Lung Cancer最新文献

{"title":"Efficacy of immune checkpoint inhibitors in pulmonary sarcomatoid carcinoma and predictive potential of mutated TP53","authors":"Mingying Wu ,&nbsp;Na Zhou ,&nbsp;Mei Guan ,&nbsp;Yingyi Wang ,&nbsp;Yuzhou Wang","doi":"10.1016/j.lungcan.2024.108068","DOIUrl":"10.1016/j.lungcan.2024.108068","url":null,"abstract":"<div><h3>Objective</h3><div>Pulmonary sarcomatoid carcinoma (PSC) is a rare, heterogeneous subgroup of non-small cell lung cancer (NSCLC). Patients with advanced PSCs have poor survival due to resistance to chemotherapy and radiotherapy, and narrow access to targeted therapy. Immune checkpoint inhibitors (ICIs) offer new hope, whereas data on their effectiveness is limited.</div></div><div><h3>Methods</h3><div>This retrospective study collected medical records of patients with advanced PSCs from January 2010 to March 2024 across two centers in China, analyzing demographic, treatment, and survival data. Sixty cases were included.</div></div><div><h3>Results</h3><div>In tumors tested for PD-L1 expression, 80 % had PD-L1 positivity, and 60 % exhibited TPS ≥ 50 %. The most frequently mutated genes in PSCs were <em>TP53</em> (25.9 %), <em>KRAS</em> (22.8 %), <em>MET</em> (7.4 %), <em>BRAF</em> (7.4 %), <em>CDKN2A/B</em> (7.4 % each), and <em>EGFR</em> (6.2 %). Median OS of patients with advanced PSCs receiving anti-PD-1 or anti-PD-L1 antibodies in any line was significantly longer compared to those who did not (NR vs. 11.2 months, p = 0.015). ICI application was an independent favorable factor for the prognosis of patients diagnosed with advanced PSC (HR 0.32, p = 0.008). In the subgroup treated with ICI-based therapies, ORR and DCR were 34.5 % and 82.8 %, respectively. The mPFS and mOS of ICI-based therapies were 12.5 and 16.0 months, respectively. <em>TP53</em> mutations and PD-L1 TPS ≥ 80 % were associated with prolonged PFS (p = 0.021, p = 0.035) and OS (p = 0.013 and p = 0.018).</div></div><div><h3>Conclusions</h3><div>Positive or high PD-L1 expression was prevalent in advanced PSCs. Anti-PD-1 or anti-PD-L1 antibodies were associated with favorable prognosis, and should be considered a key treatment option for patients with advanced PSC lacking actionable driver mutations. In addition to PD-L1 expression, <em>TP53</em> mutations have the potential to predict the efficacy of ICIs in treating patients with advanced PSC and its prognostic significance deserves further validation in larger prospective studies.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108068"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906682","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":"STK11 mutations correlate with poor prognosis for advanced NSCLC treated with first-line immunotherapy or chemo-immunotherapy according to KRAS, TP53, KEAP1, and SMARCA4 status","authors":"Andrea De Giglio ,&nbsp;Dario De Biase ,&nbsp;Valentina Favorito ,&nbsp;Thais Maloberti ,&nbsp;Alessandro Di Federico ,&nbsp;Federico Zacchini ,&nbsp;Giulia Venturi ,&nbsp;Claudia Parisi ,&nbsp;Filippo Gustavo Dall’Olio ,&nbsp;Ilaria Ricciotti ,&nbsp;Ambrogio Gagliano ,&nbsp;Barbara Melotti ,&nbsp;Francesca Sperandi ,&nbsp;Annalisa Altimari ,&nbsp;Elisa Gruppioni ,&nbsp;Giovanni Tallini ,&nbsp;Francesco Gelsomino ,&nbsp;Lorenzo Montanaro ,&nbsp;Andrea Ardizzoni","doi":"10.1016/j.lungcan.2024.108058","DOIUrl":"10.1016/j.lungcan.2024.108058","url":null,"abstract":"<div><h3>Background</h3><div>The upfront treatment of non-oncogene-addicted NSCLC relies on immunotherapy alone (ICI) or in combination with chemotherapy (CT-ICI). Genomic aberrations such as <em>KRAS</em>, <em>TP53</em>, <em>KEAP1</em>, <em>SMARCA4</em>, or <em>STK11</em> may impact survival outcomes.