The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification. J Thorac Oncol. 2015;10:1243-1260. [PMID: 26291008 DOI: 10.1097/jto.0000000000000630]

Prognostic and clinicopathological significance of the new grading system for invasive pulmonary adenocarcinoma: A systematic review and meta-analysis

In 2020, the International Association for the Study of Lung Cancer (IASLC) introduced a new grading system for invasive pulmonary adenocarcinoma (IPA). This meta-analysis aimed to validate the prognostic utility of this grading system and identify relevant clinicopathological features. The PubMed, Embase, Web of Science, and Cochrane Library databases were searched for relevant studies published between January 1, 2020 and March 5, 2024. Hazard ratios (HRs) with corresponding 95 % confidence intervals (CIs) were pooled to evaluate the effect of IASLC grading on prognosis. Odds ratios with corresponding 95 % CIs were pooled to assess relevant clinicopathological features. Twenty-two studies comprising 12,515 patients with IPA were included. Regarding overall survival, grade 3 adenocarcinomas had a worse prognosis compared with grades 1-2 (HR: 2.26, 95 % CI: 1.79-2.85, P<0.001), grade 1 (HR: 4.75, 95 % CI: 2.61-8.66, P<0.001), or grade 2 (HR: 1.71, 95 % CI: 1.28-2.29, P<0.001). Considering recurrence-free survival, grade 3 tumors had a higher recurrence risk than grades 1-2 (HR: 1.92, 95 % CI: 1.53-2.41, P<0.001), grade 1 (HR: 4.43, 95 % CI: 2.91-6.73, P<0.001), or grade 2 (HR: 1.67, 95 % CI: 1.33-2.10, P<0.001). In the subgroup analysis of stage I patients, grade 3 tumors exhibited a similarly poor prognosis. In addition, grade 3 adenocarcinomas were associated with aggressive clinicopathological features. This study demonstrated that the IASLC grading system is a robust predictor of prognostic stratification in patients with IPA, and warrants further promotion and worldwide implementation.

CT-based intratumoral and peritumoral radiomics nomogram to predict spread through air spaces in lung adenocarcinoma with diameter ≤ 3 cm: A multicenter study

Purpose

The aim of this study was to explore and develop a preoperative and noninvasive model for predicting spread through air spaces (STAS) status in lung adenocarcinoma (LUAD) with diameter ≤ 3 cm.

Methods

This multicenter retrospective study included 640 LUAD patients. Center I included 525 patients (368 in the training cohort and 157 in the validation cohort); center II included 115 patients (the test cohort). We extracted radiomics features from the intratumor, extended tumor and peritumor regions. Multivariate logistic regression and boruta algorithm were used to select clinical independent risk factors and radiomics features, respectively. We developed a clinical model and four radiomics models (the intratumor model, extended tumor model, peritumor model and fusion model). A nomogram based on prediction probability value of the optimal radiomics model and clinical independent risk factors was developed to predict STAS status.

Results

Maximum diameter and nodule type were clinical independent risk factors. The extended tumor model achieved satisfactory STAS status discrimination performance with the AUC of 0.74, 0.71 and 0.80 in the three cohorts, respectively, performed better than other radiomics models. The integrated discrimination improvement value revealed that the nomogram outperformed compared to the clinical model with the value of 12 %. Patients with high nomogram score (≥ 77.31) will be identified as STAS-positive.

Conclusions

Peritumoral information is significant to predict STAS status. The nomogram based on the extended tumor model and clinical independent risk factors provided good preoperative prediction of STAS status in LUAD with diameter ≤ 3 cm, aiding surgical decision-making.

Predicting the spread through air spaces in lung adenocarcinoma from preoperative 18 F-FDG PET/CT radiomics

OBJECTIVE

This study aimed to develop an effective radiomics-clinical model to preoperatively discriminate the spread through air spaces (STAS) in lung adenocarcinoma (ADC).

METHODS

Data from 192 ADC patients were enrolled, with 2/3 ( n  = 128) allocated as the training cohort and the remaining 1/3 ( n  = 64) designated as the validation cohort. A total of 2212 radiomics features were extracted from PET/computed tomography (PET/CT) images. The least absolute shrinkage and selection operator regression method was applied to select features. Logistic regression was used to construct radiomics and clinical models. Finally, a radiomics-clinical model that combined clinical with radiomics features was developed. The models were evaluated by receiver operating characteristic (ROC) curve and decision curve analysis.

RESULTS

The area under the ROC curve (AUC) of the radiomics-clinical model was 0.924 (95% confidence interval, 0.878-0.969) in the training cohort and 0.919 (0.833-1.000) in the validation cohort. The AUC of the radiomics model was 0.885 (0.825-0.945) in the training cohort and 0.877 (0.766-0.988) in the validation cohort. The AUC of the clinical model was 0.883 (0.814-0.951) in the training cohort and 0.896 (0.7706-1.000) in the validation cohort. The decision curve analysis indicated its clinical usefulness.

CONCLUSION

The PET/CT-based radiomics-clinical model achieved satisfactory performance in discriminating the STAS in ADC preoperatively.

Basal and AT2 cells promote IPF-lung cancer co-occurrence via EMT: Single-cell analysis

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic interstitial lung disease. With IPF, the probability of complication with lung cancer (LCA) increases considerably, and the prognosis is worse than that of simple IPF. To understand the pathological mechanisms and molecular pathways shared by these two diseases, we used the single-cell analysis from the Gene Expression Omnibus (GEO) database, and find that basal cells (BCs) and alveolar type 2 cells (AT2 cells) are important components of lung epithelial cells. Changes in molecular pathways in BCs and AT2 cells may be involved in the common pathogenesis of IPF and LCA. KRT17 and S100A14 in BCs may promote the IPF co-occurrence with LCA by mediating the EMT. WFDC2 and KRT19 may be the elements in AT2 cells that activate the EMT process to promote IPF co-occurrence with LCA. In both IPF and LCA, FN1-WNT axis may be involved in the interaction between BCs and AT2 cells. Importantly, the results of immunofluorescence colocalization experiments on tissue samples from patients with IPF and LCA were consistent with these conclusions. Basal-macrophage interactions may have also induced the IPF co-occurrence with LCA via the CYBA-ERK1/2 axis. The regulation of M2 macrophage polarization by JUN/SOD2-glycolysis axis may therefore be involved in the co-morbidity mechanism of IPF and LCA. Therefore, our results suggest that molecular changes in BCs, AT2 cells and macrophages may play important roles in the pathogenesis of IPF co-occurrence with LCA, and the cellular interactions between these cells may be critical for the progression of both diseases.

Multicenter Retrospective Analysis of Pulmonary Sarcomatoid Carcinoma Clinically Diagnosed Using Small Biopsy Specimens

Background/Aim

Pulmonary sarcomatoid carcinoma is a rare disease known for its aggressiveness, with numerous studies evaluating the efficacy of various therapeutic approaches. However, pulmonary sarcomatoid carcinoma is histologically defined according to WHO classification based on surgical specimens, whereas in clinical practice, most cases of advanced lung cancer are diagnosed based on small biopsy specimens. This retrospective study aimed to present the clinical course of patients diagnosed with pulmonary sarcomatoid carcinoma based on small biopsy specimens.

Patients and Methods

Data of patients who were diagnosed with pulmonary sarcomatoid carcinoma based on small biopsy specimens and treated with platinum-doublet chemotherapy and/or an immune checkpoint inhibitor-containing regimen between 2005 and 2022 were analyzed.

Results

Data from 12 patients were analyzed, including five patients treated with platinum-doublet chemotherapy and 11 patients treated with an immune checkpoint inhibitor-containing regimen. The median progression-free survival among the five patients treated with platinum-doublet chemotherapy was 1.5 months [95% confidence interval (CI)=0.7-4.1]. Of these, four patients subsequently received immune checkpoint inhibitor-containing therapy. The median overall survival from the initiation of platinum-doublet chemotherapy in these five patients was 14.7 months (95%CI=1.2-16.2). In contrast, 11 patients treated with immune checkpoint inhibitor therapy showed a median progression-free survival and overall survival of 8.9 months [95%CI=0.3-not estimated (NE)] and 10.8 months (95%CI=1.0-NE), respectively.

