Prognostic Significance, Radiological, and Metabolic Characteristics of Metastatic Lymph Nodes in Resectable Non-Small Cell Lung Cancer Following Neoadjuvant Chemoimmunotherapy.

IF 2.3 3区医学 Q3 ONCOLOGY

Thoracic Cancer Pub Date : 2025-05-01 DOI:10.1111/1759-7714.70073

Tianxiao Han, Sida Cheng, Xun Wang, QingYi Qi, Jinchuan Chen, Wenxiang Wang, Jian Zhou, Yun Li, Kezhong Chen, Hao Li, Fan Yang

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引用次数: 0

Abstract

Background: Metastatic lymph nodes (mLNs) exhibit different responses to neoadjuvant immunotherapy compared to the primary tumor (PT) in non-small cell lung cancer (NSCLC). Evaluating mLNs' response is crucial for predicting treatment efficacy and prognosis; however, such assessments are currently insufficient.

Methods: We enrolled 101 NSCLC patients with mLNs who underwent neoadjuvant chemoimmunotherapy followed by surgery. Survival outcomes and radiological and metabolic changes were analyzed across different lymph node pathological response groups, and a least absolute shrinkage and selection operator (LASSO) logistic regression model was developed to predict mLNs' response. RNA sequencing was performed to characterize the immune microenvironment of lymph nodes with different pathological responses.

Results: Residual tumors in mLNs were significantly associated with worse recurrence-free survival (p = 0.003) and a trend toward worse overall survival (p = 0.087). Combining the pathological responses of mLNs and PTs improved prognostic stratification. Neither radiological size changes (AUC: 0.621) nor the SUVmax reduction rate (AUC: 0.645) were effective in distinguishing mLNs response. A model combining radiological and metabolic parameters demonstrated fair prediction efficacy (AUC: 0.85). In separate analyses of N1 and N2 nodes, radiological and metabolic changes of N1 mLNs partly reflected their pathologic response (AUC: 0.734; 0.816), unlike in N2 mLNs. RNA sequencing revealed that immune infiltration in responding lymph nodes differed from non-responding ones, with higher CD8+ T cells, NK T cells, B cells, and dendritic cells in the former.

Conclusion: The pathological response of mLNs provides additional prognostic information, but current tools are ineffective for detecting residual tumors. A model integrating radiological and metabolic parameters may offer better prediction.

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新辅助化疗免疫治疗后可切除非小细胞肺癌转移淋巴结的预后意义、放射学和代谢特征。

背景：在非小细胞肺癌（NSCLC）中，与原发肿瘤（PT）相比，转移性淋巴结（mLNs）对新辅助免疫治疗的反应不同。评价mLNs的疗效对预测治疗效果和预后至关重要；但是，这种评估目前是不够的。方法：我们招募了101例伴有mLNs的NSCLC患者，他们接受了新辅助化学免疫治疗，然后进行了手术。研究人员分析了不同淋巴结病理反应组的生存结果、放射学和代谢变化，并建立了最小绝对收缩和选择算子（LASSO） logistic回归模型来预测mLNs的反应。通过RNA测序来表征不同病理反应的淋巴结免疫微环境。结果：mLNs中残留肿瘤与较差的无复发生存（p = 0.003）和较差的总生存（p = 0.087）显著相关。结合mln和PTs的病理反应，改善了预后分层。放射学大小变化（AUC: 0.621）和SUVmax减少率（AUC: 0.645）都不能有效区分mLNs的反应。结合放射学和代谢参数的模型显示出良好的预测效果（AUC: 0.85）。在N1和N2淋巴结的单独分析中，N1 mLNs的放射学和代谢变化部分反映了其病理反应(AUC: 0.734；0.816)，不同于N2 mLNs。RNA测序显示，应答淋巴结的免疫浸润与非应答淋巴结不同，前者有更多的CD8+ T细胞、NK T细胞、B细胞和树突状细胞。结论：mLNs的病理反应提供了额外的预后信息，但目前的工具无法检测残余肿瘤。综合放射学和代谢参数的模型可能提供更好的预测。

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

Thoracic Cancer ONCOLOGY-RESPIRATORY SYSTEM

CiteScore

5.20

自引率

3.40%

发文量

439

审稿时长

2 months

期刊介绍： Thoracic Cancer aims to facilitate international collaboration and exchange of comprehensive and cutting-edge information on basic, translational, and applied clinical research in lung cancer, esophageal cancer, mediastinal cancer, breast cancer and other thoracic malignancies. Prevention, treatment and research relevant to Asia-Pacific is a focus area, but submissions from all regions are welcomed. The editors encourage contributions relevant to prevention, general thoracic surgery, medical oncology, radiology, radiation medicine, pathology, basic cancer research, as well as epidemiological and translational studies in thoracic cancer. Thoracic Cancer is the official publication of the Chinese Society of Lung Cancer, International Chinese Society of Thoracic Surgery and is endorsed by the Korean Association for the Study of Lung Cancer and the Hong Kong Cancer Therapy Society. The Journal publishes a range of article types including: Editorials, Invited Reviews, Mini Reviews, Original Articles, Clinical Guidelines, Technological Notes, Imaging in thoracic cancer, Meeting Reports, Case Reports, Letters to the Editor, Commentaries, and Brief Reports.