Lung Cancer最新文献_第3页

Genomic landscape of stage 0–IA lung adenocarcinoma identified by on-site reflex targeted NGS 通过现场反射靶向NGS鉴定0-IA期肺腺癌的基因组图谱

IF 4.4 2区医学 Q1 ONCOLOGY

Lung Cancer

Pub Date : 2026-01-29 DOI: 10.1016/j.lungcan.2026.108943

Marius Ilié , Simon Heeke , Guylène Rignol , Radu Pirlog , Samantha Goffinet , Elodie Long-Mira , Sandra Lassalle , Virginie Lespinet-Fabre , Olivier Bordone , Virginie Tanga , Caroline Lacoux , Christelle Bonnetaud , Jonathan Benzaquen , Jacques Boutros , Charlotte Cohen , Abel Gomez-Caro , Charles Hugo Marquette , Jean-Philippe Berthet , Véronique Hofman , Paul Hofman

Introduction

Early molecular profiling in non-squamous non-small cell lung carcinoma (NSCLC), particularly lung adenocarcinoma (LUAD), is critical for guiding individualized treatment strategies. Limited data exist on the genomic landscape of Stage 0–IA LUAD. This study assessed the feasibility and clinical relevance of reflex targeted next-generation sequencing (NGS) performed on-site at diagnosis in resected early-stage LUAD.

Methods

We retrospectively analyzed 239 consecutive Stage 0–IA LUAD cases diagnosed between 2022 and 2024 at a single institution. Ultra-fast reflex DNA- and RNA-based NGS was performed on resected specimens using a 50-gene targeted panel. Alterations were classified according to the ESMO Scale for Clinical Actionability of Molecular Targets (ESCAT). Associations between genomic alterations, histologic subtypes, and tumor grades were evaluated.

Results

Stage IA1 was the most frequent diagnosis (46%). High-quality sequencing data were obtained in all cases, with a median turnaround time of 102 h. At least one genomic alteration was detected in 80% of tumors. KRAS mutations were most frequent (35.8%), including KRAS G12C in 16%. EGFR mutations were present in 27.2%, primarily classical sensitizing alterations. Other actionable findings included ALK fusions (3.3%), RET rearrangements (1.2%), MET exon 14 skipping (2.4%), HER2 mutations (3.7%), and BRAF V600E (0.8%). ESCAT Level I alterations were found in 34% of tumors; 20% of these co-occurred with TP53 mutations. Significant associations were observed between genomic alterations, histologic subtypes, and tumor grades.

Conclusions

Reflex NGS at diagnosis in resected Stage 0–IA LUAD is feasible, rapid, and reveals a high rate of actionable alterations, which may support its integration in the future into early-stage diagnostic workflows.

非鳞状非小细胞肺癌（NSCLC），特别是肺腺癌（LUAD）的早期分子谱分析对于指导个体化治疗策略至关重要。关于0-IA期LUAD的基因组图谱数据有限。本研究评估了在切除的早期LUAD诊断现场进行反射靶向下一代测序（NGS）的可行性和临床相关性。方法回顾性分析同一医院于2022年至2024年间诊断的239例连续0-IA期LUAD病例。采用50个基因靶向面板对切除标本进行超快速反射DNA和基于rna的NGS。根据ESMO分子靶点临床可操作性量表（ESCAT）对改变进行分类。评估了基因组改变、组织学亚型和肿瘤分级之间的关系。结果IA1期诊断最多（46%）。所有病例均获得了高质量的测序数据，平均周转时间为102小时。在80%的肿瘤中检测到至少一种基因组改变。KRAS突变发生率最高（35.8%），其中KRAS G12C突变发生率为16%。27.2%的患者发生EGFR突变，主要是经典的致敏性改变。其他可操作的发现包括ALK融合（3.3%），RET重排（1.2%），MET外显子14跳变（2.4%），HER2突变（3.7%）和BRAF V600E（0.8%）。在34%的肿瘤中发现ESCAT I级改变；其中20%与TP53突变同时发生。在基因组改变、组织学亚型和肿瘤分级之间观察到显著的关联。结论反射性NGS在诊断切除的0-IA期LUAD时是可行的，快速的，并且显示了高可操作的改变率，这可能支持其在未来整合到早期诊断工作流程中。

