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Xu H, Wang J, Al‐Nusaif M, Ma H, Le W. CCL2 promotes metastasis and epithelial-mesenchymal transition of non-small cell lung cancer via PI3K/Akt/mTOR and autophagy pathways. Cell Prolif 2024; 57:e13560. [PMID: 37850256 PMCID: PMC10905333 DOI: 10.1111/cpr.13560] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/02/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023] Open
Abstract
In non-small cell lung cancer (NSCLC), metastasis is the most common phenotype, and autophagy plays a vital role in its regulation. However, there are limited data on how autophagy-related genes and metastasis-related genes affect NSCLC progression. Our goal was to identify the genes that regulate autophagy and metastasis in NSCLC, and to assess the underlying mechanisms in this current study. RNA sequencing data from public databases were used to screen differentially expressed autophagy- and metastasis-associated genes. Enrichment analyses and immune correlations were conducted to identify hub genes and potential regulating pathways in NSCLC. In this study, we found that CCL2 expression was highly expressed in NSCLC tissues and high CCL2 level was correlated with strong infiltration in lung tissues from NSCLC patients. Overexpression of CCL2 can enhance the metastasis of NSCLC cells in nude mice. Furthermore, CCL2 activated the PI3K/Akt/mTOR signalling pathway axis, promoted epithelial-mesenchymal transition (EMT), and blocked the autophagic flux in NSCLC cells. Therefore, our results indicate that CCL2 promotes metastasis and EMT of NSCLC via PI3K/Akt/mTOR axis and autophagy signalling pathways. We believe that CCL2 could be a probable target for the diagnosis and therapeutics of NSCLC, and this study may expand our understanding of lung cancer.
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Affiliation(s)
- Hui Xu
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological DiseasesThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Jin Wang
- Department of Thoracic SurgeryThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Murad Al‐Nusaif
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological DiseasesThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Huipeng Ma
- College of Medical LaboratoryDalian Medical UniversityDalianChina
| | - Weidong Le
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological DiseasesThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
- Institute of Neurology, Sichuan Academy of Medical Science‐Sichuan Provincial HospitalMedical School of UESTCChengduChina
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Ampil F, Porter C, Sangster G, Toms J, Bozeman A. Correlation Between Oligometastatic Tumor in Two Other Visceral Organs and Prognosis in Patients With Brain Metastases. J Palliat Med 2023; 26:1715-1718. [PMID: 37917925 DOI: 10.1089/jpm.2022.0612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Background and Objective: A recent report indicated that metastases to other body organs commonly develop after stereotactic body radiation treatment for cure in patients with oligometastases (OGM) confined to one organ. This study was undertaken to determine if the presence of metastatic disease in two other visceral organs (TVO) in patients with conventionally treated brain metastases (BRM) was associated with poorer prognosis. Methods: This retrospective clinical investigation included 26 patients treated for palliation of OGM-BRM between May 1996 and February 2020. These individuals were classified according to the presence (13 patients) or absence (13 patients) of metastases in TVO. Results: With an overall mean follow-up of 16 months, 20 patients were deceased, and 6 patients were alive. The median survivals for the OGM-BRM-TVO and non-OGM-BRM-TVO subsets were 4 and 12 months, respectively; the corresponding crude survival rates at 12 months were 0% and 46% (p < 0.01). Subgroup analysis correlating prognosis to the number of BRM (single vs. multiple) and OGM-BRM categories (synchronous vs. metachronous) failed to reveal a survival advantage favoring a certain subgroup. Conclusion: Although the evidence is speculative, we believe that an aggressive disease condition is more likely present in patients with OGM-BRM-TVO. With the notion of an overall poor survival, we suggest a more tailored, less or nonharmful management approach (i.e., palliative therapy or hospice) for this particular patient cohort.
