Lung Cancer最新文献

{"title":"Lung cancer in women: current evidence and future research priorities","authors":"Monireh Sadat Seyyedsalehi ,&nbsp;Massimiliano Cani ,&nbsp;Qian Wang ,&nbsp;Chitra Thakur ,&nbsp;Umberto Malapelle ,&nbsp;Chung Yin Kong ,&nbsp;Silvia Novello ,&nbsp;Paolo Boffetta","doi":"10.1016/j.lungcan.2025.108905","DOIUrl":"10.1016/j.lungcan.2025.108905","url":null,"abstract":"<div><div>Lung cancer (LC) remains the leading cause of cancer-related mortality among women worldwide. Compared to men, LC in women presents distinct epidemiologic, biological, and clinical characteristics. A large proportion of LC cases in women occur in never-smokers, underscoring the important roles of environmental exposures, genetic susceptibility, and hormonal influences in disease pathogenesis. LC in women also displays unique molecular profiles, with a higher prevalence of actionable alterations such as epidermal growth factor receptor (<em>EGFR</em>) mutations and anaplastic lymphoma kinase (<em>ALK</em>) rearrangements, which inform targeted therapy selection. Despite advances in chemotherapy, targeted agents, and immunotherapy, sex-based differences in treatment efficacy, toxicity, and survivorship persist and remain incompletely understood. Additional barriers, including limited access to LC screening and the underrepresentation of women in clinical trials, further constrain the application of evidence-based interventions for women. This review synthesizes latest evidence on epidemiology, risk factors, molecular features, screening, treatment outcomes, and survivorship challenges in women with LC with a deep focus on novel approaches to overcome current barriers and disparities to improve prevention, early detection, treatment, and long-term survivorship care.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"213 ","pages":"Article 108905"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"KRAS-mutant advanced NSCLC: efficacy and clinical outcomes from network meta-analysis and real-world evidence","authors":"Xiaoyu Gang ,&nbsp;Yige Sun ,&nbsp;Junli Hao ,&nbsp;Suya Zhao ,&nbsp;Yizheng Wang ,&nbsp;Xinrui Yang ,&nbsp;Heming Li ,&nbsp;Mingfang Zhao","doi":"10.1016/j.lungcan.2026.108930","DOIUrl":"10.1016/j.lungcan.2026.108930","url":null,"abstract":"<div><h3>Background</h3><div><em>KRAS</em> is a common driver gene in non-small cell lung cancer (NSCLC). Owing to the absence of universally effective targeted agents and marked heterogeneity, optimal treatment selection for <em>KRAS</em>-mutant NSCLC remains uncertain. This study combined network meta-analysis (NMA) with real-world evidence to inform precision treatment strategies.</div></div><div><h3>Methods</h3><div>Thirteen randomized controlled trials were included in a Bayesian NMA to compare efficacy outcomes across regimens in <em>KRAS</em>-mutant and <em>KRAS</em> G12C-mutant NSCLC. In parallel, real-world data from advanced <em>KRAS</em>-mutant NSCLC patients treated at our center were analyzed.</div></div><div><h3>Results</h3><div>Across <em>KRAS</em> and G12C NMAs, immunotherapy-based regimens generally outperformed chemotherapy-based regimens. PD-(L)1 inhibitors monotherapy ranked highest for overall survival (OS), while chemotherapy plus PD-(L)1 inhibitors and anti-angiogenic therapy (anti-VEGF) ranked highest for progression-free survival (PFS). Chemotherapy plus dual immune checkpoint blockade (PD-(L)1 and CTLA-4) yielded a greater improvement in OS than in PFS. In our real-world cohort, first-line PD-(L)1 monotherapy achieved the best outcomes (objective response rate: 88.9%; median PFS: 22.2 months), followed by chemotherapy plus PD-(L)1 ± anti-VEGF. On multivariable analysis, ECOG performance status 0–1, PD-L1 TPS ≥ 50%, TMB ≥ 10 mut/Mb, and chemotherapy plus PD-(L)1 ± anti-VEGF were independently associated with longer first-line PFS. In subsequent lines, G12C inhibitors significantly improved outcomes versus other therapies, whereas non-G12C disease derived limited benefit from available strategies.