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引用次数: 0

Prognostic value of baseline 18F-FDG PET/CT metabolic parameters combined with clinical and pathological features in surgically resected ALK-positive non-small cell lung cancer 18F-FDG PET/CT代谢参数基线结合alk阳性非小细胞肺癌手术切除的临床和病理特征的预后价值

IF 4.4 2区医学 Q1 ONCOLOGY

Lung Cancer

Pub Date : 2026-01-29 DOI: 10.1016/j.lungcan.2026.108948

You Cheng , Jian-jiang Huang , Hao-yu Zhu , Dan Shao , Hu-bing Wu

Objective

To investigate the prognostic value of baseline ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET metabolic parameters, along with clinical and pathological characteristics, in predicting postoperative outcomes in patients with ALK-positive non-small cell lung cancer (NSCLC).

Methods

A retrospective analysis was conducted on patients at our institution with pathologically confirmed ALK-positive NSCLC. Baseline PET metabolic parameters, clinical characteristics, and pathological features were examined. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff values for all parameters. Survival analyses, including Kaplan–Meier curves, the log-rank test, and Cox proportional hazards regression, were employed to assess disease-free survival (DFS) and identify independent prognostic indicators.

Results

The analysis included 78 participants with a median follow-up time of 38.5 months (95% CI: 28.4 – 48.6). The median DFS was 72.8 months (95% CI: 44.7 – 100.8). Univariate analysis revealed significant associations between DFS and several clinical (T stage, overall clinical stage, and CYFRA21-1), PET (SUVmax, SUVmean, SUVpeak, TLG, and MTV), and pathological (Ki-67 index, tumor spread through air spaces [STAS], and pleural invasion) factors (p < 0.05, for all). Multivariate Cox regression analysis identified the following independent predictors of DFS: SUVmax (HR = 16.152, p = 0.002), STAS (HR = 6.122, p = 0.040), T stage (HR = 2.588, p = 0.049), and preoperative CYFRA21-1(HR = 6.509, p = 0.028).

Conclusion

The assessment of ¹⁸F-FDG PET metabolic parameters, pathological factors, and clinical characteristics provides independent prognostic information for postoperative outcomes in patients with ALK-positive NSCLC. These findings may help inform postoperative adjuvant treatment strategies.

目的：探讨基线18f -氟脱氧葡萄糖（18F-FDG） PET代谢参数以及临床和病理特征对alk阳性非小细胞肺癌（NSCLC）患者术后预后的预测价值。方法：回顾性分析我院病理证实的alk阳性非小细胞肺癌患者。检查基线PET代谢参数、临床特征和病理特征。进行受试者工作特征（ROC）曲线分析，确定各参数的最佳截止值。生存分析，包括Kaplan-Meier曲线、log-rank检验和Cox比例风险回归，用于评估无病生存（DFS）和确定独立预后指标。结果：分析包括78名参与者，中位随访时间为38.5个月（95% CI: 28.4 - 48.6）。中位DFS为72.8个月（95% CI: 44.7 - 100.8）。单因素分析显示，DFS与多个临床（T分期、总临床分期、CYFRA21-1）、PET （SUVmax、SUVmean、SUVpeak、TLG、MTV）和病理（Ki-67指数、肿瘤通过气腔扩散[STAS]、胸膜浸润）因素存在显著相关性(p)。18F-FDG PET代谢参数、病理因素和临床特征的评估为alk阳性NSCLC患者术后结局提供了独立的预后信息。这些发现可能有助于为术后辅助治疗策略提供信息。

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引用次数: 0

Combination therapy with lorlatinib and mitogen-activated protein kinase pathway inhibition in previously treated ALK- or ROS1-rearranged lung cancer lorlatinib联合抑制丝裂原活化蛋白激酶途径治疗先前治疗的ALK-或ros1重排肺癌。