</div></div><div><h3>Methods</h3><div>We performed an observational study of 145 patients treated with first-line IO or CT-ICI for advanced non-squamous (nsq) NSCLC at our institution tested with an extensive lab-developed NGS panel. The primary objective was to assess the clinical outcomes of STK11-mutated patients. Then, we performed an external validation through the public OAK/POPLAR dataset, including nsq NSCLC patients treated with single-agent ICI or CT.</div></div><div><h3>Results</h3><div>Most patients were male (59.7 %), former smokers (61.1 %), with ECOG PS 0–1 (84 %), and received first-line CT-IO (58.6 %). 44.8 % had a mutation in KRAS, 21.4 % in KEAP1, 50.3 % in TP53, 13.1 % in SMARCA4, and 14.4 % in the STK11 gene. The mOS was 8 mo. (95 % CI, 5–16.7) for STK11 mutated pts and 17.3 mo. for STK11 wild-type patients (95 % CI, 8.9–24.4) (p = 0.038). TP53 (8.3 vs 17.3), KRAS (9.2 vs 15.9), and KEAP1 (8.9 vs 15.9) mutated patients evidenced a trend for dismal mOS. SMARCA4 status had no impact on mOS. STK11 mutations were detrimental to OS in the univariate (HR 1.74, p = 0.041) and multivariate model (HR 1.97, p = 0.025) after adjusting for sex, age, ECOG PS, treatment (ICI vs CT-ICI), <em>KRAS</em>, <em>KEAP1</em>, <em>TP53</em>, and <em>SMARCA4</em> status. Genomic alterations did not impact the mPFS in our cohort. Within the OAK/POPLAR dataset, <em>STK11</em> mutations (60/818 pts) were significantly associated with increased death risk in the univariate (HR 2.01, p &lt; 0.001) and multivariate model (HR 1.66, p = 0.001) after adjusting for age, sex, treatment (ICI vs CT), <em>KRAS</em>, <em>KEAP1</em>, <em>TP53</em>, and <em>SMARCA4</em> status.</div></div><div><h3>Conclusion</h3><div>STK11 aberrations hampered the mOS of nsq NSCLC patients treated with first-line ICI or CT-ICI. The negative prognostic impact seems to be unrelated to ICI administration.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108058"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel clinical brain prognostic index for KRAS-mutated lung cancer and brain metastases (KRAS-BPI): Real-world evidence from two large European centers","authors":"Ioannis Zerdes ,&nbsp;Caroline Kamali ,&nbsp;Berglind Johannsdottir ,&nbsp;Miriam Blasi ,&nbsp;Christin Assmann ,&nbsp;Daniel Kazdal ,&nbsp;Albrecht Stenzinger ,&nbsp;Marcus Skribek ,&nbsp;Simon Ekman ,&nbsp;Petros Christopoulos ,&nbsp;Georgios Tsakonas","doi":"10.1016/j.lungcan.2024.108065","DOIUrl":"10.1016/j.lungcan.2024.108065","url":null,"abstract":"<div><h3>Introduction</h3><div>Several prognostic scores were developed for non-small-cell lung cancer (NSCLC) patients with brain metastases (BM), though limited data reported for the <em>KRAS</em>-mutated subgroup. <em>KRAS</em>-targeted therapies have improved extracranial and intracranial response, highlighting the need for reliable prognostic biomarkers.</div></div><div><h3>Methods</h3><div>A retrospective cohort (2010–2020) comprising 220 patients with BM <em>KRAS</em>-mutated NSCLC from two large academic Thoracic Oncology centers (Karolinska and Heidelberg) was analyzed. Clinicopathological parameters were collected from electronic health records. Prognostic factors of overall survival from BM diagnosis (BM-OS) were identified using Cox regression models.</div></div><div><h3>Results</h3><div>The median age at diagnosis was 65 years, with a female predominance (55.9 %). Adenocarcinoma was the dominant histological subtype, performance status (PS) was 0–2 in 91 % of the patients and one-third had &gt; 4 BMs. Variables independently correlated with BM-OS included the presence of primary BM disease, PS, age, symptomatic CNS disease, extracranial metastases and number of BM, and were used to design a new <em>KRAS</em>-Brain Prognostic Index (KRAS-BPI). Patients with high-index score showed significantly longer BM-OS, compared to intermediate/low-index groups (median BM-OS = 30.0 vs 9.0 vs 2.0 months, respectively).