</div></div><div><h3>Conclusions</h3><div>Immunotherapy constitutes the cornerstone of first-line therapy for <em>KRAS</em>-mutant NSCLC. Within this framework, PD-(L)1 monotherapy may be appropriate for carefully selected patients with high PD-L1 expression, whereas chemoimmunotherapy can extend benefit to broader subgroups; escalation with anti-VEGF or anti-CTLA-4 agents appears clinically promising and merits biomarker-driven prospective evaluation. KRAS G12C inhibitors are effective in later lines, while treatment options for non-G12C disease remain limited.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"213 ","pages":"Article 108930"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of monarch robotic bronchoscopy with and without mobile cone-beam CT support","authors":"Jingjing Chen,&nbsp;Dakota McNierney,&nbsp;Joe G. Zein,&nbsp;Laszlo T. Vaszar,&nbsp;Karen L. Swanson,&nbsp;Natalya Azadeh,&nbsp;Kenneth K. Sakata","doi":"10.1016/j.lungcan.2026.108910","DOIUrl":"10.1016/j.lungcan.2026.108910","url":null,"abstract":"<div><h3>Background</h3><div>Robotic-assisted bronchoscopy (RAB) is limited by CT-to-body divergence. Cone-beam CT (CBCT) may enhance tool-to-lesion alignment and diagnostic yield (DY), but the benefit of integrating mobile CBCT (mCBCT) into the Monarch^TM RAB remains understudied. This is the first study to evaluate diagnostic performance between Monarch alone versus Monarch plus mCBCT for peripheral pulmonary lesion (PPL) biopsy, hypothesizing improved DY with the combined approach.</div></div><div><h3>Methods</h3><div>This single-center retrospective study examined adults undergoing RAB biopsy for PPLs (May 2019—March 2023), applying a strict DY definition. Clinical characteristics and outcomes were evaluated in Monarch and Monarch plus mCBCT groups.</div></div><div><h3>Results</h3><div>Of 331 cases, 179 used Monarch and 152 used Monarch plus mCBCT. There was no significant difference in baseline characteristics. DY was not different (70.9 % in Monarch vs 71.7 % in Monarch plus mCBCT, p = 0.976) nor were complication rates (7.3 % in Monarch vs. 3.9 % in Monarch plus mCBCT, p = 0.291). In the Monarch group, the procedure duration was longer (77 min in Monarch vs. 69 min in Monarch plus mCBCT, p = 0.002) and the radiation dose was lower (7.4 mGy in Monarch vs. 285.9 mGy in Monarch plus mCBCT, p &lt; 0.001). Adjusted analysis demonstrated that mCBCT was not associated with improved DY (OR [95 % CI]: 1.33[0.78–2.28]) or reduced risk for complications (OR [95 % CI]: 0.41 [0.13; 1.14]). DY increased with larger nodule size but not with lesion location.</div></div><div><h3>Conclusions</h3><div>Evaluating outcomes across two sequential practice eras, the addition of mCBCT to Monarch RAB did not significantly improve DY or reduce complications but reduced procedure duration at the cost of increased radiation exposure.</div></div><div><h3>Summary</h3><div>- Evaluated diagnostic performance of Monarch™ vs. Monarch™ + mobile Cone-beam CT (mCBCT).</div><div>- Diagnostic yield and complication rates were similar.</div><div>- The mCBCT group had shorter procedure times and about 40-fold higher radiation doses.</div></div><div><h3>Conference presentation</h3><div>The study findings have been presented in American Association for Bronchology and Interventional Pulmonology Annual Conference in 2024.</div><div>The institutional review board approved all protocols (IRB 23–005284).