Background: Tumor markers such as serum carcinoembryonic antigen (CEA) and cytokeratin fragment 19 (CYFRA 21-1) are utilized for assessing the effectiveness of chemotherapy in non-small cell lung cancer (NSCLC) patients. Yet, it remains uncertain whether these markers can reliably forecast responses to combined chemoimmunotherapy. Our study aimed to examine the significance and effectiveness of these markers in predicting responses among NSCLC patients undergoing combined chemoimmunotherapy.
Methods: This two-part observational study involved patients with NSCLC who were treated with combined chemoimmunotherapy in Japanese hospitals. An initial retrospective study of these patients, with serum CEA and CYFRA 21-1 as prognostic factors for combined chemoimmunotherapy outcomes, served as a discovery cohort. Patients in a subsequent prospective study served as a validation cohort, where we assessed the prognostic accuracy of CEA and CYFRA 21-1 cut-off points determined by the discovery cohort.
Results: In total, 121 patients treated with combined chemoimmunotherapy were included, with 44 and 77 patients in the discovery and validation cohorts, respectively. Serum CYFRA 21-1 levels >3.0 ng/mL were significantly associated with progression-free survival (PFS) in both the discovery and validation cohorts (P=0.01, P=0.04, respectively). PFS did not differ significantly by CEA levels (P=0.21).
Conclusions: After combined chemoimmunotherapy treatment, serum CYFRA 21-1 stands out as a potentially valuable biomarker for predicting the prognosis of NSCLC.
{"title":"CYFRA 21-1 predicts efficacy of combined chemoimmunotherapy in patients with advanced non-small cell lung cancer: a prospective observational study.","authors":"Nobutaka Kataoka, Yuki Katayama, Tadaaki Yamada, Kenji Morimoto, Takayuki Takeda, Asuka Okada, Shinsuke Shiotsu, Yusuke Chihara, Osamu Hiranuma, Takahiro Yamada, Takahiro Ota, Taishi Harada, Isao Hasegawa, Naoya Nishioka, Masahiro Iwasaku, Shinsaku Tokuda, Koichi Takayama","doi":"10.21037/tlcr-24-190","DOIUrl":"https://doi.org/10.21037/tlcr-24-190","url":null,"abstract":"<p><strong>Background: </strong>Tumor markers such as serum carcinoembryonic antigen (CEA) and cytokeratin fragment 19 (CYFRA 21-1) are utilized for assessing the effectiveness of chemotherapy in non-small cell lung cancer (NSCLC) patients. Yet, it remains uncertain whether these markers can reliably forecast responses to combined chemoimmunotherapy. Our study aimed to examine the significance and effectiveness of these markers in predicting responses among NSCLC patients undergoing combined chemoimmunotherapy.</p><p><strong>Methods: </strong>This two-part observational study involved patients with NSCLC who were treated with combined chemoimmunotherapy in Japanese hospitals. An initial retrospective study of these patients, with serum CEA and CYFRA 21-1 as prognostic factors for combined chemoimmunotherapy outcomes, served as a discovery cohort. Patients in a subsequent prospective study served as a validation cohort, where we assessed the prognostic accuracy of CEA and CYFRA 21-1 cut-off points determined by the discovery cohort.</p><p><strong>Results: </strong>In total, 121 patients treated with combined chemoimmunotherapy were included, with 44 and 77 patients in the discovery and validation cohorts, respectively. Serum CYFRA 21-1 levels >3.0 ng/mL were significantly associated with progression-free survival (PFS) in both the discovery and validation cohorts (P=0.01, P=0.04, respectively). PFS did not differ significantly by CEA levels (P=0.21).</p><p><strong>Conclusions: </strong>After combined chemoimmunotherapy treatment, serum CYFRA 21-1 stands out as a potentially valuable biomarker for predicting the prognosis of NSCLC.</p>","PeriodicalId":23271,"journal":{"name":"Translational lung cancer research","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11384485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-31Epub Date: 2024-08-21DOI: 10.21037/tlcr-24-197
Agata Durawa, Katarzyna Dziadziuszko, Małgorzata Jelitto, Michał Gąsiorowski, Mariusz Kaszubowski, Edyta Szurowska, Witold Rzyman
Background: With increasing significance of lung cancer screening programs, it is essential to determine the group of participants, who would benefit the most from screening. In our study, we aimed to establish the correlation between lung emphysema and lung cancer risk.
Methods: The study design was cross-sectional. Low-dose computed tomography (LDCT) scans of 896 subjects from MOLTEST-BIS lung cancer screening program, including 100 subjects with detected lung cancer, were visually evaluated for the presence, type and severity of emphysema. Quantitative emphysema evaluation was performed with Siemens syngo.via Pulmo 3D application.