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Affiliation(s)
- Federico Ampil
- Department of Radiology and Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Carrie Porter
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Guillermo Sangster
- Department of Radiology and Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Jamie Toms
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Amy Bozeman
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
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Yuan J, Cheng Z, Feng J, Xu C, Wang Y, Zou Z, Li Q, Guo S, Jin L, Jiang G, Shang Y, Wu J. Prognosis of lung cancer with simple brain metastasis patients and establishment of survival prediction models: a study based on real events. BMC Pulm Med 2022; 22:162. [PMID: 35477385 PMCID: PMC9047387 DOI: 10.1186/s12890-022-01936-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/31/2022] [Indexed: 12/11/2022] Open
Abstract
Objectives The aim of this study was to explore risk factors for the prognosis of lung cancer with simple brain metastasis (LCSBM) patients and to establish a prognostic predictive nomogram for LCSBM patients. Materials and methods Three thousand eight hundred and six cases of LCSBM were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015 using SEER Stat 8.3.5. Lung cancer patients only had brain metastasis with no other organ metastasis were defined as LCSBM patients. Prognostic factors of LCSBM were analyzed with log-rank method and Cox proportional hazards model. Independent risk and protective prognostic factors were used to construct nomogram with accelerated failure time model. C-index was used to evaluate the prediction effect of nomogram. Results and conclusion The younger patients (18–65 years old) accounted for 54.41%, while patients aged over 65 accounted for 45.59%.The ratio of male: female was 1:1. Lung cancer in the main bronchus, upper lobe, middle lobe and lower lobe were accounted for 4.91%, 62.80%, 4.47% and 27.82% respectively; and adenocarcinoma accounted for 57.83% of all lung cancer types. The overall median survival time was 12.2 months. Survival rates for 1-, 3- and 5-years were 28.2%, 8.7% and 4.7% respectively. We found female (HR = 0.81, 95% CI 0.75–0.87), the married (HR = 0.80; 95% CI 0.75–0.86), the White (HR = 0.90, 95% CI 0.84–0.95) and primary site (HR = 0.45, 95% CI 0.39–0.52) were independent protective factors while higher age (HR = 1.51, 95% CI 1.40–1.62), advanced grade (HR = 1.19, 95% CI 1.12–1.25) and advanced T stage (HR = 1.09, 95% CI 1.05–1.13) were independent risk prognostic factors affecting the survival of LCSBM patients. We constructed the nomogram with above independent factors, and the C-index value was 0.634 (95% CI 0.622–0.646). We developed a nomogram with seven significant LCSBM independent prognostic factors to provide prognosis prediction.
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Affiliation(s)
- Jiaying Yuan
- Department of Respiratory and Critical Care Medicine, Shanghai Changhai Hospital, the First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Zhiyuan Cheng
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, China
| | - Jian Feng
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Chang Xu
- Clinical College of Xiangnan University, Chenzhou, 423043, China
| | - Yi Wang
- School of Life Sciences, Fudan University, Shanghai, 200433, China
| | - Zixiu Zou
- School of Life Sciences, Fudan University, Shanghai, 200433, China
| | - Qiang Li
- Department of Respiratory and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200120, China
| | - Shicheng Guo
- School of Life Sciences, Fudan University, Shanghai, 200433, China
| | - Li Jin
- School of Life Sciences, Fudan University, Shanghai, 200433, China
| | - Gengxi Jiang
- Department of Thoracic Surgery, Shanghai Changhai Hospital, the First Affiliated Hospital of Naval Military Medical University, Shanghai, 200433, China.
| | - Yan Shang
- Department of Respiratory and Critical Care Medicine, Shanghai Changhai Hospital, the First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China. .,Department of General Medicine, the First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.
| | - Junjie Wu
- Department of Pulmonary and Critical Care Medicine, Fudan University, Shanghai, 200032, China. .,Department of Pulmonary and Critical Care Medicine, Shanghai Geriatric Medical Center, Shanghai, 200032, China.
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Real-World Management and Outcomes of Crizotinib-Treated ROS1-Rearranged NSCLC: A Retrospective Canadian Cohort. Curr Oncol 2022; 29:1967-1982. [PMID: 35323360 PMCID: PMC8947433 DOI: 10.3390/curroncol29030160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
The use, safety and effectiveness of crizotinib as part of the management of ROS1-rearranged NSCLC patients in a real-world Canadian clinical cohort was the focus of this retrospective review. Twenty-one ROS1-rearranged patients with advanced/metastatic disease receiving crizotinib between 2014–2020 were identified; crizotinib demonstrated tolerability and effectiveness in this population where outcomes were similar to those described in other crizotinib-treated real-world cohorts, but lower than those of the PROFILE 1001 clinical trial population. Systemic anti-cancer therapy prior to crizotinib initiation occurred in half of the study cohort, with platin-pemetrexed and immune checkpoint inhibitors being most common. Platin-pemetrexed showed good effectiveness in this cohort, but despite high prevalence of upregulated PD-L1 expression, immune checkpoint inhibitors showed poor effectiveness in his cohort. Among all systemic therapies received, crizotinib showed the most effective disease control, although longer intervals between diagnosis and crizotinib initiation were more common among those showing a lack of clinical response to crizotinib, and patients with brain metastases at the time of crizotinib initiation also showed increased diagnosis to crizotinib initiation intervals and decreased clinical response to crizotinib. This study reveals crizotinib has clinical benefit, but timely identification of ROS1-rearrangements and initiation targeted therapies appears important to maximize outcome in this population.