</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"213 ","pages":"Article 108910"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146009919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nintedanib as switch maintenance treatment in malignant pleural mesothelioma (NEMO): A double-blind randomized phase II trial (EORTC-08112-LCG)","authors":"Omar Abdel-Rahman ,&nbsp;Paul Taylor ,&nbsp;Mary O’Brien ,&nbsp;Jo Raskin ,&nbsp;Claudio Dazzi ,&nbsp;Veerle Surmont ,&nbsp;Sabrina Zonato ,&nbsp;Robin Young ,&nbsp;Anne-Claire Toffart ,&nbsp;Petra Jankowska ,&nbsp;Adam Hassani ,&nbsp;Sandrine Marreaud ,&nbsp;Luc Boone ,&nbsp;Sanjay Popat","doi":"10.1016/j.lungcan.2026.108906","DOIUrl":"10.1016/j.lungcan.2026.108906","url":null,"abstract":"<div><h3>Introduction</h3><div>Pleural mesothelioma (PM) is a lethal malignancy in which angiogenesis and progressive fibrosis drives disease. We evaluated angiogenesis inhibition using nintedanib monotherapy as switch maintenance in patients with PM that completed 4–6 cycles of prior platinum-pemetrexed chemotherapy. The trial was performed in parallel to the LUME-Meso trial in an era prior to routine immune checkpoint inhibitor use, when platinum-pemetrexed was standard of care.</div></div><div><h3>Methods</h3><div>This is a triple-blind, placebo-controlled, multicentric, randomized, phase II study. Patients with inoperable PM (all histologies) that completed 4–6 cycles of platinum-pemetrexed chemotherapy were randomized to nintedanib or placebo. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS) and safety.</div></div><div><h3>Results</h3><div>The trial was prematurely closed due to poor accrual after LUME-meso reported. 37 patients were randomized (18 to nintedanib, 19 to placebo). All analyses performed were descriptive. The median PFS was 3.4 months (95% CI: 2.83–5.82) and 4.6 months (95% CI: 3.65–13.17) for nintedanib and placebo arms, respectively (HR = 2.25, 95% CI: 1.07–4.73) with corresponding median OS of 13.1 months (95% CI: 10.22–26.02) and 38.9 months (95% CI: 18.66-NE) for nintedanib and placebo arms, respectively (HR = 2.38, 95% CI: 1.05–5.43). Two patients (11.1%) in the nintedanib arm experienced ≥ grade 3 treatment-related adverse events. Post progression treatment was balanced between arms but more patients in the placebo arm received immunotherapy (87% vs 54%).</div></div><div><h3>Conclusions</h3><div>Descriptive analyses suggest switch maintenance nintedanib does not improve PFS nor OS compared to placebo. Efficacy of the placebo arm may be related to imbalanced immunotherapy usage.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"213 ","pages":"Article 108906"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported outcomes and time to symptomatic progression from PAPILLON: amivantamab plus chemotherapy vs chemotherapy as first-line treatment of EGFR exon 20 insertion-mutated advanced NSCLC","authors":"Luis Paz-Ares ,&nbsp;Remi Veillon ,&nbsp;Margarita Majem ,&nbsp;Caicun Zhou ,&nbsp;Ke-Jing Tang ,&nbsp;Sang-We Kim ,&nbsp;Gary Richardson ,&nbsp;Nicolas Girard ,&nbsp;Rachel E. Sanborn ,&nbsp;Aaron S. Mansfield ,&nbsp;Keunchil Park ,&nbsp;Julia Schuchard ,&nbsp;Joris Diels ,&nbsp;Jan Sermon ,&nbsp;Archan Bhattacharya ,&nbsp;Patricia Lorenzini ,&nbsp;Honeylet Wortman-Vayn ,&nbsp;Roland E. Knoblauch ,&nbsp;Trishala Agrawal ,&nbsp;Mahadi Baig ,&nbsp;Joshua K. Sabari","doi":"10.1016/j.lungcan.2025.108788","DOIUrl":"10.1016/j.lungcan.2025.108788","url":null,"abstract":"<div><h3>Background</h3><div>Epidermal growth factor receptor (<em>EGFR</em>) exon 20 insertions (Ex20ins) are the third most common type of <em>EGFR</em> mutation, occurring in up to 12% of <em>EGFR</em>-mutated non-small cell lung cancers (NSCLC). Ex20ins-mutated NSCLC can be resistant to most approved tyrosine kinase inhibitors (TKIs). The Phase III PAPILLON trial (NCT04538664) demonstrated that amivantamab plus chemotherapy significantly improves progression-free survival (PFS) compared to chemotherapy alone, leading to its approval as a first-line treatment for patients with Ex20ins NSCLC. PAPILLON further evaluated patient-reported outcomes (PROs) and time to symptomatic progression (TTSP).