Conclusion

Pulmonary sarcomatoid carcinoma diagnosed based on small biopsy specimens is refractory to platinum-doublet chemotherapy, and immune checkpoint inhibitor therapy may improve the prognosis.

Computer Assisted Nodule Analysis and Risk Yield is Associated With Occult Lymph Node Status in Clinical Stage I-IIA Lung Adenocarcinoma Undergoing Resection

BACKGROUND

Current staging work-up does not capture all occult lymph node (OLN) disease. We sought to determine if Computer Assisted Nodule Analysis and Risk Yield (CANARY) analysis could help distinguish OLN status in early-stage lung adenocarcinoma.

METHODS

Retrospective review of resected lung cancer patients from 2016 to 2021 was performed. Patients with surgically resected clinical stage I-IIA lung adenocarcinoma were included. Preoperative imaging was entered into the CANARY software, and each lesion was categorized into good, intermediate, and poor risk. OLN status was determined per pathology results. Pearson's Chi-square correlation, univariate and multivariate logistic regression models were used to assess OLN metastases as a function of CANARY risk profile, with statistical significance at α=0.05.

RESULTS

In total, the study cohort included 228 patients with median age of 70. By clinical stage, 195 (85.5%), 24 (10.5%), and 9 (3.9%) patients were determined to be in IA, IB, and IIA, respectively. 28 (12.3%) patients were found to have OLN metastases. Among them, 1 (3.6%), 3 (10.7%), and 24 (85.7%) patients had a good, intermediate, and poor CANARY risk profile, respectively. CANARY risk profile was significantly associated with OLN metastases (χ2 = 9.9, P = .007). Relative to the good/intermediate group, patients with poor risk had a more-than 3-fold increase in likelihood of having OLN metastases (odd ratio [OR] = 3.3, 95% confidence interval [CI]:1.6-9.2, P = .007).

CONCLUSION

CANARY analysis was able to risk-stratify the likelihood of OLN metastases in early-stage lung adenocarcinoma. CANARY can provide an adjunctive non-invasive tool to aid in determining an appropriate individualized treatment plan.

CT-based radiomics predictive model for spread through air space of IA stage lung adenocarcinoma

BackgroundSpread through air spaces (STAS) in lung adenocarcinoma means different treatment and worse prognosis.PurposeTo construct a radiomics model based on CT scans to predict the presence of STAS in stage IA lung adenocarcinoma, compared with the traditional clinical model.Material and MethodsThe study included 317 patients (median age = 57.21 years; age range = 45.84-68.61 years) with pathologically confirmed stage IA lung adenocarcinoma. In total, 122 (38.5%) patients were diagnosed with STAS by pathology after the operation. Two experienced radiologists independently segmented the lesions using MITK software and extracted 1791 radiomics features using Python. Single-factor t-test or Mann-Whitney U-test and LASSO were used to screen for radiomics signatures related to STAS. This study constructed a radiomics model, a clinical model, and a combined model, combining radiomics and clinical features. Model performance was evaluated using the area under the curve (AUC).ResultsBy single-factor analysis, four clinical features and 13 radiomics features were significantly associated with STAS. The three models (the clinical, radiomics, and combine models) achieved predictive efficacy, with an AUC of 0.849, 0.867, and 0.939, respectively, in the training set and 0.808, 0.848, and 0.876, respectively, in the testing set.ConclusionThe combined model based on the radiomics and clinical features of preoperative chest CT could be used to preoperatively diagnose the presence of STAS in stage IA lung adenocarcinoma and has an excellent diagnostic performance.

Multi‑omics analysis identifies different molecular subtypes with unique outcomes in early-stage poorly differentiated lung adenocarcinoma

INTRODUCTION

Early-stage poorly differentiated lung adenocarcinoma (LUAD) is plagued by a high risk of postoperative recurrence, and its prognostic heterogeneity complicates treatment and surveillance planning. We conducted this integrative multi-omics study to identify those patients with a truly high risk of adverse outcomes.

METHODS

Whole-exome, RNA and whole methylome sequencing were carried out on 101 treatment-naïve early-stage poorly differentiated LUADs. Integrated analyses were conducted to disclose molecular characteristics and explore molecular subtyping. Functional validation of key molecules was carried out through in vitro and in vivo experiments.

RESULTS

Recurrent tumors exhibited significantly higher ploidy (p = 0.024), the fraction of the genome altered (FGA, p = 0.042), and aneuploidy (p < 0.05) compared to non-recurrent tumors, as well as a higher frequency of CNVs. Additionally, recurrent tumors showed hypomethylation at both the global level and in CpG island regions. Integrative transcriptomic and methylation analyses identified three molecular subtypes (C1, C2, and C3), with the C1 subtype presenting the worst prognosis (p = 0.024). Although frequently mutated genes showed similar mutation frequencies across the three subtypes, the C1 subtype exhibited the highest tumor mutation burden (TMB), mutant-allele tumor heterogeneity (MATH), aneuploidy, and HLA loss of heterozygosity (HLA-LOH), along with relatively lower immune cell infiltration. Furthermore, GINS1 and CPT1C were found to promote LUAD progression, and their high expression correlated with a poor prognosis.

CONCLUSIONS

This multi-omics study identified three integrative subtypes with distinct prognostic implications, paving the way for more precise management and postoperative monitoring of early-stage poorly differentiated LUAD.

Surgical outcomes in mediastinal mature teratoma

Background

This study was aimed at reporting the clinical characteristics and perioperative surgical outcomes of mediastinal mature teratoma managed in a single surgical unit.

Methods

This is a retrospective analysis of 35 cases of mediastinal mature teratoma cases managed in a tertiary level thoracic surgery center over 10 years. A comprehensive analysis of perioperative surgical outcomes including complications was performed.

Results

Males (n = 22, 62.8%) were predominant in the study group. Mean age of the cohort was 31.2 ± 13.3 years. The diagnosis was unruptured mature teratoma in 17(48.6%), ruptured mature teratoma in 8 (22.8%) and mature cystic teratoma in 10 (28.6%) patients. The mean duration from symptoms was 5.5 months (range: 1 - 84 months). Open surgery was done in 22 patients (62.8%) followed by video-assisted thoracoscopic surgery in 4 (11.4%) and robotic surgery in 9 patients (25.7%). Conversion from minimal access surgery to open surgery was in 2 patients (5.7%). The mean duration of intercostal chest drainage (ICD) was 6.3 ± 1.3 days, and mean hospital stay averaged 5.8 ± 2.7 days. Most common postoperative complication was prolonged post-operative air leak (> 7 days) in 5 patients (14.3%). The peri-operative mortality was in 1 (2.8%) patient. Ruptured teratoma was a strong predictor of postoperative complications (p = 0.008).

Conclusion

Complete surgical resection is primary and effective treatment modality for mediastinal mature teratoma. A tailored approach is needed, considering the factors like tumor size, location, and relation with surrounding structures.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s12055-024-01882-8.

Prognostic Factors in EGFR Mutation-positive Patients With Bone Metastases from Lung Adenocarcinoma

Background/Aim

This study analyzed prognostic factors in patients with lung adenocarcinoma and bone metastases who tested positive for epidermal growth factor receptor (EGFR) mutations.

Patients and Methods

We retrospectively reviewed the records of 117 patients with lung adenocarcinoma and bone metastases who were followed up at a single institution for 0.2 months to 66 months. Of these 117 patients, 45 were EGFR mutation-positive and further analysis was performed for these patients. Median survival times and five-year survival rates were investigated according to performance status (PS), oligometastatic status, radiotherapy and EGFR-tyrosine kinase inhibitor (TKI) administration.