Results: Visually detected presence of centrilobular emphysema (CLE) correlated with male gender (P=0.02), age (P<0.001) and pack-years of smoking (P=0.004), as well as with quantitative assessment of Emphysema Index (EI) (P=0.008), and with emphysema clusters of given size (Clas 1-4) Clas 1, Clas 3 and Clas 4 (P<0.001). Visually assessed severity grade of emphysema correlated with age (P<0.001), pack-years of smoking history (P=0.002) and EI (P<0.001). There was a correlation between lung cancer occurrence and pack-years (P<0.001), age (P<0.001), and presence of CLE (P<0.001) but no correlation with gender (P=0.88) and EI (P=0.32) was found. In the logistic regression model pack-years, age, qualitative severity of CLE and Clas 1 were significant factors correlated with lung cancer occurrence (P<0.001).
Conclusions: Qualitative and quantitative emphysema evaluation correlate with each other. Both, presence and severity of CLE correlate with higher incidence of lung cancer. Severity of visually assessed emphysema, age and pack-years of smoking are significant predictors of lung cancer occurrence.
{"title":"Emphysema and lung cancer risk.","authors":"Agata Durawa, Katarzyna Dziadziuszko, Małgorzata Jelitto, Michał Gąsiorowski, Mariusz Kaszubowski, Edyta Szurowska, Witold Rzyman","doi":"10.21037/tlcr-24-197","DOIUrl":"https://doi.org/10.21037/tlcr-24-197","url":null,"abstract":"<p><strong>Background: </strong>With increasing significance of lung cancer screening programs, it is essential to determine the group of participants, who would benefit the most from screening. In our study, we aimed to establish the correlation between lung emphysema and lung cancer risk.</p><p><strong>Methods: </strong>The study design was cross-sectional. Low-dose computed tomography (LDCT) scans of 896 subjects from MOLTEST-BIS lung cancer screening program, including 100 subjects with detected lung cancer, were visually evaluated for the presence, type and severity of emphysema. Quantitative emphysema evaluation was performed with Siemens syngo.via Pulmo 3D application.</p><p><strong>Results: </strong>Visually detected presence of centrilobular emphysema (CLE) correlated with male gender (P=0.02), age (P<0.001) and pack-years of smoking (P=0.004), as well as with quantitative assessment of Emphysema Index (EI) (P=0.008), and with emphysema clusters of given size (Clas 1-4) Clas 1, Clas 3 and Clas 4 (P<0.001). Visually assessed severity grade of emphysema correlated with age (P<0.001), pack-years of smoking history (P=0.002) and EI (P<0.001). There was a correlation between lung cancer occurrence and pack-years (P<0.001), age (P<0.001), and presence of CLE (P<0.001) but no correlation with gender (P=0.88) and EI (P=0.32) was found. In the logistic regression model pack-years, age, qualitative severity of CLE and Clas 1 were significant factors correlated with lung cancer occurrence (P<0.001).</p><p><strong>Conclusions: </strong>Qualitative and quantitative emphysema evaluation correlate with each other. Both, presence and severity of CLE correlate with higher incidence of lung cancer. Severity of visually assessed emphysema, age and pack-years of smoking are significant predictors of lung cancer occurrence.</p>","PeriodicalId":23271,"journal":{"name":"Translational lung cancer research","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11384496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-31Epub Date: 2024-08-21DOI: 10.21037/tlcr-24-349
Jian Zhou, Quan Zheng, Yuchen Huang, Mengyuan Lyu, Tengyong Wang, Dongsheng Wu, Hu Liao
Background: Family history of cancer (FHC) has been reported to increase mortality of non-small cell lung cancer, mainly comprised of lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC). However, the impact of FHC on long-term survival remains controversial. This study aims to identify the impact of FHC on postoperative survival in LUAD and LUSC.
Methods: Patients underwent lung resection for LUAD or LUSC in West China Hospital from 2009 to 2021 were enrolled. The 5-year overall survival (OS), lung cancer-specific survival (LCSS) and progression-free survival (PFS) were compared between the patients with and without FHC. Multivariable Cox regression was also performed.
Results: A total of 6,253 patients were enrolled, including 5,685 LUAD and 568 LUSC. Altogether 18.9% (1,077/5,685) patients had FHC in LUAD, and 12.7% (72/568) patients had FHC in LUSC. In LUAD, the patients with FHC showed comparable survival compared with the patients without FHC regarding 5-year OS (87.9% vs. 86.5%, P=0.49), 5-year PFS (84.8% vs. 80.9%, P=0.06), and 5-year LCSS (89.2% vs. 88.0%, P=0.96). In LUSC, the patients with FHC had poorer survival compared with the patients without FHC according to 5-year OS (40.9% vs. 68.2%, P=0.007), 5-year PFS (42.3% vs. 66.2%, P=0.003), and 5-year LCSS (45.8% vs. 72.7%, P=0.003). Multivariate analyses indicated that FHC was an independent prognostic factor of OS, PFS, and LCSS in the patients with LUSC.
Conclusions: FHC was associated with a poor survival after lung resection in LUSC not LUAD patients. More attention should be paid in postoperative monitoring and treatment in LUSC patients with FHC.