</div></div><div><h3>Methods</h3><div>The open-label, multicenter trial randomized 308 treatment-naïve patients with advanced or metastatic NSCLC harboring Ex20ins to receive either amivantamab plus carboplatin-pemetrexed (n = 154) or chemotherapy alone (n = 154). TTSP was defined as the time to onset or worsening of lung cancer-related symptoms necessitating treatment change or clinical intervention, or death. PROs were assessed using the PROMIS PF8c and EORTC QLQ-C30.</div></div><div><h3>Results</h3><div>At 12 months, 77 % of patients in the amivantamab-chemotherapy arm remained free of symptomatic progression versus 60 % in the chemotherapy arm (HR, 0.67; 95 % CI, 0.46–0.98; p = 0.04). Physical functioning and global health status PROs were maintained in both arms, with a higher proportion of patients treated in the amivantamab-chemotherapy arm reporting stable or improved quality of life at 6 and 12 months.</div></div><div><h3>Conclusions</h3><div>Amivantamab plus chemotherapy significantly delays symptomatic progression without compromising health-related quality of life, reinforcing its role as a first-line treatment for Ex20ins-mutated NSCLC.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"213 ","pages":"Article 108788"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of preoperative ctDNA and pathological venous invasion for recurrence in EGFR-mutated non-small cell lung cancer","authors":"Yuya Murase ,&nbsp;Hayato Koba ,&nbsp;Hideharu Kimura ,&nbsp;Isao Matsumoto ,&nbsp;Tsukasa Ueda ,&nbsp;Shunichi Nomura ,&nbsp;Sachiko Arai ,&nbsp;Nanao Terada ,&nbsp;Liu Yifeng ,&nbsp;Shigeki Nanjo ,&nbsp;Yuichi Tambo ,&nbsp;Takafumi Kobayashi ,&nbsp;Satoshi Watanabe ,&nbsp;Kenta Yamamura ,&nbsp;Noriyuki Ohkura ,&nbsp;Miki Abo ,&nbsp;Akihiro Nomura ,&nbsp;Seiji Yano","doi":"10.1016/j.lungcan.2025.108818","DOIUrl":"10.1016/j.lungcan.2025.108818","url":null,"abstract":"<div><h3>Introduction</h3><div>Curative surgery followed by adjuvant osimertinib according to pathological stage (pStage) is standard for resectable epidermal growth factor receptor (<em>EGFR</em>)-mutated non-small cell lung cancer (NSCLC). Nevertheless, recurrence remains a concern even in Stage IA, for which adjuvant osimertinib is not indicated. We evaluated the utility of circulating tumor DNA (ctDNA) to predict recurrence in patients with resected pStage I-III <em>EGFR</em>-mutated NSCLC and examined prognostic value of preoperative biomarkers and pathological features.</div></div><div><h3>Methods</h3><div>Between January 2017 and May 2020, 382 patients with lung tumors underwent surgery at Kanazawa University Hospital, including 88 with NSCLC harboring common <em>EGFR</em> mutations. Preoperative ctDNA was analyzed using droplet digital PCR, targeting <em>EGFR</em> mutations. Patients were followed for up to 6.4 years, and disease-free survival (DFS) and overall survival (OS) were evaluated.</div></div><div><h3>Results</h3><div>Preoperative ctDNA positivity was detected in 26.1 % and venous invasion in 39.8 %. ctDNA-positive patients had lower 60-month DFS (54.1 % vs. 84.1 %; HR = 3.25; 95 % CI, 1.13–9.21; <em>p</em> = 0.028) and 60-month OS (65.1 % vs. 95.9 %; HR = 6.10; 95 % CI, 1.11–33.46; <em>p</em> = 0.037). Venous invasion was independently associated with poorer DFS (HR = 8.73; 95 % CI, 1.81–41.93; <em>p</em> = 0.0068). In combined analyses, no recurrences occurred in the double-negative, whereas the double-positive had a lower 60-month DFS than the single-positive (HR = 3.61; 95 % CI, 1.19–10.93; <em>p</em> = 0.023).</div></div><div><h3>Conclusion</h3><div>Preoperative ctDNA detection and pathological venous invasion provide complementary prognostic information, and venous invasion is an independent predictor of recurrence risk in <em>EGFR</em>-mutated NSCLC. Combined assessment may refine postoperative risk stratification and inform perioperative management.