Clinical lung cancer最新文献

英文中文

Letter to the Editor: Durvalumab Consolidation in PD-L1 Negative Stage III NSCLC: Real-World Evidence Beyond Regulatory Boundaries 致编辑的信：Durvalumab在PD-L1阴性III期NSCLC中的巩固：超越监管界限的现实证据。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-11-10 DOI: 10.1016/j.cllc.2025.11.008

Pınar Peker

引用次数: 0

Factors Associated With Provider Decision-Making of Early-Stage Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy or Sublobar Resection 早期肺癌患者接受立体定向放射治疗或肺叶下切除术的相关因素

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-11-09 DOI: 10.1016/j.cllc.2025.11.006

Agostina E. Velo , Jeremy Mudd , Christopher G. Slatore , Raja Flores , Scott Swanson , Cardinale B. Smith , Mark Chidel , Kenneth E. Rosenzweig , Jeffrey A. Kern , Juan P. Wisnivesky

Background

Treatment decision-making for early-stage non–small cell lung cancer (NSCLC) in patients who have high-operative risk is complex. Identifying patient factors that influence physicians’ choices between sublobar resection and stereotactic body radiotherapy (SBRT) is important for guiding cancer care.

Methods

In this multicenter prospective study, patients with stage I NSCLC at high surgical risk were treated with either sublobar resection or SBRT. We collected data on demographics, comorbidities, lung function, functional status, and tumor characteristics. Before treatment, the primary physician rated each patient’s candidacy for SBRT versus sublobar resection on a 0 to 100 scale. Linear regression was used to identify factors influencing treatment recommendations.

Results

Among 331 patients, 62% received SBRT. Older age (mean difference [MD] 0.66 per year; 95% confidence interval [CI], 0.18 to 1.14) and chronic obstructive pulmonary disease (MD 9.77; 95% CI, 0.54 to 18.99) were associated with higher likelihood of SBRT candidacy. In contrast, higher forced expiratory volume (MD −0.23 per % increase; 95% CI, −0.42 to −0.04), larger tumor size (MD −4.13 per cm increase; 95% CI, −8.13 to −0.12), and better functional scores (MD −0.99; 95% CI, −1.64 to −0.35) decreased the likelihood of being considered for SBRT.

Conclusions

In patients with early-stage NSCLC with high-operative risk, treatment decisions are influenced by age, comorbidities, lung function, and tumor features. These findings can guide clinicians in evaluating treatment options and support shared decision-making.

背景：高手术风险的早期非小细胞肺癌（NSCLC）患者的治疗决策是复杂的。确定影响医生在叶下切除和立体定向放射治疗（SBRT）之间选择的患者因素对指导癌症治疗具有重要意义。方法：在这项多中心前瞻性研究中，手术风险高的I期NSCLC患者接受叶下切除术或SBRT治疗。我们收集了人口统计学、合并症、肺功能、功能状态和肿瘤特征的数据。治疗前，主治医生对每位患者进行SBRT和叶下切除术的候选性评分，评分范围从0到100。采用线性回归确定影响治疗建议的因素。结果：331例患者中，62%接受了SBRT治疗。年龄较大（平均差异[MD]每年0.66；95%可信区间[CI] 0.18至1.14）和慢性阻塞性肺疾病（MD 9.77； 95%可信区间[CI] 0.54至18.99）与SBRT候选可能性较高相关。相反，较高的用力呼气量（MD增加-0.23 %;95% CI, -0.42至-0.04）、较大的肿瘤大小（MD每厘米增加-4.13;95% CI, -8.13至-0.12）和较好的功能评分（MD -0.99; 95% CI, -1.64至-0.35）降低了考虑进行SBRT的可能性。结论：在手术风险高的早期NSCLC患者中，治疗决策受年龄、合并症、肺功能和肿瘤特征的影响。这些发现可以指导临床医生评估治疗方案并支持共同决策。