IF 4.4 2区医学 Q1 ONCOLOGY

Lung Cancer

Pub Date : 2026-01-27 DOI: 10.1016/j.lungcan.2026.108945

Jaime L. Schneider , Alona Muzikansky , Elizabeth Krueger , Justin F. Gainor , Jessica J. Lin , Susan Symes , Alice T. Shaw , Ibiayi Dagogo-Jack

Background

Anaplastic lymphoma kinase (ALK) or ROS proto-oncogene 1 (ROS1) rearranged non-small cell lung cancers (NSCLC) develop bypass resistance mechanisms that activate mitogen-activated protein kinase (MAPK) pathway signaling. We conducted a study to evaluate the ALK/ROS1 inhibitor lorlatinib combined with MAPK pathway inhibitors: binimetinib (MEK inhibitor) or TNO155 (SHP2 inhibitor).

Patients and methods

This phase IB study employed a 3 + 3 design. Patients who had disease progression on ALK or ROS1 inhibitors received lorlatinib (50 mg or 75 mg daily) with binimetinib (30 mg or 45 mg BID) or TNO155 (40 mg or 50 mg daily). The primary objective of phase 1 was determining the recommended phase 2 dose for the combinations. The primary objective of the phase 2 portion was determining the objective response rate (ORR) of each combination. Secondary endpoints included safety and tolerability and progression-free survival.

Results

In this phase IB clinical trial, 17 patients received lorlatinib and binimetinib; two patients received lorlatinib with TNO155. All patients with ALK + NSCLC had received prior lorlatinib. Among 15 evaluable patients in the lorlatinib-binimetinib cohort, one (6.7%) had a partial response (duration of response: 114 days), eight (53.3%) had stable disease, and six (40%) experienced primary progression. Median progression-free survival on lorlatinib-binimetinib was 51 days (95% CI 39–107). Treatment-related adverse events associated with lorlatinib-binimetinib were primarily grade 1–2, including rash (65%), edema (47%), and lipid abnormalities (47%). One patient discontinued treatment for grade 2 retinopathy. In the lorlatinib-TNO155 arm, both patients stopped treatment due to rapid disease progression and pleural effusions, limiting efficacy evaluation. The study was terminated due to slow accrual before advancing to the phase 2 component.

Conclusions

Regimens co-targeting the MAPK pathway and ALK or ROS1 had limited efficacy in unselected patients with lorlatinib-resistant NSCLC, underscoring the need for more effective and biomarker-informed treatment strategies.

背景：间变性淋巴瘤激酶（ALK）或ROS原癌基因1 （ROS1）重排的非小细胞肺癌（NSCLC）发展旁路耐药机制，激活丝裂原活化蛋白激酶（MAPK）信号通路。我们进行了一项研究，评估ALK/ROS1抑制剂lorlatinib联合MAPK途径抑制剂：binimetinib （MEK抑制剂）或TNO155 （SHP2抑制剂）。患者和方法：该IB期研究采用3 + 3设计。ALK或ROS1抑制剂有疾病进展的患者接受lorlatinib （50mg或75mg /天）联合binimetinib （30mg或45mg BID）或TNO155 （40mg或50mg /天）治疗。第一阶段的主要目标是确定联合治疗的推荐第二阶段剂量。2期部分的主要目标是确定每种组合的客观缓解率（ORR）。次要终点包括安全性、耐受性和无进展生存期。结果：在这项IB期临床试验中，17例患者接受了lorlatinib和binimetinib；2例患者联合TNO155接受氯拉替尼治疗。所有ALK + NSCLC患者先前均接受过氯拉替尼治疗。在lorlatinib-binimetinib队列中的15例可评估患者中，1例（6.7%）有部分缓解（缓解持续时间：114天），8例（53.3%）病情稳定，6例（40%）出现原发性进展。lorlatinib-binimetinib的中位无进展生存期为51天（95% CI 39-107）。与lorlatinib-binimetinib相关的治疗相关不良事件主要为1-2级，包括皮疹（65%）、水肿（47%）和脂质异常（47%）。1例患者因2级视网膜病变停止治疗。在lorlatinib-TNO155组中，两名患者因疾病快速进展和胸腔积液而停止治疗，限制了疗效评估。该研究在进入第二阶段前因累积缓慢而终止。结论：联合靶向MAPK途径和ALK或ROS1的方案在未选择的lorlatinib耐药NSCLC患者中疗效有限，强调需要更有效和生物标志物信息的治疗策略。