Results

The five-year survival rate of EGFR mutation-positive patients was 9.2%, and median survival time was 22.7 months; their mean age was 69.5 years. Many EGFR mutation-positive patients had a PS of 2, and the median survival time showed significant differences according to PS (0/1/2 vs. 3/4) and oligometastatic status.

Conclusion

Although there was no difference in the mean survival time between patients receiving or not receiving bone radiotherapy, the treatment effectively reduced pain and prevented paralysis. As a first-line treatment in EGFR mutation-positive patients, first- or second-generation TKIs followed by third-generation TKIs showed favorable outcomes.

Development and internal validation of predictive models for spread through air spaces in clinical stage IA lung adenocarcinoma

OBJECTIVE

Spread through air spaces (STAS) in lung adenocarcinoma impacted prognosis and treatment decisions, but lacked reliable preoperative prediction. We aimed to construct an easy-to-use model for clinical stage IA adenocarcinoma patients.

METHODS

This study analyzed 1212 patients with clinical stage IA lung adenocarcinoma undergoing lung resections from November 2020 to January 2022. Two logistic regression models were developed. Model 1 used demographic and computed tomography features, and Model 2 incorporated maximum standardized uptake values additionally. Internal validation used tenfold cross-validation. Model discrimination and calibration were described by the area under the curve (AUC) and Spiegelhalter z test, respectively.

RESULTS

Prevalence of STAS was 10.6%. Model 1 consisted of maximum tumor diameter, smoking history, location, spiculation and lobulation, showing moderate discrimination (AUC = 0.700). Model 2 consisted of smoking history, the maximum standardized uptake value, spiculation and lobulation, receiving an AUC of 0.807 and good calibration. Model 2 has a sensitivity and a specificity of 0.857 and 0.652. A nomogram for Model 2 was also developed.

CONCLUSION

Our study developed and validated two predictive models for STAS for clinical stage IA lung adenocarcinoma. Model 2, integrating maximum standardized uptake value, outperformed Model 1 and offered a more comprehensive approach to predicting STAS. Surgeon could consider the results of Model 2 and intraoperative frozen sections sequentially to optimize surgical strategies. External validation remained warranted.

Diagnostic performance of radiomics analysis for pulmonary cancer airway spread: a systematic review and meta-analysis

PURPOSE

Spread through air spaces (STAS) is a unique metastatic pattern of pulmonary cancer closely associated with patient prognosis. This study evaluates the application of radiomics in the diagnosis of pulmonary cancer STAS through meta-analysis and explores its clinical significance and potential limitations.

METHODS

We systematically searched the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases for relevant studies between inception and April 1, 2024. The main evaluation indicators included sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the curve (AUC). A total of 18 studies, covering 6,642 lung cancer cases, were included in the systematic review.

RESULTS

In the development cohort, the sensitivity of radiomics for diagnosing STAS was 0.80 [95% confidence interval (CI): 0.75-0.84; P < 0.001; I2: 72.8%], and the specificity was 0.79 (95% CI: 0.71-0.85; P < 0.001; I2: 93.4%). In the validation cohort, the sensitivity was 0.81 (95% CI: 0.75-0.86; P < 0.001; I2: 45.8%), and the specificity was 0.74 (95% CI: 0.68-0.80; P < 0.001; I2: 65.0%). The summary AUC for both cohorts was 0.85 (95% CI: 0.82-0.88). Deeks' funnel plot analysis showed no significant publication bias in either cohort (P values: 0.963 and 0.106, respectively).

CONCLUSION

Radiomics analysis demonstrates important clinical significance in the diagnosis of pulmonary cancer STAS, with promising sensitivity and specificity results in both development and validation cohorts.

CLINICAL SIGNIFICANCE

While radiomics analysis offers valuable diagnostic insights for STAS in pulmonary cancer, its limitations must be carefully considered. Future research should focus on addressing these limitations and further exploring the application prospects of radiomics in lung cancer diagnosis and treatment.

Liquid biopsy in lung cancer

Precision medicine based on biomarkers, such as genetic abnormalities and PD-L1 expression, has been established for the treatment of nonsmall cell lung cancer. Recently, liquid biopsy has emerged as a valuable and minimally invasive alternative. This method analyzes blood and other bodily fluids to detect cancer-related genetic abnormalities and molecular residual disease (MRD). Liquid biopsy, which includes testing for circulating tumor cells, circulating tumor DNA (ctDNA), and microRNA (miRNA), offers several advantages over conventional methods. It is minimally invasive, can be performed repeatedly, and provides crucial information for early cancer diagnosis, genotyping, and treatment monitoring. Elevated ctDNA levels and miRNA markers show promise for early diagnosis. Liquid biopsy complements traditional tissue biopsy during genotyping, particularly when tumor samples are insufficient. Tests such as Cobas® EGFR Mutation Test v2 and Guardant360® CDx have been shown to be effective in detecting genetic mutations and guiding treatment decisions. Although the accuracy of liquid biopsy is still lower than that of tissue biopsy, its clinical utility continues to improve. For cancer prediction recurrence and treatment monitoring, ctDNA analysis can detect MRD earlier than conventional imaging, offering potential benefits for treatment adjustment and early relapse detection. The continuous development and validation of liquid biopsy methods are essential for improving personalized lung cancer treatment strategies.

Multidisciplinary treatment of advanced or metastatic ALK-positive non-small cell lung cancer: Real-world data on Brigatinib combined with local therapy

Anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) often shows incomplete responses and progression despite tyrosine kinase inhibitor (TKI) therapy. Preliminary data suggest that combining brigatinib, an ALK-selective TKI, with surgery or radiotherapy may improve outcomes. We retrospectively analyzed patients with advanced ALK-positive NSCLC who received brigatinib as first-line treatment combined with local therapy to assess safety and efficacy of this approach in a real-world setting. Among 9 patients, 6 (67%) had stage III and 3 (33%) had stage IV adenocarcinoma. Five patients received surgery, 3 received radiotherapy, and 1 received both. Brigatinib-related adverse events (AEs) occurred in 78% of patients, primarily mild (grade ≤ 2). Severe AEs (grade ≥ 3) were seen in 22% of patients and included dyspnea and hypertension. Brigatinib was discontinued in 22% of patients due to toxicity. Local therapy-related AEs were mostly grade 1. The objective response rate was 89%, with 2 complete and 6 partial responses. At data cutoff, brigatinib was ongoing in 55% of patients, with a median treatment duration of 14 months and a 2-year progression-free survival rate of 100%. Combining brigatinib with local therapy appears safe and potentially more effective for advanced ALK-positive NSCLC. Further studies are warranted.

Diagnostic value of exosome-derived lncRNA PITPNA-AS1 in lung cancer

Background

Lung cancer is one of the most lethal types of cancer, and effective diagnostic biomarkers are required. There is increasing evidences that exosome-secreted lncRNAs could play an important role in lung cancer diagnosis. However, the diagnostic value and molecular mechanism of the key lncRNA PITPNA-AS1 in lung cancer remain unclear.

Methods

qRT-PCR was conducted to determine the levels of exosomal lncRNA PITPNA-AS1 in pleural effusions from lung adenocarcinoma, squamous cell lung carcinoma, and small cell lung cancer patients. Receiver operating characteristic (ROC) curve analyses were used to evaluate the diagnostic accuracy of PITPNA-AS1. Its role in lung cancer development was determined by a series of experiments, including CCK-8, flow cytometry, and transwell assays. RNA pull-down and RNA immunoprecipitation assays were carried out to examine the interaction between PITPNA-AS1 and Fragile X messenger ribonucleoprotein 1 (FMR1).