</div></div><div><h3>Conclusions</h3><div>In the largest real-word data study of <em>KRAS</em>-mutated NSCLC patients with BM, we developed a novel prognostic tool for improved patient stratification.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108065"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative immunotherapy plus chemotherapy versus chemotherapy alone for patients with resectable pulmonary lymphoepithelioma-like carcinoma","authors":"Mengjie Lei ,&nbsp;Xuanye Zhang ,&nbsp;Li-na Hu ,&nbsp;Sha Fu ,&nbsp;Meihua Xiao ,&nbsp;Zhiqing Long ,&nbsp;Honglin Zhu ,&nbsp;Yixin Zhou ,&nbsp;Shaodong Hong","doi":"10.1016/j.lungcan.2024.108057","DOIUrl":"10.1016/j.lungcan.2024.108057","url":null,"abstract":"<div><h3>Background</h3><div>Primary pulmonary lymphoepithelioma-like carcinoma (PLELC) is a rare subtype of non-small-cell lung cancer. This study aims to compare the efficacy and safety of perioperative PD-1/PD-L1 inhibitor plus chemotherapy versus chemotherapy alone in stage II-IIIB PLELC patients.</div></div><div><h3>Patients and methods</h3><div>This retrospective study included stage II-IIIB PLELC patients. Patients received either perioperative immuno-chemotherapy (IO-Chemo) or chemotherapy alone (Chemo). Data on patient characteristics, treatments, efficacy, toxicities, and pathology were collected. Primary endpoints were major pathological response (MPR) and event-free survival (EFS). Secondary endpoints included objective response rate (ORR), overall survival (OS), and adverse events (AEs).</div></div><div><h3>Results</h3><div>A total of 72 patients were included in this retrospective study. The ORR was 75.0 % in the IO-Chemo group and 58.3 % in the Chemo group (odds ratio [OR] 0.47 [95 % CI 0.15–1.42]; <em>P</em> = 0.200). The percentage of patients achieving major pathological response (MPR) was 54.2 % in the IO-Chemo group and 12.5 % in the Chemo group (OR 1.91 [95 % CI 1.22–2.99]; <em>P</em> &lt; 0.001). Pathological complete response (pCR) was achieved by 33.3 % of patients in the IO-Chemo group compared to 4.2 % in the Chemo group (OR 1.44 [95 % CI 1.08–1.92]; <em>P</em> = 0.002). The median EFS was not reached in the IO-Chemo group, whereas it was 35.0 months in the Chemo group (95 % CI 14.2–55.8; hazard ratio [HR] 0.42 [95 % CI 0.19–0.93]; <em>P</em> = 0.031). Median overall survival (OS) was not reached after a median follow-up of 47.0 months. Multivariate analysis indicated that the PD-1/PD-L1 inhibitor combination was independently associated with longer EFS (HR = 0.32 [95 % CI 0.11–0.95]; <em>P</em> = 0.043). AEs of any grade occurred in 91.7 % of the patients in the IO-Chemo group versus 89.6 % in the Chemo group.</div></div><div><h3>Conclusions</h3><div>In patients with resectable PLELC, perioperative PD-1/PD-L1 inhibitor plus chemotherapy resulted in significantly longer EFS and a higher percentage of patients achieving MPR and pCR than chemotherapy alone, with a tolerable safety profile.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108057"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of cryobiopsy during medical thoracoscopy for diagnosing malignant pleural mesothelioma","authors":"Hayato Nanami ,&nbsp;Yuji Matsumoto ,&nbsp;Hideaki Furuse ,&nbsp;Midori Tanaka ,&nbsp;Takaaki Tsuchida ,&nbsp;Yuichiro Ohe","doi":"10.1016/j.lungcan.2024.108074","DOIUrl":"10.1016/j.lungcan.2024.108074","url":null,"abstract":"<div><h3>Objectives</h3><div>Malignant pleural mesothelioma (MPM) is difficult to differentiate from other pleural diseases, and its diagnosis requires adequate tissue sampling. Although medical thoracoscopy is an established diagnostic procedure for pleural diseases, there is no consensus on whether it guarantees a high diagnostic yield for MPM. Cryobiopsy has been shown to have the potential to improve tissue sampling in other diseases; therefore, we aimed to investigate its efficacy in diagnosing MPM.