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引用次数: 0

Immune-inflammatory predictors of early and brain recurrence in young patients with resected non-small cell lung cancer 非小细胞肺癌切除术后年轻患者早期和脑复发的免疫炎症预测因子

IF 4.4 2区医学 Q1 ONCOLOGY

Lung Cancer

Pub Date : 2026-01-26 DOI: 10.1016/j.lungcan.2026.108946

Debora Brascia , Giuseppe Mangiameli , Maria Teresa Congedo , Maria Giovanna Mastromarino , Chiara Catelli , Marco Schiavon , Veronica Giudici , Alessia Senatore , Alessandro Bonis , Marco Lucchi , Luca Luzzi , Stefano Magaritora , Federico Rea , Giuseppe Marulli

Objectives

Non–small-cell lung cancer (NSCLC) diagnosed before the age of 50 is uncommon and remains poorly characterized from a prognostic perspective. This study aimed to identify clinical, pathological, and inflammatory–immune predictors of recurrence, early recurrence, and brain metastasis after curative resection in young patients.

Methods

This multicenter retrospective study included 224 consecutive patients aged <50 years who underwent anatomical lung resection between 2015 and 2024 at five Italian centers. Recurrence-free survival (RFS) was analyzed using Fine–Gray competing-risk regression and overall survival (OS) using Cox proportional hazards models. Early recurrence was defined as occurring within 12 months after surgery. The prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR), PD-L1 expression, and their combined phenotypes was explored. An exploratory ROC-derived NLR cut-off of 2.35 was used for stratification.

Results

During follow-up, 65 patients (29.0%) experienced recurrence, with brain metastases representing the most frequent distant site (10.3% overall). Early recurrence occurred in 11.6% of patients. On multivariable analysis, higher NLR independently predicted recurrence (sHR 1.37, 95% CI 1.09–1.73), mortality (HR 1.82, 95% CI 1.27–2.61), and early recurrence (OR 3.61, 95% CI 1.07–12.21). PD-L1 expression alone was not prognostic; however, when combined with NLR, it identified inflammatory–immunologic phenotypes with different risks of brain metastasis among patients who recurred (p = 0.051).

Conclusions

Young-onset NSCLC is characterized by a high burden of early and distant recurrence, particularly involving the brain. Preoperative NLR is a robust predictor of recurrence, early relapse, and mortality. Combined NLR–PD-L1 phenotypes identify a subgroup at increased risk of neurotropic relapse.

目的：50岁前诊断的非小细胞肺癌（NSCLC）并不常见，从预后的角度来看，其特征仍然很差。本研究旨在确定年轻患者治愈性切除后复发、早期复发和脑转移的临床、病理和炎症免疫预测因素。方法本多中心回顾性研究纳入了224例年龄50岁的连续患者，这些患者于2015年至2024年在意大利5个中心接受了解剖性肺切除术。采用Fine-Gray竞争风险回归分析无复发生存期（RFS），采用Cox比例风险模型分析总生存期（OS）。早期复发定义为术后12个月内发生。探讨术前中性粒细胞与淋巴细胞比值（NLR）、PD-L1表达及其联合表型的预后价值。采用roc衍生的探索性NLR截止值为2.35进行分层。结果随访期间，65例患者（29.0%）出现复发，其中脑转移是最常见的远端部位（10.3%）。11.6%的患者出现早期复发。在多变量分析中，较高的NLR独立预测了复发（sHR 1.37, 95% CI 1.09-1.73）、死亡率（HR 1.82, 95% CI 1.27-2.61）和早期复发（OR 3.61, 95% CI 1.07-12.21）。单独的PD-L1表达不影响预后；然而，当联合NLR时，它确定了复发患者中具有不同脑转移风险的炎症免疫表型（p = 0.051）。结论年轻发病的非小细胞肺癌的特点是早期和远处复发的负担高，特别是累及大脑。术前NLR是复发、早期复发和死亡率的可靠预测指标。联合NLR-PD-L1表型确定了嗜神经性复发风险增加的亚组。

