Clinicopathological and molecular characterization of non–small cell lung cancer with pericardial effusions

IF 2.6 3区医学 Q3 ONCOLOGY

Cancer Cytopathology Pub Date : 2025-04-14 DOI:10.1002/cncy.70015

Weijie Ma MD, Nathalie J. Rodrigues Simoes MD, Peter P. Seery, Tianhong Li MD, PhD, Laura J. Tafe MD, Darcy A. Kerr MD, Xiaoying Liu MD

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Abstract

Background

Cytological evaluation is essential for assessing pericardial effusions (PEs) in non–small cell lung cancer (NSCLC). This study retrospectively examined the clinicopathological, molecular, and prognostic characteristics of patients with NSCLC with PE.

Methods

Clinical data from 80 patients with NSCLC with PE treated at an academic center over the course of 15 years were reviewed. PE specimens were categorized according to the International System for Reporting Serous Fluid Cytopathology (ISRSFC). The analysis included patient demographics, molecular alterations, cytopathology, histology, and survival outcomes.

Results

Of the 80 patients, 36 (45%) were female and 90% had stage IV disease. A smoking history was noted in 58 patients (72.5%), and 22 patients (27.5%) presented with tamponade. Lung adenocarcinoma predominated (87.5%). The ISRSFC categorized 25% of the specimens as negative for malignancy (NFM), 7.5% as atypia of undetermined significance (AUS), 3.75% as suspicious for malignancy (SFM), and 63.75% as malignant (MAL). Immunohistochemistry in 57 specimens identified thyroid transcription factor 1 (65%) as the most frequently positive marker. Molecular analysis revealed p53 mutations (59.1%) as the most prevalent, followed by KRAS (34.1%) and EGFR (15.9%). Kaplan–Meier analysis showed significantly better survival for NFM patients than non-NFM patients (MAL, SFM, and AUS; p = .0036). Bloody PEs and tamponade were associated with worse outcomes. The immunotherapy group achieved the most prolonged survival among stage IV patients (9.07 months; p = .017). Cox regression confirmed cytology-negative status as an independent prognostic factor.

Conclusions

Cytological evaluation and ISRSFC classification are crucial for NSCLC-associated PEs. A multidisciplinary approach integrating cytology, immunohistochemistry, and molecular profiling is essential for optimal management and prognosis.

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伴有心包积液的非小细胞肺癌的临床病理学和分子特征描述

背景：细胞学评估是非小细胞肺癌（NSCLC）的心包积液（PEs）是必要的。本研究回顾性分析了非小细胞肺癌合并PE患者的临床病理、分子和预后特征。方法回顾某学术中心15年来收治的80例非小细胞肺癌合并肺栓塞患者的临床资料。PE标本按照国际浆液细胞病理学报告系统（ISRSFC）分类。分析包括患者人口统计学、分子改变、细胞病理学、组织学和生存结果。结果80例患者中，36例（45%）为女性，90%为IV期。58例（72.5%）患者有吸烟史，22例（27.5%）患者有填塞。肺腺癌居多（87.5%）。ISRSFC将25%的标本分类为恶性阴性（NFM）， 7.5%为不确定意义的异型（AUS）， 3.75%为可疑恶性（SFM）， 63.75%为恶性（MAL）。57例标本的免疫组化鉴定甲状腺转录因子1（65%）为最常见的阳性标记物。分子分析显示p53突变最为常见（59.1%），其次是KRAS（34.1%）和EGFR（15.9%）。Kaplan-Meier分析显示，NFM患者的生存率显著高于非NFM患者(MAL、SFM和AUS；p = .0036)。血肿和填塞与较差的预后相关。免疫治疗组在IV期患者中获得了最长的生存期(9.07个月；p = .017)。Cox回归证实细胞学阴性状态是一个独立的预后因素。结论细胞学评估和ISRSFC分级对非小细胞肺癌相关pe至关重要。结合细胞学、免疫组织化学和分子谱的多学科方法对于优化管理和预后至关重要。

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 Cytopathology 医学-病理学

CiteScore

7.00

自引率

17.60%

发文量

130

审稿时长

1 months

期刊介绍： Cancer Cytopathology provides a unique forum for interaction and dissemination of original research and educational information relevant to the practice of cytopathology and its related oncologic disciplines. The journal strives to have a positive effect on cancer prevention, early detection, diagnosis, and cure by the publication of high-quality content. The mission of Cancer Cytopathology is to present and inform readers of new applications, technological advances, cutting-edge research, novel applications of molecular techniques, and relevant review articles related to cytopathology.