Recurrence Risk and Its Impact on Current Treatment Strategies in Early and Locally Advanced NSCLC.

IF 1.6 4区 医学 Q4 ONCOLOGY
Charlotte Tegenbosch, Karolien Vekens
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引用次数: 0

Abstract

Background/aim: Recurrence rates in early and locally advanced non-small-cell lung cancer (NSCLC) remain high despite curative treatment. Recently, the survival benefit of immune checkpoint inhibitors (ICI) in the (neo)adjuvant setting in patients with stage II-III NSCLC has been demonstrated. This study aimed to identify predisposing factors for disease recurrence to select patients who would benefit from multimodality treatment.

Patients and methods: This retrospective observational study included patients with stage I-IIIA NSCLC discussed at the Thoracic Multidisciplinary Tumour Board of the University Hospital, Brussels, between 2017 and 2021.

Results: Of the 167 patients, 34% had a recurrence, with a median time to recurrence of 9.1 months [272 (interquartile range=175-621.5) days]. The highest recurrence rate (56.5%) was observed in cTNM stage IIIA. Of surgical patients who were not eligible for (neo)adjuvant ICI according to current European reimbursement criteria, 21.7% developed disease recurrence. Twelve out of 20 patients eligible for ICI had no recurrence at a median follow-up of 34.1 months and would have been overtreated if they had received ICI therapy. Treatment modality and TNM stage were significantly associated with recurrence and worse progression-free survival (p<0.05). Stereotactic body radiotherapy, higher TNM stage and the presence of serine/threonine kinase 11 (STK11) mutation were significantly associated with worse overall survival.

Conclusion: European reimbursement criteria for (neo)adjuvant ICI in surgical patients are based on TNM stage (T≥4 cm or N1/N2 disease). However, TNM stage alone does not give the full picture. In patients undergoing surgery, the presence of the STK11 mutation was significantly associated with worse overall survival. We suggest the integration of analysis of circulating tumour DNA into perioperative strategies to reduce over- and undertreatment.

早期和局部晚期非小细胞肺癌复发风险及其对当前治疗策略的影响
背景/目的:早期和局部晚期非小细胞肺癌(NSCLC)的复发率尽管得到了有效治疗,但仍然很高。最近,免疫检查点抑制剂(ICI)在II-III期非小细胞肺癌(NSCLC)患者的(新)辅助治疗中获得了生存益处。本研究旨在确定疾病复发的易感因素,以选择从多模式治疗中受益的患者。患者和方法:这项回顾性观察性研究包括2017年至2021年间在布鲁塞尔大学医院胸部多学科肿瘤委员会讨论的I-IIIA期非小细胞肺癌患者。结果:167例患者中,34%的患者复发,中位复发时间为9.1个月[272(四分位数间距=175-621.5)天]。复发率最高的是cTNM IIIA期(56.5%)。根据目前的欧洲报销标准,不符合(新)辅助ICI的手术患者中,21.7%出现了疾病复发。20例符合ICI治疗条件的患者中有12例在34.1个月的中位随访中没有复发,如果他们接受了ICI治疗,就会出现过度治疗。治疗方式和TNM分期与复发和更差的无进展生存期显著相关(结论:手术患者(新)辅助ICI的欧洲报销标准是基于TNM分期(T≥4 cm或N1/N2疾病)。然而,仅凭TNM阶段并不能给出全貌。在接受手术的患者中,STK11突变的存在与较差的总生存率显著相关。我们建议将循环肿瘤DNA分析整合到围手术期策略中,以减少治疗过度和治疗不足。
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
Anticancer research
Anticancer research 医学-肿瘤学
CiteScore
3.70
自引率
10.00%
发文量
566
审稿时长
2 months
期刊介绍: ANTICANCER RESEARCH is an independent international peer-reviewed journal devoted to the rapid publication of high quality original articles and reviews on all aspects of experimental and clinical oncology. Prompt evaluation of all submitted articles in confidence and rapid publication within 1-2 months of acceptance are guaranteed. ANTICANCER RESEARCH was established in 1981 and is published monthly (bimonthly until the end of 2008). Each annual volume contains twelve issues and index. Each issue may be divided into three parts (A: Reviews, B: Experimental studies, and C: Clinical and Epidemiological studies). Special issues, presenting the proceedings of meetings or groups of papers on topics of significant progress, will also be included in each volume. There is no limitation to the number of pages per issue.
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