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Wang M, Wu Q, Zhang J, Qin G, Yang T, Liu Y, Wang X, Zhang B, Wei Y. Prognostic impacts of extracranial metastasis on non-small cell lung cancer with brain metastasis: A retrospective study based on surveillance, epidemiology, and end results database. Cancer Med 2020; 10:471-482. [PMID: 33320433 PMCID: PMC7877345 DOI: 10.1002/cam4.3562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/25/2020] [Accepted: 10/02/2020] [Indexed: 12/15/2022] Open
Abstract
This study was designed to investigate the prognostic value of the number and sites of extracranial metastasis (ECM) in NSCLC patients with BM. NSCLC patients with BM from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015 were enrolled in analysis. Patients from 2010 to 2013 were included in the training set and those from 2014 to 2015 in the validation set. ECM sites among different subtypes of NSCLC were compared by Chi-square tests. Kaplan-Meier methods and Cox regression models were performed to analyze survival data. Competing-risks analysis was used to predict cumulative incidence rates for CSS and non-CSS cause. We included 5974 patients in the training cohort and 3561 patients in the validation cohort. Most (nearly 80%) NSCLC patients with BM showed 0-1 involved extracranial organ, with the most and least common ECM organ being bone and distant lymph nodes (DLNs) among all subtypes of NSCLC, respectively. The number of involved extracranial organs was an independent prognostic factor for patients with BM from NSCLC (p < 0.001). Patients with 0-1 ECM had better survival than those with larger number of involved extracranial organs (p < 0.001). Cumulative incidence rates for CSS were increased with the number of ECM raising (p < 0.001). All involved extracranial organs were associated with worse survival (p < 0.05). In patients with single-organ ECM, we observed a better prognosis in lung and bone metastasis, while liver metastasis showed worst survival. But the difference in survival in these patient groups was relatively small. Patients with liver metastasis had higher cumulative incidence rates for CSS than that in patients with lung and bone metastasis (p < 0.05). More extracranial metastases were associated with poor prognosis in NSCLC patients with BM and ECM sites showed limited effect on survival. Tailored treatments would be reasonable for BM patients from NSCLC with different metastasis patterns.
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Affiliation(s)
- Miao Wang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Qiuji Wu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jun Zhang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Guizhen Qin
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Tian Yang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yixin Liu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xulong Wang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Boyu Zhang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yongchang Wei
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.,Hubei Cancer Clinical Study Center Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
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Muniz TP, de Jesus VHF, Sousa VAR, Barbosa MVDR, de Lima VCC. A modified recursive partitioning analysis for predicting overall survival in patients with non-small cell lung cancer and central nervous system metastases. J Thorac Dis 2019; 11:3909-3919. [PMID: 31656665 DOI: 10.21037/jtd.2019.08.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Non-small cell lung cancer (NSCLC) is a major cause of brain metastases. Nonetheless, patients with central nervous system (CNS) spread are poorly represented in clinical trials. We sought to evaluate the overall survival (OS) of patients with NSCLC and CNS metastases. Methods Patients with NSCLC and CNS metastases treated at A. C. Camargo Cancer Center from January 2007 to December 2017 were selected. The primary endpoint was OS following the diagnosis of CNS metastasis. The Kaplan-Meier method was applied to calculate OS. Prognostic factors were assessed by the Cox Proportional Hazards model. As an exploratory analysis, a survival tree was generated based upon the two most statistically significant variables in the multivariate model and one additional clinically meaningful variable. Results In total, 311 patients were included. Median OS was 10.3 months (95% CI, 8.7-13.1 months). ECOG performance status 2-4 (HR 2.12; 95% CI, 1.40-3.20; P<0.01) and the absence of a driver mutation (HR 3.30; 95% CI, 1.85-5.90; P<0.01) were strongly associated with worse OS. A Modified Recursive Partitioning Analysis (mRPA) was developed based on the curves generated by the survival tree. mRPA stratified our cohort in four subgroups with significantly different OS (3.1 to 43 months) and it outperformed both RPA and GPA in predicting OS in our population. Conclusions OS in our cohort was better than previously reported. However, prognosis is widely variable and is mostly dictated by performance status and the presence of a driver mutation.