{"title":"Immune-inflammatory predictors of early and brain recurrence in young patients with resected non-small cell lung cancer","authors":"Debora Brascia , Giuseppe Mangiameli , Maria Teresa Congedo , Maria Giovanna Mastromarino , Chiara Catelli , Marco Schiavon , Veronica Giudici , Alessia Senatore , Alessandro Bonis , Marco Lucchi , Luca Luzzi , Stefano Magaritora , Federico Rea , Giuseppe Marulli","doi":"10.1016/j.lungcan.2026.108946","DOIUrl":"10.1016/j.lungcan.2026.108946","url":null,"abstract":"<div><h3>Objectives</h3><div>Non–small-cell lung cancer (NSCLC) diagnosed before the age of 50 is uncommon and remains poorly characterized from a prognostic perspective. This study aimed to identify clinical, pathological, and inflammatory–immune predictors of recurrence, early recurrence, and brain metastasis after curative resection in young patients.</div></div><div><h3>Methods</h3><div>This multicenter retrospective study included 224 consecutive patients aged <50 years who underwent anatomical lung resection between 2015 and 2024 at five Italian centers. Recurrence-free survival (RFS) was analyzed using Fine–Gray competing-risk regression and overall survival (OS) using Cox proportional hazards models. Early recurrence was defined as occurring within 12 months after surgery. The prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR), PD-L1 expression, and their combined phenotypes was explored. An exploratory ROC-derived NLR cut-off of 2.35 was used for stratification.</div></div><div><h3>Results</h3><div>During follow-up, 65 patients (29.0%) experienced recurrence, with brain metastases representing the most frequent distant site (10.3% overall). Early recurrence occurred in 11.6% of patients. On multivariable analysis, higher NLR independently predicted recurrence (sHR 1.37, 95% CI 1.09–1.73), mortality (HR 1.82, 95% CI 1.27–2.61), and early recurrence (OR 3.61, 95% CI 1.07–12.21). PD-L1 expression alone was not prognostic; however, when combined with NLR, it identified inflammatory–immunologic phenotypes with different risks of brain metastasis among patients who recurred (p = 0.051).</div></div><div><h3>Conclusions</h3><div>Young-onset NSCLC is characterized by a high burden of early and distant recurrence, particularly involving the brain. Preoperative NLR is a robust predictor of recurrence, early relapse, and mortality. Combined NLR–PD-L1 phenotypes identify a subgroup at increased risk of neurotropic relapse.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"213 ","pages":"Article 108946"},"PeriodicalIF":4.4,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078924","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}

引用次数: 0

Response to the letter of Peng Bai and Jun Zhang on Cost-effectiveness of Adjuvant Alectinib in ALK-positive NSCLC—Considerations for Broader Applicability 对白鹏、张军关于alk阳性nsclc中佐剂Alectinib的成本-效果的回复——对更广泛适用性的考虑

IF 4.4 2区医学 Q1 ONCOLOGY

Lung Cancer

Pub Date : 2026-01-26 DOI: 10.1016/j.lungcan.2026.108944

Romain Supiot , Léopoldine du Manoir de Juaye , Christos Chouaid

引用次数: 0

Immunotherapy in uncommon EGFR-mutant NSCLC: Revisiting a therapeutic gray zone 罕见egfr突变NSCLC的免疫治疗：重新审视治疗的灰色地带