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引用次数: 0

Neoadjuvant Chemo-Immunotherapy for Surgically Resectable Non-Small Cell Lung Cancer: Balancing Promise and Pitfalls 手术切除的非小细胞肺癌的新辅助化疗-免疫治疗：平衡希望和缺陷。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-11-08 DOI: 10.1016/j.cllc.2025.11.007

Parth Anil Desai, Hossein Borghaei, Martin J. Edelman

Abstract

Definitive resection has long anchored curative therapy for early–stage and locally advanced non–small cell lung cancer (NSCLC), with adjuvant platinum doublets—and now adjuvant immune–checkpoint inhibitors (ICIs)—providing incremental gains in disease–free survival. Neoadjuvant chemo–immunotherapy may amplify benefit by expanding tumour–specific T–cell clones in situ, thereby addressing occult micrometastatic disease. Randomised trials (CheckMate 816, KEYNOTE–671, AEGEAN, CheckMate 77T) consistently improve event–free survival, pathological response, and in some cases overall survival over neoadjuvant chemotherapy alone. However, none compared directly with the long–standing standard of upfront surgery followed by adjuvant therapy, and 15–24 % of enrolled patients never reach the operating room—most commonly because of radiographic progression (5–8 %) or evolving surgical ineligibility. Consequently, roughly one in five potentially curable patients may lose their window for resection, highlighting a clinically meaningful tradeoff. These findings underscore three priorities: (i) rigorous prospective comparison of perioperative versus purely adjuvant systemic strategies—now underway in the PROSPECT–LUNG trial (NCT06632327); (ii) biomarker discovery to predict primary resistance and identify patients better served by immediate surgery; and (iii) nuanced shared decision–making that balances hoped–for systemic control against the risk of surgical attrition. Realising the full promise of ICIs in resectable NSCLC will require optimising both treatment sequencing and patient selection.

长期以来，决定性切除术一直是早期和局部晚期非小细胞肺癌（NSCLC）的根治性治疗，辅助铂双药和现在的辅助免疫检查点抑制剂（ICIs）提供了无病生存期的增量收益。新辅助化学免疫治疗可以通过原位扩增肿瘤特异性t细胞克隆来扩大益处，从而解决隐匿的微转移性疾病。随机试验（CheckMate 816, KEYNOTE-671， AEGEAN, CheckMate 77T）持续提高无事件生存期，病理反应，在某些情况下，与单独新辅助化疗相比，总生存期。然而，没有直接与长期标准的前期手术后辅助治疗进行比较，15- 24%的入组患者从未进入手术室，最常见的原因是放射学进展（5- 8%）或逐渐不适合手术。因此，大约五分之一的潜在可治愈的患者可能会失去切除的机会，这突出了临床上有意义的权衡。这些发现强调了三个重点：(i)围手术期与纯辅助全身策略的严格前瞻性比较——目前正在进行的PROSPECT-LUNG试验（NCT06632327）；（ii）发现生物标志物，以预测原发性耐药性，并确定最好立即手术治疗的患者；（三）细致入微的共同决策，以平衡所希望的系统控制和手术损耗的风险。实现ICIs在可切除的非小细胞肺癌中的全部前景，将需要优化治疗顺序和患者选择。

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引用次数: 0

Brief Report: Lung Cancer Diagnoses among Lung Cancer Screening Program Participants With Family History of Lung Cancer 简要报告：有肺癌家族史的肺癌筛查项目参与者的肺癌诊断

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-11-07 DOI: 10.1016/j.cllc.2025.11.005

Julia G. Katcher , Christine C. Shusted , Padmanabh Bhatt , Brooke M. Ruane , Jenna Markle , Gregory C. Kane , Kuang-Yi Wen , Hee-Soon Juon , Julie A. Barta

•
Among screening-eligible adults, lung cancer is diagnosed more often in those with family history of lung cancer
•
Patients with family history had higher frequency of stage IV disease
•
Considering family history in risk assessment could improve lung cancer screening strategies

