer, as well as ongoing clinical trials to explore unmet needs.
Collapse
Affiliation(s)
- Shiqiang Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China.,Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, People's Republic of China
| | - Chongling Hu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, People's Republic of China
| | - Fei Xie
- Department of Neurosurgery, Ziyang First People's Hospital, Ziyang 641300, People's Republic of China
| | - Yanhui Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| |
Collapse
|
12
|
Miyata-Morita K, Morita S, Matsutani N, Kondo F, Soejima Y, Sawabe M. Frequent appearance of club cell (Clara cell)-like cells as a histological marker for ALK-positive lung adenocarcinoma. Pathol Int 2019; 69:688-696. [PMID: 31625265 DOI: 10.1111/pin.12864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 09/15/2019] [Indexed: 12/12/2022]
Abstract
Anaplastic lymphoma kinase-rearranged (ALK+ ) lung cancers show characteristic histological features, such as solid signet ring cell patterns and mucinous cribriform patterns; however, these features are not always observed in ALK+ lung cancers. We noticed that club cell (Clara cell)-like cells (CLCs) were frequently present in the papillary portion of ALK+ lung adenocarcinomas. In this study, we investigated the importance of CLCs in papillary patterns of ALK+ lung cancers. We compared the histological features of 18 ALK+ cases with 62 control cases (22 epidermal growth factor receptor-positive (EGFR+ ) and 40 ALK- and EGFR-negative (ALK- /EGFR- ) cases). The present study analyzed presence of papillary pattern, proportion of papillary pattern area, presence of micropapillary pattern, frequency of CLCs and lengths of snout. The frequency of CLCs in ALK+ cases was significantly higher than that in EGFR+ cases and ALK- /EGFR- cases. Micropapillary pattern was more frequently observed in ALK+ cases than that in ALK- /EGFR- cases (P < 0.001). The present study indicated that the high frequency of CLCs in papillary patterns was significantly associated with ALK+ cases. When solid signet ring cell patterns and mucinous cribriform patterns are absent, the high frequency of CLCs in papillary adenocarcinoma could be a useful histological marker for ALK+ lung cancers.
Collapse
Affiliation(s)
- Kana Miyata-Morita
- Department of Pathology, Teikyo University Hospital, Tokyo, Japan.,Department of Molecular Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeki Morita
- Department of Pathology, Teikyo University Hospital, Tokyo, Japan.,Department of Pathology, Mitsui Memorial Hospital, Tokyo, Japan
| | | | - Fukuo Kondo
- Department of Pathology, Teikyo University Hospital, Tokyo, Japan
| | - Yurie Soejima
- Department of Molecular Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoji Sawabe
- Department of Molecular Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
13
|
Wang M, Yu L, Wei X, Wei Y. Role of tumor gene mutations in treatment response to immune checkpoint blockades. PRECISION CLINICAL MEDICINE 2019; 2:100-109. [PMID: 35692451 PMCID: PMC8985804 DOI: 10.1093/pcmedi/pbz006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/09/2019] [Accepted: 03/07/2019] [Indexed: 02/05/2023] Open
Abstract
Early studies shed light on the immune suppression of immune checkpoint molecules in the cancer microenvironment, with later studies applying immune checkpoint blockade (ICB) in treatment of various malignancies. Despite the encouraging efficacy of ICBs in a substantial subset of cancer patients, the treatment response varies. Gene mutations of both tumor cells and immune cells in the tumor microenvironment have recently been identified as potential predictors of the ICB response. Recent developments in gene expression profiling of tumors have allowed identification of a panel of mutated genes that may affect tumor cell response to ICB treatment. In this review, we discuss the association of the ICB response with gene expression and mutation profiles in tumor cells, which it is hoped will help to optimize the clinical application of ICBs in cancer patients.
Collapse
Affiliation(s)
- Manni Wang
- Laboratory of Aging Research and Nanotoxicology, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, Chengdu, PR China
| | - Liu Yu
- Laboratory of Aging Research and Nanotoxicology, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, Chengdu, PR China
| | - Xiawei Wei
- Laboratory of Aging Research and Nanotoxicology, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, Chengdu, PR China
| | - Yuquan Wei
- Laboratory of Aging Research and Nanotoxicology, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, Chengdu, PR China
| |
Collapse
|
14
|
Wei JW, Tafe LJ, Linnik YA, Vaickus LJ, Tomita N, Hassanpour S. Pathologist-level classification of histologic patterns on resected lung adenocarcinoma slides with deep neural networks. Sci Rep 2019; 9:3358. [PMID: 30833650 PMCID: PMC6399447 DOI: 10.1038/s41598-019-40041-7] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/06/2019] [Indexed: 12/22/2022] Open
Abstract
Classification of histologic patterns in lung adenocarcinoma is critical for determining tumor grade and treatment for patients. However, this task is often challenging due to the heterogeneous nature of lung adenocarcinoma and the subjective criteria for evaluation. In this study, we propose a deep learning model that automatically classifies the histologic patterns of lung adenocarcinoma on surgical resection slides. Our model uses a convolutional neural network to identify regions of neoplastic cells, then aggregates those classifications to infer predominant and minor histologic patterns for any given whole-slide image. We evaluated our model on an independent set of 143 whole-slide images. It achieved a kappa score of 0.525 and an agreement of 66.6% with three pathologists for classifying the predominant patterns, slightly higher than the inter-pathologist kappa score of 0.485 and agreement of 62.7% on this test set. All evaluation metrics for our model and the three pathologists were within 95% confidence intervals of agreement. If confirmed in clinical practice, our model can assist pathologists in improving classification of lung adenocarcinoma patterns by automatically pre-screening and highlighting cancerous regions prior to review. Our approach can be generalized to any whole-slide image classification task, and code is made publicly available at https://github.com/BMIRDS/deepslide .
Collapse
Affiliation(s)
- Jason W Wei
- Department of Biomedical Data Science, Dartmouth College, Hanover, NH, USA
- Department of Computer Science, Dartmouth College, Hanover, NH, USA
| | - Laura J Tafe
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Yevgeniy A Linnik
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Louis J Vaickus
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Naofumi Tomita
- Department of Biomedical Data Science, Dartmouth College, Hanover, NH, USA
| | - Saeed Hassanpour
- Department of Biomedical Data Science, Dartmouth College, Hanover, NH, USA.
- Department of Computer Science, Dartmouth College, Hanover, NH, USA.
- Department of Epidemiology, Dartmouth College, Lebanon, NH, USA.
| |
Collapse
|
15
|
Jiang L, Mino-Kenudson M, Roden AC, Rosell R, Molina MÁ, Flores RM, Pilz LR, Brunelli A, Venuta F, He J. Association between the novel classification of lung adenocarcinoma subtypes and EGFR/KRAS mutation status: A systematic literature review and pooled-data analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 45:870-876. [PMID: 30833014 DOI: 10.1016/j.ejso.2019.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/06/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study aims to determine the association of EGFR/KRAS mutation status with histological subtypes of lung adenocarcinoma (LAC) based on the IASLC/ATS/ERS classification. METHODS Pubmed and Cochrane databases were searched from January 2011 to June 2018 for studies that included patients with LAC who underwent surgical resection were classified according to the new IASLC/ATS/ERS classification. EGFR/KRAS status assessment was requireded. The primary outcome was determined by the odds ratio (OR) of the incidence of mutation status of certain of each histological subtype. The reference group consisted of EGFR/KRAS mutation negative patients. RESULTS Twenty-seven eligible studies involving 9022 patients with mutation gene detection were included for analysis. Among them, 6717 (74.5%) patients were from the Asian region and, 2305 (25.5%) patients were from Non-Asian regions. The most prevalent subtype was acinar (34.7%), followed by papillary (22.9%), lepidic (18.9%), solid (13.6%), micropapillary (6.3%), and invasive mucinous adenocarcinoma (3.5%). EGFR mutations were more common in patients with resected lepidic predominant adenocarcinoma (OR,1.76; 95%CI, 1.38-2.24;p < 0.01) and were rarely found in solid predominant adenocarcinoma (OR,0.28; 95%CI, 0.23-0.34;p < 0.01) or IMA (OR,0.10; 95%CI, 0.06-0.14;p < 0.01). Conversely, KRAS mutations were characterized by IMA (OR,7.01; 95%CI, 5.11-9.62;p < 0.01), and were less frequently identified in lepidic (OR,0.58; 95%CI, 0.45-0.75;p < 0.01) and acinar (OR,0.65; 95%CI, 0.55-0.78;p < 0.01) predominant subtypes. Further analyses were performed in Asian and Non-Asian groups and the results were consistent. CONCLUSIONS The current study confirms that the IASLC/ATS/ERS classification is associated with driver gene alterations in resected LAC.