IF 4.4 2区医学 Q1 ONCOLOGY

Lung Cancer

Pub Date : 2026-01-26 DOI: 10.1016/j.lungcan.2026.108938

Jun Hyeok Lim, Woo Kyung Ryu, Jeong-Seon Ryu

引用次数: 0

Real-world occurrence of severe gastrointestinal bleeding in patients receiving amivantamab plus lazertinib: A two-case series among 25 consecutive cases 阿米万他单加拉泽替尼治疗的患者实际发生的严重胃肠道出血：25例连续病例中的2例系列。

IF 4.4 2区医学 Q1 ONCOLOGY

Lung Cancer

Pub Date : 2026-01-25 DOI: 10.1016/j.lungcan.2026.108947

Kosuke Hashimoto, Masakazu Takahara, Reina Ishii, Tatsuhiko Uno, Ou Yamaguchi, Atsuto Mouri, Hisao Imai, Hiroshi Kagamu, Kyoichi Kaira

Amivantamab plus lazertinib is an emerging targeted therapy directed against epidermal growth factor receptor (EGFR) and mesenchymal–epithelial transition pathways for the treatment of EGFR-mutated non-small cell lung cancer. Although clinical trials have not reported significant gastrointestinal bleeding (GIB), we describe two real-world cases (representing 8% of 25 treated patients) who developed life-threatening GIB during therapy. Both patients exhibited progressive hypoalbuminemia and gastrointestinal mucosal edema preceding the onset of bleeding. Contrast-enhanced computed tomography and endoscopic evaluation demonstrated diffuse bowel wall edema and multiple mucosal ulcers. Both the patients received apixaban. One patient recovered with supportive management, while the other died of hemorrhagic shock. These findings suggest that real-world patients, who are often older, treated in later lines of therapy, and using concomitant anticoagulants, may be more vulnerable to severe gastrointestinal complications than those enrolled in controlled clinical trials. Close monitoring of serum albumin levels and gastrointestinal symptoms is recommended to prevent potentially fatal complications.

Amivantamab + lazertinib是一种针对表皮生长因子受体（EGFR）和间充质-上皮转化途径的新兴靶向疗法，用于治疗EGFR突变的非小细胞肺癌。虽然临床试验没有报告显著的胃肠道出血（GIB），但我们描述了两个现实世界的病例（占25名治疗患者的8%），他们在治疗期间发展为危及生命的GIB。两例患者在出血前均表现出进行性低白蛋白血症和胃肠道粘膜水肿。对比增强计算机断层扫描和内镜检查显示弥漫性肠壁水肿和多发粘膜溃疡。两例患者均接受阿哌沙班治疗。一名患者在支持治疗后恢复，而另一名患者死于失血性休克。这些发现表明，现实世界中的患者，通常年龄较大，接受较晚的治疗，并同时使用抗凝剂，可能比参加对照临床试验的患者更容易出现严重的胃肠道并发症。建议密切监测血清白蛋白水平和胃肠道症状，以预防潜在的致命并发症。

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引用次数: 0

Methodological considerations in assessing the clinical impact of TP53 classifications in advanced NSCLC 评估晚期非小细胞肺癌TP53分类的临床影响的方法学考虑

IF 4.4 2区医学 Q1 ONCOLOGY

Lung Cancer

Pub Date : 2026-01-23 DOI: 10.1016/j.lungcan.2026.108937

Xiaorong Lu, Shanshan Yuan

引用次数: 0

Targeting HGF/MET and CXCL1/CXCR2 axes bypasses resistance to KRASG12C inhibitors in NSCLC 靶向HGF/MET和CXCL1/CXCR2轴可绕过NSCLC对KRASG12C抑制剂的耐药性。

IF 4.4 2区医学 Q1 ONCOLOGY

Lung Cancer

Pub Date : 2026-01-21 DOI: 10.1016/j.lungcan.2026.108939

A. Cavazzoni , M. Pagano Mariano , A. Palladini , G. Digiacomo , S. La Monica , M. Bonelli , M. Galetti , I. Pace , R. Roncarati , E. Giovannetti , P. Aretini , R. Minari , M. Treccani , M. Pluchino , C.A. Lagrasta , S. Angelicola , G. Mazzaschi , P. Bordi , F. Gelsomino , F. Agustoni , R. Alfieri

Background

Resistance to KRAS^G12C inhibitors sotorasib and adagrasib, approved for KRAS^G12C-mutant advanced Non-Small Cell Lung Cancer (NSCLC), involves multiple subclonal events, raising significant concerns about overcoming the resistant phenotype. Cytokines, chemokines, and growth factors are key mediators of drug resistance and targeting their signaling pathways is an emerging strategy in cancer therapy.

