Lung Cancer最新文献

{"title":"Associations between progastrin-releasing peptide (ProGRP) and neuron-specific enolase (NSE) and survival in patients with limited-stage small cell lung cancer (LS SCLC) receiving chemoradiotherapy (CRT)","authors":"Miriam Grønberg ,&nbsp;Marianne Aanerud ,&nbsp;Tarje Onsøien Halvorsen ,&nbsp;Kristin Toftaker Killingberg ,&nbsp;Bjørn Henning Grønberg","doi":"10.1016/j.lungcan.2025.108678","DOIUrl":"10.1016/j.lungcan.2025.108678","url":null,"abstract":"<div><h3>Background</h3><div>There are no established biomarkers for predicting outcomes of chemoradiotherapy (CRT) in limited-stage small cell lung cancer (SCLC). Progastrin-releasing peptide (ProGRP) is a more sensitive and specific biomarker of SCLC than neuron-specific enolase (NSE). We investigated whether ProGRP was associated with treatment outcomes in a randomized phase II trial of LS SCLC (n = 170).</div></div><div><h3>Methods</h3><div>Patients received platinum–etoposide chemotherapy and were randomized to receive twice-daily (BID) thoracic radiotherapy (TRT) of either 45 Gy or 60 Gy. Patients commencing TRT with baseline measurements of ProGRP and NSE were eligible for this study.</div></div><div><h3>Results</h3><div>We analyzed 89 patients. Median age was 65 years, 56.2 % were female, 89.9 % had performance status 0–1, and 85.4 % had stage III disease. At baseline, 79.8 % had elevated ProGRP and 58.4 % elevated NSE. After CRT, 23.6 % had elevated ProGRP and 5.6 % elevated NSE. Patients with elevated ProGRP at baseline had shorter PFS (median 12.2 months vs. not reached [NR], p = 0.006) and OS (median 29.3 months vs. NR, p = 0.001) than patient. Similarly, elevated ProGRP after CRT was associated with shorter PFS (median 11.1 months vs. NR, p = 0.006) and OS (median 30.6 months vs. NR, p = 0.002). Patients with elevated baseline ProGRP but normalized ProGRP after CRT had longer PFS (median 49.3 months vs. 7.8 months, p = 0.003) and OS (median NR vs. 30.5, p &lt; 0.001) than patients with persistently elevated ProGRP. All associations remained significant in multivariable analyses. NSE was not associated with PFS or OS.</div></div><div><h3>Conclusion</h3><div>ProGRP levels at baseline and after CRT were associated with PFS and OS in patients with LS SCLC.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"207 ","pages":"Article 108678"},"PeriodicalIF":4.4,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766849","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 survival outcomes of immune checkpoint inhibitor therapy after standard treatment failure in EGFR-mutated NSCLC: A nationwide cohort study","authors":"Jiyeon Lee ,&nbsp;Miryoung Kim ,&nbsp;Hyun Jin Han ,&nbsp;Siin Kim ,&nbsp;Hae Sun Suh","doi":"10.1016/j.lungcan.2025.108682","DOIUrl":"10.1016/j.lungcan.2025.108682","url":null,"abstract":"<div><h3>Background</h3><div>Immune checkpoint inhibitors (ICIs) have shown limited efficacy in EGFR-mutated NSCLC, and their role in later-line settings remains unclear. This study aimed to evaluate the real-world effectiveness of ICI monotherapy compared to chemotherapy in patients with EGFR-mutated NSCLC who had limited remaining treatment options.</div></div><div><h3>Methods</h3><div>We conducted a target trial emulation using data from the Cancer Public Library Database under the K-CURE project, which integrates national cancer registry, mortality, medical check-up and health insurance claims data in Korea. Eligible patients were aged ≥ 18 years, had EGFR-mutated NSCLC with progression after both EGFR-TKI and platinum-based chemotherapy, and initiated ICI monotherapy or chemotherapy between August 2017 and December 2020. Propensity score matching was used to balance treatment groups. Overall survival was analyzed using time-dependent statistical methods to account for non-proportional hazards.