Collapse
Affiliation(s)
- Long Jiang
- Department of Thoracic Surgery/Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, PR China.
| | | | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, USA
| | - Rafael Rosell
- Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Hospital Germans Trias I Pujol, Ctra Canyet, Badalona, Barcelona, Spain
| | - Miguel Ángel Molina
- Pangaea Biotech, S.L., Hospital Universitario Quirón Dexeus, Barcelona, Spain
| | - Raja M Flores
- Department of Thoracic Surgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Lothar R Pilz
- Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Germany
| | | | - Federico Venuta
- Department of Surgery "Paride Stefanini"-Thoracic Surgery Unit, Policlinico Umberto I, University of Rome, Italy
| | - Jianxing He
- Department of Thoracic Surgery/Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, PR China.
| | | |
Collapse
|
16
|
Survival analysis and pathological features of advanced non-small cell lung cancer with miliary pulmonary metastases in patients harboring epidermal growth factor receptor mutations. J Cancer Res Clin Oncol 2018; 144:1601-1611. [DOI: 10.1007/s00432-018-2681-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/28/2018] [Indexed: 10/25/2022]
|
17
|
Hiew K, Hart CA, Ali A, Elliott T, Ramani V, Sangar V, Lau M, Maddineni S, Brown M, Clarke N. Primary Mutational Landscape Linked with Pre-Docetaxel Lactate Dehydrogenase Levels Predicts Docetaxel Response in Metastatic Castrate-Resistant Prostate Cancer. Eur Urol Focus 2018; 5:831-841. [PMID: 29699892 DOI: 10.1016/j.euf.2018.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/04/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Docetaxel chemotherapy is a standard of care for metastatic castrate-resistant prostate cancer (mCRPC): 40-50% of patients achieve a biochemical response. However, there is a lack of response predictive biomarkers. OBJECTIVE To assess lactate dehydrogenase (LDH) as a docetaxel response biomarker in mCRPC and to examine the association of LDH with genomic alterations in primary diagnostic biopsies. DESIGN, SETTING, AND PARTICIPANTS Clinical and associated primary tumour-targeted next-generation sequencing data from matched training (n=150) and test (n=120) cohorts of progressive mCRPC patients receiving docetaxel therapy were analysed. Data were correlated with large-scale prostate cancer genomic datasets. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Prostate-specific antigen (PSA) response, radiographic response, biochemical progression-free survival (PFS), overall survival (OS), genomic analysis of primary biopsies, and genomic datasets (Memorial Sloan Kettering Cancer Center [MSKCC] and SU2C/PCF). RESULTS AND LIMITATIONS Serum LDH ≥450U/l is a reliable prognostic biomarker (area under the curve: 0.757 [standard deviation 0.054, 95% confidence interval [CI] 0.650-0.864, p<0.001]) in progressive mCRPC, predicting PFS at 3 mo. Patients with LDH ≥450U/l were poorer PSA responders, with shorter PFS (213 vs 372 d, hazard ratio [HR] 1.876, 95% CI 1.289-2.7300) and OS (362 vs 563 d, HR 1.630, 95% CI 1.127-2.357). High LDH is an independent surrogate marker for survival following docetaxel and predicts a poor radiological response (p=0.043). Of the 14 patients with LDH ≥450U/l available for next-generation sequencing, nine (64.3%) were more likely to have DNA repair gene mutation(s) (BRCA1/2, ATM, CHEK2, Fanconi anaemia gene) in their primary biopsy. Cross correlation with MSKCC and SU2C/PCF databases revealed a positive correlation between LDHA, PARP1 (r=0.667, p<0.01), and other DNA repair genes. CONCLUSIONS Genomic abnormalities of LDHA and DNA repair in primary biopsies link to high pretreatment LDH and poor response to docetaxel in mCRPC. PATIENT SUMMARY The presence of mutations of the lactate dehydrogenase and DNA repair pathways are associated with aggressive prostate cancer and poor response to chemotherapy later in the disease.
Collapse
Affiliation(s)
- Kenneth Hiew
- Genito Urinary Cancer Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK; Department of Urology, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Claire A Hart
- Genito Urinary Cancer Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Adnan Ali
- Genito Urinary Cancer Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Tony Elliott
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Vijay Ramani
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK; Department of Urology, University Hospital of South Manchester NHS Trust, Manchester, UK
| | - Vijay Sangar
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK; Department of Urology, University Hospital of South Manchester NHS Trust, Manchester, UK
| | - Maurice Lau
- Department of Urology, Salford Royal NHS Foundation Trust, Manchester, UK; Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Satish Maddineni
- Department of Urology, Salford Royal NHS Foundation Trust, Manchester, UK; Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mick Brown
- Genito Urinary Cancer Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK; FASTMAN, Prostate Cancer UK, Movember Centre of Excellence, UK.
| | - Noel Clarke
- Genito Urinary Cancer Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK; Department of Urology, Salford Royal NHS Foundation Trust, Manchester, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Department of Urology, The Christie NHS Foundation Trust, Manchester, UK; FASTMAN, Prostate Cancer UK, Movember Centre of Excellence, UK
| |
Collapse
|
18
|
Tsiara A, Liontos M, Kaparelou M, Zakopoulou R, Bamias A, Dimopoulos MA. Implementation of immunotherapy in the treatment of advanced non-small cell lung cancer (NSCLC). ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:144. [PMID: 29862233 DOI: 10.21037/atm.2018.02.07] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Mechanisms of tumor immune surveillance and immune escape have been recently elucidated and led to the development of a new therapeutic field in oncology, that of immunotherapy. Immunotherapy aims to reactivate the immune system against cancer. Neoplasias like non-small cell lung cancer (NSCLC) are of particular interest and clinical studies with immunotherapeutic agents have shown significant survival benefit. Several agents have gained corresponding regulatory approvals. In particular, nivolumab, pembrolizumab and atezolizumab have been approved for second-line treatment of NSCLC, pembrolizumab is the only immune checkpoint inhibitor that has been approved in the first-line treatment and durvalumab is approved in the locally advanced disease. In this review, we aim to present the implementation of immunotherapy in the treatment of advanced NSCLC. We will discuss not only the approved regimens but also the future perspectives, the serious adverse events such as hyperprogression and the possible predictive markers that will aid the selection of the patients that will benefit from immunotherapy.
Collapse
Affiliation(s)
- Anna Tsiara
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Michalis Liontos
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Kaparelou
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Roubini Zakopoulou
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Aristotelis Bamias
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| |
Collapse
|
19
|
Motono N, Funasaki A, Sekimura A, Usuda K, Uramoto H. Prognostic value of epidermal growth factor receptor mutations and histologic subtypes with lung adenocarcinoma. Med Oncol 2018; 35:22. [DOI: 10.1007/s12032-018-1082-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/09/2018] [Indexed: 01/03/2023]
|
20
|
Identifying candidates for gamma knife radiosurgery among elderly patients with brain metastases. J Neurooncol 2018; 137:559-565. [PMID: 29327172 DOI: 10.1007/s11060-018-2745-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/03/2018] [Indexed: 01/17/2023]
Abstract
We investigated the outcomes of gamma knife radiosurgery (GKRS) for elderly patients (≥ 65 years) with brain metastases, and identified survival-associated factors. We retrospectively analyzed data from 115 patients treated with GKRS for 1-15 brain metastases. The median patient age was 72 years; most primary tumors were pulmonary (n = 83). The mean lesion volume was 2.1 ± 4.8 mL. A mean dose of 19.3 Gy was delivered to the mean 63.9% isodose line. The median overall survival (OS) was 5.3 months (95% confidence interval [CI] 3.5-7.1). During follow-up (median, 5.1 months), 91 patients died of primary cancer progression while 1 died of unknown causes. The 6- and 12-month local control rates were 94.9 and 88.1%, respectively. On multivariate analysis, female sex (p = 0.005, hazard ratio [HR] 0.533, 95% CI 0.343-0.827) and a controlled primary tumor (p < 0.001, HR 0.328, 95% CI 0.180-0.596) were significantly favorable prognostic factors. Of non-small cell lung cancer patients with EGFR mutations, 76.5% were women (p = 0.005). The median OS of EGFR-mutant and EGFR-wildtype patients were 19.1 and 4.7 months, respectively (p = 0.080). Brain metastases < 3 mL showed better local control rates after GKRS (p = 0.005). GKRS produces favorable outcomes in women with brain metastases who are ≥ 65 years and have controlled primary tumors. Such patients are therefore suitable candidates for GKRS.
Collapse
|
21
|
Zhao X, Zhang Y, Qian K, Zhao L, Wang W, Teng LH. Prognostic significance of the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification of stage I lung adenocarcinoma: A retrospective study based on analysis of 110 Chinese patients. Thorac Cancer 2017; 8:565-571. [PMID: 28834269 PMCID: PMC5668519 DOI: 10.1111/1759-7714.12464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/17/2017] [Accepted: 05/17/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the relationship between predominant subtype, classification, and prognosis in Chinese stage I lung adenocarcinoma patients according to the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) International Multidisciplinary Lung Adenocarcinoma Classification. METHODS Between 2000 and 2010, 110 patients with stage I lung adenocarcinoma underwent surgery at Xuanwu Hospital. Two pathologists independently reclassified all resected specimens according to the IASLC/ATS/ERS classification. Survival curves were plotted using the Kaplan-Meier method. The Cox proportional hazard model was used for multivariate analysis. RESULTS There were no cases of adenocarcinoma in situ, and three cases of minimally invasive adenocarcinoma. There were 107 cases of invasive adenocarcinoma: 12 lepidic, 32 acinar, 30 papillary, 18 micropapillary, and 15 solid predominant subtypes. Patients with micropapillary and solid predominant tumors had significantly poorer disease-free survival compared to those with other subtypes of predominant tumors (P = 0.021). Multivariate analysis revealed that the new classification (P = 0.003) and T stage (P = 0.034) were independent predictors of disease-free and overall survival, respectively. CONCLUSION The predominant subtype in the primary tumor was associated with prognosis in resected stage I lung adenocarcinoma.