Results

We discovered PITPNA-AS1 in exosomes from lung cancer patients. Its expression was significantly increased in lung cancer patients compared to non-cancer patients, and it was strongly associated with tumor stage, lymph node metastasis, and distant metastasis in all lung cancer subtypes assessed (all p<0.05). ROC curve analyses demonstrated that exosomal PITPNA-AS1 had a high accuracy for differentiating among lung cancer subtypes. Furthermore, PITPNA-AS1 boosted H1299 and A549 cell proliferation, migration, and invasion. Mechanistically, via direct interaction, PITPNA-AS1 increased FMR1 stability by preventing its ubiquitination.

Conclusions

These results reveal that exosome-derived lncRNA PITPNA-AS1 acts as an oncogene to promote malignant biological behaviors and is a promising diagnostic biomarker in lung cancer.

Prognostic Benefit of Segmentectomy for Patients with Low Muscle Mass in Early-Stage Lung Cancer

BACKGROUND

Although segmentectomy is less invasive than lobectomy, little is known about the effect of these procedures on postoperative outcomes of patients with low muscle mass. This study examined the postoperative prognosis of patients with non-small cell lung cancer according to the surgical procedure type and preoperative muscle mass.

METHODS

This study retrospectively reviewed data of patients who underwent lobectomy or segmentectomy for early-stage non-small cell lung cancer with ground glass opacity-dominant tumor up to 3 cm in size or solid-dominant tumor up to 2 cm in size between 2010 and 2020. The preoperative muscle mass was evaluated based on the height-adjusted erector spinae muscle mass on preoperative chest computed tomography images. The overall survival was compared between patients with low and high muscle mass in the lobectomy and segmentectomy groups. Multivariable analyses were performed to identify prognostic factors for overall survival.

RESULTS

The study enrolled 371 patients: 162 in the lobectomy group and 209 in the segmentectomy group. The 5-year overall survival was significantly poorer for the patients with low muscle mass than for those with high muscle mass in the lobectomy group (83.9 % vs. 91.9 %; p = 0.018), whereas no significant difference was observed in the segmentectomy group (93.5 % vs. 94.9 %; p = 0.54). In the several multivariable models, low muscle mass was an independent prognostic factor in the lobectomy group (hazard ratio [HR], range, 2.3-2.4; p value range, 0.027-0.042) but not in the segmentectomy group (HR range, 1.6-2.0; p value range, 0.19-0.36).

CONCLUSIONS

Segmentectomy should be actively considered for patients with low muscle mass because of its lower invasiveness.

Myc family proteins: Molecular drivers of tumorigenesis and resistance in neuroendocrine tumors

Neuroendocrine cancers are a diverse and poorly understood collection of malignancies derived from neuroendocrine cells throughout the body. These cancers uniquely exhibit properties of both the nervous and endocrine systems. Only a limited number of genetic driver mutations have been identified in neuroendocrine cancers, however the mechanisms of how these genetic aberrations alter tumor biology remain elusive. Recent studies have implicated the MYC family of transcription factors as important oncogenic factors in neuroendocrine tumors. We take a systematic approach to understand the roles of the MYC family (c-MYC, n-MYC, l-MYC) in the tumorigenesis of neuroendocrine cancers of the lung, GI tract, pancreas, kidney, prostate, pediatric neuroblastoma, and adrenal glands. Reflecting the complexity of neuroendocrine cancers, we highlight the roles of the MYC family in deregulating the cell cycle and transcriptional networks, invoking cellular plasticity, affecting proliferation capacity, aiding in chromatin remodeling, angiogenesis, metabolic changes, and resistance mechanisms. Depicting the diversity of neuroendocrine cancers, we suggest new approaches in understanding the underlying tumorigenic processes of neuroendocrine cancers from the perspective of MYC.

Uncertain Resection in Lung Cancer: A Comprehensive Review of the International Association for the Study of Lung Cancer Classification

Objective: We explored the impact of uncertain resection in lung cancer on overall survival and disease-free survival. Methods: We performed an exhaustive literature review of all studies comparing prognosis after resection according to the IASLC classification, from the PubMed, Cochrane, MEDLINE, and Google Scholar databases. Results: Overall, 68 original studies were included, of which 67 were retrospective and 1 was prospective, with 81 785 patients included over 46 years. R(un) reclassification was mostly caused by a lack of hilar or mediastinal node dissection, or because of metastasis in the highest node. R(un) is a strong factor for higher recurrence and mortality, while its effects seem limited in early stages. Carcinoma in situ at bronchial margin resection (CIS BRM) does not show an effect on survival, while positive pleural cytology (Cy+) and positive highest mediastinal lymph node (HMLN+) appear to be highly predictive of recurrence and death. Discussion: The R(un) classification of the IASLC appears highly relevant, especially in locally advanced stages IIb-IIIA, and helps to discriminate patients with poor prognosis despite being classified as R0 in the UICC classification. Conclusions: The use of this more precise classification would allow for better stratification of recurrence risk and more effective use of adjuvant therapies. Cy+ patients should receive adjuvant chemotherapy, while CIS BRM patients could likely benefit from endoscopic surveillance to detect local recurrences. HMLN+ patients should be considered at high risk of recurrence, and adjuvant radio-chemotherapy should be considered.

Pulmonary Large-Cell Neuroendocrine Carcinoma, a Multifaceted Disease-Case Report and Literature Review

Background and Clinical Significance: This article explores the complexity of large-cell neuroendocrine carcinoma (LCNEC) by presenting a clinical case involving a 17-year-old admitted for persistent wheezing, with no history of respiratory toxin exposure, a background of atopy, and a suspected diagnosis of bronchial asthma. Given the patient's age and the nature of the symptoms, the condition was initially diagnosed as asthma, leading to the initiation of maximum inhalation therapy. Case Presentation: Despite proper adherence and correct administration, symptoms persisted, necessitating the use of oral corticosteroids. Imaging revealed an extensive inhomogeneous mass in the cervical esophagus and trachea, along with a similar tumor in the right hilum, prompting bronchoscopy. The diagnosis of LCNEC was confirmed through imaging, histopathological findings, and a detailed immunohistochemical profile. Initially misdiagnosed as adenoid cystic carcinoma, this case highlights the diagnostic challenges and the importance of rigorous evaluation. Conclusions: It emphasizes that recurrent wheezing in adolescents is not always indicative of asthma and requires careful differential diagnosis to uncover less common causes.

Trop-2 expression in non-small cell lung cancer

Trophoblast cell-surface antigen 2 (Trop-2) is highly expressed in non-small cell lung cancer (NSCLC) and has become an attractive target for antibody-drug conjugates (ADCs). ADC tumor target expression is essential in investigating the predictive value of Trop-2 and Trop-2 ADC efficacy. Although Trop-2 mRNA expression in NSCLC has been described, protein-level expression is poorly understood. We investigated Trop-2 expression landscape across multiple data and sample sets to characterize mRNA expression and address the gap in protein-expression profiling. Trop-2 expression was analyzed using available mRNA, mutation, and protein data in three datasets: (1) The Cancer Genome Atlas (TCGA) included clinical-pathological and survival data in NSCLC adenocarcinoma and squamous cell carcinoma; (2) sample set 1 (adenocarcinoma) and (3) sample set 2 (adenocarcinoma, squamous cell carcinoma) underwent sequencing and immunohistochemistry for Trop-2 RNA, protein (Robust Prototype Assay, SP295 clone) and mutation analysis. Trop-2 was highly expressed in NSCLC and expression was similar in adenocarcinoma and squamous cell carcinoma and across baseline characteristics including patient age, sex, and tumor stage. Trop-2 expression was not associated with clinically relevant genetic alterations. Trop-2 was not a prognostic factor in NSCLC (TCGA survival data). High Trop-2 expression in NSCLC was independent of evaluated baseline characteristics, histology, and driver alterations. Trop-2 protein expression at any level was observed in 82% to 90% of NSCLC across sample sets; similar proportions of adenocarcinoma and squamous cell carcinoma expressed Trop-2. These data support broad Trop-2 ADC use in NSCLC.