</div></div><div><h3>Material and Methods</h3><div>Patients who underwent medical thoracoscopy at our institution between January 2013 and June 2023 and were finally diagnosed with MPM were analyzed. Patients who underwent biopsies with forceps and/or electrocautery devices were defined as the conventional group, whereas those who underwent biopsies with an additional cryoprobe were categorized as the cryo group. Diagnostic performance was compared between the two groups.</div></div><div><h3>Results</h3><div>Among 347 patients who underwent medical thoracoscopy, 69 patients, 34 in the cryo group and 35 in the conventional group, were diagnosed with MPM. The overall diagnostic yield was 76.8 %, and the cryo group had a significantly higher yield than the conventional group (88.2 % vs. 65.7 %, <em>P</em> = 0.044). Furthermore, the subtype was confirmed in most of the patients in the cryo group but only in approximately two-thirds of those in the conventional group (79.4 % vs. 42.9 %, <em>P</em> = 0.003). Regarding safety, two patients (5.9 %) developed pneumothorax in the cryo group, and two (5.7 %) developed pneumonia in the conventional group.</div></div><div><h3>Conclusion</h3><div>Cryobiopsy is effective in improving the subtype confirmation rate as well as MPM diagnostic yield compared to conventional biopsy.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108074"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074935","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":"Sunvozertinib monotherapy in EGFR tyrosine kinase inhibitor-resistant non-small cell lung cancer with EGFR mutations","authors":"Mengzhao Wang ,&nbsp;Yan Xu ,&nbsp;Wen-Tsung Huang ,&nbsp;Wu-Chou Su ,&nbsp;Bo Gao ,&nbsp;Chee Khoon Lee ,&nbsp;Jian Fang ,&nbsp;Xuehua Zhu ,&nbsp;Zhenfan Yang ,&nbsp;Pasi A. Jänne ,&nbsp;James Chih-Hsin Yang","doi":"10.1016/j.lungcan.2024.108053","DOIUrl":"10.1016/j.lungcan.2024.108053","url":null,"abstract":"<div><h3>Background</h3><div>Multiple agents can be used to treat patients with EGFR mutated non-small cell lung cancer (NSCLC) who develop resistance to EGFR tyrosine kinase inhibitors (TKIs), but the clinical outcome was not satisfactory, especially in patients with multiple lines of prior therapies. Therefore, there is an unmet medical need for these patients. Sunvozertinib is an oral, potent, irreversible, and mutant-selective EGFR TKI targeting EGFR mutations with weak activity against wild-type EGFR. We investigated the efficacy and safety of sunvozertinib monotherapy in treating EGFR TKI-resistant patients with NSCLC harboring EGFR mutations.</div></div><div><h3>Methods</h3><div>This was a pooled analysis of phase 1 and 2 studies (WU-KONG1, WU-KONG2 and WU-KONG15). Eligible patients received sunvozertinib at doses ranging from 50 mg to 400 mg once daily. Efficacy endpoints included objective response rate (ORR), disease control rate (DCR), duration of response (DoR) and progression free survival (PFS). Safety endpoints included adverse events and serious adverse events. In addition, plasma specimens were collected at baseline to assess EGFR mutation types and genetic alterations in EGFR downstream signaling pathway.</div></div><div><h3>Results</h3><div>Forty patients were enrolled. Ninety percent received ≥ 3 prior lines of therapies. The best ORR was 27.5 %, and DCR was 60 %. The median DoR and PFS were 6.5 months and 6 months, respectively. Higher ORR was seen in patients whose last line of treatment was chemotherapy rather than EGFR TKI (31.6 % vs. 14.3 %). Greater responses were seen in patients with EGFR sensitizing and T790M double mutations (ORR: 55.6 %). The safety profile of sunvozertinib was consistent with previous reports.