Collapse
Affiliation(s)
- Xin Zhao
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yi Zhang
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kun Qian
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lan Zhao
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liang H Teng
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
22
|
Zou J, Lv T, Zhu S, Lu Z, Shen Q, Xia L, Wu J, Song Y, Liu H. Computed tomography and clinical features associated with epidermal growth factor receptor mutation status in stage I/II lung adenocarcinoma. Thorac Cancer 2017; 8:260-270. [PMID: 28383802 PMCID: PMC5415462 DOI: 10.1111/1759-7714.12436] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 01/25/2023] Open
Abstract
Background The relationship between epidermal growth factor receptor (EGFR) gene mutation status, preoperative computed tomography (CT), and clinical features in patients with small peripheral lung adenocarcinoma (<3 cm) was investigated. Methods We included 209 patients who underwent surgical resection for stage I or II lung adenocarcinoma at Nanjing General Hospital between December 2010 and May 2016. 171 cases of patients underwent a pretreatment chest CT. Eleven different CT descriptors were assessed. Multiple logistic regression analyses were performed to identify independent risk factors for the prediction of EGFR mutation. Receiver operating characteristic analysis was used to evaluate the performance of the logistic regression model. Results EGFR mutation was determined in 126 patients (60.3%) and appeared more frequently in women (P = 0.025), never‐smokers (P < 0.001), and patients with a carcinoembryonic antigen level <2.6 ng/ml (P = 0.045). Papillary predominant adenocarcinomas (P = 0.014), intermediate/low pathologic grade tumors (P = 0.003), tumors in the upper lobe (P = 0.028), and showing ground‐glass opacity (GGO) or mixed GGO on CT (P = 0.039) also more frequently harbored EGFR mutations. GGO on CT, acinar or papillary predominant adenocarcinoma, and non‐smoker were identified in multivariable analyses as significantly independent risk factors. The multiple logistic regression model showed high predictive power for identifying EGFR mutations. The CT features were similar between the L858R and 19 deletion mutations. Conclusions Combined CT and clinical features may be helpful for determining the presence of EGFR mutations in patients with small peripheral lung adenocarcinoma, particularly in patients where mutational profiling is not available or possible.
Collapse
Affiliation(s)
- Jiawei Zou
- Department of Respiratory Medicine, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Tangfeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Suhua Zhu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhenfeng Lu
- Department of Pathology, Jinling Hospital, Nanjing, China
| | - Qin Shen
- Department of Pathology, Jinling Hospital, Nanjing, China
| | - Leilei Xia
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Jie Wu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Southern Medical University, Nanjing, China.,Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Hongbing Liu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| |
Collapse
|
23
|
Vaideeswar P, Nayak SS, Verma A, Goel NA. Pulmonary miliary papillary/micropapillary adenocarcinoma manifesting as carcinomatous encephalitis. J Postgrad Med 2017; 63:191-193. [PMID: 28272062 PMCID: PMC5525484 DOI: 10.4103/0022-3859.201410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The histological pattern and the associated molecular aberrations have an important bearing in the prognosis of pulmonary adenocarcinomas. Papillary and micropapillary growth patterns with mutations in epidermal growth factor receptor and anaplastic large-cell lymphoma kinase rearrangements have an aggressive clinical course. We report one such cancer in a 49-year-old woman, where it assumed a miliary pattern in the lungs, and the patient presented with neurological symptoms related to carcinomatous encephalitis, an infrequent metastatic manifestation.
Collapse
Affiliation(s)
- P Vaideeswar
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S S Nayak
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - A Verma
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N A Goel
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
24
|
Guo Z, Yi F, Yin W, Zhang Y, Li Q, Gu Y, Xiao Y, Cao B, Ma L, Liang L. Clinical value of the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification of lung adenocarcinoma. Thorac Cancer 2017; 8:159-169. [PMID: 28220630 PMCID: PMC5415459 DOI: 10.1111/1759-7714.12419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/27/2016] [Accepted: 12/27/2016] [Indexed: 01/15/2023] Open
Abstract
Background We explored correlations between the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, epidermal growth factor receptor (EGFR) mutation status, and prognosis. Methods Data from 293 patients with lung adenocarcinoma were classified according to the new classification. Fisher’s exact, χ2, and log‐rank tests and Cox regression analysis were used to analyze correlations between EGFR mutation status, lung cancer prognosis, and the new histologic subtype. Disease‐free survival and progression‐free survival (PFS) were estimated using the Kaplan–Meier method. Results Lepidic and non‐solid adenocarcinomas showed significantly elevated EGFR mutation rates (79.0% and 65.8%, respectively; P < 0.05). EGFR mutation status was only associated with gender (P < 0.001). EGFR mutation‐positive patients who received targeted therapy had better median PFS than those who received chemotherapy as first‐line treatment (P < 0.001). The median PFS of patients with exon 19 and exon 21 mutations who received first‐line targeted therapy were 12.5 and 9.5 months, respectively (P = 0.970). Patients with micropapillary predominant adenocarcinomas had the shortest disease‐free survival (<18 months) and PFS. Histologic subtype (P = 0.036), treatment type (P = 0.031), and EGFR mutation status (P = 0.019) might be good prognostic factors for lung adenocarcinoma. Conclusion Patients with exon 19 mutations obtained greater benefits from targeted therapy. In the new classification, EGFR mutation rates are higher in lepidic cases and in cases without the solid subtype. The micropapillary subtype of adenocarcinoma has the worst prognosis, while the lepidic subtype has the best.
Collapse
Affiliation(s)
- Ziwei Guo
- Department of Tumor Chemotherapy and Radiation Sickness, Third Hospital, Peking University, Beijing, China.,Department of Medical Oncology, International Hospital, Peking University, Beijing, China
| | - Fumei Yi
- Department of Tumor Chemotherapy and Radiation Sickness, Third Hospital, Peking University, Beijing, China
| | - Wencheng Yin
- Department of Tumor Chemotherapy and Radiation Sickness, Third Hospital, Peking University, Beijing, China
| | - Yu Zhang
- Department of Tumor Chemotherapy and Radiation Sickness, Third Hospital, Peking University, Beijing, China
| | - Qian Li
- Department of Tumor Chemotherapy and Radiation Sickness, Third Hospital, Peking University, Beijing, China
| | - Yangchun Gu
- Department of Tumor Chemotherapy and Radiation Sickness, Third Hospital, Peking University, Beijing, China
| | - Yu Xiao
- Department of Tumor Chemotherapy and Radiation Sickness, Third Hospital, Peking University, Beijing, China
| | - Baoshan Cao
- Department of Tumor Chemotherapy and Radiation Sickness, Third Hospital, Peking University, Beijing, China
| | - Liwen Ma
- Department of Tumor Chemotherapy and Radiation Sickness, Third Hospital, Peking University, Beijing, China
| | - Li Liang
- Department of Tumor Chemotherapy and Radiation Sickness, Third Hospital, Peking University, Beijing, China
| |
Collapse
|
25
|
Kelly D, Mc Sorley L, O'Shea E, Mc Carthy E, Bowe S, Brady C, Sui J, Dawod MA, O'Brien O, Graham D, McCarthy J, Burke L, Power D, O'Reilly S, Bambury RM, Mahony DO. A regional analysis of epidermal growth factor receptor (EGFR) mutated lung cancer for HSE South. Ir J Med Sci 2017; 186:855-857. [PMID: 28185061 DOI: 10.1007/s11845-017-1579-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 02/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND EGFR mutated lung cancer represents a subgroup with distinct clinical presentations, prognosis, and management requirements. We investigated the survival, prognostic factors, and real-world treatment of NSCLC patients with EGFR mutation in clinical practice. METHODS A retrospective review of all specimens sent for EGFR analysis from December 2009 to September 2015 was performed. Patient demographics, specimen type, EGFR mutation status/type, stage at diagnosis, treatment, response rate, and survival data were recorded. RESULTS 27/334 (8%) patient specimens sent for EGFR testing tested positive for a sensitising EGFR mutation. The median age was 65 years (40-85 years). Exon 19 deletion represented the most commonly detected alteration, accounting for 39% (n = 11). First-line treatment for those with Exon 18, 19, or 21 alterations (n = 24) was with an EGFR tyrosine kinase inhibitor (TKI) in 79% (n = 19). Objective response rate among these patients was 74% and median duration of response was 13 months (range 7-35 months). CONCLUSION The incidence of EGFR mutation in our cohort of NSCLC is 9% which is consistent with mutation incidence reported in other countries. The rate of EGFR mutation in our population is slightly below that reported internationally, but treatment outcomes are consistent with published data. Real-world patient data have important contributions to make with regard to quality measurement, incorporating patient experience into guidelines and identifying safety signals.
Collapse
Affiliation(s)
- D Kelly
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland.
| | - L Mc Sorley
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - E O'Shea
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - E Mc Carthy
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - S Bowe
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - C Brady
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - J Sui
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - M A Dawod
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - O O'Brien
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - D Graham
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - J McCarthy
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - L Burke
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - D Power
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - S O'Reilly
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - R M Bambury
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - D O Mahony
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| |
Collapse
|
26
|
Cai YR, Dong YJ, Wu HB, Yu DP, Zhou LJ, Su D, Zhang L, Chen XJ. Expression level of CRKL and AXL combined with exon 19 deletion in EGFR and ALK status confer differential prognosis of lung adenocarcinoma subtypes. Oncol Lett 2016; 12:3312-3322. [PMID: 27899998 DOI: 10.3892/ol.2016.5080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 07/22/2016] [Indexed: 12/13/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is a lethal cancer-related disease in population. Adenocarcinoma (AC) is subclassified into several subtypes based on the new classification by the International Association for the Study of Lung Cancer, American Thoracic Society and European Respiratory Society in 2011. Correlation between original expression of Crk-like (CRKL) and anaplastic lymphoma receptor tyrosine kinase in diverse histological components of AC and epidermal growth factor receptor (EGFR) or ALK status was evaluated by immunohistochemistry and sequencing in present study. A total of 106 cases, including 83 patients (78.3%) with mixed-type ACs, were assessed in the present study using eligible follow-up data. The ACs consisted of 32 acinar, 12 papillary, 5 mucinous, 11 micropapillary and 46 solid-predominant ACs. In total, 69.8% samples were composed of 2 or 3 histological components, with different expression levels of CRKL and AXL. ACs with EGFR mutation had a higher level of AXL expression compared with ACs without mutation (P=0.019). Multivariate survival analysis showed that AC subtypes and EGFR mutation subtypes were significantly associated with the progression-free survival (PFS) time. Acinar AC was the subtype with the most notable PFS time (30.6 months), which was significantly different from the PFS time of papillary, mucinous, micropapillary and solid-predominant ACs (hazard ratio, 0.4; 95% CI, 0.21-0.75; P=0.005). Among the ACs with exon 19 mutation, the median PFS time (28.8 months) of patients with a lower level of AXL protein expression was increased compared with the PFS time of patients with the L858R mutation and wild-type EGFR (9.1 months and 11 months, respectively; P=0.03), whereas no significant difference in ACs with an increased level of AXL expression. However, AC patients with higher level of CRKL expression had better PFS (28.8 months) than patients with the L858R mutation and wild-type EGFR (9.1 months and 11.3 months, respectively). Exon 19 deletion is an important status that is associated with an improved response to conventional chemotherapy. The identification of EGFR mutations combined with CRKL and AXL status may potentially alter the way that lung AC is treated.