Methods

We generated cell clones from KRAS^G12C-mutated NSCLC cells treated with KRAS inhibitors and cell cultures from a sotorasib-resistant patient-derived xenograft (PDX). Gene mutations and changes in gene expression were evaluated using NGS, RNAseq. The mRNA and protein levels encoded by the Hepatocyte Growth Factor (HGF) and CXCL1 genes were quantified using RT-PCR and ELISA assay. The effect of drug combination was obtained by the Sulforhodamine-B assay and analyzed by Combenefit Software. Cell death was detected by Annexin-V assay. Cell signaling and epithelial-to-mesenchymal transition were evaluated by Western blotting.

Results

NSCLC cell clones and PDX cell cultures with acquired and intrinsic resistance to KRAS^G12C inhibitors exhibited elevated levels of CXCL1 and HGF expression and secretion, with activation of CXCR2 and c-MET signalling pathways. The combination of CXCR2 and c-MET inhibitors led to synergistic inhibition of cell growth and reduced cell viability by inhibiting the ERK1/2 and AKT signalling pathways. This combination also reversed EMT and induced apoptosis in sotorasib- and adagrasib-resistant clones, regardless of the genetic alterations responsible for resistance.

Conclusions

CXCL1/CXCR2 and HGF/c-MET may represent compensatory pathways that sustain proliferation and survival in resistance to KRAS^G12C inhibitors. The simultaneous blockade of these signals may offer a novel strategy for bypassing resistance.

背景：KRASG12C抑制剂sotorasib和adagasib的耐药被批准用于KRASG12C突变的晚期非小细胞肺癌（NSCLC），涉及多个亚克隆事件，引起了对克服耐药表型的重大关注。细胞因子、趋化因子和生长因子是耐药的关键介质，靶向它们的信号通路是癌症治疗的新兴策略。方法：我们从KRAS抑制剂处理的krasg12c突变的非小细胞肺癌细胞和来自sotorasib耐药患者来源的异种移植物（PDX）的细胞培养中获得细胞克隆。采用NGS、RNAseq检测基因突变及基因表达变化。采用RT-PCR和ELISA法定量检测肝细胞生长因子（HGF）和CXCL1基因编码的mRNA和蛋白水平。联合用药效果采用硫代丹- b法测定，并用Combenefit软件进行分析。Annexin-V法检测细胞死亡情况。Western blotting检测细胞信号转导和上皮-间质转化。结果：对KRASG12C抑制剂具有获得性和内在抗性的NSCLC细胞克隆和PDX细胞培养表现出CXCL1和HGF表达和分泌水平升高，CXCR2和c-MET信号通路被激活。CXCR2和c-MET抑制剂联合使用可通过抑制ERK1/2和AKT信号通路协同抑制细胞生长和降低细胞活力。该组合还逆转了sotorasib和adagrasib耐药克隆的EMT并诱导细胞凋亡，而不考虑导致耐药的遗传改变。结论：CXCL1/CXCR2和HGF/c-MET可能是KRASG12C抑制剂耐药过程中维持增殖和存活的代偿途径。同时阻断这些信号可能提供一种新的策略来绕过阻力。

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引用次数: 0

Prognostic significance of consolidation-to-tumor ratio in stage IA solid predominant non-mucinous adenocarcinoma: a paradigm for risk stratification IA期实性非黏液性腺癌的实变与肿瘤比值的预后意义：一种风险分层的范例

IF 4.4 2区医学 Q1 ONCOLOGY

Lung Cancer

Pub Date : 2026-01-21 DOI: 10.1016/j.lungcan.2026.108934

Yura Ahn , Geun Dong Lee , SeHoon Choi , Hyeong Ryul Kim , Yong-Hee Kim , Dong Kwan Kim , Seung-Il Park , Jooae Choe , Jae Kwang Yun

Objective

The optimal consolidation-to-tumor ratio (CTR) cutoff for survival stratification in radiologically solid-predominant adenocarcinoma (CTR > 0.5) remains unclear. This study aimed to evaluate the prognostic significance of CTR in clinical-stage IA non-mucinous lung adenocarcinoma with CTR > 0.5.