</div></div><div><h3>Conclusions</h3><div>Sunvozertinib has promising activity implying future investigations in the patients with EGFR mutated NSCLC who developed resistance to prior EGFR TKI.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108053"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794993","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":"Real-world status of multimodal treatment of Stage IIIA-N2 non-small cell lung cancer in Japan: Results from the SOLUTION study, a non-interventional, multicenter cohort study","authors":"Hidehito Horinouchi ,&nbsp;Haruyasu Murakami ,&nbsp;Hideyuki Harada ,&nbsp;Tomotaka Sobue ,&nbsp;Tomohiro Kato ,&nbsp;Shinji Atagi ,&nbsp;Toshiyuki Kozuki ,&nbsp;Takaaki Tokito ,&nbsp;Satoshi Oizumi ,&nbsp;Masahiro Seike ,&nbsp;Kadoaki Ohashi ,&nbsp;Tadashi Mio ,&nbsp;Takashi Sone ,&nbsp;Chikako Iwao ,&nbsp;Takeshi Iwane ,&nbsp;Ryo Koto ,&nbsp;Masahiro Tsuboi","doi":"10.1016/j.lungcan.2024.108027","DOIUrl":"10.1016/j.lungcan.2024.108027","url":null,"abstract":"<div><h3>Objectives</h3><div>There is limited consensus on resectability criteria for Stage IIIA-N2 non-small cell lung cancer (NSCLC). We examined the patient characteristics, N2 status, treatment decisions, and clinical outcomes according to the treatment modality for Stage IIIA-N2 NSCLC in Japan.</div></div><div><h3>Materials and methods</h3><div>Patients with Stage IIIA-N2 NSCLC in Japan were consecutively registered in the SOLUTION study between 2013 and 2014. Patients were divided according to treatment (chemoradiotherapy [CRT], surgery + perioperative therapy [neoadjuvant and/or adjuvant therapy], surgery alone). Demographic characteristics, N2 status (number and morphological features), pathological information, and treatments were analyzed descriptively. Overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) were estimated using the Kaplan–Meier method.</div></div><div><h3>Results</h3><div>Of 227 patients registered, 133 underwent CRT, 56 underwent surgery + perioperative therapy, and 38 underwent surgery alone. The physicians reported the following reasons for unresectability for 116 of 133 CRT patients: large number of metastatic lymph nodes (70.7 %), extranodal infiltration (25.0 %), poor surgical tolerance (19.0 %), or other reasons (18.1 %). CRT was more frequently performed in patients whose lymph nodes had an infiltrative appearance (64.3 %) and was the predominant treatment in patients with multiple involved stations (discrete: 60.0 %; infiltrative: 80.4 %). Distant metastasis with/without local progression was found in 50.4 %, 50.0 %, and 36.8 % of patients in the CRT, surgery + perioperative therapy, and surgery alone groups, respectively. The respective 3-year OS and DFS/PFS rates (median values) were as follows: surgery + perioperative therapy—61.9 % (not reached) and 37.1 % (22.4 months; DFS); CRT group—42.2 % (31.9 months) and 26.8 % (12.0 months; PFS); surgery alone group—37.7 % (26.5 months) and 28.7 % (12.6 months; DFS).</div></div><div><h3>Conclusion</h3><div>This study has illuminated the real-world decision rules for choosing between surgical and non-surgical approaches in patients with Stage IIIA-N2 NSCLC. Our landmark data could support treatment decision making for using immune checkpoint inhibitors and targeted therapy for driver oncogenes in the perioperative therapy era.