Collapse
Affiliation(s)
- Yi-Ran Cai
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, P.R. China
| | - Yu-Jie Dong
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, P.R. China
| | - Hong-Bo Wu
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, P.R. China
| | - Da-Ping Yu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, P.R. China
| | - Li-Juan Zhou
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, P.R. China
| | - Dan Su
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, P.R. China
| | - Li Zhang
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, P.R. China
| | - Xue-Jing Chen
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, P.R. China
| |
Collapse
|
27
|
Differences among lesions with exon 19, exon 21 EGFR mutations and wild types in surgically resected non-small cell lung cancer. Sci Rep 2016; 6:31636. [PMID: 27527915 PMCID: PMC4985828 DOI: 10.1038/srep31636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/22/2016] [Indexed: 02/07/2023] Open
Abstract
The clinical behavior of patients with advanced non-small cell lung cancer (NSCLC) differ between epidermal growth factor receptor (EGFR) exon 19 deletion (Ex19) and EGFR exon 21 L858R mutation (Ex21). This study aimed to evaluate whether these differences exist in surgically resected NSCLC. A total of 198 patients with surgically resected NSCLC harbouring Ex19 (n = 53), Ex21 (n = 51), and EGFR wild-type (Wt) (n = 94) were analyzed. The clinicopathological features, laboratory parameters, recurrent sites and disease-free survival (DFS) were compared according to mutational EGFR status. Ex21 occurred more frequently in female (p < 0.001), never-smokers (p < 0.001), adenocarcinoma (p < 0.001), low grade (p = 0.013) than Wt lesions. Ex19 occurred more frequently in female (p = 0.016), never-smokers (p = 0.008), adenocarcinoma (p < 0.001), low grade (p = 0.025) than Wt lesions. Ex 21 lesions (p = 0.026) had larger lepidic components than Wt lesions. Wt lesions had larger mucinous variant components than Ex21 lesions (p = 0.045) and Ex19 lesions (p = 0.015). Ex21 lesions were associated with lower pretreatment neutrophil: lymphocyte ratio (NLR) than Wt lesions (p = 0.017). The recurrent sites and DFS were similar among patients with Wt, Ex19 and Ex21.
Collapse
|
28
|
Cha YJ, Kim HR, Lee CY, Cho BC, Shim HS. Clinicopathological and prognostic significance of programmed cell death ligand-1 expression in lung adenocarcinoma and its relationship with p53 status. Lung Cancer 2016; 97:73-80. [DOI: 10.1016/j.lungcan.2016.05.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 02/07/2023]
|
29
|
Matsuzawa R, Kirita K, Kuwata T, Umemura S, Matsumoto S, Fujii S, Yoh K, Kojima M, Niho S, Ohmatsu H, Ochiai A, Tsuboi M, Goto K, Ishii G. Factors influencing the concordance of histological subtype diagnosis from biopsy and resected specimens of lung adenocarcinoma. Lung Cancer 2016; 94:1-6. [DOI: 10.1016/j.lungcan.2016.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/10/2016] [Accepted: 01/17/2016] [Indexed: 11/24/2022]
|
30
|
Liu Y, Kim J, Qu F, Liu S, Wang H, Balagurunathan Y, Ye Z, Gillies RJ. CT Features Associated with Epidermal Growth Factor Receptor Mutation Status in Patients with Lung Adenocarcinoma. Radiology 2016; 280:271-80. [PMID: 26937803 DOI: 10.1148/radiol.2016151455] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Purpose To retrospectively identify the relationship between epidermal growth factor receptor (EGFR) mutation status, predominant histologic subtype, and computed tomographic (CT) characteristics in surgically resected lung adenocarcinomas in a cohort of Asian patients. materials and Methods This study was approved by the institutional review board, with waiver of informed consent. Preoperative chest CT findings were retrospectively evaluated in 385 surgically resected lung adenocarcinomas. A total of 30 CT descriptors were assessed. EGFR mutations at exons 18-21 were determined by using the amplification refractory mutation system. Multiple logistic regression analyses were performed to identify independent factors of harboring EGFR mutation status. The final model was selected by using the backward elimination method, and two areas under the receiver operating characteristic curve (ROC) were compared with the nonparametric approach of DeLong, DeLong, and Clarke-Pearson. Results EGFR mutations were found in 168 (43.6%) of 385 patients. Mutations were found more frequently in (a) female patients (P < .001); (b)those who had never smoked (P < .001); (c)those with lepidic predominant adenocarcinomas (P = .001) or intermediate pathologic grade (P < .001); (e) smaller tumors (P < .001); (f)tumors with spiculation (P = .019), ground-glass opacity (GGO) or mixed GGO (P < .001), air bronchogram (P = .006), bubblelike lucency (P < .001), vascular convergence (P = .024), thickened adjacent bronchovascular bundles (P = .027), or pleural retraction (P < .001); and (g) tumors without pleural attachment (P = .004), a well-defined margin (P = .010), marked heterogeneous enhancement (P = .001), severe peripheral emphysema (P = .002), severe peripheral fibrosis (P = .013), or lymphadenopathy (P = .028). The most important and significantly independent prognostic factors of harboring EGFR-activating mutation for the model with both clinical variables and CT features were those who had never smoked and those with smaller tumors, bubblelike lucency, homogeneous enhancement, or pleural retraction when adjusting for histologic subtype, pathologic grade, or thickened adjacent bronchovascular bundles. ROC curve analysis showed that use of clinical variables combined with CT features (area under the ROC curve = 0.778) was superior to use of clinical variables alone (area under the ROC curve = 0.690). Conclusion CT imaging features of lung adenocarcinomas in combination with clinical variables can be used to prognosticate EGFR mutation status better than use of clinical variables alone. (©) RSNA, 2016 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Ying Liu
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla
| | - Jongphil Kim
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla
| | - Fangyuan Qu
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla
| | - Shichang Liu
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla
| | - Hua Wang
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla
| | - Yoganand Balagurunathan
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla
| | - Zhaoxiang Ye
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla
| | - Robert J Gillies
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla
| |
Collapse
|
31
|
Qiang G, Huang W, Liang C, Xu R, Yan J, Xu Y, Wang YE, DA J, Shi B, Guo Y, Liu D. Association between histopathological subtype, 18F-fluorodeoxyglucose uptake and epidermal growth factor receptor mutations in lung adenocarcinoma. Oncol Lett 2016; 11:1769-1777. [PMID: 26998075 PMCID: PMC4774527 DOI: 10.3892/ol.2016.4154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 01/05/2016] [Indexed: 12/28/2022] Open
Abstract
The aim of the present study was to investigate the association between histopathological subtypes, epidermal growth factor receptor (EGFR) mutations and 18F-fluorodeoxyglucose (FDG) uptake in patients with lung adenocarcinoma (ADC). The cases of 97 patients with lung ADC who underwent 18F-FDG positron emission tomography-computed tomography prior to surgical resection were retrospectively reviewed. The patients were stratified according to the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) classification, and graded using a histopathological scoring system. EGFR mutations were identified. Clinicopathological characteristics associated with EGFR mutation status were evaluated using univariate and multivariate analyses. EGFR mutation was identified in 45.4% of the patients and was associated with gender, smoking history, maximum standardized uptake value (SUVmax) and histopathological score. ADC patients with a low SUVmax were more likely to exhibit EGFR mutations compared with patients with a high SUVmax (P=0.018). Patients with a lower histopathological score possessed a significantly lower SUVmax compared with patients with a higher score (P<0.001). Furthermore, the histopathological score and smoking history of the patients were identified to be independent predictors for EGFR mutations, according to multivariate logistic regression analysis. In conclusion, SUVmax and EGFR mutations were associated with lung ADC patients stratified according to the IASLC/ATS/ERS classification. Overall, SUVmax has the potential to be a useful marker in stratifying pre-operative patients with lung ADC and identifying EGFR mutations.