Predicting Benign and Malignant Subpleural Pulmonary Lesions With a Nomogram Model Using Clinical and B-Mode Ultrasound Parameters

OBJECTIVE

To develop and validate an individualized nomogram for distinguishing between benign and malignant subpleural pulmonary lesions (SPLs) using B-mode ultrasound imaging and clinical data.

METHODS

A total of 425 patients with SPLs were enrolled and classified into two groups: 220 patients were diagnosed with malignant lesions, and 205 with benign lesions. Patients were randomly assigned to a development cohort (DC, n = 297) and a validation cohort (VC, n = 128) in a 7:3 ratio. Statistical analyses included rank-sum tests and chi-square tests. Boruta analysis was used to identify key features associated with malignant SPLs. The multivariable logistic regression model based on independent malignant SPL factors was developed and represented as a nomogram. The model's performance was assessed in terms of discrimination, calibration and clinical utility.

RESULTS

Six variables were selected to construct the nomogram: age, pack-year of smoking, air bronchogram, the angle between the lesion border and the thoracic wall, posterior echo of the lesion and visceral pleural invasion. The area under the receiver operating characteristic curve for the model was 0.859 (95% CI: 0.816-0.901) in the DC and 0.862 (95% CI: 0.800-0.923) in the VC. Calibration curve analysis demonstrated that the nomogram closely aligned with the ideal curve, reflecting its good calibration. Furthermore, decision curve analysis, clinical impact curve (CIC) and net reduction curve (NRC) further confirmed the model's favorable clinical utility.

CONCLUSION

We have developed a nomogram that serves as an effective tool for assessing malignant SPLs. This model holds significant promise as a complementary diagnostic aid, particularly in primary healthcare settings and bedside examination.

Multidisciplinary expert consensus on diagnosis and treatment of multiple lung cancers

The rising incidence of multiple lung cancers (MLCs), encompassing multiple primary lung cancers (MPLCs) and intrapulmonary metastasis (IPM), poses two significant clinical challenges. First, distinguishing between MPLC and IPM remains difficult due to insufficiently accurate criteria and ambiguous integration of genetic testing. Second, standardized therapeutic protocols are still lacking. To address these issues, the Lung Cancer Expert Committee of China Anti-Cancer Association (CACA) assembled a multidisciplinary expert panel spanning thoracic surgery, pulmonary medicine, oncology, radiology, and pathology. Following a comprehensive literature review ending on October 23, 2024, the panel engaged in iterative discussions and conducted two rounds of expert voting, culminating in 25 evidence-based recommendations across five key domains: epidemiology, pre-treatment evaluation, definitive diagnostics, surgical treatment, and non-surgical treatment. This consensus provides clinicians with practical guidance to enhance diagnostic precision and therapeutic decision-making in MLC management while highlighting unmet needs to inform future guideline development.

Evaluation of cytomorphological examination in the diagnosis of pleural effusion

Cytological examination serves as a crucial diagnostic tool for pleural effusion, with its diagnostic efficacy influenced by variations in specimen processing and staining techniques. Cellular morphological analysis of pleural effusions was performed using Wright-Giemsa staining to assess its diagnostic accuracy and clinical utility in differentiating the various etiologies of exudative pleural effusion. A routine examination was conducted on 2305 cases of unexplained pleural effusion, followed by cellular classification and morphological analysis in 1376 cases identified as exudative effusion. Among the 479 patients with malignant tumors, cytomorphological examination identified malignant cells in 295 patients, resulting in a clinical diagnosis coincidence rate of 98.6%. Abnormal cells, including malignant and heterogeneous nuclear cells, were observed in 364 cases, yielding a detection rate of 76.0%. The proportion of positive malignant cells in the newly diagnosed patient group was significantly higher than that in the previously diagnosed group (P < 0.01). Cytological analysis revealed the presence of bacteria, fungi, and phagocytes in 51 out of 1376 cases. The positivity rate for multiple bacterial infections detected through cytology was significantly greater than that identified by culture (P < 0.01). Additionally, various special morphologies and pathogens, which are rare in clinical practice, were detected, including mixed metastasis of small cell lung carcinoma and adenocarcinoma cells, as well as concurrent infections with Talaromyces marneffei and Pneumocystis jirovecii. This method enables the rapid and comprehensive differentiation between malignant tumors, tuberculosis, pneumonia, and rare exudative pleural effusions resulting from specific clinical conditions.

Identification of new HLA-A*0201-restricted cytotoxic T lymphocyte epitopes from LDHC in lung adenocarcinoma

Background

Lactate dehydrogenase C (LDHC) is a kind of cancer-testis antigen (CTA) that has been reported to be a biomarker for diagnosis, efficacy evaluation, and recurrence monitoring of lung adenocarcinoma (LUAD). This study aims to assess the value of LDHC in peptide-based vaccines for LUAD immunotherapy.

Methods

The LDHC recombinant protein was purified and its effect on PC9 cells was evaluated by wound healing assay, Transwell invasion, and migration assay. Ten HLA-A2-restricted LDHC-derived peptides were predicted and synthesized, and the affinity for the HLA-A2 molecule was analyzed by T2 binding assay and molecule docking. Enzyme-linked immunospot (ELISpot) and LDH cytotoxicity assay were performed to determine the interferon-γ (IFN-γ) release level and tumor cell lysis ability of peptide-induced specific cytotoxic T lymphocytes (CTLs).

Results

The LDHC recombinant protein promoted invasion and migration of PC9 cells. Three HLA-A2-restricted LDHC-derived peptides P2 (LDHC170-180, FRYLIGEKLGV), P5 (LDHC116-124, IMKSIIPAI), and P6 (LDHC172-180, YLIGEKLGV) had high affinity for the HLA-A2 molecule at 50 μg/mL. P6 (LDHC172-180, YLIGEKLGV) elicited the strongest IFN-γ-secreting cytotoxic T lymphocyte (CTL) response and exhibited potent cytotoxicity against HLA-A2-positive cells with high LDHC expression.

Conclusions

LDHC may serve as a targetable biomarker for peptide-based immunotherapy of LUAD.

Low-Malignant-Potential Adenocarcinoma: A Histological Category with a Significantly Better Prognosis than Other Solid Adenocarcinomas at IA Stage

INTRODUCTION

Low-malignant-potential adenocarcinoma has been defined as a type of non-mucinous tumor, which has a total tumor size measuring ≤ 3 cm, exhibits ≥ 15% lepidic growth, lacks non-predominant high-grade patterns (≥10% cribriform, ≥5% micropapillary, ≥5% solid), has an absence of angiolymphatic or visceral pleural invasion, spread through air spaces (STAS), necrosis and >1 mitosis per 2 mm2. The aim of this study is to validate, with regard to cancer-specific survival (CSS) and disease-free survival (DFS), the proposed definition of LMP adenocarcinoma in an independent external cohort of lung adenocarcinoma patients having undergone surgical resection, and having presented with a long follow-up period.

METHODS

Clinicopathological characteristics of patients who underwent lung resection for adenocarcinoma from 1 January 2005 to 31 December 2014 were retrospectively analyzed. Patients with ground-glass opacity (GGO) and part-solid tumors, minimally invasive adenocarcinoma (MIA), adenocarcinoma in situ (AIS), tumors ≥5 cm in size, nodal involvement and/or distant metastases, patients who underwent neoadjuvant treatment, and those who had an incomplete follow-up or a follow-up shorter than 60 months were excluded. The proposed criteria for low-malignant-potential adenocarcinoma (LMPA) were tumor size ≤ 3 cm, invasive size ≥ 0,5 cm, lepidic growth ≥ 15%, and absence of the following: mitosis (>1 per 2 mm2), mucinous subtype, angiolymphatic invasion, visceral pleural invasion, spread through air spaces (STAS) and tumor necrosis. End points were disease-free survival (DFS) and cancer-specific survival (CSS). The log-rank test was used to assess differences between subgroups.