</div></div><div><h3>Results</h3><div>Of 1,914 eligible patients, 663 matched pairs were analyzed. While standard Cox analysis showed no significant OS difference (HR 0.91, 95 % CI 0.80–1.03), time-dependent analyses revealed a late survival benefit for ICI beyond 6.8 months (HR 0.72, 95 % CI 0.59–0.88). Subgroup analyses revealed heterogeneous treatment effects, with greater long-term benefits in patients of older age, those with concurrent malignancies, and those without prior osimertinib exposure. Sensitivity analyses suggested a potential role for high PD-L1 expression as a biomarker of ICI response in this setting.</div></div><div><h3>Conclusion</h3><div>ICI monotherapy may offer time-dependent survival benefits over chemotherapy in selected patients with EGFR-mutated NSCLC after standard treatment failure, supporting its consideration in later-line clinical decision-making.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"206 ","pages":"Article 108682"},"PeriodicalIF":4.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723452","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":"Robotic-assisted bronchoscopy for histopathologic subtyping of primary lung adenocarcinoma","authors":"Or Kalchiem-Dekel ,&nbsp;Rastko Rakočević ,&nbsp;Nicolas Toumbacaris ,&nbsp;Kay See Tan ,&nbsp;Tejaswi R. Nadig ,&nbsp;Prasad S. Adusumilli ,&nbsp;Joseph Dycoco ,&nbsp;Robert P. Lee ,&nbsp;Catherine L. Oberg ,&nbsp;Katherine D. Gray ,&nbsp;Bernard J. Park ,&nbsp;Gaetano Rocco ,&nbsp;Jaime E. Chaft ,&nbsp;Stephen B. Solomon ,&nbsp;David R. Jones ,&nbsp;Mohit Chawla ,&nbsp;Bryan C. Husta ,&nbsp;Marina K. Baine ,&nbsp;Matthew J. Bott","doi":"10.1016/j.lungcan.2025.108681","DOIUrl":"10.1016/j.lungcan.2025.108681","url":null,"abstract":"<div><h3>Background</h3><div>The identification of high-grade patterns and mucinous features of invasive primary lung adenocarcinoma on biopsy specimens can have implications on therapeutic decisions across all stages of disease. Shape sensing robotic-assisted bronchoscopy (ssRAB) is an emerging modality for the concomitant diagnosis and staging of lung cancer. We evaluated the performance of ssRAB for adenocarcinoma pattern identification, and particularly high-grade patterns, as well as the histopathologic concordance between biopsy and surgical resection specimens.</div></div><div><h3>Methods</h3><div>Patients with lung adenocarcinoma diagnosed via ssRAB forceps or cryobiopsy specimens between October 2019 and December 2023 were included in the analysis. Biopsy specimens were evaluated for the identification of histopathologic patterns and mucinous features. A generalized linear mixed model quantified the association between pre- and intra-operative factors and successful pattern identification on biopsy. The concordance between high-grade patterns and mucinous features on ssRAB-acquired biopsy and poorly differentiated grade and mucinous features on subsequent surgical resection was determined.</div></div><div><h3>Results</h3><div>A total of 242 ssRAB-acquired specimens were included in the final analysis. The biopsy specimen was sufficient to identify adenocarcinoma histopathologic patterns in 71 %. In a multivariable analysis, sampling by cryobiopsy was positively associated with pattern identification (OR 3.54, CI: 1.02–12.30; P = 0.04), as compared with forceps biopsy. A corresponding surgical resection specimen was available in 66 cases. The sensitivity, specificity, positive, and negative predictive values of biopsy were 63, 72, 61, and 74 %, respectively for the presurgical detection of poorly differentiated adenocarcinoma, and 87, 100, 100, and 96 %, respectively for the presurgical detection of mucinous features.</div></div><div><h3>Conclusion</h3><div>This study is the first to report the performance of ssRAB-acquired biopsy for identification of adenocarcinoma patterns and its concordance with surgical resection. Our findings align with those previously reported for percutaneous lung biopsy. ssRAB emerges as a viable tool for the identification of adenocarcinoma patterns. Future studies are needed to confirm these findings in larger patient cohorts.