Collapse
Affiliation(s)
- Guangliang Qiang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Wei Huang
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing 100191, P.R. China
| | - Chaoyang Liang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Rui Xu
- Department of Nuclear Medicine, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Jue Yan
- Department of Nuclear Medicine, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Yanyan Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Y E Wang
- Department of Pathology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Jiping DA
- Department of Pathology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Bin Shi
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Yongqing Guo
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| |
Collapse
|
32
|
Russell PA, Wright GM. Predominant histologic subtype in lung adenocarcinoma predicts benefit from adjuvant chemotherapy in completely resected patients: discovery of a holy grail? ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:16. [PMID: 26855952 PMCID: PMC4716942 DOI: 10.3978/j.issn.2305-5839.2015.10.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/03/2015] [Indexed: 01/01/2023]
Abstract
The recently published 2015 World Health Organisation (WHO) classification of lung tumors, which is based on the 2011 International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ATS) multidisciplinary classification, recommends diagnosis of resected lung adenocarcinoma according to the predominant histologic subtype. This has been shown to correlate with overall and disease-free survival (DFS) in many studies from four continents. Now classification according to predominant histologic subtype has been demonstrated to predict benefit from adjuvant chemotherapy in a subset of patients with completely resected lung adenocarcinoma previously included in the International Adjuvant Lung Cancer Trial (IALT), JBR.10, Cancer and Leukemia Group B (CALGB) 9633 and Adjuvant Navelbine International Trialist Association 01 (ANITA) adjuvant chemotherapy trials, all of which were part of the LACE-Bio study. This "hot-off-the press" landmark investigation further cements the clinical importance of classification of resected lung adenocarcinoma according to predominant histologic subtype and suggests that it could be a critical factor for patient stratification in future clinical trials.
Collapse
|
33
|
Cao Y, Zhu LZ, Jiang MJ, Yuan Y. Clinical impacts of a micropapillary pattern in lung adenocarcinoma: a review. Onco Targets Ther 2015; 9:149-58. [PMID: 26770064 PMCID: PMC4706128 DOI: 10.2147/ott.s94747] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Lung adenocarcinoma with a micropapillary pattern (MPPAC) has recently drawn increased attention among researchers. Micropapillary-predominant adenocarcinoma (MPA), which is defined by micropapillary pattern (MPP), is the primary histological pattern observed semiquantitatively in 5% increments on resection specimens, and MPA was formally determined to be a new histological subtype according to the new multidisciplinary classification in 2011. According to published studies, MPPAC is most common in males and nonsmokers and is associated with lymphatic invasion, pleural invasion, and lymph node metastases. MPPAC often presents as part-solid and lobulated nodules in computed tomography scans. MPP tends to have a higher maximum standardized uptake value as determined by fluorodeoxyglucose positron emission tomography combined with computed tomography, indicating a high risk of recurrence. Molecular markers, including vimentin, napsin A, phosphorylated c-Met, cytoplasmic maspin, Notch-1, MUC1, and tumoral CD10, may have higher expression in MPPAC than other subtypes; conversely, markers such as MUC4 and surfactant apoprotein A have lower expression in MPPAC. MPPAC with EGFR mutations can benefit from treatment with EGFR tyrosine kinase inhibitors. Furthermore, a complete lobectomy may be more suitable than limited resection for MPPAC because of the low sensitivity of intraoperative frozen sections and the high risk of lymph node metastasis. MPA benefits more from adjuvant chemotherapy than do other histological subtypes, whereas MPA does not benefit from adjuvant radiotherapy. Of note, MPP is associated with poor prognosis in early-stage lung adenocarcinoma, but the prognostic value of MPP is controversial in advanced-stage lung adenocarcinoma.
Collapse
Affiliation(s)
- Ying Cao
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Li-Zhen Zhu
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Meng-Jie Jiang
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Ying Yuan
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| |
Collapse
|
34
|
de Souza LR, Muehlmann LA, Matos LC, Simón-Vázquez R, Lacava ZGM, De-Paula AMB, Mosiniewicz-Szablewska E, Suchocki P, Morais PC, González-Fernández Á, Báo SN, Azevedo RB. Antitumor activity and systemic effects of PVM/MA-shelled selol nanocapsules in lung adenocarcinoma-bearing mice. NANOTECHNOLOGY 2015; 26:505101. [PMID: 26580675 DOI: 10.1088/0957-4484/26/50/505101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Selol is a semi-synthetic compound containing selenite that is effective against cancerous cells and safer for clinical applications in comparison with other inorganic forms of selenite. Recently, we have developed a formulation of poly(methyl vinyl ether-co-maleic anhydride)-shelled selol nanocapsules (SPN), which reduced the proliferative activity of lung adenocarcinoma cells and presented little deleterious effects on normal cells in in vitro studies. In this study, we report on the antitumor activity and systemic effects induced by this formulation in chemically induced lung adenocarcinoma-bearing mice. The in vivo antitumor activity of the SPN was verified by macroscopic quantification, immunohistochemistry and morphological analyses. Toxicity analyses were performed by evaluations of the kidney, liver, and spleen; analyses of hemogram and plasma levels of alanine aminotransferase, aspartate transaminase, urea, and creatinine; and DNA fragmentation and cell cycle activity of the bone marrow cells. Furthermore, we investigated the potential of the SPN formulation to cause hemolysis, activate the complement system, provoke an inflammatory response and change the conformation of the plasma proteins. Our results showed that the SPN reduced the area of the surface tumor nodules but not the total number of tumor nodules. The biochemical and hematological findings were suggestive of the low systemic toxicity of the SPN formulation. The surface properties of the selol nanocapsules point to characteristics that are consistent with the treatment of the tumors in vivo: low hemolytic activity, weak inflammatory reaction with no activation of the complement system, and mild or absent conformational changes of the plasma proteins. In conclusion, this report suggests that the SPN formulation investigated herein exhibits anti-tumoral effects against lung adenocarcinoma in vivo and is associated with low systemic toxicity and high biocompatibility.
Collapse
Affiliation(s)
- Ludmilla Regina de Souza
- Institute of Biological Sciences, Molecular Biology Programme, University of Brasília, Brasília/DF, 70910-900, Brazil
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Clay TD, Russell PA, Do H, Sundararajan V, Conron M, Wright GM, Dobrovic A, Moore MM, McLachlan SA. Associations between the IASLC/ATS/ERS lung adenocarcinoma classification and EGFR and KRAS mutations. Pathology 2015; 48:17-24. [PMID: 27020204 DOI: 10.1016/j.pathol.2015.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 08/04/2015] [Accepted: 08/11/2015] [Indexed: 01/08/2023]
Abstract
We sought to investigate the frequency of mutations in epidermal growth factor receptor (EGFR) and Kirsten-RAS (KRAS) by each pathological subtype for patients with resected pulmonary adenocarcinoma as defined by the IASLC/ATS/ERS classification. Histological examination determined the predominant subtype according to the IASLC/ATS/ERS classification. EGFR and KRAS mutations were determined by high-resolution melting and Sanger sequencing. Clinical data were collected from medical records and clinicians. The 178 consecutive patients consisted of 48% males, median age 68 years (range 20-87) and smoking history 78%. The tumour stage was I in 62%, II in 18% and III in 20%. The mutation rates were: EGFR 30%; KRAS 28%. The rate of EGFR mutations in the acinar predominant reference group (n=76), was 37%. The solid predominant subtype showed significantly fewer EGFR mutations [3/33 (9%), odds ratio 0.17 (0.05-0.61), p=0.007]. No differences in mutation rate were observed in other subtypes. No association was found between KRAS mutations and predominant histological subtype. Advanced stage and solid predominant subtype were negative prognostic factors. EGFR mutations can be present in adenocarcinoma of any predominant subtype, however rarely in solid predominant tumours. No association was found between KRAS mutation and the predominant histological subtype.
Collapse
Affiliation(s)
- T D Clay
- St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Australia.
| | - P A Russell
- St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Australia
| | - H Do
- University of Melbourne, Australia; Translational Genomics and Epigenetics Laboratory, Olivia Newton John Cancer Research Institute, Heidelberg Australia; School of Cancer Medicine, La Trobe University, Australia
| | | | - M Conron
- St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Australia
| | - G M Wright
- St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
| | - A Dobrovic
- University of Melbourne, Australia; Translational Genomics and Epigenetics Laboratory, Olivia Newton John Cancer Research Institute, Heidelberg Australia; School of Cancer Medicine, La Trobe University, Australia
| | - M M Moore
- St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Australia
| | - S A McLachlan
- St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Australia
| |
Collapse
|
36
|
Shi X, Pang Q, Zhao G, Zhao L, Wang P. [Advances of Pulmonary Adenocarcinoma with Micropapillary Pattern]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 18:701-5. [PMID: 26582227 PMCID: PMC6000319 DOI: 10.3779/j.issn.1009-3419.2015.11.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
伴微乳头结构(micropapillary pattern, MPP)肺腺癌是一种临床少见的具有高度侵袭性的恶性肿瘤,近年来因其高死亡率被人们所重视。2011年关于肺腺癌的病理新分类将其作为一种独立的病理类型,此后针对该类肺癌个体化治疗的相关研究逐渐展开。近期的相关研究发现,伴MPP肺腺癌在转移机制、临床病理学、影像学、治疗及预后方面具有显著异质性。本文对伴MPP肺腺癌转移机制及相关临床研究进展进行探讨。
Collapse
Affiliation(s)
- Xiangyu Shi
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Qingsong Pang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Gang Zhao
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Lujun Zhao
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Ping Wang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| |
Collapse
|
37
|
Li S, Tian H, Yue W, Li L, Gao C, Si L, Hu W, Qi L, Lu M, Cheng C, Cui J, Chen G. Clinicopathological and prognostic significance of metastasis-associated protein 1 expression and its correlation with angiogenesis in lung invasive adenocarcinomas, based on the 2011 IASLC/ATS/ERS classification. Oncol Lett 2015; 11:224-230. [PMID: 26870192 PMCID: PMC4727071 DOI: 10.3892/ol.2015.3839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 10/05/2015] [Indexed: 01/04/2023] Open
Abstract
Based on previous findings regarding the angiogenic activities and prognostic roles of metastasis-associated protein 1 (MTA1) in early-stage non-small cell lung cancer, the clinicopathological and prognostic significance of MTA1 protein expression, and its correlation with angiogenesis in lung invasive adenocarcinoma, were further assessed in the present study, according to the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. High protein expression levels of MTA1 were commonly observed in patients with lung invasive adenocarcinoma, and were significantly correlated with tumor size (P=0.030), lymph node metastasis (P=0.021) and microvessel density (P=0.015). Survival analysis demonstrated that patients with high protein expression levels of MTA1 exhibited significantly shorter five-year disease-free and overall survival than those patients whose protein expression levels of MTA1 were low (24.5% vs. 48.7%, P=0.001, and 34.7% vs. 59.2%, P=0.005, respectively). In addition, Cox regression multivariate analysis demonstrated that high protein expression levels of MTA1 significantly correlated with unfavorable five-year disease-free survival (P=0.024). These findings indicate that MTA1 protein expression may possess clinical potential as an indicator of progressive phenotype. Therefore, MTA1 is a promising prognostic predictor to identify subgroups of patients with high risk of relapse, and a potentially novel therapeutic target for antiangiogenesis in patients with lung invasive adenocarcinoma.