•在符合筛查条件的成年人中，有肺癌家族史的人更常被诊断出肺癌•有家族史的患者患IV期疾病的频率更高•在风险评估中考虑家族史可以改善肺癌筛查策略

引用次数: 0

Letter to the Editor: “Prognostic Implications of Lymph Node Status in Non–Small-Cell Lung Cancer Patients Before and After Neoadjuvant Chemoimmunotherapy: A Multicenter Retrospective Study” 致编辑的信：“新辅助化疗免疫治疗前后非小细胞肺癌患者淋巴结状态对预后的影响：一项多中心回顾性研究”

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-11-07 DOI: 10.1016/j.cllc.2025.11.001

Parth Aphale, Shashank Dokania, Himanshu Shekhar

引用次数: 0

Association Between Lung Volume Reduction and Symptomatic Radiation Pneumonitis in Lung Cancer Patients Undergoing Definitive Concurrent Chemoradiotherapy. 肺癌患者接受明确的同步放化疗时肺体积缩小与症状性放射性肺炎的关系。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-11-05 DOI: 10.1016/j.cllc.2025.10.007

Jeong Won Lee, Sea-Won Lee, Hyeseon Kang, Yun Hee Lee

Purpose: This study assessed lung volume alterations during radiotherapy (RT) and their predictive value for symptomatic radiation pneumonitis (RP) in lung cancer patients undergoing definitive concurrent chemoradiotherapy (CCRT) MATERIALS AND METHODS: This retrospective study included 49 patients who underwent re-simulation four-dimensional (4D) computed tomography (CT) during RT. Lung volume was measured on the 30% phase of 4D CT at initial and re-simulation scans. Associations between volume changes and symptomatic RP were analyzed using the Mann-Whitney U test. To determine the optimal cut-off value, ROC analysis and the Youden index were utilized. RP was graded based on CTCAE v5.0.

Results: Among the 49 patients, seven (14.3%) developed symptomatic RP. Dosimetric parameters did not differ significantly between patients with and without RP. However, changes in ipsilateral lung volume were significantly associated with symptomatic RP. A volume decrease >130 cm³ or a relative reduction <-7% was predictive of RP (P = .001). The area under the ROC curve for absolute change and relative change of ipsilateral lung volume were 0.905 and 0.883, respectively.

Conclusion: Ipsilateral lung volume reduction during RT may serve as an early predictor of symptomatic RP, independent of traditional dosimetric factors. Monitoring volume changes with re-simulation CT could enhance RP risk assessment and guide adaptive RT planning.

目的：本研究评估肺癌患者在放疗（RT）期间肺体积的改变及其对确诊同步放化疗（CCRT）的症状性放射性肺炎（RP）的预测价值。材料和方法：本回顾性研究包括49例患者，他们在放疗期间接受了重新模拟四维计算机断层扫描（CT）。在初次扫描和重新模拟扫描时，在4D CT的30%期测量肺体积。使用Mann-Whitney U检验分析容积变化与症状性RP之间的关系。为了确定最佳临界值，采用ROC分析和约登指数。RP评分基于CTCAE v5.0。结果：49例患者中，7例（14.3%）出现症状性RP。剂量学参数在RP患者和非RP患者之间没有显著差异。然而，同侧肺体积的变化与症状性RP显著相关。结论：放疗期间同侧肺体积缩小可作为症状性RP的早期预测指标，独立于传统剂量学因素。再模拟CT监测体积变化可增强RP风险评估，指导适应性RT计划。

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引用次数: 0

Minimally Invasive Surgery Versus SABR in Stage IA NSCLC: Interpreting Real-World Evidence with Caution 微创手术与SABR治疗IA期非小细胞肺癌：谨慎解读现实证据

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-11-04 DOI: 10.1016/j.cllc.2025.11.002