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"207 ","pages":"Article 108681"},"PeriodicalIF":4.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757861","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":"Biomarker landscape in advanced NSCLC: insights from a national prospective registry","authors":"Mariano Provencio ,&nbsp;Manuel Cobo ,&nbsp;Delvys Rodriguez-Abreu ,&nbsp;Enric Carcereny ,&nbsp;Virginia Calvo ,&nbsp;Rafael López Castro ,&nbsp;Reyes Bernabé ,&nbsp;Manuel Fernandez Bruno ,&nbsp;Joaquim Bosch-Barrera ,&nbsp;Edel del Barco ,&nbsp;Karla Medina ,&nbsp;Alfredo Sanchez-Hernandez ,&nbsp;Guillermo Suay ,&nbsp;Ana Laura Ortega ,&nbsp;Sergio Vázquez ,&nbsp;Martin Lazaro-Quintela ,&nbsp;Maria Guirado ,&nbsp;Anna Estival ,&nbsp;Mariola Blanco ,&nbsp;Alexandra Cantero ,&nbsp;Bartomeu Massutí","doi":"10.1016/j.lungcan.2025.108680","DOIUrl":"10.1016/j.lungcan.2025.108680","url":null,"abstract":"<div><h3>Objectives</h3><div>The determination of actionable genes is a necessity in lung cancer for proper care practice. The Spanish Lung Cancer Group (Fundación GECP) has performed an exploratory analysis of this aspect, specifically in stage IV non-small cell lung cancer (NSCLC).</div></div><div><h3>Materials and methods</h3><div>The Thoracic Tumor Registry (TTR) is a Spanish prospective, observational cohort study. At the time of data extraction (March 2024), 27,399 patients were enrolled from 82 hospitals.</div></div><div><h3>Results</h3><div>There were 13,583 patients with stage IV NSCLC. The analysis of at least one tumor marker was performed in 85.7 % of non-squamous and 62.8 % of squamous patients (p-value &lt; 0.001), with differences between autonomous communities. In the non-squamous population, the three most frequently analysed markers were EGFR (77.3 %), ALK (66.1 %) and PD-L1 (56.3 %). Biomarker profiling has undergone a more pronounced and extensive development in squamous histology in recent years. Molecular determinations that do not have a generally approved targeted therapy have also increased. Biomarker testing in patients with ECOG PS 2 is lower compared to ECOG PS &lt; 2 (77.6 % vs 82.6 %, p-value &lt; 0.001). Sub-analysis shows rates also vary by hospital size.</div></div><div><h3>Conclusion</h3><div>The analysis of tumor markers in stage IV NSCLC patients continues to increase in Spain, at the same level as in Europe o USA, despite the absence of national plans. There are clinically guided determinations that are rare in squamous histology but have an appreciable percentage of positivity. Even in patients with ECOG PS2, biomarker testing with high clinical suspicion should be considered.</div></div><div><h3>Clinical Trial Registration</h3><div>NCT02941458.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"207 ","pages":"Article 108680"},"PeriodicalIF":4.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757860","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":"Characterization and economic burden of KRASG12C-mutant lung cancer in real-world Spanish practice: a retrospective observational study (SILK study)","authors":"Noemí Reguart ,&nbsp;Laura Sampietro-Colom ,&nbsp;Òscar Juan-Vidal ,&nbsp;Mònica Aguiló ,&nbsp;Edurne Arriola ,&nbsp;Joan Sánchez ,&nbsp;Carla Fernández-Barceló ,&nbsp;Ismail Abbas ,&nbsp;Carlos López ,&nbsp;Xavier Botella ,&nbsp;Francesc Cots ,&nbsp;Cristina Teixido ,&nbsp;Daniel Martínez ,&nbsp;Sarai Palanca ,&nbsp;Emma Borràs ,&nbsp;Laura Masfarré ,&nbsp;Cristina Siles Cuesta ,&nbsp;Maria Eugenia Gas Lopez ,&nbsp;Laura Planellas ,&nbsp;Ariadna Lloansí","doi":"10.1016/j.lungcan.2025.108677","DOIUrl":"10.1016/j.lungcan.2025.108677","url":null,"abstract":"<div><h3>Introduction</h3><div>Real-world evidence on the direct healthcare costs of patients with <em>KRAS</em>G12C-mutant non-small-cell lung cancer (NSCLC) is limited.