Collapse
Affiliation(s)
- Shuhai Li
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Weiming Yue
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Lin Li
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Cun Gao
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Libo Si
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Wensi Hu
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Lei Qi
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Ming Lu
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Chuanle Cheng
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Jingjing Cui
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Guanqing Chen
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| |
Collapse
|
38
|
Isaka T, Yokose T, Ito H, Nagata M, Furumoto H, Nishii T, Katayama K, Yamada K, Nakayama H, Masuda M. Correlations Between the EGFR Mutation Status and Clinicopathological Features of Clinical Stage I Lung Adenocarcinoma. Medicine (Baltimore) 2015; 94:e1784. [PMID: 26496308 PMCID: PMC4620834 DOI: 10.1097/md.0000000000001784] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Advanced lung cancers with epidermal growth factor receptor (EGFR) exon 19 deletions (Ex19s) and EGFR exon 21 L858R point mutations (Ex21s) exhibit different clinical behavior. However, these differences are unclear in resectable primary lung tumors.The clinicopathological features of 88 (20.9%) Ex19, 124 (29.4%) Ex21, and 198 (46.9%) EGFR wild-type (Wt) clinical stage I primary adenocarcinomas resected between January 1, 2012 and October 31, 2014 were compared by using Chi-square tests, residual error analysis, analysis of variance, and Tukey tests.Ex21 lesions occurred more frequently in women and never-smokers and had a higher tumor disappearance rate (TDR: 59.6% vs 43.9%; P < 0.001) and lower maximum standardized uptake value (maxSUV: 2.0 vs 3.5; P < 0.01) than Wt lesions; Ex19 lesions had intermediate values (52.8% and 2.6). There was a low frequency of vascular invasion in Ex21 lesions (12.1%; P < 0.05) and a high frequency in Wt lesions (22.7%; P < 0.05). Most Ex19 lesions were intermediate-grade adenocarcinoma (lepidic, acinar, and papillary predominant: 73.9%; P < 0.05). Wt and Ex21 lesions were predominately high-grade (micropapillary or solid predominant, mucinous variant) and low-grade (adenocarcinoma in situ and minimally invasive adenocarcinoma) adenocarcinoma, respectively. Wt lesions had smaller lepidic components (42.1% vs 56.3%; P < 0.001) and larger papillary and solid components (papillary: 15.5% vs 9.0%; P < 0.05; solid: 13.2% vs 3.2%; P < 0.001) than Ex21 lesions. Most Ex19 lesions had intermediate component rates.Most Ex21 lesions were low-grade adenocarcinoma with lepidic growth patterns. Wt high-grade adenocarcinomas included solid and papillary components with vascular invasion. Ex19 lesions were intermediate grade between Ex21 and Wt.
Collapse
Affiliation(s)
- Tetsuya Isaka
- From the Department of Thoracic Surgery (TI, HI, MN, HF, TN, HN); Department of Pathology (TY); Kanagawa Cancer Center Research Institute Cancer Prevention and Control Division (KK); Department of Thoracic Oncology, Kanagawa Cancer Center (KY); and Department of Surgery, Yokohama City University, Yokohama, Kanagawa, Japan (TI, MM)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Marino FZ, Liguori G, Aquino G, La Mantia E, Bosari S, Ferrero S, Rosso L, Gaudioso G, De Rosa N, Scrima M, Martucci N, La Rocca A, Normanno N, Morabito A, Rocco G, Botti G, Franco R. Intratumor Heterogeneity of ALK-Rearrangements and Homogeneity of EGFR-Mutations in Mixed Lung Adenocarcinoma. PLoS One 2015; 10:e0139264. [PMID: 26422230 PMCID: PMC4589235 DOI: 10.1371/journal.pone.0139264] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/10/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Non Small Cell Lung Cancer is a highly heterogeneous tumor. Histologic intratumor heterogeneity could be 'major', characterized by a single tumor showing two different histologic types, and 'minor', due to at least 2 different growth patterns in the same tumor. Therefore, a morphological heterogeneity could reflect an intratumor molecular heterogeneity. To date, few data are reported in literature about molecular features of the mixed adenocarcinoma. The aim of our study was to assess EGFR-mutations and ALK-rearrangements in different intratumor subtypes and/or growth patterns in a series of mixed adenocarcinomas and adenosquamous carcinomas. METHODS 590 Non Small Cell Lung Carcinomas tumor samples were revised in order to select mixed adenocarcinomas with available tumor components. Finally, only 105 mixed adenocarcinomas and 17 adenosquamous carcinomas were included in the study for further analyses. Two TMAs were built selecting the different intratumor histotypes. ALK-rearrangements were detected through FISH and IHC, and EGFR-mutations were detected through IHC and confirmed by RT-PCR. RESULTS 10/122 cases were ALK-rearranged and 7 from those 10 showing an intratumor heterogeneity of the rearrangements. 12/122 cases were EGFR-mutated, uniformly expressing the EGFR-mutated protein in all histologic components. CONCLUSION Our data suggests that EGFR-mutations is generally homogeneously expressed. On the contrary, ALK-rearrangement showed an intratumor heterogeneity in both mixed adenocarcinomas and adenosquamous carcinomas. The intratumor heterogeneity of ALK-rearrangements could lead to a possible impact on the therapeutic responses and the disease outcomes.
Collapse
Affiliation(s)
- Federica Zito Marino
- Pathology Unit, Istituto Nazionale Tumori “Fondazione G. Pascale”-IRCCS, Naples, Italy
| | - Giuseppina Liguori
- Pathology Unit, Istituto Nazionale Tumori “Fondazione G. Pascale”-IRCCS, Naples, Italy
| | - Gabriella Aquino
- Pathology Unit, Istituto Nazionale Tumori “Fondazione G. Pascale”-IRCCS, Naples, Italy
| | - Elvira La Mantia
- Pathology Unit, Istituto Nazionale Tumori “Fondazione G. Pascale”-IRCCS, Naples, Italy
| | - Silvano Bosari
- Department of Pathophysiology and Organ Transplantation, University of Milan Medical School, Milan, Italy; Division of Pathology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico Milan, Italy
| | - Stefano Ferrero
- Department of Biomedical, Surgical and Dental Sciences, University of Milan Medical School, Milan, Italy; Division of Pathology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico Milan, Italy
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico Milan, Italy
| | - Gabriella Gaudioso
- Department of Pathophysiology and Organ Transplantation, University of Milan Medical School, Milan, Italy; Division of Pathology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico Milan, Italy
| | - Nicla De Rosa
- Department of Oncology and Anatomic Pathology, Hospital of National Relevance (AORN) Vincenzo Monaldi, Naples, Italy
| | - Marianna Scrima
- Biogem scarl, Institute for Genetic Research “Gaetano Salvatore”, Ariano Irpino (Avellino), Italy
| | - Nicola Martucci
- Division of Thoracic Surgery, Department of Thoracic Surgical and Medical Oncology, Istituto Nazionale Tumori “Fondazione G. Pascale”-IRCCS, Naples, Italy
| | - Antonello La Rocca
- Division of Thoracic Surgery, Department of Thoracic Surgical and Medical Oncology, Istituto Nazionale Tumori “Fondazione G. Pascale”-IRCCS, Naples, Italy
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori “Fondazione G. Pascale”-IRCCS, Naples, Italy
| | - Alessandro Morabito
- Medical Oncology Unit, Department of Thoracic Surgical and Medical Oncology, Istituto Nazionale Tumori “Fondazione G. Pascale”-IRCCS, Naples, Italy
| | - Gaetano Rocco
- Division of Thoracic Surgery, Department of Thoracic Surgical and Medical Oncology, Istituto Nazionale Tumori “Fondazione G. Pascale”-IRCCS, Naples, Italy
| | - Gerardo Botti
- Pathology Unit, Istituto Nazionale Tumori “Fondazione G. Pascale”-IRCCS, Naples, Italy
| | - Renato Franco
- Pathology Unit, Istituto Nazionale Tumori “Fondazione G. Pascale”-IRCCS, Naples, Italy
- * E-mail:
| |
Collapse
|
40
|
Lin C, Chen X, Li M, Liu J, Qi X, Yang W, Zhang H, Cai Z, Dai Y, Ouyang X. Programmed Death-Ligand 1 Expression Predicts Tyrosine Kinase Inhibitor Response and Better Prognosis in a Cohort of Patients With Epidermal Growth Factor Receptor Mutation-Positive Lung Adenocarcinoma. Clin Lung Cancer 2015; 16:e25-35. [PMID: 25801750 DOI: 10.1016/j.cllc.2015.02.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Cheng Lin
- Department of Oncology, Fuzhou General Hospital of Nanjing Military Command, Fuzong Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiong Chen
- Department of Oncology, Fuzhou General Hospital of Nanjing Military Command, Fuzong Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Meifang Li
- Department of Oncology, Fujian Provincial Cancer Hospital, Jinan District, Fuzhou, Fujian, China
| | - Jingnan Liu
- Department of Oncology, Fuzhou General Hospital of Nanjing Military Command, Fuzong Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xingfeng Qi
- Department of Pathology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou, Fujian, China
| | - Wenting Yang
- Department of Pathology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou, Fujian, China
| | - Hairong Zhang
- Department of Epidemiology and Health Statistics, Fujian Medical University School of Public Health, Fuzhou, Fujian, China
| | - Zhongfu Cai
- Department of Oncology, 180th Hospital of People's Liberation Army, Quanzhou, Fujian, China
| | - Yun Dai
- Division of Hematology and Oncology, Department of Medicine, Virginia Commonwealth University, Massey Cancer Center, Richmond, VA
| | - Xuenong Ouyang
- Department of Oncology, Fuzhou General Hospital of Nanjing Military Command, Fuzong Clinical College of Fujian Medical University, Fuzhou, Fujian, China.