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Lewitzki V, Klement RJ, Hess S, Kosmala R, Nieder C, Flentje M. External validation of a prognostic score predicting overall survival for patients with brain metastases based on extracranial factors. Clin Transl Radiat Oncol 2019; 16:15-20. [PMID: 30906886 PMCID: PMC6411583 DOI: 10.1016/j.ctro.2019.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/23/2019] [Indexed: 12/25/2022] Open
Abstract
We provide an external validation of the extracranial prognostic score developed by Nieder et al. This extracranial score could effectively define the patients with very short survival. A new combination of extracranial score with DS-GPA-score achieved an even better discrimination
Purpose The aim of our study was an external validation of the extracranial prognostic score predicting survival of patients with brain metastases receiving cranial irradiation on data from a single institution. Materials and methods A retrospective analysis of 524 patients with brain metastases treated with cranial radiotherapy in a single tertiary center was performed. Three predictive scores were calculated and assessed for their ability to discriminate prognostic groups: (i) The Recursive Partitioning Analysis (RPA) score (available for 524 patients); (ii) the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) score (464 patients); (iii) the extracranial score (EC-S) developed by Nieder et al. which is based on serum albumin, lactate dehydrogenase (LDH) and the number of extracranial organs involved (157 patients). Discrimination of each score was assessed by Gönen & Heller’s concordance probability estimate (CPE). The calibration was checked by comparing median survival estimates of each risk group with the corresponding values of the datasets from which the scores were derived. Finally, a multivariable Cox regression model was built by using the least absolute shrinkage and selection operator on a large number of variables including all three scores. Results With a CPE = 0.626 ± 0.022, the EC-S had the best discriminatory power. The EC-S also appeared to be better calibrated and had the best ability to separate patients with a very poor prognosis: patients with combination of low albumin, elevated LDH and more than 1 extracranial organ with metastatic involvement had a median survival time of only 0.6 months (CI95% 0.1–1.1) and a hazard ratio for death of 6.36 (2.67–15.14) compared to patients with no extracranial metastases and normal levels of albumin and LDH. In the multivariable Cox model serum albumin, LDH, treatment modality, DS-GPA and EC-S were retained as prognostic factors. An ad hoc combination of both DS-GPA and EC-S into a new score was possible for 134 patients and indicated a slightly better discrimination (CPE = 0.636 ± 0.023) than either DS-GPA or EC-S alone. Conclusions This study provides an independent validation of the prognostic EC-S which was the best prognostic model for defining the patients who obviously did not benefit from radiation therapy of brain metastases in terms of overall survival. The combination of the EC-S with the established DS-GPA score resulted in a slight increase in discriminatory ability. The new EC-GPA score needs further validation in larger patient cohorts.
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Affiliation(s)
- Victor Lewitzki
- University of Würzburg, Department of Radiation Oncology, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Rainer J Klement
- Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, 97422 Schweinfurt, Germany
| | - Sebastian Hess
- University of Würzburg, Department of Radiation Oncology, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Rebekka Kosmala
- University of Würzburg, Department of Radiation Oncology, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Carsten Nieder
- Department of Clinical Medicine, Faculty of Health Science, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Oncology and Palliative Medicine, Nordland Hospital Trust, 8092 Bodø, Norway
| | - Michael Flentje
- University of Würzburg, Department of Radiation Oncology, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
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Sun G, Ding X, Bi N, Wang Z, Wu L, Zhou W, Zhao Z, Wang J, Zhang W, Fan J, Zhang W, Dong X, Lv N, Song Y, Zhan Q, Wang L. Molecular predictors of brain metastasis-related microRNAs in lung adenocarcinoma. PLoS Genet 2019; 15:e1007888. [PMID: 30707694 PMCID: PMC6374053 DOI: 10.1371/journal.pgen.1007888] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 02/13/2019] [Accepted: 12/11/2018] [Indexed: 02/07/2023] Open
Abstract
Brain metastasis (BM) is a major complication of lung adenocarcinoma (LAD). An investigation of the pathogenic mechanisms of BM, as well as the identification of appropriate molecular markers, is necessary. The aim of this study was to determine the expression patterns of microRNAs (miRNAs) in LAD with BM, and to investigate the biological role of these miRNAs during tumorigenesis. miRNA array profiles were used to identify BM-associated miRNAs. These miRNAs were independently validated in 155 LAD patients. Several in vivo and in vitro assays were performed to verify the effects of miRNAs on BM. We identified six miRNAs differentially expressed in patients with BM as compared to patients with BM. Of these, miR-4270 and miR-423-3p were further investigated. miR-4270 and miR-423-3p directly targeted MMP19 and P21, respectively, to influence cell viability, migration, and colony formation in vitro. miR-4270 downregulation and miR-423-3p upregulation was associated with an increased risk of BM in LAD patients. Thus, our results suggested that miR-4270 and miR-423-3p might play an important role in BM pathogenesis in LAD patients, and that these miRNAs might be useful prognostic and clinical treatment targets. Brain metastasis (BM) is a major complication of lung carcinoma. Here, we aimed to identify the key miRNAs involved in BM lung cancer. We first profiled miRNA expression in 32 tissues from NSCLC patients with BM and 55 tissues from NSCLC patients without BM. We independently validated our results in 68 additional tissues from NSCLC patients. Based on our results, we identified a panel of miRNAs that distinguish BM lung adenocarcinomas from non-BM We report here for the first time that either miR-4270 downregulation or miR-423-3p upregulation significantly increased cell proliferation, colony formation, and migration in vitro. miR-4270 and miR-423-3p increased the risk of BM in mouse models by targeting MMP19 and P21, respectively. Our results suggested that miR-4270 and miR-423-3p might be useful markers of BM in lung adenocarcinoma.