Asim Armagan Aydin , Erkan Kayikcioglu

引用次数: 0

Germline Mutation Analysis and Real-World Impact in a Selected Cohort of Patients with Non-Small Cell Lung Cancer: INHERITY LC Study. 非小细胞肺癌患者的生殖系突变分析和现实世界的影响：遗传LC研究。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-11-01 DOI: 10.1016/j.cllc.2025.10.012

María Zurera, Juan Carlos Laguna, Laura Mezquita, Oliver Higuera, Sebastián Menao, María Arruebo, Javier Torres Jimenez, Javier de Castro, Dolores Isla, Rodrigo Lastra

Purpose: Hereditary predisposition has not traditionally been considered a significant risk factor for non-small-cell lung cancer (NSCLC), and germline testing is not routinely established. INHERITY LC is a prospective multicenter study designed to explore the prevalence of germline variants in a selected cohort of patients with NSCLC and to assess the clinical impact of germline testing in NSCLC.

Methods: Germline genetic testing was conducted using next-generation sequencing (NGS) using a 72-gene panel. 145 patients with NSCLC who met one of the following criteria were selected: 1) family history of NSCLC; 2) young age and negative/low tobacco exposure; or 3) presence of somatic actionable mutations.

Results: Pathogenic germline variants (PGVs) were identified in 15 patients (10.3%; 95% CI, 5.9-16.3), involving the following genes: BRCA2 (1), CHEK2 (2), ATM (2), PALB2 (1), BARD1 (1), XRCC2 (1), MRE11 (1), NBN (3), FAN1 (1), MLH1 (1), and TP53 (1). A notably higher prevalence of PGVs (22%) was observed among patients who met all three selection criteria. After 1 year of prospective follow-up, cascade testing was performed in PGV-positive families, leading to the identification of 12 healthy relatives carrying PGVs.

Conclusion: The INHERITY LC study identified a PGV prevalence of 10.3% in a selected NSCLC cohort, with most variants affecting genes involved in the DNA damage repair (DDR) pathway. The application of specific selection criteria may enhance the yield of germline testing in this setting. Larger confirmatory studies are warranted to demonstrate that germline testing and genetic counseling for NSCLC may have implications for prevention, early detection, and treatment.

目的：遗传易感性传统上不被认为是非小细胞肺癌（NSCLC）的重要危险因素，生殖系检测也没有常规建立。heritage LC是一项前瞻性多中心研究，旨在探索非小细胞肺癌患者中生殖系变异的患病率，并评估非小细胞肺癌生殖系检测的临床影响。方法：采用新一代测序技术（NGS）对72个基因进行生殖系基因检测。145例符合以下条件之一的非小细胞肺癌患者：1)有非小细胞肺癌家族史；2)年轻和负/低烟草暴露；或3)体细胞可操作突变的存在。结果：在15例患者中鉴定出致病性种系变异（PGVs）（10.3%; 95% CI, 5.9-16.3），涉及以下基因：BRCA2(1)、CHEK2(2)、ATM(2)、PALB2(1)、BARD1(1)、XRCC2(1)、MRE11(1)、NBN(3)、FAN1(1)、MLH1(1)和TP53(1)。在满足所有三个选择标准的患者中观察到明显更高的pgv患病率（22%）。经过1年的前瞻性随访，对pgv阳性家庭进行级联检测，鉴定出12名携带pgv的健康亲属。结论：heritage LC研究发现，在选定的NSCLC队列中，PGV患病率为10.3%，其中大多数变异影响DNA损伤修复（DDR）途径相关基因。在这种情况下，应用特定的选择标准可以提高种系检测的产量。更大规模的确证性研究证明，非小细胞肺癌的生殖系检测和遗传咨询可能对预防、早期发现和治疗有意义。

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引用次数: 0

Germline Variants in Indian Non-Small Cell Lung Cancer Patients With Familial Aggregation: A Prospective Cohort Study 印度非小细胞肺癌患者的生殖系变异与家族聚集：一项前瞻性队列研究

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-10-27 DOI: 10.1016/j.cllc.2025.10.020