RESULTS

Out of 80 patients meeting the proposed criteria, 14 (17.5%) had the LMPA characteristics defined. The mean follow-up time was 67 ± 39 months. A total of 19 patients died, all in the non-LMPA category, and 33 patients experienced recurrence: 4 (28.5%) with LMPA and 29 (43.9%) with non-LMPA. Log-rank analysis showed 100% 10-year CSS for patients with LMPA and 77.4% for patients without LMPA, with this difference being statistically significant (p-value = 0.047). Univariate analysis showed a significant association with the cStage (AJCC eighth edition), both for CSS (p value = 0.005) and DFS (p-value = 0.003). LMPA classification did not show a statistically significant impact on CSS and DFS, likely due to the limited number of events (CSS p-value = 0.232 and DFS p-value = 0.213). No statistical association was found for CSS and DFS with pT, the number of resected nodes (< or >10) or the number of resected N2 stations (< or >2).

CONCLUSIONS

Our study confirmed the prognostic role of LMPA features, with a low risk of recurrence and a good CSS and DFS. The criteria for diagnosis are replicable and feasible for application. The clinical implications of these findings, such as pre-operative prediction and surveillance scheduling, may be the topic of future prospective studies.

Primary Pulmonary Myxoid Sarcoma Located in the Left Lung Parenchyma: Case Report with a Review of Literature

INTRODUCTION

Primary pulmonary myxoid sarcoma (PPMS) is a very rare low-grade sarcoma. It is known to have a characteristic chromosomal translocation at t(2;22)(q33;q12) and a distinctive genetic alteration, Ewing sarcoma breakpoint region 1 (EWSR1):cAMP response element binding protein 1 fusion. Most cases of PPMS reported so far have been found in the bronchi or bronchioles, and there are only a few cases of them arising from the peripheral lung parenchyma.

CASE PRESENTATION

A 58-year-old man was referred to our department for diagnosis and treatment because a computed tomography (CT) scan showed a 15mm nodule in the left lung. For diagnosis and treatment, he underwent a video-assisted wedge resection. The tumor protruded from the lung parenchyma and had a very striking appearance. Histological features and immunostaining results were not enough to make the diagnosis. Fluorescence in situ hybridization (FISH) analysis was subsequently performed, which suggested EWSR1 gene rearrangement, leading to the final diagnosis of PPMS. The patient is alive 18 months postoperatively with no evidence of recurrence.

CONCLUSIONS

We encountered a rare case of PPMS arising from the peripheral lung parenchyma. In addition, our case was diagnosed as an overlap lesion of PPMS and angiomatoid fibrous histiocytoma. We can expect a good prognosis with surgical resection alone for the treatment of PPMS, but more accumulation of cases is desired for the establishment of an accurate diagnosis and prediction of the disease course.

Ten-Year Observational Study of Patients with Lung Adenocarcinoma: Clinical Outcomes, Prognostic Factors, and Five-Year Survival Rates

Background/Objectives: Lung carcinoma is the leading cause of cancer-related deaths globally, with lung adenocarcinoma being the most prevalent subtype. This study aims to review the clinical data and survival outcomes of patients diagnosed with lung adenocarcinoma who underwent surgical treatment. Methods: We retrospectively analyzed 471 patients (mean age 65.9 ± 7.81 years, range 38-86; 53.5% women) with histopathologically confirmed lung adenocarcinoma who underwent a lobectomy, bilobectomy, or pneumonectomy between May 2012 and December 2022. All patients were followed for up to five years post-surgery. Their medical histories, including previous neoplasms, comorbidities, tumor characteristics, and symptoms, were thoroughly reviewed. We calculated the overall survival rate and evaluated the impact of tumor grading and spread through air spaces (STAS) on patient outcomes. Results: The survival rate for the entire cohort was 76.23%. No significant survival differences emerged between G1 and G2 tumors, whereas both showed markedly better survival rates than G3 tumors. When these findings were applied to a simplified two-tier grading system (low grade vs. high grade), survival analyses showed a clear stratification of prognosis. Patients with STAS had a lower survival rate than those without STAS. Conclusions: Our findings indicate that a simplified grading system may improve prognostic evaluations for lung adenocarcinoma patients. Furthermore, STAS is a crucial factor affecting survival rates and should be considered in future treatment strategies. Expanding research in this area is essential to enhance treatment approaches for lung adenocarcinoma patients.

Treatment status, survival and gene expression analysis of large-cell neuroendocrine lung carcinoma: a real-world study in China

Background

Large-cell neuroendocrine lung carcinoma (LCNEC) is a rare subtype of lung cancer that lacks standard treatment at present.

Purpose

This study aimed to investigate the treatment status, failure pattern, survival outcome, and gene expression profile of LCNEC in China.

Design

This is a real-world retrospective study combined with transcriptome sequencing of LCNEC tumors.

Methods

Patients with newly diagnosed LCNEC at Beijing Chest Hospital from 2015 to 2022 were retrospectively reviewed. Treatment, failure pattern, and survival were analyzed. Transcriptome sequencing of LCNEC and non-small-cell lung cancer was conducted for differentiated expressed genes exploration and enrichment analysis.

Results

In all, 151 eligible patients met the criteria: stage I (24.5%), II (9.9%), IIIA (13.9%), and IIIB-IV (51.7%). Median progression-free survival (PFS) and overall survival (OS) were 7.9 and 17.8 months for an entire cohort of patients. For stage I/II and IIIA patients receiving radical operation or chemoradiation, 47 out of 77 cases developed treatment failure with 2-year cumulative systemic/distant failure (SF), locoregional failure (LRF), and overall failure rates of 65.2%, 52.7%, and 30.8%, respectively. Failure incidence increased with stage development. Stage III disease presented with a significantly higher cumulative SF rate (2-year, 57.3% vs 29.7%; p = 0.010) but a similar LRF rate (2-year, 41.5% vs 37.6%, p = 0.369) than stage I/II, achieving favorable SF-free survival and comparable LRF-free survival. Adding adjuvant chemotherapy to surgery reduced distant dissemination which translated into survival benefit (2-year SF, 53.7% vs 41.3%, p = 0.055; 2-year OS, 37.1% vs 79.9%, p < 0.001). For advanced LCNEC, immunochemotherapy and chemotherapy alone achieved PFS of 10.3 and 4.7 months, respectively (p = 0.045). Differential gene expression analysis revealed that antigen presentation/processing, chemokine signaling, CXCR4, and IFN-γ pathways were upregulated in LCNEC, suggesting the vulnerability of LCNEC to immunotherapy. Besides, MMP9, AGT, COL1A2, COL1A1, and CXCL9 may play vital roles in the LCNEC pathogenesis.

Conclusion

LCNEC is a highly aggressive disease and incorporation of immunotherapy might be an effective treatment option.

Seizures caused by a solitary fibrous tumour of the pleura: an unusual presentation of Doege-Potter syndrome

Doege-Potter syndrome (DPS) is a rare condition that causes hypoinsulinaemic hypoglycaemia due to solitary fibrous tumours (SFTs). This case report details the treatment of a man in middle adulthood (ages 40-65) diagnosed with DPS after experiencing syncope and vasovagal episodes, which led to the discovery of a large mass in the pleura. Following various diagnostic tests confirming the SFT, the patient required anticonvulsant therapy and glucose infusions due to recurrent seizures and severe hypoglycaemia prior to surgery. After the surgical removal of the tumour, both hypoglycaemia and the need for anticonvulsants were resolved. This case highlights the importance of considering DPS in patients with unexplained hypoglycaemia and intrathoracic masses. It concludes that surgical resection is the preferred treatment for SFTs associated with DPS, offering a favourable prognosis, and emphasises the need for regular follow-up to monitor for potential recurrence.