Materials and methods

We retrospectively analyzed patients who underwent curative resection for clinical stage IA non-mucinous adenocarcinoma with CTR > 0.5 between 2011 and 2021. Optimal cutoffs for overall survival (OS) and freedom from recurrence (FFR) were determined using maximized log-rank statistics. Patients were stratified according to the derived CTR cutoff values, and OS and FFR were compared among the CTR groups before and after propensity score matching (PSM).

Results

Among 2,789 patients included, the optimal CTR cutoffs for OS and FFR were 0.84 and 0.85, respectively. Based on the 0.85 cutoff, patients were categorized into three groups: 0.5 < CTR ≤ 0.85 (n = 672), 0.85 < CTR < 1 (n = 229), and CTR = 1 (n = 1,888). OS and FFR were significantly worse in the 0.85 < CTR < 1 group compared to the 0.5 < CTR ≤ 0.85 group (p < 0.05) but not significantly different from the CTR = 1 group (p > 0.05). These trends persisted after PSM. The 0.85 < CTR < 1 group exhibited a higher proportion of pathological risk factors (high-grade patterns, lymphovascular invasion, and nodal metastasis) than the 0.5 < CTR ≤ 0.85 group (all p < 0.05) and was comparable to the CTR = 1 group, except for lymphovascular invasion (p = 0.045). Dichotomization into 0.5 < CTR ≤ 0.85 and 0.85 < CTR ≤ 1 revealed significantly worse OS and FFR in the 0.85 < CTR ≤ 1 group across PSM cohorts for both lobectomy and sublobar resection.

Conclusion

A CTR cutoff of 0.85 effectively distinguishes survival outcomes in patients with clinical stage IA adenocarcinoma and CTR > 0.5 and may inform risk stratification and postoperative surveillance.

目的对放射学上以实性为主的腺癌进行生存分层的最佳实变-肿瘤比（CTR > 0.5）界限尚不清楚。本研究旨在评价CTR在临床期非黏液肺腺癌（CTR = 0.5）中的预后意义。材料和方法回顾性分析2011年至2021年间CTR为0.5的临床IA期非粘液腺癌行根治性切除术的患者。总生存（OS）和复发自由（FFR）的最佳截止使用最大对数秩统计确定。根据得到的CTR截断值对患者进行分层，比较倾向评分匹配（PSM）前后CTR组的OS和FFR。结果在纳入的2789例患者中，OS和FFR的最佳CTR截止值分别为0.84和0.85。根据0.85的截点将患者分为3组：0.5 < CTR≤0.85 （n = 672）、0.85 < CTR < 1 （n = 229）和CTR = 1 （n = 1888）。0.85 < CTR <； 1组的OS和FFR显著低于0.5 < CTR≤0.85组（p < 0.05），但与CTR = 1组无显著差异（p > 0.05）。这些趋势在PSM之后依然存在。CTR = 0.85 <； 1组的病理危险因素（高级别病变、淋巴血管浸润和淋巴结转移）比例高于CTR = 0.5 < CTR≤0.85组（p < 0.05），除淋巴血管浸润外，与CTR = 1组相当（p = 0.045）。将患者分为0.5 < CTR≤0.85和0.85 <； CTR≤1两组，无论是肺叶切除术还是叶下切除术，在PSM队列中，0.85 <； CTR≤1组的OS和FFR均明显较差。结论CTR截断值为0.85可有效区分临床分期IA期腺癌患者的生存结局，CTR截断值为0.5，可提示风险分层和术后监测。

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引用次数: 0