Clinical lung cancer最新文献

Background: The prognosis of stage I non-small cell lung cancer (NSCLC) remains significant heterogeneity. It is not clear whether adjuvant epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy can reduce recurrence and improve survival in patients with stage I disease, especially stage IA.

Methods: This retrospective, single-center, observational, propensity score-matched study enrolled patients with completely resected pathological stage I invasive lung adenocarcinoma (LUAD) with sensitive EGFR mutations. Inverse probability of treatment weighting (IPTW) was applied to address the imbalance in baseline characteristics. The primary endpoint was relapse-free survival (RFS), and the secondary endpoint was overall survival (OS). RFS and OS were calculated using the Kaplan-Meier method, and the log-rank test was used to compare differences between the two groups. The hazard ratio (HR) and 95% confidence interval (CI) were calculated using Cox regression. Stratified analysis was performed according to the risk of recurrence determined by tumor characteristics and surgical procedure.

Results: A total of 819 eligible patients were included in the study. After IPTW, 823 patients were included in the analysis, of which 183 (22.2%) patients were in the EGKF-TKI group and 640 (77.8%) patients were in the observation group. In patients with stage I disease, the 5-year RFS was 92.6% in the EGFR-TKI group, compared with 77.0% in the observation group (HR = 0.26; 95% CI, 0.15-0.46; P < .001). Superior RFS was observed with adjuvant EGFR-TKI therapy in most predefined subgroups. There was no significant difference in OS between the two groups for patients with stage I, stage IA, or stage IB disease.

Conclusions: Our study demonstrates that adjuvant EGFR-TKI therapy improves RFS in patients with stage IA and IB invasive LUAD, but the difference in OS is not statistically significant.

Purpose/objectives: While stereotactic body radiation therapy (SBRT) or hypofractionated radiation therapy (HFRT) is routinely used to treat inoperable early-stage non-small lung cancer (esNSCLC) patients with peripheral tumors, SBRT or HFRT for central (cenT) and ultracentral tumors (UCT) remains controversial. To treat patients with tumors located within 0-2 cm of critical mediastinal structures (CMSTs), we employ an institution specific hypofractionated radiation regimen (isHFRT) with a biologically effective dose (BED) of 98.59 using 17 fractions to a dose of 6987 cGy.

Methods: We conducted a single-institution retrospective review of patients with esNSCLC treated with this isHFRT between 2011 and 2020, evaluating both tumor control rates and rates of treatment related toxicity.

Results: Of the 31 patients evaluated, 61.3% of patients had UCTs while 38.7% had cenTs. At 1- and 3 years, local control (LC) was noted to be 93.5% and 86.8% respectively. 1-year overall survival (OS) was 74.2% for all comers, 75.0% for patients with cenTs and 73.7% for patients with UCTs (p = 0.70). 3-year OS was 20.8%. Only 22.6% of patients who expired at 1-year experienced disease progression. At 12 months, adverse event free survival (AEFS) was 67.7%. While 25.8% (n = 8) of patients experienced a Grade 2 (G2) or greater toxicity, no patient experienced a G2 or greater cardiotoxicity. Only 1 patient (3.3%) experienced a Grade 5 toxicity (fatal hemoptysis 12-months following treatment). Review of the case demonstrated that the maximum tracheobronchial tree dose had been exceeded.

Conclusions: Our isHFRT for patients with esNSCLC proves a safe and effective treatment for medically inoperable esNSCLC patients with cenTs and UCTs with comparable rates of toxicity when compared to prior studies.

Next-Generation Sequencing (NGS) has an increasing role in patients with advanced non-small-cell lung cancer (aNSCLC) and, in parallel, the use of targeted therapy dramatically improves the outcome of those with actionable alterations. In this scenario, the possible prognostic significance of some features provided by NGS testing and, among these, of Variant Allele Frequency (VAF), is still unclear. Herein, we report a real-world single-center prospective cohort of 88 consecutive patients with aNSCLC profiled by NGS and harboring a classic EGFR mutation, who were treated with the standard first-line tyrosine kinase inhibitor osimertinib. A subset of patients with shorter progression-free survival (PFS) was characterized by extremely high VAF/tumor cellularity, >1.7 adjusted VAF (aVAF). Median PFS was 5.3 months shorter in the high aVAF cohort; a similar trend was observed in overall survival too. No significant association between aVAF and TP53 mutations, Tumor Mutational Burden or other clinical, pathological or molecular features was found. Our findings suggest that NGS could improve the traditional binary classification of EGFR mutations in aNSCLC, highlighting a correlation between high EGFR mutations aVAF and worse outcome.

Background: Small cell lung cancer (SCLC) represents approximately 10%-15% of all lung cancer cases in the United States. The extent of surgery for early-stage SCLC remains controversial,with the treatment standard being chemotherapy or chemoradiotherapy. We aim to evaluate outcomes among the patients who underwent a lobectomy or segmentectomy in SCLC diagnosed on the day of resection.

Methods: This retrospective cohort study utilized the NCDB. We examined patients >18 who underwent a lobectomy or segmentectomy between 2010 and 2019 who had clinically node negative SCLC diagnosed at the time of resection. Outcome variables include 5- year, 30-day, 90-day mortality and readmission rates. Propensity score matching was utilized to compare outcomes between groups.

Results: 564 patients were examined, with a mean age of 68. Males comprised of 42.9% of the cohort. 65 (12%) patients underwent segmentectomy and 499 (88%) patients underwent lobectomy. There were no differences in nodal upstaging (P = .31) and T stage upstaging (P = .37) between the 2 cohorts. 90.2% of the population was clinical stage I (P = .003). There were no significant differences in 5- year, 30-day, 90-day mortality (P = .22, P = .40, P = .77), and readmission (P = .57) in this cohort. After PSM (n = 118) there continued to be no significant difference in all outcomes between cohorts.

Conclusions: In this study, we found that rates of T and N upstaging, 5-year mortality, and short-term outcomes did not differ amongst cohorts, showing that patients who undergo segmentectomy may not benefit from undergoing a more extensive resection.