STAS: New explorations and challenges for thoracic surgeons

Spread through air spaces (STAS) represents a relatively novel concept in the pathology of lung cancer, and it specifically refers to the dissemination of tumour cells into the parenchymal air spaces adjacent to the primary tumour. In 2015, the World Health Organization (WHO) classified STAS as a new invasive form of lung adenocarcinoma (LUAD). Many studies investigated the role of STAS and revealed its association with the prognosis of LUAD and its influence on the outcomes of other malignant pulmonary neoplasms. Additionally, the underlying mechanisms and predictive models of STAS have received considerable attention in recent years. This paper provides a comprehensive overview of the research advancements and prospects of STAS by examining it from multiple perspectives.

Therapeutic targeting of TGF-β in lung cancer

Transforming growth factor-β (TGF-β) plays a complex role in lung cancer pathophysiology, initially acting as a tumor suppressor by inhibiting early-stage tumor growth. However, its role evolves in the advanced stages of the disease, where it contributes to tumor progression not by directly promoting cell proliferation but by enhancing epithelial-mesenchymal transition (EMT) and creating a conducive tumor microenvironment. While EMT is typically associated with enhanced migratory and invasive capabilities rather than proliferation per se, TGF-β's influence on this process facilitates the complex dynamics of tumor metastasis. Additionally, TGF-β impacts the tumor microenvironment by interacting with immune cells, a process influenced by genetic and epigenetic changes within tumor cells. This interaction highlights its role in immune evasion and chemoresistance, further complicating lung cancer therapy. This review provides a critical overview of recent findings on TGF-β's involvement in lung cancer, its contribution to chemoresistance, and its modulation of the immune response. Despite the considerable challenges encountered in clinical trials and the development of new treatments targeting the TGF-β pathway, this review highlights the necessity for continued, in-depth investigation into the roles of TGF-β. A deeper comprehension of these roles may lead to novel, targeted therapies for lung cancer. Despite the intricate behavior of TGF-β signaling in tumors and previous challenges, further research could yield innovative treatment strategies.

Actionable Mutations and Survival Rates in Non-Small Cell Lung Cancer

Background

In Jordan, lung cancer ranks as the second most common tumor, and there is an urgent need to explore the genetic landscape of lung cancer. This study aimed to identify the actionable mutations in lung cancer samples in Jordanians by targeted next-generation sequencing (NGS) and to investigate the correlations with clinical and pathological parameters.

Methods

Totally, 121samples were prepared for NGS by DNA extractions from formalin-fixed paraffin-embedded (FFPE) blocks, followed by library preparation using the AmpliSeq Colon and Lung panel, which covers mutational hot spot regions for 22 cancer genes.

Results

Amongst 121 patients, 88% of those treated for non-small lung carcinoma were successfully analyzed; 35 (29%) carried one mutation or more in actionable genes (KRAS, EGFR, ALK, BRAF, and MET). There are no significant differences between actionable mutation carriers and non-carriers concerning histological tumor type, tumor stage, metastasis, smoking habits, and gender. However, the analysis of survival probabilities revealed lower survival times for females compared to males, as well as for those patients who had metastasis events, smoking, or relapse after treatment.

Conclusions

The type and rates of mutations detected for lung tumors in Jordan are relatively similar to those found in other populations previously studied, although some differences exist. However, lung tumors in Jordan require new customized treatment prescriptions based on prior genetic studies, as part of the hoped-for trend toward precision medicine.

The prognostic value of lymphovascular invasion for stage I lung adenocarcinoma based on the presence of ground-glass opacity

OBJECTIVES

There is still a debate regarding the prognostic implication of lymphovascular invasion (LVI) in stage I lung adenocarcinoma. Ground-glass opacity (GGO) on CT is known to correlate with a less invasive or lepidic component in adenocarcinoma, which may influence the strength of prognostic factors. This study aimed to explore the prognostic value of LVI in stage I lung adenocarcinoma based on the presence of GGO.

MATERIALS AND METHODS

Stage I lung adenocarcinoma patients receiving lobectomy between 2010 and 2019 were retrospectively categorized as GGO-positive or GGO-negative (solid adenocarcinoma) on CT. Multivariable Cox regression analyses were performed for disease-free survival (DFS) and overall survival (OS) to evaluate the prognostic significance of pathologic LVI based on the presence of GGO.

RESULTS

Of 924 patients included (mean age, 62.5 ± 9.2 years; 505 women), 525 (56.8%) exhibited GGO-positive adenocarcinoma and 116 (12.6%) were diagnosed with LVI. LVI was significantly more frequent in solid than GGO-positive adenocarcinoma (20.1% vs. 6.9%, p < 0.001). Multivariable analysis identified LVI and visceral pleural invasion (VPI) as significant prognostic factors for shorter DFS among solid adenocarcinoma patients (LVI, hazard ratio (HR): 1.89, p = 0.004; VPI, HR: 1.65, p = 0.003) but not GGO-positive patients (p = 0.76 and p = 0.87). In contrast, LVI was not a significant prognostic factor for OS in either group (p > 0.05).

CONCLUSION

In stage I lung adenocarcinoma, pathologic LVI was associated with DFS only in patients with solid lung adenocarcinoma.

CLINICAL RELEVANCE STATEMENT

Lymphovascular invasion (LVI) significantly affects disease-free survival in solid-stage I lung adenocarcinoma patients, but not those with ground-glass opacity (GGO) adenocarcinoma. Risk stratification considering both GGO on CT and LVI may identify patients benefiting from increased surveillance.

KEY POINTS

The presence of ground-glass opacity portends different prognoses for lung adenocarcinoma. In stage I lung adenocarcinoma, lymphovascular invasion (LVI) was significantly more frequent in solid adenocarcinomas than in ground-glass opacity (GGO)-positive adenocarcinomas. LVI was not associated with overall survival in patients with either solid adenocarcinomas or GGO adenocarcinomas.

Identification of Defined Molecular Subgroups on the Basis of Immunohistochemical Analyses and Potential Therapeutic Vulnerabilities of Pulmonary Carcinoids

INTRODUCTION

Multi-omic studies have identified three molecular separated pulmonary carcinoid (PC) subgroups (A1, A2, B) with distinctive mRNA expression profiles (e.g., orthopedia homeobox protein [OTP], achaete-scute homolog [ASCL1], and hepatocyte nuclear factor 1 homeobox A [HNF1A]). We aimed to establish an immunohistochemical (IHC) biomarker panel that enables subgroup identification, and assessment of its potential clinical relevance.

METHODS

All patients with resected pulmonary carcinoids (2003-2012) were identified from the Dutch Cancer/Pathology Registry, and tumors were revised. The IHC expression of OTP, ASCL1, and HNF1A was scored in a blinded fashion in a mRNA-profiled (n = 5 per subgroup) and national carcinoid cohort (N = 478). The expression of potential therapeutic targets (somatostatin receptor type 2a [SSTR2A] and delta-like canonical Notch ligand 3 [DLL3]) was assessed. Immunohistochemistry was assessed using H-scoring.

RESULTS

OTP, ASCL1, and HNF1A reported similar IHC and mRNA expression patterns in the matched primary samples. In the national cohort, IHC separated PCs into subgroups A1 (n = 224 [53%], OTPhigh-ASCL1high-HNF1Alow), A2 (n = 161 [38%], OTPhigh-ASCL1low-HNF1Ahigh), and B (n = 37 [9%], OTPlow-ASCL1low-HNF1Ahigh). In 12% of PCs, no distinct classification could be provided. Patients with A1 were enriched for older age (83% > 50 y), female individuals (83%), and peripheral location (55%) with low SSTR2A (median = 10) and high DLL3 (median = 52) expression. A2 included younger patients (34% < 40 y) and endobronchial/central (87%) tumors with high SSTR2A (median = 160), but low DLL3 (median 0) expression. Group B included more male individuals (59%) and recurrence was more frequent (19%) than in groups A1 (8%) and A2 (6%). Neuroendocrine cell hyperplasia was enriched in A1 (25%) compared with A2 (3%) and B (0%).