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Affiliation(s)
- Guogui Sun
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Radiation Oncology, North China University of Science and Technology Affiliated People's Hospital, Hebei, China
| | - Xiao Ding
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Radiation Oncology, Shandong Provincial Hospital, Shandong, China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiwu Wang
- Department of Radiation Oncology, North China University of Science and Technology Affiliated People's Hospital, Hebei, China
| | - Lihong Wu
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhou
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zitong Zhao
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingbo Wang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weimin Zhang
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Fan
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - WenJue Zhang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Dong
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Lv
- Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongmei Song
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail: (YS); (QZ); (LHW)
| | - Qimin Zhan
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Laboratory of Molecular Oncology, Peking University Cancer Hospital and Institute, Beijing, China
- * E-mail: (YS); (QZ); (LHW)
| | - LuHua Wang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail: (YS); (QZ); (LHW)
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9
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Therapeutic Effect of First-line Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor (EGFR-TKI) Combined with Whole Brain Radiotherapy on Patients with EGFR Mutation-positive Lung Adenocarcinoma and Brain Metastases. Curr Med Sci 2018; 38:1062-1068. [DOI: 10.1007/s11596-018-1984-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/03/2018] [Indexed: 10/27/2022]
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10
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Zhu Q, Sun Y, Cui Y, Ye K, Yang C, Yang D, Ma J, Liu X, Yu J, Ge H. Clinical outcome of tyrosine kinase inhibitors alone or combined with radiotherapy for brain metastases from epidermal growth factor receptor (EGFR) mutant non small cell lung cancer (NSCLC). Oncotarget 2017; 8:13304-13311. [PMID: 28076323 PMCID: PMC5355097 DOI: 10.18632/oncotarget.14515] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/27/2016] [Indexed: 01/05/2023] Open
Abstract
This study compared treatment outcomes between TKI monotherapy and TKI administration combined with brain radiotherapy (TKI + RT) in 133 non-small cell lung cancer (NSCLC) patients with brain metastasis (BM). We also evaluated the association of different epidermal growth factor receptor (EGFR) mutation subtypes with treatment outcome. To screen for potential variables affecting cranial progression free survival (PFS) and overall survival (OS), we performed univariate and multivariate analysis based on Cox proportional-hazards models. Median cranial PFS and OS were longer for the TKI + RT group (n = 67) than TKI alone group (n = 66). Intracranial metastasis correlated with a better median OS than extracranial metastasis. For patients with exon 21 mutations, TKI + RT yielded a better median OS and cranial PFS than TKI alone. However, there were no significant differences in median OS and cranial PFS between the two treatment groups for patients with exon 19 deletions. Thus EGFR-mutant NSCLC patients with BM could benefit more from TKI + RT than from TKI monotherapy, especially when they suffer from exon 21 mutations. However, TKI + RT confers no advantage over TKI treatment alone for patients with exon 19 deletions. These results underscore the urgent need to develop individualized disease management strategies in clinical practice.
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Affiliation(s)
- Qianqian Zhu
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Yanan Sun
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Yingying Cui
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Ke Ye
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Chengliang Yang
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Daoke Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Jie Ma
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Xiao Liu
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, 250117, Shandong Province, China
| | - Hong Ge
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
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11
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Yin G, Li C, Chen H, Luo Y, Orlandini LC, Wang P, Lang J. Predicting brain metastases for non-small cell lung cancer based on magnetic resonance imaging. Clin Exp Metastasis 2017; 34:115-124. [PMID: 28101700 DOI: 10.1007/s10585-016-9833-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 12/08/2016] [Indexed: 12/18/2022]
Abstract
In this study the relationship between brain structure and brain metastases (BM) occurrence was analyzed. A model for predicting the time of BM onset in patients with non-small cell lung cancer (NSCLC) was proposed. Twenty patients were used to develop the model, whereas the remaining 69 were used for independent validation and verification of the model. Magnetic resonance images were segmented into cerebrospinal fluid, gray matter (GM), and white matter using voxel-based morphometry. Automatic anatomic labeling template was used to extract 116 brain regions from the GM volume. The elapsed time between the MRI acquisitions and BM diagnosed was analyzed using the least absolute shrinkage and selection operator method. The model was validated using the leave-one-out cross validation (LOOCV) and permutation test. The GM volume of the extracted 11 regions of interest increased with the progression of BM from NSCLC. LOOCV test on the model indicated that the measured and predicted BM onset were highly correlated (r = 0.834, P = 0.0000). For the 69 independent validating patients, accuracy, sensitivity, and specificity of the model for predicting BM occurrence were 70, 75, and 66%, respectively, in 6 months and 74, 82, and 60%, respectively, in 1 year. The extracted brain GM volumes and interval times for BM occurrence were correlated. The established model based on MRI data may reliably predict BM in 6 months or 1 year. Further studies with larger sample size are needed to validate the findings in a clinical setting.
