I期非小细胞肺癌术前循环肿瘤DNA检测、叶下切除与复发风险的关系

IF 7.6 1区医学 Q1 ONCOLOGY

European Journal of Cancer Pub Date : 2025-01-13 DOI:10.1016/j.ejca.2025.115237

Tae Hee Hong , Soohyun Hwang , Chris Abbosh , Abhijit Dasgupta , Yeong Jeong Jeon , Junghee Lee , Seong Yong Park , Jong Ho Cho , Yong Soo Choi , Young Mog Shim , Tiffany Hung , Jörg Bredno , Darren Hodgson , Myung-Ju Ahn , Hong Kwan Kim

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引用次数: 0

摘要

背景：叶下切除术越来越被认为是早期非小细胞肺癌的有效治疗方法。然而，迄今为止还没有研究调查了术前ctDNA检测在指导I期NSCLC手术决策（如选择叶下切除术）中的潜在作用。方法：2014年3月至2020年12月，前瞻性招募临床I期非小细胞肺癌（CTR >.5）患者。术前血浆样本分析使用tumor-naïve，甲基化为基础的无细胞DNA测定。根据术前ctDNA状态评估叶下切除术与肺叶切除术对无复发生存率（RFS）的影响。术前ctDNA检测与临床病理因素之间的关系也进行了研究。结果：共纳入544例患者，其中女性178例[33 %]；中位年龄66岁[IQR， 60-71]岁]。188例（35% %）患者术前检测到ctDNA。在术前没有ctDNA的患者中，叶下切除术并没有显著增加复发的风险（校正HR， 1.01, p = 0.98）。然而，在ctdna阳性的患者中，叶下切除术与复发风险增加相关(调整后HR， 2.25；95 % ci, 1.12-4.54； = 0.024页)。术前ctDNA患者有较高的淋巴结分期率(OR, 3.58；p 结论：术前tumor-naïve ctDNA分析有望识别可能无法通过叶下切除术充分治疗的侵袭性肿瘤患者。这种方法可以帮助个性化治疗策略，潜在地改善早期非小细胞肺癌患者的预后。

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Association of pre-surgical circulating tumor DNA detection, use of sublobar resection with risk of recurrence in stage I non-small cell lung cancer

Background

Sublobar resection is increasingly recognized as an effective treatment for early-stage NSCLC. However, no studies to date have investigated the potential role of preoperative ctDNA detection in guiding surgical decisions, such as opting for sublobar resection, in stage I NSCLC.

Methods

Patients with solid-dominant (CTR>0.5), clinical stage I NSCLC were prospectively recruited between March 2014 and December 2020. Pre-surgical plasma samples were analyzed using a tumor-naïve, methylation-based cell-free DNA assay. The impact of sublobar resection versus lobectomy on recurrence-free survival (RFS) was assessed according to pre-surgical ctDNA status. Associations between pre-surgical ctDNA detection and clinicopathologic factors were also investigated.

Results

The analysis included 544 patients (178 women [33 %]; median age 66 [IQR, 60–71] years). Pre-surgical ctDNA was detected in 188 (35 %) patients. In patients without presurgical ctDNA, sublobar resection did not significantly increase the risk of relapse (adjusted HR, 1.01, p = 0.98). However, among ctDNA-positive patients, sublobar resection was associated with an increased risk of relapse (adjusted HR, 2.25; 95 % CI, 1.12–4.54; p = 0.024). Patients with presurgical ctDNA had higher rates of nodal upstaging (OR, 3.58; p < 0.001) and exhibited higher pathologic grade (p = 0.021), perineural invasion (p < 0.001), and lymphovascular invasion (p < 0.001).

Conclusions

Pre-surgical tumor-naïve ctDNA analysis holds promise in identifying patients with aggressive tumors that may not be sufficiently managed with sublobar resection. This approach can help personalize treatment strategies, potentially improving outcomes for patients with early-stage NSCLC.

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来源期刊

European Journal of Cancer 医学-肿瘤学

CiteScore

11.50

自引率

4.80%

发文量

953

审稿时长

23 days

期刊介绍： The European Journal of Cancer (EJC) serves as a comprehensive platform integrating preclinical, digital, translational, and clinical research across the spectrum of cancer. From epidemiology, carcinogenesis, and biology to groundbreaking innovations in cancer treatment and patient care, the journal covers a wide array of topics. We publish original research, reviews, previews, editorial comments, and correspondence, fostering dialogue and advancement in the fight against cancer. Join us in our mission to drive progress and improve outcomes in cancer research and patient care.