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"213 ","pages":"Article 108818"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune-related disorders in patients with Thymic Epithelial Tumors: from pathogenesis to tailored interventions","authors":"Erica Pietroluongo ,&nbsp;Giovannella Palmieri ,&nbsp;Paolo Antonio Ascierto ,&nbsp;Margaret Ottaviano","doi":"10.1016/j.lungcan.2026.108915","DOIUrl":"10.1016/j.lungcan.2026.108915","url":null,"abstract":"<div><h3>Background and objective</h3><div>Thymic epithelial tumors (TETs) are rare malignancies often associated with immunological disorders (IDs), including autoimmune diseases and paraneoplastic syndromes. Myasthenia gravis (MG) is the most frequently reported condition, although other IDs can manifest across various organ systems. This review aims to give an overview of the current knowledge on the epidemiology, pathogenesis, and management of IDs associated with TETs, emphasizing their prognostic impact and challenges in clinical practice.</div></div><div><h3>Methods</h3><div>We performed a narrative review using PubMed and Embase databases to identify relevant literature published between January 1971 and October 2024. Keywords included “thymic epithelial tumors”, “immunological disorders,” “autoimmune diseases,” and “paraneoplastic syndromes.” Only peer-reviewed articles in English were included.</div></div><div><h3>Key content and findings</h3><div>This review examines the association of TETs with the most frequent IDs, including MG, pure red cell aplasia, and Good’s syndrome. The prognostic implications of IDs in TETs remain unclear, and the available literature presents conflicting data. While some studies suggest correlations with favourable outcomes, others fail to establish IDs as independent prognostic factors for recurrence-free survival (RFS) or overall survival (OS).</div></div><div><h3>Conclusions</h3><div>The management of TETs with associated IDs requires a multidisciplinary approach that integrates tumor-specific treatments and tailored interventions for immune-related disorders. Advances in understanding molecular mechanisms have shed light on their pathogenesis. Nevertheless, gaps persist regarding prognostic implications and long-term management. Future efforts should focus on identifying predictive biomarkers for immune complications, optimizing therapies, and enhancing international data collection to clarify the impact of IDs on patient outcomes.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"213 ","pages":"Article 108915"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological considerations in assessing the clinical impact of TP53 classifications in advanced NSCLC","authors":"Xiaorong Lu,&nbsp;Shanshan Yuan","doi":"10.1016/j.lungcan.2026.108937","DOIUrl":"10.1016/j.lungcan.2026.108937","url":null,"abstract":"","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"213 ","pages":"Article 108937"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic significance of consolidation-to-tumor ratio in stage IA solid predominant non-mucinous adenocarcinoma: a paradigm for risk stratification","authors":"Yura Ahn ,&nbsp;Geun Dong Lee ,&nbsp;SeHoon Choi ,&nbsp;Hyeong Ryul Kim ,&nbsp;Yong-Hee Kim ,&nbsp;Dong Kwan Kim ,&nbsp;Seung-Il Park ,&nbsp;Jooae Choe ,&nbsp;Jae Kwang Yun","doi":"10.1016/j.lungcan.2026.108934","DOIUrl":"10.1016/j.lungcan.2026.108934","url":null,"abstract":"<div><h3>Objective</h3><div>The optimal consolidation-to-tumor ratio (CTR) cutoff for survival stratification in radiologically solid-predominant adenocarcinoma (CTR &gt; 0.5) remains unclear. This study aimed to evaluate the prognostic significance of CTR in clinical-stage IA non-mucinous lung adenocarcinoma with CTR &gt; 0.5.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed patients who underwent curative resection for clinical stage IA non-mucinous adenocarcinoma with CTR &gt; 0.5 between 2011 and 2021. Optimal cutoffs for overall survival (OS) and freedom from recurrence (FFR) were determined using maximized log-rank statistics. Patients were stratified according to the derived CTR cutoff values, and OS and FFR were compared among the CTR groups before and after propensity score matching (PSM).