</div></div><div><h3>Material and Methods</h3><div>Multicenter, observational, retrospective study in patients newly diagnosed with advanced-stage NSCLC harboring the <em>KRAS</em>G12C mutation within real-world clinical practice in Spain. Patient characteristics, treatment patterns, outcomes, and direct healthcare costs were collected from medical records and administrative databases between January 1, 2016, and March 9, 2022.</div></div><div><h3>Results</h3><div>127 patients were included in the study, with global and disease-related economic data available for 125 and 104 patients, respectively. Most patients (97.6%) were current or former smokers. The most prevalent co-mutations or genetic alterations at baseline involved <em>TP53</em> (38.2%), <em>ATM</em> (20.0%), and <em>STK11</em> (15.4%) genes. 94 patients (74.0%) received systemic therapy. Chemotherapy was the most common first-line (63.8%) and immunotherapy the most common second-line therapy (64.6%). Median progression-free survival (95% CI) for the first, second and third treatment lines was 4.6 (2.8–7.8), 3.8 (1.5–8.2), and 2.2 (0.1–9.9) months, respectively. Median overall survival (95% CI) was 7.7 (4.9–11.0), 9.0 (3.0–14.3), and 8.9 (0.1–19.7) months, respectively. Total global cost over the study period amounted to €5,706,820 (€46,023 per patient), with pharmacological costs totaling €2,353,299 (€18,978 per patient). Disease-related costs were €4,219,410 (€40,965 per patient), with disease-related pharmacological costs of €2,157,627 (€20,948 per patient).</div></div><div><h3>Conclusion</h3><div>These real-world data highlight the limited outcomes for most NSCLC patients with <em>KRAS</em>G12C mutations, underscoring the significant clinical and economic burden associated with their care. The evaluation of the impact of novel and effective targeted therapies is therefore warranted.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"206 ","pages":"Article 108677"},"PeriodicalIF":4.5,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704121","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":"Icotinib plus chemotherapy as neoadjuvant treatment for resectable stage II-IIIB EGFR-mutant lung adenocarcinoma: a phase II study (NEOIPOWER)","authors":"Fangliang Lu ,&nbsp;Chao Lv ,&nbsp;Xin Yang ,&nbsp;Minglei Zhuo ,&nbsp;Jia Wang ,&nbsp;Hongchao Xiong ,&nbsp;Jinfeng Chen ,&nbsp;Shi Yan ,&nbsp;Yuzhao Wang ,&nbsp;Shanyuan Zhang ,&nbsp;Nan Wu","doi":"10.1016/j.lungcan.2025.108676","DOIUrl":"10.1016/j.lungcan.2025.108676","url":null,"abstract":"<div><h3>Background</h3><div><em>EGFR</em> tyrosine kinase inhibitors (<em>EGFR</em>-TKIs) have shown activity in the neoadjuvant setting of <em>EGFR</em>-mutant (<em>EGFR</em>m) non-small cell lung cancer; however, data on the combination of neoadjuvant <em>EGFR</em>-TKIs plus chemotherapy are limited. This study aimed to evaluate the safety and efficacy of neoadjuvant icotinib plus chemotherapy for stage II-IIIB <em>EGFR</em>m lung adenocarcinoma.</div></div><div><h3>Methods</h3><div>NEOIPOWER is a single-arm, phase II study (NCT05104788). Eligible adult patients with resectable, stage II-IIIB, <em>EGFR</em>m lung adenocarcinoma received 8 weeks of 125 mg icotinib three times daily plus two 21-day cycles of chemotherapy (pemetrexed 500 mg/m² and carboplatin AUC5 on day 1), followed by surgical resection. The primary endpoint was major pathologic response (MPR) rate. Secondary endpoints were R0 resection rate, objective response rate (ORR), pathologic complete response (pCR), disease control rate (DCR), disease-free survival (DFS), overall survival, and safety.