背景:据报道,癌症家族史(FHC)会增加非小细胞肺癌(主要包括肺腺癌(LUAD)和肺鳞癌(LUSC))的死亡率。然而,FHC 对长期生存的影响仍存在争议。本研究旨在确定 FHC 对 LUAD 和 LUSC 术后生存率的影响:方法:选取2009年至2021年在华西医院接受肺切除术的LUAD或LUSC患者作为研究对象。比较有FHC和无FHC患者的5年总生存期(OS)、肺癌特异性生存期(LCSS)和无进展生存期(PFS)。同时还进行了多变量考克斯回归:共有6253名患者入组,其中包括5685名LUAD患者和568名LUSC患者。18.9%(1,077/5,685)的 LUAD 患者患有 FHC,12.7%(72/568)的 LUSC 患者患有 FHC。在LUAD中,与无FHC的患者相比,有FHC的患者在5年OS(87.9% vs. 86.5%,P=0.49)、5年PFS(84.8% vs. 80.9%,P=0.06)和5年LCSS(89.2% vs. 88.0%,P=0.96)方面的生存率相当。在LUSC中,根据5年OS(40.9% vs. 68.2%,P=0.007)、5年PFS(42.3% vs. 66.2%,P=0.003)和5年LCSS(45.8% vs. 72.7%,P=0.003),与无FHC的患者相比,有FHC的患者生存率较低。多变量分析表明,FHC是LUSC患者OS、PFS和LCSS的独立预后因素:结论:FHC与LUSC而非LUAD患者肺切除术后的生存率有关。结论:FHC 与 LUSC 而非 LUAD 患者肺切除术后的不良生存率相关,因此应更加重视对 FHC LUSC 患者的术后监测和治疗。
{"title":"Effect of family history of cancer on postoperative survival in patients with non-small cell lung cancer.","authors":"Jian Zhou, Quan Zheng, Yuchen Huang, Mengyuan Lyu, Tengyong Wang, Dongsheng Wu, Hu Liao","doi":"10.21037/tlcr-24-349","DOIUrl":"https://doi.org/10.21037/tlcr-24-349","url":null,"abstract":"<p><strong>Background: </strong>Family history of cancer (FHC) has been reported to increase mortality of non-small cell lung cancer, mainly comprised of lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC). However, the impact of FHC on long-term survival remains controversial. This study aims to identify the impact of FHC on postoperative survival in LUAD and LUSC.</p><p><strong>Methods: </strong>Patients underwent lung resection for LUAD or LUSC in West China Hospital from 2009 to 2021 were enrolled. The 5-year overall survival (OS), lung cancer-specific survival (LCSS) and progression-free survival (PFS) were compared between the patients with and without FHC. Multivariable Cox regression was also performed.</p><p><strong>Results: </strong>A total of 6,253 patients were enrolled, including 5,685 LUAD and 568 LUSC. Altogether 18.9% (1,077/5,685) patients had FHC in LUAD, and 12.7% (72/568) patients had FHC in LUSC. In LUAD, the patients with FHC showed comparable survival compared with the patients without FHC regarding 5-year OS (87.9% <i>vs.</i> 86.5%, P=0.49), 5-year PFS (84.8% <i>vs.</i> 80.9%, P=0.06), and 5-year LCSS (89.2% <i>vs.</i> 88.0%, P=0.96). In LUSC, the patients with FHC had poorer survival compared with the patients without FHC according to 5-year OS (40.9% <i>vs.</i> 68.2%, P=0.007), 5-year PFS (42.3% <i>vs.</i> 66.2%, P=0.003), and 5-year LCSS (45.8% <i>vs.</i> 72.7%, P=0.003). Multivariate analyses indicated that FHC was an independent prognostic factor of OS, PFS, and LCSS in the patients with LUSC.</p><p><strong>Conclusions: </strong>FHC was associated with a poor survival after lung resection in LUSC not LUAD patients. More attention should be paid in postoperative monitoring and treatment in LUSC patients with FHC.</p>","PeriodicalId":23271,"journal":{"name":"Translational lung cancer research","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11384475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-31Epub Date: 2024-07-18DOI: 10.21037/tlcr-24-470
Feichao Bao, Jiaming Wang, Chen Shen, Fenghao Yu, Marko Jakopović, Xiuxiu Hao, Yang Chen, Yiyang Wang, Zhitao Gu, Wentao Fang
Background: Immunotherapy has been recommended for neoadjuvant therapy in patients with locally advanced non-small cell lung cancer (NSCLC). However, its effect on surgical resection has not yet been examined. This study aimed to examine the effect of induction immunotherapy on surgical resection in terms of the surgical approach, resection extent, and perioperative recovery.
Methods: We performed a real-world study comprising consecutive patients with clinical stage IB-IIIB NSCLC who received surgical resection after induction immunotherapy from January 2019 to September 2021. The perioperative outcomes were compared in terms of the surgical approach and resection extent.
Results: Among 68 patients, 37 (54.4%) achieved a clinical objective response. Standard resection was performed in 37 patients (54.4%), while extended resection was necessary in the other 31 patients (45.6%). Minimally invasive surgery (MIS) was attempted in 37 cases (54.4%), with only 1 (2.7%) conversion. MIS was significantly more commonly accomplished in patients with a clinical objective response than those without (67.6% vs. 35.5%, P=0.008). Patients with a clinical objective response were more likely to have their tumors removed via MIS and/or standard resection (75.7% vs. 51.6%, P=0.04), while those without a clinical objective response more often required extended resection using an open approach. Patients receiving standard resection or MIS had significantly better perioperative outcomes than those who underwent extended resection or thoracotomy (all P<0.05).