</div></div><div><h3>Results</h3><div>Among 2,789 patients included, the optimal CTR cutoffs for OS and FFR were 0.84 and 0.85, respectively. Based on the 0.85 cutoff, patients were categorized into three groups: 0.5 &lt; CTR ≤ 0.85 (n = 672), 0.85 &lt; CTR &lt; 1 (n = 229), and CTR = 1 (n = 1,888). OS and FFR were significantly worse in the 0.85 &lt; CTR &lt; 1 group compared to the 0.5 &lt; CTR ≤ 0.85 group (p &lt; 0.05) but not significantly different from the CTR = 1 group (p &gt; 0.05). These trends persisted after PSM. The 0.85 &lt; CTR &lt; 1 group exhibited a higher proportion of pathological risk factors (high-grade patterns, lymphovascular invasion, and nodal metastasis) than the 0.5 &lt; CTR ≤ 0.85 group (all p &lt; 0.05) and was comparable to the CTR = 1 group, except for lymphovascular invasion (p = 0.045). Dichotomization into 0.5 &lt; CTR ≤ 0.85 and 0.85 &lt; CTR ≤ 1 revealed significantly worse OS and FFR in the 0.85 &lt; CTR ≤ 1 group across PSM cohorts for both lobectomy and sublobar resection.</div></div><div><h3>Conclusion</h3><div>A CTR cutoff of 0.85 effectively distinguishes survival outcomes in patients with clinical stage IA adenocarcinoma and CTR &gt; 0.5 and may inform risk stratification and postoperative surveillance.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"213 ","pages":"Article 108934"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incremental prognostic value of immune cell densities beyond clinical parameters in non-small cell lung cancer","authors":"Love Nordling ,&nbsp;Max Backman ,&nbsp;Artur Mezheyeuski ,&nbsp;Joakim Lindblad ,&nbsp;Nataša Sladoje ,&nbsp;Patrick Micke","doi":"10.1016/j.lungcan.2026.108935","DOIUrl":"10.1016/j.lungcan.2026.108935","url":null,"abstract":"<div><h3>Background</h3><div>Multiplex immunofluorescence imaging enables detailed characterization of the tumor immune microenvironment, but whether immune cell densities add prognostic value beyond established clinical factors in non-small cell lung cancer (NSCLC) remains unclear.</div></div><div><h3>Methods</h3><div>Tissue samples from an NSCLC cohort (n = 298) were stained with a multiplex immunofluorescence panel targeting immune cell markers (CD4, CD8, FoxP3, CD20), cancer cells (pan-cytokeratin), and cell nuclei (DAPI). We quantified immune cell densities, nuclear pleomorphism features, and clinical variables, and trained four machine learning models (logistic regression, random forest, support vector machine, and k-nearest neighbors) to predict overall survival.</div></div><div><h3>Results</h3><div>Clinical parameters consistently demonstrated the strongest performance in predicting long and short-term survival (logistic regression mean accuracy 0.60 ± 0.01, AUC 0.66 ± 0.01). The addition of immune cell densities revealed a small, statistically significant improvement in survival prediction (accuracy 0.62 ± 0.01, p &lt; 0.01, AUC 0.67 ± 0.01, p = 0.04), while nuclear pleomorphism features did not improve prediction. When combined with clinical parameters, immune cell densities also improved survival stratification in Cox regression analyses numerically (HR = 0.51 vs. 0.55 for clinical parameters alone). Model interpretation analyses showed that stage and performance status have the largest effect on model performance. Selected immune cell densities (tumor CD4-helper and stroma B-cells) have a limited but consistent effect.</div></div><div><h3>Conclusion</h3><div>Clinical parameters remain the dominant predictors of outcome in NSCLC, with immune cell densities providing only limited prognostic value for clinical stratification. The openly available code and datasets present a unique resource for method development or focused analysis.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"213 ","pages":"Article 108935"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}