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108027"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating tumour budding could improve the new grading system for lung adenocarcinoma","authors":"Kirsi K. Volmonen ,&nbsp;Mikko J. Rönty ,&nbsp;Anastasia Sederholm ,&nbsp;Juuso I. Paajanen ,&nbsp;Ilkka K. Ilonen ,&nbsp;Airi E. Jartti ,&nbsp;Aija H. Knuuttila","doi":"10.1016/j.lungcan.2024.108067","DOIUrl":"10.1016/j.lungcan.2024.108067","url":null,"abstract":"<div><h3>Objectives</h3><div>To study the prognostic significance of tumour budding (TB) compared with the grading of lung adenocarcinoma (LAC).</div></div><div><h3>Materials and methods</h3><div>The postoperative haematoxylin and eosin-stained histological slices of 207 surgically treated LAC patients were retrospectively reviewed by a lung pathologist. Two groups were formed from the cohort: the high-grade TB group (≥10 buds) and low-grade TB group (0–9 buds). The prognostic significance of high-grade TB for the 5-year progression-free survival (PFS) and overall survival (OS) of patients was studied using the Kaplan–Meier method and Cox regression models. A novel four-tier grading system for LACs was developed by combining the World Health Organization (WHO) grading system and high-grade TB. The computed tomography (CT) imaging features of the tumours were assessed semiquantitatively by two chest radiologists.</div></div><div><h3>Results</h3><div>There were 166 patients with low-grade TB and 41 LAC patients with high-grade TB. Most of the tumours with high-grade TB were Grade 3 tumours. The median follow-up time was 60 months. The 5-year PFS was lower in the high-grade TB group than in the low-grade TB group (37.6 vs. 50.9 months, <em>p</em> &lt; 0.001). High-grade TB remained an independent prognostic factor for poor PFS (clinical model: hazard ratio [HR] = 2.07, adj. <em>p</em> = 0.012, histopathological model: adj. HR = 2.09, adj. <em>p</em> = 0.010). Compared with the WHO Grade 3 group, the Novel Grade 4 group had a shorter mean PFS (36.7 vs. 45.3 months), and according to the PFS analysis, the novel four-tier grading system was superior to the WHO grading system (AIC = 591.9 vs. AIC = 596.6, ΔAIC &gt; 2). On CT, tumours with higher TBs are usually smooth or spiculated.</div></div><div><h3>Conclusion</h3><div>This is the first study to show that high-grade TB is associated with a higher LAC grade. The incorporation of TB into the WHO grading scheme may improve the prognostic significance of LAC grading.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108067"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An international and multidisciplinary EORTC survey on resectability of stage III non-small cell lung cancer","authors":"Ilias Houda ,&nbsp;Idris Bahce ,&nbsp;Chris Dickhoff ,&nbsp;Tiuri E. Kroese ,&nbsp;Stephanie G.C. Kroeze ,&nbsp;Alessio V. Mariolo ,&nbsp;Marco Tagliamento ,&nbsp;Laura Moliner ,&nbsp;Mariana Brandão ,&nbsp;Yassin Pretzenbacher ,&nbsp;John Edwards ,&nbsp;Isabelle Opitz ,&nbsp;Alessandro Brunelli ,&nbsp;Matthias Guckenberger ,&nbsp;Paul E. van Schil ,&nbsp;Sanjay Popat ,&nbsp;Torsten Blum ,&nbsp;Corinne Faivre-Finn ,&nbsp;Dirk de Ruysscher ,&nbsp;Jordi Remon ,&nbsp;Lizza E.L. Hendriks","doi":"10.1016/j.lungcan.2024.108061","DOIUrl":"10.1016/j.lungcan.2024.108061","url":null,"abstract":"<div><h3>Introduction</h3><div>The EORTC-Lung Cancer Group initiated a Delphi consensus process to establish a consensual definition of resectable stage III non-small cell lung cancer (NSCLC) for the use in clinical trials, including a systematic review, survey, and review of clinical cases. Here, the survey results are presented, aimed to identify areas of controversy.