Conclusions: The results of this large single-center retrospective cohort indicate that in terms of a better clinical response, effective induction immunotherapy could help reduce the resection extent and/or provide more opportunities to perform MIS, resulting in better recovery.
背景:免疫疗法已被推荐用于局部晚期非小细胞肺癌(NSCLC)患者的新辅助治疗。然而,免疫疗法对手术切除的影响尚未得到研究。本研究旨在从手术方式、切除范围和围手术期恢复等方面考察诱导免疫疗法对手术切除的影响:我们进行了一项真实世界研究,研究对象包括2019年1月至2021年9月期间接受诱导免疫治疗后手术切除的临床IB-IIIB期NSCLC连续患者。根据手术方式和切除范围对围手术期结果进行了比较:68例患者中,37例(54.4%)获得了临床客观反应。37名患者(54.4%)接受了标准切除术,另外31名患者(45.6%)则需要扩大切除范围。37例患者(54.4%)尝试了微创手术(MIS),只有1例患者(2.7%)转为微创手术。有临床客观反应的患者完成微创手术的比例明显高于无临床客观反应的患者(67.6% 对 35.5%,P=0.008)。有临床客观反应的患者更有可能通过 MIS 和/或标准切除术切除肿瘤(75.7% 对 51.6%,P=0.04),而无临床客观反应的患者则更多需要使用开放式方法进行扩大切除。与接受扩大切除术或开胸手术的患者相比,接受标准切除术或MIS的患者围手术期预后要好得多(所有PC结论均一致):这一大型单中心回顾性队列的结果表明,就更好的临床反应而言,有效的诱导免疫疗法有助于缩小切除范围和/或提供更多的机会进行 MIS,从而获得更好的恢复。
{"title":"Effective induction immunotherapy minimizes surgical invasiveness for locally advanced lung cancer.","authors":"Feichao Bao, Jiaming Wang, Chen Shen, Fenghao Yu, Marko Jakopović, Xiuxiu Hao, Yang Chen, Yiyang Wang, Zhitao Gu, Wentao Fang","doi":"10.21037/tlcr-24-470","DOIUrl":"https://doi.org/10.21037/tlcr-24-470","url":null,"abstract":"<p><strong>Background: </strong>Immunotherapy has been recommended for neoadjuvant therapy in patients with locally advanced non-small cell lung cancer (NSCLC). However, its effect on surgical resection has not yet been examined. This study aimed to examine the effect of induction immunotherapy on surgical resection in terms of the surgical approach, resection extent, and perioperative recovery.</p><p><strong>Methods: </strong>We performed a real-world study comprising consecutive patients with clinical stage IB-IIIB NSCLC who received surgical resection after induction immunotherapy from January 2019 to September 2021. The perioperative outcomes were compared in terms of the surgical approach and resection extent.</p><p><strong>Results: </strong>Among 68 patients, 37 (54.4%) achieved a clinical objective response. Standard resection was performed in 37 patients (54.4%), while extended resection was necessary in the other 31 patients (45.6%). Minimally invasive surgery (MIS) was attempted in 37 cases (54.4%), with only 1 (2.7%) conversion. MIS was significantly more commonly accomplished in patients with a clinical objective response than those without (67.6% <i>vs.</i> 35.5%, P=0.008). Patients with a clinical objective response were more likely to have their tumors removed via MIS and/or standard resection (75.7% <i>vs.</i> 51.6%, P=0.04), while those without a clinical objective response more often required extended resection using an open approach. Patients receiving standard resection or MIS had significantly better perioperative outcomes than those who underwent extended resection or thoracotomy (all P<0.05).</p><p><strong>Conclusions: </strong>The results of this large single-center retrospective cohort indicate that in terms of a better clinical response, effective induction immunotherapy could help reduce the resection extent and/or provide more opportunities to perform MIS, resulting in better recovery.</p>","PeriodicalId":23271,"journal":{"name":"Translational lung cancer research","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11384483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-31Epub Date: 2024-08-17DOI: 10.21037/tlcr-24-461
Dan Pu, Hong-E Zhang, Lu Li
Background: Chemotherapy combined with immunotherapy is currently the standard first-line treatment for advanced small-cell lung cancer (SCLC). Immunotherapy can induce specific adverse events, called immune-related adverse events (irAEs). IrAEs of bones have rarely been reported. However, identifying bone irAEs could be important in avoiding misdiagnosis and ensuring appropriate patient management. This is the first report describing the diagnosis of irAEs of osteoblastic bone changes mimicking bone metastasis in a SCLC patient treated with durvalumab.