</div></div><div><h3>Results</h3><div>From October 25, 2021, to April 2, 2023, 30 patients were enrolled and completed neoadjuvant therapy. MPR was observed in 6.7 % of patients (95% CI, 0.8–22.1%), which did not meet the primary endpoint. No patients had pCR. Twenty-eight (93.3 %) patients underwent surgery, of whom 27 (96.4 %) achieved R0 resection, and pathological downstaging was observed in 10 (35.7 %) patients. The ORR was 83.3 % (95% CI, 65.3–94.4 %) and DCR was 96.7 % (95% CI, 82.8–99.9 %) among 30 treated patients. With a median follow-up of 25.0 (range, 6.4–33.6) months, the median DFS was not reached (95% CI, 25.1-not estimable), and the 2-year DFS rate was 92.0 %. Grade 3 treatment-related adverse events (TRAEs) were reported in 6 (20.0 %) patients and mainly included leukopenia (6.7 %) and neutropenia (6.7 %). No grade 4 or 5 TRAEs were observed, and no deaths occurred.</div></div><div><h3>Conclusion</h3><div>Neoadjuvant icotinib combined with chemotherapy did not meet its primary endpoint for MPR rate in resectable stage II-IIIB <em>EGFR</em>m lung adenocarcinoma, but demonstrated a manageable safety profile.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"206 ","pages":"Article 108676"},"PeriodicalIF":4.5,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704119","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":"Definition of resectable stage III non-small cell lung cancer: A systematic review from EORTC lung cancer group","authors":"E. Xenophontos ,&nbsp;N. Giaj Levra ,&nbsp;V. Durieux ,&nbsp;W.H. van Geffen ,&nbsp;G. Grisay ,&nbsp;C. De la Pinta Alonso ,&nbsp;H. Arasanz ,&nbsp;E. Prisciandaro ,&nbsp;R. Ferrara ,&nbsp;J. Derks ,&nbsp;J. Von der Thusen ,&nbsp;C. Dickhoff ,&nbsp;M. Brandão ,&nbsp;C. Faivre-Finn ,&nbsp;J. Edwards ,&nbsp;D.De Ruysscher ,&nbsp;J. Remon ,&nbsp;A-M.C. Dingemans ,&nbsp;T. Berghmans","doi":"10.1016/j.lungcan.2025.108671","DOIUrl":"10.1016/j.lungcan.2025.108671","url":null,"abstract":"<div><h3>Background</h3><div>Stage III non-small cell lung cancer (NSCLC) is a heterogenous disease requiring a multimodality treatment approach. For resectable stage III NSCLC, treatments incorporating surgery might be beneficial, however, a definition on resectable disease is lacking. The European Organization for the Treatment and Research of Cancer (EORTC) Lung Cancer Group initiative aims to provide a uniform definition of resectable stage III NSCLC. As part of this initiative, we conducted a systematic review to identify definitions on resectability; the medical specialties involved for making the decision and the required work-up aiding the decision.</div></div><div><h3>Methodology</h3><div>Studies were included if they provided data or definitions on resectability in stage III NSCLC and were published in English, Dutch, or French between 2005- 2022.</div></div><div><h3>Results</h3><div>Out of 70 eligible articles, 46 provided tumour characteristics determining resectability. Factors against resection included: N3 or bulky N2 disease and locally invasive tumours. Factors favouring resection included N2-single station involvement and cT3N1. It remained unclear whether N2-multiple station and cT4N0-1 without invasion were defined as resectable. A multidisciplinary board including a thoracic surgeon, a medical (pneumo)oncologist and a radiation oncologist were involved in the decision in 95% of studies. PET-CT was considered standard in 70% and brain MRI/CT in 89% of the studies. A pathological mediastinal nodal confirmation was mandatory in 80% of the studies.</div></div><div><h3>Conclusions</h3><div>This systematic literature review highlights tumour characteristics related to resectability, the specialties responsible for the decision and the most appropriate staging work-up in stage III NSCLC.