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Affiliation(s)
- Gang Yin
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, No.55, the 4th Section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Churong Li
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, No.55, the 4th Section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Heng Chen
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China
| | - Yangkun Luo
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, No.55, the 4th Section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Lucia Clara Orlandini
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, No.55, the 4th Section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Pei Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, No.55, the 4th Section, Renmin South Road, Chengdu, 610041, Sichuan, China.
| | - Jinyi Lang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, No.55, the 4th Section, Renmin South Road, Chengdu, 610041, Sichuan, China.
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12
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Rades D, Schild SE. Lung cancer: Best supportive care - a reasonable option for patients with brain metastases? Nat Rev Clin Oncol 2016; 13:722-724. [PMID: 27824047 DOI: 10.1038/nrclinonc.2016.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, Arizona 85259, USA
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13
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Xu H, Li Z, Guo Y, Peng X, Qin J. Probing the response of lung tumor cells to inflammatory microvascular endothelial cells on fluidic microdevice. Electrophoresis 2016; 38:311-319. [DOI: 10.1002/elps.201600278] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 01/14/2023]
Affiliation(s)
- Hui Xu
- State Key Laboratory of Fine Chemicals; Dalian University of Technology; Dalian P. R. China
- Dalian Institute of Chemical Physics; Chinese Academy of Sciences; Dalian P. R. China
| | - Zhongyu Li
- State Key Laboratory of Fine Chemicals; Dalian University of Technology; Dalian P. R. China
- Dalian Institute of Chemical Physics; Chinese Academy of Sciences; Dalian P. R. China
| | - Yaqiong Guo
- Dalian Institute of Chemical Physics; Chinese Academy of Sciences; Dalian P. R. China
| | - Xiaojun Peng
- State Key Laboratory of Fine Chemicals; Dalian University of Technology; Dalian P. R. China
| | - Jianhua Qin
- Dalian Institute of Chemical Physics; Chinese Academy of Sciences; Dalian P. R. China
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14
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Guérin A, Sasane M, Dea K, Zhang J, Culver K, Nitulescu R, Wu EQ, Macalalad AR. The economic burden of brain metastasis among lung cancer patients in the United States. J Med Econ 2016; 19:526-36. [PMID: 26735844 DOI: 10.3111/13696998.2016.1138962] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Brain metastases among lung cancer patients can impair cognitive and functional ability, complicate care, and reduce survival. This study focuses on the economic burden of brain metastasis in lung cancer-direct healthcare costs to payers and indirect costs to patients, payers, and employers-in the US. METHODS Retrospective study using claims data from over 60 self-insured Fortune 500 companies across all US census regions (January 1999-March 2013). Adult, non-elderly lung cancer patients with brain metastasis were evaluated over two study periods: (1) pre-diagnosis (≤30 days prior to first observed lung cancer diagnosis to ≤30 days prior to first-observed brain metastasis diagnosis) and (2) post-diagnosis (≤30 days prior to first observed brain metastasis diagnosis to end of continuous eligibility or observation). OUTCOME MEASURES Healthcare costs to payers and resource utilization, salary loss to patients, disability payouts for payers, and productivity loss to employers. RESULTS A total of 132 patients were followed for a median of 8.4 and 6.6 months in the pre- and post-diagnosis periods, respectively. At diagnosis of brain metastasis, 21.2% of patients were on leave of absence and 6.1% on long-term disability leave. Substantial differences were observed in the pre- vs post-diagnosis periods. Specifically, patients incurred much greater healthcare utilization in the post-diagnosis period, resulting in $25,579 higher medical costs per-patient-per-6-months (PPP6M). During this period, patients missed significantly more work days, generating an incremental burden of $2853 PPP6M in salary loss for patients, $2557 PPP6M in disability payments for payers, and $4570 PPP6M in productivity loss for employers. LIMITATIONS Type of primary lung cancer and extent of brain metastasis could not be assessed in the data. The analysis was also limited to patients with comprehensive disability coverage. CONCLUSIONS Development of brain metastasis among lung cancer patients is associated with a substantial economic burden to payers, patients, and employers.