Case description: In this report, we describe a unique and challenging case in which a 54-year-old female patient with SCLC treated with durvalumab, an immunotherapy drug, exhibited osteoblastic bone changes that appeared similar to bone metastasis on imaging but were actually a side effect of immunotherapy. Before treatment, imaging revealed no bone metastasis. In the third month after treatment with durvalumab, computed tomography (CT) revealed multiple bone alterations, predominantly osteoblastic lesions with minor osteolytic changes. Various imaging tests suggested bone metastasis, but she had no symptoms related to bone disease. Notably, the lesions in the chest had achieved a partial response. Based on a comprehensive analysis of the CT-guided pathological biopsy results, the patient's symptoms, and the biological characteristics of SCLC, we determined that these bone changes were irAEs occurring in the skeletal system. The patient was followed up for 10 months, during which time the bone lesions remained stable.
Conclusions: IrAEs of bones are rare, and their manifestations vary. Sometimes, the imaging manifestations of bone irAEs are difficult to distinguish from bone metastasis. If patients show variable treatment responses between different lesions, careful evaluation (including a pathological biopsy) is necessary.
{"title":"Immune-related osteoblastic bone alterations mimicking bone metastasis in a small-cell lung cancer patient treated with durvalumab: a case report.","authors":"Dan Pu, Hong-E Zhang, Lu Li","doi":"10.21037/tlcr-24-461","DOIUrl":"https://doi.org/10.21037/tlcr-24-461","url":null,"abstract":"<p><strong>Background: </strong>Chemotherapy combined with immunotherapy is currently the standard first-line treatment for advanced small-cell lung cancer (SCLC). Immunotherapy can induce specific adverse events, called immune-related adverse events (irAEs). IrAEs of bones have rarely been reported. However, identifying bone irAEs could be important in avoiding misdiagnosis and ensuring appropriate patient management. This is the first report describing the diagnosis of irAEs of osteoblastic bone changes mimicking bone metastasis in a SCLC patient treated with durvalumab.</p><p><strong>Case description: </strong>In this report, we describe a unique and challenging case in which a 54-year-old female patient with SCLC treated with durvalumab, an immunotherapy drug, exhibited osteoblastic bone changes that appeared similar to bone metastasis on imaging but were actually a side effect of immunotherapy. Before treatment, imaging revealed no bone metastasis. In the third month after treatment with durvalumab, computed tomography (CT) revealed multiple bone alterations, predominantly osteoblastic lesions with minor osteolytic changes. Various imaging tests suggested bone metastasis, but she had no symptoms related to bone disease. Notably, the lesions in the chest had achieved a partial response. Based on a comprehensive analysis of the CT-guided pathological biopsy results, the patient's symptoms, and the biological characteristics of SCLC, we determined that these bone changes were irAEs occurring in the skeletal system. The patient was followed up for 10 months, during which time the bone lesions remained stable.</p><p><strong>Conclusions: </strong>IrAEs of bones are rare, and their manifestations vary. Sometimes, the imaging manifestations of bone irAEs are difficult to distinguish from bone metastasis. If patients show variable treatment responses between different lesions, careful evaluation (including a pathological biopsy) is necessary.</p>","PeriodicalId":23271,"journal":{"name":"Translational lung cancer research","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11384499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-31Epub Date: 2024-08-28DOI: 10.21037/tlcr-24-65
Yi Feng, Caichen Li, Bo Cheng, Ying Chen, Peiling Chen, Zixun Wang, Xiangyuan Zheng, Juan He, Feng Zhu, Wei Wang, Wenhua Liang
Background: Lung cancer is responsible for most cancer-related deaths, and non-small cell lung cancer (NSCLC) accounts for the majority of cases. Targeted therapy has made promising advancements in systemic treatment for NSCLC over the last two decades, but inadequate drug targets with clinically proven survival benefits limit its universal application in clinical practice compared to chemotherapy and immunotherapy. There is an urgent need to explore new drug targets to expand the beneficiary group. This study aims to identify druggable genes and to predict the efficacy and prognostic value of the corresponding targeted drugs in NSCLC.
Methods: Two-sample mendelian randomization (MR) of druggable genes was performed to predict the efficacy of their corresponding targeted therapy for NSCLC. Subsequent sensitivity analyses were performed to assess potential confounders. Accessible RNA sequencing data were incorporated for subsequent verifications, and Kaplan-Meier survival curves of different gene expressions were used to explore the prognostic value of candidate druggable genes.
Results: MR screening encompassing 4,863 expression quantitative trait loci (eQTL) and 1,072 protein quantitative trait loci (pQTL, with 453 proteins overlapping) were performed. Seven candidate druggable genes were identified, including CD33, ENG, ICOSLG and IL18R1 for lung adenocarcinoma, and VSIR, FSTL1 and TIMP2 for lung squamous cell carcinoma. The results were validated by further transcriptomic investigations.
Conclusions: Drugs targeting genetically supported genomes are considerably more likely to yield promising efficacy and succeed in clinical trials. We provide compelling genetic evidence to prioritize drug development for NSCLC.