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"207 ","pages":"Article 108671"},"PeriodicalIF":4.4,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757982","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 impact of lepidic growth in intermediate and high-grade lung adenocarcinoma","authors":"Benedikt Niedermaier ,&nbsp;Erik Rolf ,&nbsp;Michael Allgäuer ,&nbsp;Laura V. Klotz ,&nbsp;Marc A. Schneider ,&nbsp;Kadriya Yuskaeva ,&nbsp;Martin E. Eichhorn ,&nbsp;Hauke Winter","doi":"10.1016/j.lungcan.2025.108674","DOIUrl":"10.1016/j.lungcan.2025.108674","url":null,"abstract":"<div><h3>Background</h3><div>Grade 1 lung adenocarcinomas, which are characterized by predominantly lepidic growth and less than 20 % high-risk patterns, have a favorable survival rate compared to higher-grade tumors. However, the prognostic relevance of lepidic components in intermediate and high-grade tumors (grades 2–3) remains unclear. We investigated whether lepidic growth impacts survival in grade 2–3 stage I lung adenocarcinomas.</div></div><div><h3>Methods</h3><div>479 consecutive patients who underwent curative resection for non-mucinous lung adenocarcinoma in pathologic grade 2–3 and stage I were enrolled in this retrospective, single-center study. The impact of lepidic components and other predictors on survival was assessed in multivariable cox regression.</div></div><div><h3>Results</h3><div>Lepidic growth was present in 300 (62.6 %) tumors. Patients with lepidic-positive tumors were significantly older (median age 67 vs. 65 years, p = 0.015), more frequently never-smokers (22.1 % vs. 9.9 %, p = 0.001), had higher proportions of acinar-predominant (69.0 % vs. 53.1 %, p = 0.001), and fewer solid-predominant tumors (7.0 % vs. 26.8 %, p &lt; 0.001). Median follow-up was 67 months (IQR 47–92). Multivariable Cox analysis demonstrated no significant association between lepidic growth and overall or recurrence-free survival. Factors significantly affecting recurrence-free survival included age ≥ 70 years (HR 1.40, p = 0.046), stage IB (HR 1.52, p = 0.017), grade 3 tumors (HR 1.42, p = 0.040), and lymphatic invasion (HR 1.67, p = 0.011).</div></div><div><h3>Conclusion</h3><div>Lepidic growth did not demonstrate prognostic significance in intermediate and high-grade non-mucinous lung adenocarcinoma in this study.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"206 ","pages":"Article 108674"},"PeriodicalIF":4.5,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698958","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 impact of extracapsular extension of lymph nodes in resected lung cancer: analysis by new N subcategories and histologic types","authors":"Yura Ahn ,&nbsp;Shi A. Kim ,&nbsp;Sang Min Lee ,&nbsp;Bokyung Ahn ,&nbsp;Sehoon Choi ,&nbsp;Kyung-Hyun Do ,&nbsp;Joon Beom Seo","doi":"10.1016/j.lungcan.2025.108673","DOIUrl":"10.1016/j.lungcan.2025.108673","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite being an R1 descriptor, the effects of extracapsular extension (ECE) on survival are inconsistent and remains invalidated under N2 subcategorization (pN2a and pN2b). This study aimed to validate the survival effect of ECE across N subcategories and histologic types.</div></div><div><h3>Materials and methods</h3><div>Patients who underwent lobectomy or pneumonectomy for NSCLC between 2010 and 2022, with proven pN-positive status and Union for International Cancer Control R0 designation, were retrospectively included. Effect of ECE on overall survival (OS) and recurrence-free survival (RFS) was assessed using multivariable Cox proportional hazard models, while that on recurrence patterns (locoregional vs. distant) was assessed using Fine–Gray subdistribution hazard models.