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Affiliation(s)
- A Guérin
- a a Analysis Group, Inc. , Montreal , QC , Canada
| | - M Sasane
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - K Dea
- a a Analysis Group, Inc. , Montreal , QC , Canada
| | - J Zhang
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - K Culver
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - R Nitulescu
- a a Analysis Group, Inc. , Montreal , QC , Canada
| | - E Q Wu
- c c Analysis Group, Inc. , Boston , MA , USA
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15
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Rieber J, Schmitt J, Warth A, Muley T, Kappes J, Eichhorn F, Hoffmann H, Heussel CP, Welzel T, Debus J, Thomas M, Steins M, Rieken S. Outcome and prognostic factors of multimodal therapy for pulmonary large-cell neuroendocrine carcinomas. Eur J Med Res 2015; 20:64. [PMID: 26272455 PMCID: PMC4536693 DOI: 10.1186/s40001-015-0158-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/03/2015] [Indexed: 01/23/2023] Open
Abstract
Background There is controversy whether patients diagnosed with large-cell neuroendocrine carcinoma (LCNEC) should be treated according to protocols for non-small cell lung cancers (NSCLC) or small cell lung cancers (SCLC), especially with regard to the administration of prophylactic cranial irradiation (PCI). This study was set up to determine the incidence of brain metastases and to investigate the outcome following multimodal treatment in 70 patients with LCNEC. Methods Seventy patients with histologically confirmed LCNEC were treated at the University Hospital of Heidelberg between 2001 and 2014. Data were collected retrospectively. Al most all patients received thoracic surgery as initial treatment (94 %). Chemotherapy was administered in 32 patients as part of the initial treatment. Fourteen patients were treated with adjuvant or definitive thoracic radiotherapy according to NSCLC protocols. Cranial radiotherapy due to brain metastases, mostly given as whole brain radiotherapy (WBRT), was received by fourteen patients. Statistical analysis was performed using the long-rank test and the Kaplan–Meier method. Results Without PCI, the detected rate for brain metastases was 25 % after a median follow-up time of 23.4 months, which is comparable to NSCLC patients in general. Overall (OS), local (LPFS), brain metastases-free survival (BMFS) and extracranial distant progression-free survival (eDPFS) was 43, 50, 63 and 50 % at 5 years, respectively. Patients with incomplete resection showed a survival benefit from adjuvant radiotherapy. The administration of adjuvant chemotherapy improved the general worse prognosis in higher pathologic stages. Conclusion In LCNEC patients, the administration of radiotherapy according to NSCLC guidelines appears reasonable and contributes to acceptable results of multimodal treatment regimes. The low incidence of spontaneous brain metastases questions a possible role of PCI.
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Affiliation(s)
- Juliane Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.
| | - Julian Schmitt
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.
| | - Arne Warth
- Institute for Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany.
| | - Thomas Muley
- Translational Research Unit, Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
| | - Jutta Kappes
- Translational Research Unit, Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany. .,Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Amalienstraße 20, 69126, Heidelberg, Germany.
| | - Florian Eichhorn
- Translational Research Unit, Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany. .,Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Amalienstraße 20, 69126, Heidelberg, Germany.
| | - Hans Hoffmann
- Translational Research Unit, Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany. .,Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Amalienstraße 20, 69126, Heidelberg, Germany.
| | - Claus Peter Heussel
- Translational Research Unit, Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany. .,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik gGmbH, University Hospital Heidelberg, Heidelberg, Germany. .,Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Thomas Welzel
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.
| | - Michael Thomas
- Translational Research Unit, Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany. .,Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Amalienstraße 20, 69126, Heidelberg, Germany.
| | - Martin Steins
- Translational Research Unit, Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany. .,Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Amalienstraße 20, 69126, Heidelberg, Germany.
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.