{"title":"Identifying genetically-supported drug repurposing targets for non-small cell lung cancer through mendelian randomization of the druggable genome.","authors":"Yi Feng, Caichen Li, Bo Cheng, Ying Chen, Peiling Chen, Zixun Wang, Xiangyuan Zheng, Juan He, Feng Zhu, Wei Wang, Wenhua Liang","doi":"10.21037/tlcr-24-65","DOIUrl":"https://doi.org/10.21037/tlcr-24-65","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer is responsible for most cancer-related deaths, and non-small cell lung cancer (NSCLC) accounts for the majority of cases. Targeted therapy has made promising advancements in systemic treatment for NSCLC over the last two decades, but inadequate drug targets with clinically proven survival benefits limit its universal application in clinical practice compared to chemotherapy and immunotherapy. There is an urgent need to explore new drug targets to expand the beneficiary group. This study aims to identify druggable genes and to predict the efficacy and prognostic value of the corresponding targeted drugs in NSCLC.</p><p><strong>Methods: </strong>Two-sample mendelian randomization (MR) of druggable genes was performed to predict the efficacy of their corresponding targeted therapy for NSCLC. Subsequent sensitivity analyses were performed to assess potential confounders. Accessible RNA sequencing data were incorporated for subsequent verifications, and Kaplan-Meier survival curves of different gene expressions were used to explore the prognostic value of candidate druggable genes.</p><p><strong>Results: </strong>MR screening encompassing 4,863 expression quantitative trait loci (eQTL) and 1,072 protein quantitative trait loci (pQTL, with 453 proteins overlapping) were performed. Seven candidate druggable genes were identified, including <i>CD33</i>, <i>ENG</i>, <i>ICOSLG</i> and <i>IL18R1</i> for lung adenocarcinoma, and <i>VSIR</i>, <i>FSTL1</i> and <i>TIMP2</i> for lung squamous cell carcinoma. The results were validated by further transcriptomic investigations.</p><p><strong>Conclusions: </strong>Drugs targeting genetically supported genomes are considerably more likely to yield promising efficacy and succeed in clinical trials. We provide compelling genetic evidence to prioritize drug development for NSCLC.</p>","PeriodicalId":23271,"journal":{"name":"Translational lung cancer research","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11384480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-31Epub Date: 2024-08-12DOI: 10.21037/tlcr-24-269
Abdi T Gudina, Charles Kamen, Lindsey J Mattick, Francisco Cartujano-Barrera, Michelle C Janelsins, Deborah Ossip, M Patricia Rivera, Kevin Fiscella, Ana-Paula Cupertino
Background: Despite its efficacy in reducing lung cancer (LC)-specific mortality by 20%, screening with low-dose computed tomography (LDCT) in eligible groups remains low (5-16%). Black individuals are more commonly affected by LC than other racial/ethnic groups in the United States (U.S.) but less likely to undergo LC screening (LCS). Our study aimed to explore the knowledge and beliefs of Black individuals at high risk regarding LCS.
Methods: Black individuals (n=17) who met the 2021 United States Preventive Services Task Force (USPSTF) LCS eligibility criteria were recruited in upstate New York. In-depth semi-structured interviews were conducted, audio recorded, and transcribed to explore knowledge and beliefs that could influence the uptake of LCS. A qualitative thematic analysis method was used to identify and analyze themes within the data.
Results: We identified principal themes about LC and LCS. Although most participants reported that smoking was the major risk factor for LC, some participants placed more emphasis on other factors as the major risk factors for LC and de-emphasized the role of smoking. Most participants were not aware that screening for LC existed. Several barriers and facilitators for LCS were identified.
Conclusions: Awareness about LCS among Black individuals is low. Addressing barriers may help increase LCS rates among Black individuals, ultimately reducing their LC mortality. The findings from our study have important implications in designing more effective interventions involving community health workers and healthcare clinicians to increase LCS uptake among Black individuals at high risk.
{"title":"Knowledge and beliefs about lung cancer screening among Black individuals at high risk: a qualitative approach.","authors":"Abdi T Gudina, Charles Kamen, Lindsey J Mattick, Francisco Cartujano-Barrera, Michelle C Janelsins, Deborah Ossip, M Patricia Rivera, Kevin Fiscella, Ana-Paula Cupertino","doi":"10.21037/tlcr-24-269","DOIUrl":"https://doi.org/10.21037/tlcr-24-269","url":null,"abstract":"<p><strong>Background: </strong>Despite its efficacy in reducing lung cancer (LC)-specific mortality by 20%, screening with low-dose computed tomography (LDCT) in eligible groups remains low (5-16%). Black individuals are more commonly affected by LC than other racial/ethnic groups in the United States (U.S.) but less likely to undergo LC screening (LCS). Our study aimed to explore the knowledge and beliefs of Black individuals at high risk regarding LCS.</p><p><strong>Methods: </strong>Black individuals (n=17) who met the 2021 United States Preventive Services Task Force (USPSTF) LCS eligibility criteria were recruited in upstate New York. In-depth semi-structured interviews were conducted, audio recorded, and transcribed to explore knowledge and beliefs that could influence the uptake of LCS. A qualitative thematic analysis method was used to identify and analyze themes within the data.</p><p><strong>Results: </strong>We identified principal themes about LC and LCS. Although most participants reported that smoking was the major risk factor for LC, some participants placed more emphasis on other factors as the major risk factors for LC and de-emphasized the role of smoking. Most participants were not aware that screening for LC existed. Several barriers and facilitators for LCS were identified.</p><p><strong>Conclusions: </strong>Awareness about LCS among Black individuals is low. Addressing barriers may help increase LCS rates among Black individuals, ultimately reducing their LC mortality. The findings from our study have important implications in designing more effective interventions involving community health workers and healthcare clinicians to increase LCS uptake among Black individuals at high risk.</p>","PeriodicalId":23271,"journal":{"name":"Translational lung cancer research","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11384478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-31Epub Date: 2024-08-12DOI: 10.21037/tlcr-24-283
Xin Wen, Meng-Wen Liu, Bin Qiu, Yan-Mei Wang, Jiu-Ming Jiang, Xue Zhang, Xu Jiang, Lin Li, Meng Li, Li Zhang
Background: Research has demonstrated that radiomics models are capable of forecasting the characteristics of lung cancer. Nevertheless, due to radiomics' poor interpretability, its applicability in clinical settings remains restricted. This investigation sought to verify the correlation between radiomics features (RFs) and the biological behavior of clinical stage IA adenocarcinomas.