| |
Collapse
|
41
|
Suda K, Mitsudomi T. Role of EGFR mutations in lung cancers: prognosis and tumor chemosensitivity. Arch Toxicol 2015; 89:1227-40. [DOI: 10.1007/s00204-015-1524-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 04/27/2015] [Indexed: 01/08/2023]
|
42
|
Lampaki S, Lazaridis G, Zarogoulidis K, Kioumis I, Papaiwannou A, Tsirgogianni K, Karavergou A, Tsiouda T, Karavasilis V, Yarmus L, Darwiche K, Freitag L, Sakkas A, Kantzeli A, Baka S, Hohenforst-Schmidt W, Zarogoulidis P. Defining the role of tyrosine kinase inhibitors in early stage non-small cell lung cancer. J Cancer 2015; 6:568-74. [PMID: 26000049 PMCID: PMC4439943 DOI: 10.7150/jca.11893] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 04/14/2015] [Indexed: 01/17/2023] Open
Abstract
Historical, the non-small cell lung cancer (NSCLC) was as a united disease entity and the chemotherapy to the metastatic cancer had limited results. Recent studies for the metastatic non-small cell lung cancer led to the ascertainment that the NSCLC does not constitute exclusively a disease entity, but different neoplasms guided from different molecular paths, different biological behavior and at extension requires different confrontation. Thus the new direction for the therapeutic approach of NSCLC is henceforth the most individualized approach based on the activated molecular paths of tumor. Distinct subtypes of NSCLC are driven by a specific genetic alteration, like EGFR, ALK, ROS1 or BRAF mutations, and these genetic alterations are sensitized to the inhibition of specific oncogenic pathways. The benefit from the use of tyrosine kinase inhibitors in patients with EGFR mutations it was confirmed by six randomized studies of phase III that investigated the role of gefitinib, erlotinib and afatinib. In these studies the response rates vary in the impressive percentages from 55% to 86% and were connected with a remarkable median progression free survival of approximately 8 to 13 months, and with better quality of life compared to that of chemotherapy. In early stages NSCLC is needed the individualization of systemic treatment in order to reduce toxicity that is observed in the classic chemotherapy and to impact outcome. The role of EGFR TKI's has been evaluated in the adjuvant chemotherapy in early stage resected NSCLC. The data from these studies suggest that adjuvant TKI therapy might not increase the overall survival, but delay the recurrences. Prospective trials restricted to EGFR or ALK driven NSCLC subsets potentially offering the opportunity for a definitive answer in early disease adjuvant setting (ALCHEMIST) or as induction treatment before stage III chemo-radiotherapy (RTOG 1210/Alliance 31101), are ongoing. Ongoing prospective trials may offer the opportunity for a definitive answer of the role of tyrosine kinase inhibitors in induction treatment before chemo-radiotherapy or in early disease adjuvant therapy.
Collapse
Affiliation(s)
- Sofia Lampaki
- 1. Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Lazaridis
- 2. Department of Medical Oncology, "G. Papageorgiou" University Hospital, Thessaloniki, Greece, Nea Eukarpia
| | - Konstantinos Zarogoulidis
- 1. Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- 1. Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonis Papaiwannou
- 1. Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Tsirgogianni
- 1. Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Karavergou
- 1. Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodora Tsiouda
- 3. Pulmonary Department, "Theageneio Anticancer" Hospital, Thessaloniki, Greece, Alexander Simeonidi 2
| | - Vasilis Karavasilis
- 3. Pulmonary Department, "Theageneio Anticancer" Hospital, Thessaloniki, Greece, Alexander Simeonidi 2
| | - Lonny Yarmus
- 4. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, U.S.A
| | - Kaid Darwiche
- 5. Department of Interventional Pulmonology, Ruhrlandklinik, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Lutz Freitag
- 5. Department of Interventional Pulmonology, Ruhrlandklinik, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Antonios Sakkas
- 6. Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany
| | - Angeliki Kantzeli
- 7. Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany
| | - Sofia Baka
- 8. Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece
| | | | - Paul Zarogoulidis
- 1. Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
43
|
de Melo AC, Karen de Sá V, Sternberg C, Olivieri ER, Werneck da Cunha I, Fabro AT, Carraro DM, de Barros e Silva MJ, Pimenta Inada HK, de Mello ES, Soares FA, Takagaki T, Ferreira CG, Capelozzi VL. Mutational Profile and New IASLC/ATS/ERS Classification Provide Additional Prognostic Information about Lung Adenocarcinoma: A Study of 125 Patients from Brazil. Oncology 2015; 89:175-86. [DOI: 10.1159/000376552] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/27/2015] [Indexed: 11/19/2022]
|
44
|
Thunnissen E. Pulmonary adenocarcinoma histology. Transl Lung Cancer Res 2015; 1:276-9. [PMID: 25806193 DOI: 10.3978/j.issn.2218-6751.2012.10.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 10/30/2012] [Indexed: 01/05/2023]
Affiliation(s)
- Erik Thunnissen
- VU University Medical Center, Dept. Pathology, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| |
Collapse
|
45
|
Somatic STK11 and Concomitant STK11/KRAS Mutational Frequency in Stage IV Lung Adenocarcinoma Adrenal Metastases. J Thorac Oncol 2015; 10:531-4. [DOI: 10.1097/jto.0000000000000391] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
46
|
Mansuet-Lupo A, Bobbio A, Blons H, Becht E, Ouakrim H, Didelot A, Charpentier MC, Bain S, Marmey B, Bonjour P, Biton J, Cremer I, Dieu-Nosjean MC, Sautès-Fridman C, Régnard JF, Laurent-Puig P, Alifano M, Damotte D. The new histologic classification of lung primary adenocarcinoma subtypes is a reliable prognostic marker and identifies tumors with different mutation status: the experience of a French cohort. Chest 2015; 146:633-643. [PMID: 24676429 DOI: 10.1378/chest.13-2499] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Histologic classification of lung adenocarcinoma subtype has a prognostic value in most studies. However, lung adenocarcinoma characteristics differ across countries. Here, we aimed at validating the prognostic value of this classification in a large French series of lung adenocarcinoma. METHODS We reviewed 407 consecutive lung adenocarcinomas operated on between 2001 and 2005 and reclassified them according to the International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification and subsequently graded them into low, intermediate, and high grade. We analyzed the relevance of this classification according to clinical, pathologic, and molecular analysis. RESULTS Patients (median age, 61 years; 288 men) underwent lobectomy (n = 378) or pneumonectomy (n = 29). Patients' overall survival at 5 and 10 years was 53.2% and 32.6%, respectively. Union for International Cancer Control stage distribution was 189 stage I, 104 stage II, 107 stage III, and seven stage IV. Low-grade tumor was found in one patient, intermediate grade in 275 patients, and high grade in 131 patients. KRAS and EGFR mutations were detected in 34% and 9.6%, respectively. Histologic grade was significantly correlated with extent of resection (P = .01), thyroid transcriptional factor-1 expression (P = .00000001), vascular emboli (P = .03), and EGFR mutations (P = .01). Mucinous adenocarcinomas were associated with KRAS mutations (P = .003). At univariate analysis, age, extent of resection, histologic grade, pleural invasion, vascular emboli, pathologic T and N, and stage were predictive of survival. At multivariate analysis, age (P = .0001), histologic grade (P = .03), and stage (P = .000003) were independent prognostic factors. CONCLUSIONS IASLC/ATS/ERS classification of lung adenocarcinomas predicts survival in French population. Histologic grade correlates with clinical, pathologic and molecular parameters suggesting different oncogenic pathways.