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16
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Odabas H, Ulas A, Aydin K, Inanc M, Aksoy A, Yazilitas D, Turkeli M, Yuksel S, Inal A, Ekinci AS, Sevinc A, Demirci NS, Uysal M, Alkis N, Dane F, Aliustaoglu M, Gumus M. Is second-line systemic chemotherapy beneficial in patients with non-small cell lung cancer (NSCLC)? A multicenter data evaluation by the Anatolian Society of Medical Oncology. Tumour Biol 2015; 36:9641-8. [PMID: 26150339 DOI: 10.1007/s13277-015-3728-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/28/2015] [Indexed: 11/24/2022] Open
Abstract
Patients with advanced non-small cell lung cancer (NSCLC) generally require second-line treatment although their prognosis is poor. In this multicenter study, we aimed to detect the characteristics related to patients and disease that can predict the response to second-line treatments in advanced NSCLC. Data of 904 patients who have progressed after receiving first-line platinum-based chemotherapy in 11 centers with the diagnosis of stage IIIB and IV NSCLC and who were evaluated for second-line treatment were retrospectively analyzed. The role of different factors in determining the benefit of second-line treatment was analyzed. Median age of patients was 57 years (range 19-86). Docetaxel was the most commonly used (20.9 %, n = 189) single agent, while gemcitabine-platinum was the most commonly used (6.7 %, n = 61) combination chemotherapy regimen in second-line setting. According to survival analysis, median progression-free survival after first-line treatment (PFS2) was 3.5 months (standard error (SE) 0.2; 95 % confidence interval (CI), 3.2-3.9), median overall survival (OS) was 6.7 months (SE 0.3; 95 % CI, 6.0-7.3). In multivariate analysis, independent factors affecting PFS2 were found to be hemoglobin (Hb) level over 12 g/dl and treatment-free interval (TFI) longer than 3 months (p = 0.006 and 0.003, respectively). Similarly, in OS analysis, Hb level over 12 g/dl and time elapsed after the first-line treatment that is longer than 3 months were found to be independent prognostic factors (p = 0.0001 and 0.045, respectively). In light of these findings, determining and using the parameters for which the treatment will be beneficial prior to second-line treatment can increase success rate.
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Affiliation(s)
- Hatice Odabas
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
| | - Arife Ulas
- Department of Medical Oncology, Abdurrahman Yurtaslan Oncology Hospital, Ankara, Turkey
| | - Kubra Aydin
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
| | - Mevlude Inanc
- Department of Medical Oncology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Asude Aksoy
- Department of Medical Oncology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Dogan Yazilitas
- Department of Medical Oncology, Konya Education and Research Hospital, Konya, Turkey
| | - Mehmet Turkeli
- Department of Medical Oncology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Sinemis Yuksel
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
| | - Ali Inal
- Department of Medical Oncology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Ahmet S Ekinci
- Department of Medical Oncology, Abdurrahman Yurtaslan Oncology Hospital, Ankara, Turkey
| | - Alper Sevinc
- Department of Medical Oncology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Nebi S Demirci
- Department of Medical Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Mukremin Uysal
- Department of Medical Oncology, Kocatepe University Faculty of Medicine, Afyon, Turkey
| | - Necati Alkis
- Department of Medical Oncology, Abdurrahman Yurtaslan Oncology Hospital, Ankara, Turkey
| | - Faysal Dane
- Department of Medical Oncology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Aliustaoglu
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
| | - Mahmut Gumus
- Department of Medical Oncology, Bezmialem Vakif University School of Medicine, Adnan Menderes Bulvari Fatih, Istanbul, Turkey.
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17
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Xiang Z, Chen J, Zhang H, Shen L, Wei Q. Whole Brain Radiotherapy-Based Combined Modality Treatment of Brain Metastases from Non-Small Cell Lung Cancer: A Retrospective Analysis of Prognostic Factors. Oncol Res Treat 2015; 38:35-40. [DOI: 10.1159/000371501] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/27/2014] [Indexed: 11/19/2022]
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18
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Leth T, von Oettingen G, Lassen-Ramshad YA, Lukacova S, Høyer M. Survival and prognostic factors in patients treated with stereotactic radiotherapy for brain metastases. Acta Oncol 2015; 54:107-14. [PMID: 24874928 DOI: 10.3109/0284186x.2014.921724] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Stereotactic radiation therapy (SRT) of brain metastases is used with good effect around the world, but no consensus exists regarding which prognostic factors that are related to favourable or unfavourable prognosis after the treatment. A better definition of these factors will ensure a more precise application of the treatment. MATERIAL AND METHODS A consecutive cohort of the 198 patients treated for brain metastases with SRT without concurrent whole-brain radiation therapy at our department from 2001 to 2012 was retrospectively analysed. RESULTS Median survival was seven months and median time to clinical cerebral progression was eight months. The multivariate analysis revealed age ≥ 65 years, Performance Status ≥ 2, extracranial metastases and size of metastasis > 20 mm as independent prognostic factors related to shorter survival. No factors were independently related to clinical cerebral progression. CONCLUSION We identified four prognostic factors related to survival after SRT for brain metastases. The grouping of patients by these factors is useful to determine the level of treatment. We discourage the delivery of SRT to patients with 3-4 unfavourable prognostic factors because of the very short median survival of two months.
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Affiliation(s)
- Thomas Leth
- Department of Oncology, Aarhus University Hospital , Aarhus , Denmark
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