Methods: A retrospective analysis was conducted on patients diagnosed with clinical stage IA lung adenocarcinoma who underwent resection between May 2005 and December 2018. Detailed radiomics examination of the primary tumor was carried out utilizing preoperative computed tomography (CT) images. Subsequently, patients were grouped based on their RFs using consensus clustering, enabling comparison of tumor biological characteristics among the clusters. Survival disparities among the clusters were evaluated through Kaplan-Meier and Cox analyses.
Results: A consensus cluster analysis was performed on 669 patients [median age, 58 years; interquartile range (IQR), 50-64 years, 257 males, 412 females], and three distinct clusters were identified. Cluster 2 was associated with radiological solid adenocarcinoma [119 of 324 (36.7%), P<0.001], larger tumors with median tumor size of 2.1 cm with IQR of 1.7 to 2.5 cm (P<0.001), central tumor [91 of 324 (28.1%), P=0.002], pleural invasion [87 of 324 (26.9%), P<0.001], occult lymph node metastasis (ONM) [106 of 324 (32.7%), P<0.001], and a higher frequency of metastasis or recurrence [62 of 324 (19.1%), P<0.001]. The frequency of histological grade 3 was the highest in Cluster 3 [8 of 34 (23.5%), P<0.001]. Cluster 1 was associated with pure ground glass nodules (pGGNs) [184 of 310 (59.4%), P<0.001], smaller tumors with median tumor size of 1.1 cm with IQR of 0.8 to 1.4 cm (P<0.001), no pleural invasion [276 of 310 (89.0%), P<0.001], histological grade 1 [114 of 248 (46.0%), P<0.001], ONM negative [292 of 310 (94.2%), P<0.001], and a lower rate of metastasis or recurrence [298 of 310 (96.1%), P<0.001].
Conclusions: Differences in tumor biological behavior were detected among consensus clusters based on the RFs of clinical stage IA adenocarcinoma.
{"title":"CT-based radiomic consensus clustering association with tumor biological behavior in clinical stage IA adenocarcinoma: a retrospective study.","authors":"Xin Wen, Meng-Wen Liu, Bin Qiu, Yan-Mei Wang, Jiu-Ming Jiang, Xue Zhang, Xu Jiang, Lin Li, Meng Li, Li Zhang","doi":"10.21037/tlcr-24-283","DOIUrl":"https://doi.org/10.21037/tlcr-24-283","url":null,"abstract":"<p><strong>Background: </strong>Research has demonstrated that radiomics models are capable of forecasting the characteristics of lung cancer. Nevertheless, due to radiomics' poor interpretability, its applicability in clinical settings remains restricted. This investigation sought to verify the correlation between radiomics features (RFs) and the biological behavior of clinical stage IA adenocarcinomas.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients diagnosed with clinical stage IA lung adenocarcinoma who underwent resection between May 2005 and December 2018. Detailed radiomics examination of the primary tumor was carried out utilizing preoperative computed tomography (CT) images. Subsequently, patients were grouped based on their RFs using consensus clustering, enabling comparison of tumor biological characteristics among the clusters. Survival disparities among the clusters were evaluated through Kaplan-Meier and Cox analyses.</p><p><strong>Results: </strong>A consensus cluster analysis was performed on 669 patients [median age, 58 years; interquartile range (IQR), 50-64 years, 257 males, 412 females], and three distinct clusters were identified. Cluster 2 was associated with radiological solid adenocarcinoma [119 of 324 (36.7%), P<0.001], larger tumors with median tumor size of 2.1 cm with IQR of 1.7 to 2.5 cm (P<0.001), central tumor [91 of 324 (28.1%), P=0.002], pleural invasion [87 of 324 (26.9%), P<0.001], occult lymph node metastasis (ONM) [106 of 324 (32.7%), P<0.001], and a higher frequency of metastasis or recurrence [62 of 324 (19.1%), P<0.001]. The frequency of histological grade 3 was the highest in Cluster 3 [8 of 34 (23.5%), P<0.001]. Cluster 1 was associated with pure ground glass nodules (pGGNs) [184 of 310 (59.4%), P<0.001], smaller tumors with median tumor size of 1.1 cm with IQR of 0.8 to 1.4 cm (P<0.001), no pleural invasion [276 of 310 (89.0%), P<0.001], histological grade 1 [114 of 248 (46.0%), P<0.001], ONM negative [292 of 310 (94.2%), P<0.001], and a lower rate of metastasis or recurrence [298 of 310 (96.1%), P<0.001].</p><p><strong>Conclusions: </strong>Differences in tumor biological behavior were detected among consensus clusters based on the RFs of clinical stage IA adenocarcinoma.</p>","PeriodicalId":23271,"journal":{"name":"Translational lung cancer research","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11384472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-31Epub Date: 2024-08-27DOI: 10.21037/tlcr-24-265
Kuan Xu, Yilv Lv, Tangbing Chen, Yuchen Han, Hanqing Huang, Hong Yu, Bo Ye
Background: The International Association for the Study of Lung Cancer (IASLC) pathology panel has proposed a new grading system for invasive lung adenocarcinoma (LADC). This study aims to validate this novel grading system for invasive LADC using propensity score matching (PSM), with a specific focus on patients exhibiting spread through air space (STAS).