Aayushi Agrawal , Sindhura Durga Chitikela , Abhay Rastogi , Sachin Khurana , Deepam Pushpam , Raja Pramanik , Akash Kumar , Aparna Sharma , Monika Chettri , Ishaan Gupta , Amber Rathore , Deepali Jain , Sachin Kumar , Prabhat Singh Malik

Background

While smoking is a principal risk factor for lung cancer, the steadily increasing incidence in never smokers is underscoring the impact of additional factors, such as genetic predisposition. The presence of pathogenic or likely pathogenic germline variants in cancer predisposition genes has been recognized as a contributing factor to lung cancer, suggesting that familial aggregation is a pertinent criterion for genetic testing. This study attempts to identify the prevalence of Pathogenic germline variants (PGVs) in Indian lung cancer patients with familial aggregation.

Methods

Patients with non-small cell lung cancer (NSCLC) were screened for significant family history and they underwent genetic testing. Germline DNA from blood samples was analyzed using a next-generation sequencing panel of 143 cancer predisposition genes. The clinical, pathological, demographic, and survival data of patients with positive family history and PGVs were analyzed.

Results

A total of 750 patients were screened, with 137 (18.26%) identified as having a significant family history, and a median age of 60 years (range: 21-79 years). Of these, 103 patients underwent next-generation sequencing (NGS), revealing pathogenic or likely pathogenic alterations in 17 individuals. These 17 patients exhibited mutations across 12 genes, 10 of which were associated with DNA damage repair pathways. Most commonly mutated genes were ATM and BRCA2. One unaffected first-degree relative (FDR) from 12 of these 17 patient’s family were tested, and 8 such FDRs were found to carry the same mutation as that of the index patient.

Conclusion

In this study we report the frequency of pathogenic/likely pathogenic (P/LP) germline variants in Indian patients with NSCLC with significant family history of cancer to be 16.5%. It suggests the potential utility of genetic testing to guide targeted screening strategies in this high-risk population.

虽然吸烟是肺癌的主要危险因素，但从不吸烟者中发病率的稳步上升强调了其他因素的影响，如遗传易感性。癌症易感基因中存在致病性或可能致病性的生殖系变异已被认为是肺癌的一个促成因素，这表明家族聚集是基因检测的一个相关标准。本研究试图确定致病性种系变异（PGVs）在印度肺癌家族聚集患者中的患病率。方法筛选非小细胞肺癌（NSCLC）患者的显著家族史，并进行基因检测。来自血液样本的生殖系DNA使用新一代测序小组对143个癌症易感基因进行了分析。分析阳性家族史和pgv患者的临床、病理、人口学和生存资料。结果共筛查750例患者，其中有明显家族史的137例（18.26%），中位年龄为60岁（范围：21-79岁）。其中，103名患者进行了下一代测序（NGS），在17名患者中发现了致病性或可能致病性的改变。这17名患者表现出12个基因的突变，其中10个与DNA损伤修复途径相关。最常见的突变基因是ATM和BRCA2。对这17例患者家族中12例的1例未受影响的一级亲属（FDR）进行了检测，发现8例此类FDR携带与该例患者相同的突变。结论在本研究中，我们报道了印度有明显癌症家族史的非小细胞肺癌患者中致病/可能致病（P/LP）种系变异的频率为16.5%。这表明，基因检测的潜在效用，以指导有针对性的筛选策略，在这一高危人群。

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引用次数: 0

Re: “Re-biopsy Feasibility and Clinical Impact on Metastatic Non-Small-Cell Lung Cancer with EGFR/ALK/ROS Oncogenic Driver Progression after Optimal Targeted Therapy: A Multicenter Real-World Analysis” 再活检的可行性和临床影响转移性非小细胞肺癌与EGFR/ALK/ROS癌源性进展后的最佳靶向治疗：多中心真实世界分析

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-10-26 DOI: 10.1016/j.cllc.2025.10.017

Mehmet Mutlu Çatlı, Arif Hakan Önder

引用次数: 0

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