</div></div><div><h3>Results</h3><div>Among 1713 patients included, the prevalence of ECE increased with the pN category: 11.6 % in pN1 (87/751), 17.6 % in pN2a (104/581), and 44.6 % in pN2b (170/381). ECE was an independent risk factor for poor OS and RFS in all pN-positive patients, after covariate adjustment (all p &lt; 0.05). Patients with ECE consistently exhibited higher risks of mortality and RFS events compared to their ECE-negative counterparts across pN1, pN2a, and pN2b (all p &lt; 0.05). Upon stratification by histologic type, ECE exhibited negative effects exclusively in adenocarcinoma (all p &lt; 0.05), not in non-adenocarcinoma (all p &gt; 0.05). ECE was an independent risk factor for locoregional recurrence (p = 0.002) but not for distant recurrence (p = 0.090).</div></div><div><h3>Conclusion</h3><div>ECE demonstrated a negative effect across pN1, pN2a, and pN2b, validating its role as an R1 descriptor. The negative effect of ECE exclusively in adenocarcinoma highlights the need to interpret ECE status with respect to histology.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"206 ","pages":"Article 108673"},"PeriodicalIF":4.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690674","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":"Adjuvant therapy in pStage IA1–IIA lung adenocarcinoma (pN0): A multicenter study focusing on EGFR mutations and recurrence patterns (CReGYT-01 EGFR study)","authors":"K. Fujino ,&nbsp;K. Suda ,&nbsp;M. Yoshikawa ,&nbsp;K. Shien ,&nbsp;K. Suzawa ,&nbsp;K. Nomura ,&nbsp;F. Kinoshita ,&nbsp;S. Takamori ,&nbsp;K. Hayasaka ,&nbsp;H. Notsuda ,&nbsp;S. Muto ,&nbsp;S. Katsumata ,&nbsp;M. Shimokawa ,&nbsp;J. Soh ,&nbsp;Y. Ohde ,&nbsp;R. Matsushima ,&nbsp;Y. Shinchi ,&nbsp;Y. Motooka ,&nbsp;H. Saishoji ,&nbsp;T. Koga ,&nbsp;M. Suzuki","doi":"10.1016/j.lungcan.2025.108672","DOIUrl":"10.1016/j.lungcan.2025.108672","url":null,"abstract":"<div><h3>Background</h3><div>Adjuvant treatment strategies based on EGFR mutation status remain unestablished in stage I–II lung adenocarcinoma. Although UFT is an established adjuvant therapy in Japan for resected pathological N0 (pN0) lung adenocarcinoma, its clinical utility according to EGFR mutation status remains unclear. This study aimed to evaluate the efficacy of UFT and recurrence patterns in pStage IA1–IIA disease, with a primary focus on pStage IA3–IIA and the influence of EGFR mutation status.</div></div><div><h3>Methods</h3><div>This multicenter retrospective study included 2,462 patients with pStage IA1–IIA lung adenocarcinoma (TNM 8th edition) who underwent complete resection at 21 institutions in Japan (2015–2018). Propensity score matching was employed to adjust for baseline differences between treatment groups. We evaluated the survival benefit of UFT by EGFR mutation status and analyzed recurrence patterns based on EGFR status and other clinicopathological variables.</div></div><div><h3>Results</h3><div>In the post-PSM cohort (N = 600), UFT significantly improved overall survival (OS) (p = 0.007, HR = 0.546), particularly in EGFR wild-type patients (p &lt; 0.001, HR = 0.403). UFT also prolonged recurrence-free survival (RFS) in EGFR wild-type cases (p = 0.004, HR = 0.604). No OS or RFS benefit was observed in EGFR mutation-positive patients. Subgroup analysis showed that UFT provided significant OS benefit in patients with high-malignancy histological subtypes such as solid/micropapillary (HR = 0.32, 95 % CI: 0.13–0.80). EGFR mutation and lymphovascular invasion were independent predictors of recurrence, with EGFR mutations associated specifically with distant and CNS recurrence.</div></div><div><h3>Conclusions</h3><div>Adjuvant UFT improves OS and RFS in EGFR wild-type pStage IA3–IIA lung adenocarcinoma, particularly in patients with high-risk pathological features. In contrast, UFT is ineffective in EGFR mutation-positive cases, highlighting the need for refined adjuvant treatment strategies tailored to EGFR status and tumor biology in early-stage lung adenocarcinoma with pathological N0 (pN0).</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"206 ","pages":"Article 108672"},"PeriodicalIF":4.5,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704120","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}