Methods: We retrospectively analyzed the clinicopathologic features of a large cohort of 910 non-mucinous LADCs with STAS from 2017 to 2020 and classified them according to the novel grading system. We applied PSM to adjust for potential confounders between the grading groups. Kaplan-Meier and Cox proportional hazards models were adopted for prognostic evaluation.
Results: The results showed that the IASLC grading system (grades 2 and 3) stratified well in terms of recurrence-free survival (RFS) and overall survival (OS) (P=0.02 and P=0.02, respectively) after matching, with Grade 3 being an independent predictor of RFS [hazard ratio (HR), 1.533; P=0.02] and OS (HR, 2.765; P=0.02) in multivariable models. The concordance index (C-index) and area under the curve (AUC) of the IASLC system were 0.719 and 0.754 for recurrence and 0.844 and 0.891 for death, respectively. In addition, anaplastic lymphoma kinase (ALK) fusion and tumor protein p53 (TP53) mutations were detected more frequently in grade 3 tumors, while epidermal growth factor receptor (EGFR) mutations were more prevalent in grade 2 tumors. The IASLC grade did not predict the benefit of adjuvant chemotherapy (ACT).
Conclusions: This study suggests that the new IASLC grading system is a valuable prognostic tool for patients with STAS-positive LADC.
{"title":"Evaluation of the novel International Association for the Study of Lung Cancer grading system in adenocarcinoma with spread through air space.","authors":"Kuan Xu, Yilv Lv, Tangbing Chen, Yuchen Han, Hanqing Huang, Hong Yu, Bo Ye","doi":"10.21037/tlcr-24-265","DOIUrl":"https://doi.org/10.21037/tlcr-24-265","url":null,"abstract":"<p><strong>Background: </strong>The International Association for the Study of Lung Cancer (IASLC) pathology panel has proposed a new grading system for invasive lung adenocarcinoma (LADC). This study aims to validate this novel grading system for invasive LADC using propensity score matching (PSM), with a specific focus on patients exhibiting spread through air space (STAS).</p><p><strong>Methods: </strong>We retrospectively analyzed the clinicopathologic features of a large cohort of 910 non-mucinous LADCs with STAS from 2017 to 2020 and classified them according to the novel grading system. We applied PSM to adjust for potential confounders between the grading groups. Kaplan-Meier and Cox proportional hazards models were adopted for prognostic evaluation.</p><p><strong>Results: </strong>The results showed that the IASLC grading system (grades 2 and 3) stratified well in terms of recurrence-free survival (RFS) and overall survival (OS) (P<i>=</i>0.02 and P<i>=</i>0.02, respectively) after matching, with Grade 3 being an independent predictor of RFS [hazard ratio (HR), 1.533; P<i>=</i>0.02] and OS (HR, 2.765; P<i>=</i>0.02) in multivariable models. The concordance index (C-index) and area under the curve (AUC) of the IASLC system were 0.719 and 0.754 for recurrence and 0.844 and 0.891 for death, respectively. In addition, anaplastic lymphoma kinase (<i>ALK</i>) fusion and tumor protein p53 (<i>TP53</i>) mutations were detected more frequently in grade 3 tumors, while epidermal growth factor receptor (<i>EGFR</i>) mutations were more prevalent in grade 2 tumors. The IASLC grade did not predict the benefit of adjuvant chemotherapy (ACT).</p><p><strong>Conclusions: </strong>This study suggests that the new IASLC grading system is a valuable prognostic tool for patients with STAS-positive LADC.</p>","PeriodicalId":23271,"journal":{"name":"Translational lung cancer research","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11384489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}