</div></div><div><h3>Methods</h3><div>A survey was distributed among the members of six international organizations related to lung cancer. Respondents were interrogated on the resectability (not limited to the technical resectability) of all stage III NSCLC TNM-subsets (8th edition). Additionally, four N2-subdivisions were used. The threshold for agreement was 75%. Answers with “yes” were considered upfront resectable. “Yes” and “maybe” were grouped together and considered potentially resectable. Answers with “no” were considered unresectable.</div></div><div><h3>Results</h3><div>558 responses were collected from thoracic surgeons (38%), radiation oncologists (27%), medical oncologists (17%), pulmonologists (14%), and others (4%). Most worked in a specialized center (80%), had &gt;5 years of experience (80%), were European (76%), male (73%), and treated &gt;20 patients with stage III NSCLC annually (77%). Agreement was found in 26 (70%) out of 37 TNM-subsets: 9 (24%) were considered (potentially) resectable, and 17 (46%) unresectable. There was no agreement for 11 (30%) TNM-subsets: smaller tumors with N2-multistation, larger tumors with N2-single station, and invasive T4-tumors with maximum N2-single station involvement.</div></div><div><h3>Conclusions</h3><div>This international and multidisciplinary survey showed agreement on the resectability for the majority of stage III NSCLC TNM-subsets, but also identified several TNM-subsets for which no agreement was found.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108061"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic impact of the N2 subclassification and stage migration in the ninth edition of the TNM classification in surgically resected lung cancer","authors":"Masayuki Nakao ,&nbsp;Ayumi Suzuki ,&nbsp;Junji Ichinose ,&nbsp;Yosuke Matsuura ,&nbsp;Sakae Okumura ,&nbsp;Hironori Ninomiya ,&nbsp;Mingyon Mun","doi":"10.1016/j.lungcan.2024.108073","DOIUrl":"10.1016/j.lungcan.2024.108073","url":null,"abstract":"<div><h3>Objectives</h3><div>In the ninth edition of the TNM classification of lung cancer, N2 is subdivided into single-station (N2a) and multiple-station involvement (N2b), and some stage changes are made to stage II–III. This study aimed to validate the new classification and determine the effect of stage migration and vice versa on the prognosis of each pathological stage due to these changes.</div></div><div><h3>Materials and Methods</h3><div>A total of 1,754 patients with surgically resected lung cancer were included. Clinical characteristics of patients at each new pathological N (pN) status were compared. Overall survival (OS) was evaluated according to the new pN status and pathological stages.</div></div><div><h3>Results</h3><div>The OS of pN2a patients tended to be superior to that of pN2b patients without significance (p = 0.083). Several patient characteristics, including clinical N status, were not significantly different between pN2a and pN2b. The OS of the downstaged patients (T1N1M0 from IIB to IIA, T1N2aM0 from IIIA to IIB, and T3N2aM0 from IIIB to IIIA) was not significantly different from that of other patients in the same stages (p = 0.376, p = 0.630, and p = 0.970, respectively). The OS of the upstaged patients (T3N2bM0 from IIIA to IIIB) was significantly better than that of other patients in the same stage (p &lt; 0.001). The 5-year OS rates of stages IIIA and IIIB were 63.3 % and 49.4 % in the eighth edition and 58.9 % and 54.3 % in the ninth edition, respectively.</div></div><div><h3>Conclusion</h3><div>Although the N2 subclassification had some impact on survival stratification, it was difficult to predict the subdivided pN2 status, preoperatively. The OS difference in stage III was smaller in the ninth edition than in the eighth edition, due to the complex effects of stage migration and vice versa.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108073"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915461","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}