Collapse
Affiliation(s)
- Audrey Mansuet-Lupo
- INSERM, U1138, Team Cancer, Immune Control, and Escape, Centre de Recherche des Cordeliers, Paris, France; Université Pierre et Marie Curie-Paris 6, Paris, France; Université Paris Descartes-Paris 5, Paris, France; Université Denis Diderot-Paris 7, Paris, France; Service de Pathologie, Paris, France
| | - Antonio Bobbio
- Hôpitaux Universitaire Paris Centre, AP-HP, Service de Chirurgie Thoracique, Paris, France
| | - Hélène Blons
- Université Pierre et Marie Curie-Paris 6, Paris, France; Université Paris Descartes-Paris 5, Paris, France; Hôpitaux Universitaire Paris Centre, AP-HP, Service de Chirurgie Thoracique, Paris, France; Hôpitaux Universitaire Paris Centre, AP-HP, Service de Biochimie, Paris, France; Hôpital Européen Georges Pompidou, AP-HP; and UMR-S775, Paris, France; INSERM, Faculté de médecine des Saints Pères, Paris, France
| | - Etienne Becht
- INSERM, U1138, Team Cancer, Immune Control, and Escape, Centre de Recherche des Cordeliers, Paris, France; Université Pierre et Marie Curie-Paris 6, Paris, France; Université Paris Descartes-Paris 5, Paris, France; Université Denis Diderot-Paris 7, Paris, France
| | - Hanane Ouakrim
- INSERM, U1138, Team Cancer, Immune Control, and Escape, Centre de Recherche des Cordeliers, Paris, France
| | - Audrey Didelot
- Hôpital Européen Georges Pompidou, AP-HP; and UMR-S775, Paris, France; INSERM, Faculté de médecine des Saints Pères, Paris, France
| | | | | | - Béatrice Marmey
- INSERM, U1138, Team Cancer, Immune Control, and Escape, Centre de Recherche des Cordeliers, Paris, France; Université Pierre et Marie Curie-Paris 6, Paris, France; Université Paris Descartes-Paris 5, Paris, France
| | - Patricia Bonjour
- INSERM, U1138, Team Cancer, Immune Control, and Escape, Centre de Recherche des Cordeliers, Paris, France; Université Pierre et Marie Curie-Paris 6, Paris, France; Université Paris Descartes-Paris 5, Paris, France
| | - Jérôme Biton
- INSERM, U1138, Team Cancer, Immune Control, and Escape, Centre de Recherche des Cordeliers, Paris, France; Université Pierre et Marie Curie-Paris 6, Paris, France; Université Paris Descartes-Paris 5, Paris, France
| | - Isabelle Cremer
- INSERM, U1138, Team Cancer, Immune Control, and Escape, Centre de Recherche des Cordeliers, Paris, France; Université Pierre et Marie Curie-Paris 6, Paris, France; Université Paris Descartes-Paris 5, Paris, France
| | - Marie-Caroline Dieu-Nosjean
- INSERM, U1138, Team Cancer, Immune Control, and Escape, Centre de Recherche des Cordeliers, Paris, France; Université Pierre et Marie Curie-Paris 6, Paris, France; Université Paris Descartes-Paris 5, Paris, France
| | - Catherine Sautès-Fridman
- INSERM, U1138, Team Cancer, Immune Control, and Escape, Centre de Recherche des Cordeliers, Paris, France; Université Pierre et Marie Curie-Paris 6, Paris, France; Université Paris Descartes-Paris 5, Paris, France
| | - Jean-François Régnard
- Université Pierre et Marie Curie-Paris 6, Paris, France; Université Paris Descartes-Paris 5, Paris, France; Hôpitaux Universitaire Paris Centre, AP-HP, Service de Chirurgie Thoracique, Paris, France
| | - Pierre Laurent-Puig
- Université Pierre et Marie Curie-Paris 6, Paris, France; Université Paris Descartes-Paris 5, Paris, France; Hôpitaux Universitaire Paris Centre, AP-HP, Service de Chirurgie Thoracique, Paris, France; Hôpitaux Universitaire Paris Centre, AP-HP, Service de Biochimie, Paris, France; Hôpital Européen Georges Pompidou, AP-HP; and UMR-S775, Paris, France; INSERM, Faculté de médecine des Saints Pères, Paris, France
| | - Marco Alifano
- Université Pierre et Marie Curie-Paris 6, Paris, France; Université Paris Descartes-Paris 5, Paris, France; Hôpitaux Universitaire Paris Centre, AP-HP, Service de Chirurgie Thoracique, Paris, France
| | - Diane Damotte
- INSERM, U1138, Team Cancer, Immune Control, and Escape, Centre de Recherche des Cordeliers, Paris, France; Université Pierre et Marie Curie-Paris 6, Paris, France; Université Paris Descartes-Paris 5, Paris, France; Université Denis Diderot-Paris 7, Paris, France; Service de Pathologie, Paris, France.
| |
Collapse
|
47
|
Early lung cancer with lepidic pattern: adenocarcinoma in situ, minimally invasive adenocarcinoma, and lepidic predominant adenocarcinoma. Curr Opin Pulm Med 2015; 20:309-16. [PMID: 24811831 DOI: 10.1097/mcp.0000000000000065] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This review gives a comprehensive overview on recent developments in the classification of neoplastic lung lesions with lepidic growth patterns, comprising the adenocarcinoma (ADC) precursor lesions atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), and minimally invasive adenocarcinoma (MIA) as well as lepidic predominant adenocarcinoma (LPA). RECENT FINDINGS The concept of a continuum between the precursor lesions AAH and AIS to MIA and frankly invasive ADC is backed by a wealth of recent data showing a gradual decrease in overall survival from 100% for AAH, AIS, and MIA to moderately lower rates for LPA. Further, it has been shown that the morphologic categorization of these tumors can be done with reasonable reliability and that nonmucinous lepidic tumors show distinct molecular alterations with high rates of epidermal growth factor receptor mutations. Importantly, lepidic tumor growth is also mirrored by specific characteristics in computed tomography images, arguing for a combined assessment of histomorphology and imaging data for an optimized classification of lepidic neoplasms. SUMMARY The validity and clinical importance of the novel concept of ADC precursor lesions and LPA have been confirmed by clinical, radiological, morphological, and molecular data. Thereby, it has evolved into a valuable tool to aid in clinical decision-making.
Collapse
|
48
|
Chao L, Yi-Sheng H, Yu C, Li-Xu Y, Xin-lan L, Dong-Lan L, Jie C, Yi-Lon W, Hui LY. Relevance of EGFR mutation with micropapillary pattern according to the novel IASLC/ATS/ERS lung adenocarcinoma classification and correlation with prognosis in Chinese patients. Lung Cancer 2014; 86:164-9. [DOI: 10.1016/j.lungcan.2014.08.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 08/18/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
|
49
|
Tang ER, Schreiner AM, Pua BB. Advances in lung adenocarcinoma classification: a summary of the new international multidisciplinary classification system (IASLC/ATS/ERS). J Thorac Dis 2014; 6:S489-501. [PMID: 25349701 DOI: 10.3978/j.issn.2072-1439.2014.09.12] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/26/2014] [Indexed: 11/14/2022]
Abstract
Due to advances in the understanding of lung adenocarcinoma since the advent of its 2004 World Health System classification, an international multidisciplinary panel [sponsored by the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS)] has recently updated the classification system for lung adenocarcinoma, the most common histologic type of lung cancer. Here, we summarize and highlight the new criteria and terminology, certain aspects of its clinical relevance and its potential treatment impact, and future avenues of research related to the new system.
Collapse
Affiliation(s)
- Elizabeth R Tang
- 1 Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA ; 2 Department of Pathology, 3 Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Andrew M Schreiner
- 1 Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA ; 2 Department of Pathology, 3 Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Bradley B Pua
- 1 Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA ; 2 Department of Pathology, 3 Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| |
Collapse
|
50
|
Lee MC, Kadota K, Buitrago D, Jones DR, Adusumilli PS. Implementing the new IASLC/ATS/ERS classification of lung adenocarcinomas: results from international and Chinese cohorts. J Thorac Dis 2014; 6:S568-80. [PMID: 25349708 DOI: 10.3978/j.issn.2072-1439.2014.09.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/26/2014] [Indexed: 12/13/2022]
Abstract
A new histologic classification of lung adenocarcinoma was proposed by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) in 2011 to provide uniform terminology and diagnostic criteria for multidisciplinary strategic management. This classification proposed a comprehensive histologic subtyping (lepidic, acinar, papillary, micropapillary, and solid pattern) and a semi-quantitative assessment of histologic patterns (in 5% increments) in an effort to choose a single, predominant pattern in invasive adenocarcinomas. The prognostic value of this classification has been validated in large, independent cohorts from multiple countries. In patients who underwent curative-intent surgery, those with either an adenocarcinoma in situ (AIS) or a minimal invasive adenocarcinoma have nearly 100% disease-free survival and are designated "low grade tumors". For invasive adenocarcinomas, the acinar and papillary predominant histologic subtypes were usually designated as "intermediate grade" while the solid and micropapillary predominant histologic subtypes were designated "high grade" tumors; this was based on the statistic difference of overall survival. This classification, coupled with additional prognostic factors [nuclear grade, cribriform pattern, high Ki-67 labeling index, thyroid transcription factor-1 (TTF-1) immunohistochemistry, immune markers, and (18)F-fluorodeoxyglucose uptake on positron emission tomography (PET)] that we have published on, could further stratify patients into prognostic subgroups and may prove helpful for individual patient care. With regard to Chinese oncologists, the implementation of this new classification only requires hematoxylin and eosin (H&E) stained slides and basic pathologic training, both of which require no additional costs. More importantly, this new classification system could provide informative data for better selection and stratification of clinical trials and molecular studies.
Collapse
Affiliation(s)
- Ming-Ching Lee
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ; 3 Center for Cell Engineering, Sloan Kettering Institute, New York, NY 10065, USA
| | - Kyuichi Kadota
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ; 3 Center for Cell Engineering, Sloan Kettering Institute, New York, NY 10065, USA
| | - Daniel Buitrago
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ; 3 Center for Cell Engineering, Sloan Kettering Institute, New York, NY 10065, USA
| | - David R Jones
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ; 3 Center for Cell Engineering, Sloan Kettering Institute, New York, NY 10065, USA
| | - Prasad S Adusumilli
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ; 3 Center for Cell Engineering, Sloan Kettering Institute, New York, NY 10065, USA
| |
Collapse
|