Pulmonary adenocarcinoma of low malignant potential defines indolent NSCLC associated with overdiagnosis in the national lung screening trial.

IF 2.2 4区医学 Q3 ONCOLOGY

Cancer Biomarkers Pub Date : 2024-05-22 DOI:10.3233/CBM-230452

Eric J Burks, Travis B Sullivan, Kimberly M Rieger-Christ

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引用次数: 0

Abstract

Background: The national lung screening trial (NLST) demonstrated a reduction in lung cancer mortality with lowdose CT (LDCT) compared to chest x-ray (CXR) screening. Overdiagnosis was high (79%) among bronchoalveolar carcinoma (BAC) currently replaced by adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and adenocarcinoma of low malignant potential (LMP) exhibiting 100% disease specific survival (DSS).

Objective: Compare the outcomes and proportions of BAC, AIS, MIA, and LMP among NLST screendetected stage IA NSCLC with overdiagnosis rate.

Methods: Whole slide images were reviewed by a thoracic pathologist from 174 of 409 NLST screen-detected stage IA LUAD. Overdiagnosis rates were calculated from follow-up cancer incidence rates.

Results: Most BAC were reclassified as AIS/MIA/LMP (20/35 = 57%). The 7-year DSS was 100% for AIS/MIA/LMP and 94% for BAC. Excluding AIS/MIA/LMP, BAC behaved similarly to NSCLC (7-year DSS: 86% vs. 83%, p= 0.85) The overdiagnosis rate of LDCT stage IA NSCLC was 16.6% at 11.3-years, matching the proportion of AIS/MIA/LMP (16.2%) but not AIS/MIA (3.5%) or BAC (22.8%).

Conclusions: AIS/MIA/LMP proportionally matches the overdiagnosis rate among stage IA NSCLC in the NLST, exhibiting 100% 7-year DSS. Biomarkers designed to recognize AIS/MIA/LMP preoperatively, would be useful to prevent overtreatment of indolent screen-detected cancers.

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低恶性潜能肺腺癌定义了全国肺筛查试验中与过度诊断相关的轻度 NSCLC。

背景：全国肺筛查试验（NLST）表明，与胸部 X 光（CXR）筛查相比，低剂量 CT（LDCT）筛查可降低肺癌死亡率。支气管肺泡癌（BAC）的过度诊断率很高（79%），目前已被原位腺癌（AIS）、微小浸润性腺癌（MIA）和低恶性潜能腺癌（LMP）取代，疾病特异性生存率（DSS）达到 100%：比较NLST筛查出的具有过度诊断率的IA期NSCLC中BAC、AIS、MIA和LMP的结果和比例：胸部病理学家对 409 例 NLST 筛选出的 IA 期 LUAD 中的 174 例进行了全切片图像审查。根据随访癌症发病率计算过度诊断率：大多数 BAC 被重新分类为 AIS/MIA/LMP（20/35 = 57%）。AIS/MIA/LMP的7年DSS为100%，BAC为94%。排除AIS/MIA/LMP，BAC的表现与NSCLC相似（7年DSS：86% vs. 83%，p= 0.85）。LDCTⅠA期NSCLC在11.3年的过度诊断率为16.6%，与AIS/MIA/LMP的比例（16.2%）一致，但与AIS/MIA（3.5%）或BAC（22.8%）不一致：结论：AIS/MIA/LMP与NLST中IA期NSCLC的过度诊断率成正比，显示出100%的7年DSS。旨在术前识别AIS/MIA/LMP的生物标记物将有助于防止对筛查出的轻度癌症进行过度治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Biomarkers ONCOLOGY-

CiteScore

5.20

自引率

3.20%

发文量

195

审稿时长

3 months

期刊介绍： Concentrating on molecular biomarkers in cancer research, Cancer Biomarkers publishes original research findings (and reviews solicited by the editor) on the subject of the identification of markers associated with the disease processes whether or not they are an integral part of the pathological lesion. The disease markers may include, but are not limited to, genomic, epigenomic, proteomics, cellular and morphologic, and genetic factors predisposing to the disease or indicating the occurrence of the disease. Manuscripts on these factors or biomarkers, either in altered forms, abnormal concentrations or with abnormal tissue distribution leading to disease causation will be accepted.