CONCLUSIONS

An OTP, ASCL1, and HNF1A IHC panel enables the identification of molecular-defined pulmonary carcinoid subgroups with distinct clinical phenotypes and diverging therapeutic vulnerabilities that require further prospective evaluation.

Prevalent findings on low-dose CT scan lung cancer screening: a French prospective pilot study

Despite significant therapeutic advances, lung cancer remains the biggest killer among cancers. In France, there is no national screening program against lung cancer. Thus, in this perspective, the Foch Hospital decided to implement a pilot and clinical low-dose CT screening program to evaluate the efficiency of such screening. The purpose of this study was to describe the prevalent findings of this low-dose CT screening program. Participants were recruited in the screening program through general practitioners (GPs), pharmacists, and specialists from June 2023 to June 2024. The inclusion criteria included male or female participants aged 50 to 80 years, current smokers or former smokers who had quit less than 15 years prior, with a smoking history of over 20 pack-years. Chest CT scans were conducted at Foch Hospital using a low-dose CT protocol based on volume mode with a multi-slice scanner (≥60 slices) without contrast injection. In total, 477 participants were recruited in the CT scan screening, 235 (49%) were males with a median age of 60 years [56-67] and 35 smoke pack-years [29-44] and 242 females (51%) with a median age of 60 years [55-60] and 30 smoke pack-years [25-40]. Eight participants showed positive nodules on CT scan, as a 1.7% rate. 66.7% of diagnosed cancers were in early stages (0-I). It is feasible to implement structured lung cancer screening using low-dose CT in a real-world setting among the general population. This approach successfully identifies most early-stage cancers that could be treated curatively.

Pulmonary Carcinosarcoma Imitating Teratocarcinosarcoma: A Case Report

Pulmonary carcinosarcoma is a rare tumor composed of non-small-cell carcinomas and sarcomatous elements, which is poorly differentiated in most cases. We present a case of carcinosarcoma with a well-differentiated carcinomatous component that required a differential diagnosis from tumors derived from teratomas, such as teratocarcinosarcoma. We present a case of a 68-year-old man who visited our hospital for an examination of a 22-mm lung tumor. The patient underwent left S1+2 segmentectomy, and his postoperative course was uneventful. No recurrence was observed in the 21-month postoperative follow-up period. The segmentectomy specimen revealed a yellow-white, well-circumscribed mass. The tumor consisted of well-differentiated squamous and glandular epithelia, and sarcomatous components of immature spindle cells, chondrosarcoma, and rhabdomyosarcoma. The patient was diagnosed with carcinosarcoma. This case included well-differentiated carcinomatous components, and it was necessary to differentiate it from teratocarcinosarcomas. There was no neural component, and without SMARCA4 loss, which is observed in teratocarcinosarcoma, and ruled out teratocarcinosarcoma. Carcinosarcomas are characterized by a biphasic histopathological pattern, making it difficult to accurately diagnose them on biopsy, which only captures a portion of the tumor. The possibility of carcinosarcoma should be considered even when the tumors derived from teratomas are suspected on preoperative biopsy.

Neoadjuvant bronchoscopic photodynamic therapy to facilitate airway and parenchymal sparing lobectomies in two patients with central airway neuroendocrine tumors: A patient centered approach

BACKGROUND

NCCN guidelines recommend surgical resection for well differentiated pulmonary neuroendocrine tumors (NETs), also known as carcinoid tumors, when they present in the lungs. Fortunately, most pulmonary NETs will not require extensive surgical resection beyond a lobectomy. We report two cases in which large pulmonary NETs would have required more extensive surgical resection, including a carinal pneumonectomy and a left lower lobe sleeve resection. However, after taking patient's preferences into account, neoadjuvant photodynamic therapy was able to decrease the overall tumor burden helping to facilitate airway and parenchymal sparing surgical lobectomies.

MATERIALS

Interventional pulmonology (IP) and Cardiothoracic surgery (CTS) discussed options extensively with each patient and formulated a plan to perform neoadjuvant bronchoscopic followed by surgical resection if there were any remaining NET on follow up bronchoscopy. Both patients received infusions of porfimer sodium (Photofrin ®, Pinnacle Biologics) at 2mg/kg. Per standard protocol, they each underwent a series of bronchoscopies 48 h after infusion, in which endobronchial NET was illuminated with a fiberoptic catheter delivering up to 200J/cm per treatment. After the initial illumination bronchoscopy, a cryo probe was used to debulk necrotic tumor and allow for repeat illumination of residual tumor. Both patients received extensive education on avoiding phototoxicity.

OUTCOMES

Both patients underwent follow up restaging bronchoscopies revealing cleared central airways and only residual NET at the subsegmental level. As such, both underwent lobectomies, avoiding more extensive surgical resection. Both are free of disease at four years and 18 months follow up, respectively. Both patients were satisfied with their outcomes and the autonomy they were given in formulating their treatment plan.

CONCLUSIONS

While photodynamic therapy has been shown to be an effective stand alone, neoadjuvant, and adjuvant therapy for pulmonary NETs, surgical resection is still required in select patients. We present two cases of in which desired patient outcomes led to the use of neoadjuvant PDT to help facilitate airway and parenchymal sparing lobectomies, thus avoiding more extensive surgical resection and possible long-term morbidity.

Pathological & radiological variables in the diagnosis of bronchopulmonary carcinoids (BPCs) with a focus on Antigen Kiel 67 (Ki-67) proliferation index

BACKGROUND

Bronchopulmonary carcinoids (BPCs) are classified into typical carcinoids (TC) and atypical carcinoids (AC), based on the mitotic count and absence/presence of necrosis on pathology specimens. There are limitations to accurate measurement of these criteria. It important to study other markers like Ki-67, to enhance the diagnostic accuracy of lung carcinoids.

OBJECTIVE AND METHODOLOGY

Retrospective analysis of BPCs treated with surgery between 2012-2022, to examine the accuracy of Ki-67 on the diagnostic specimen, concordance of diagnostic and resection specimens, diagnostic accuracy of Positron Emission Tomography (PET) and concordance of clinical and pathological staging.

RESULTS

205 patients were included in the analysis (final diagnosis TC 180, AC 25). Mean age 60.5 years and 68 % female. Ki-67 (<5% vs. 5-30 %) on diagnostic biopsy, available in 64 % (n = 131) of the cohort, had specificity (diagnose TC correctly) of 89.4 % (95 %CI 80.4 %-94.7 %) and sensitivity (diagnose AC correctly) of 77.8 % (40.2 %-96.1 %). This compared to 97.5 % (90.3 %-99.6 %) and 36.4 % (12.4 %-68.4 %) for mitotic count (<2mitoses/2mm2 vs. 2-10mitoses/2mm2) and 100 % (94.4 %-100 %) and 21.4 % (5.7 %-51.2 %) for necrosis (absence vs. presence). A pre-resection diagnosis of TC (including surgical biopsy) shows better concordance with final diagnosis on resection specimen (94.9 %, 95 %CI 88.7 %-97.9 %, n = 117) as compared to the diagnosis of AC 83.3 % (95 %CI 50.9 %-97.1 %, n = 12). Concordance for AC appears higher with image guided lung biopsy 80 % (95 % CI, 29.9 %-98.9 %) than bronchoscopy 50 % (9.5 %-90.5 %). SUVmax on 18FDG-PET was a modest predictor of BPC sub-type with an AUC of 0.684 (95 % CI: 0.545,0.823). The clinical and pathological staging were concordant in 46 % (85/184) cases. However, 27 % (50/184) were upstaged and 13 % (23/172) found to have occult nodal metastases on pathology review of the surgical specimens.

CONCLUSION

The diagnosis and sub-typing of BPCs on diagnostic specimens is challenging. Our data suggest Ki-67 could increase diagnostic accuracy, but further research is needed to confirm this.

Sustained Remission With Atezolizumab in a Frail, Geriatric Patient With Advanced-Stage Large Cell Neuroendocrine Carcinoma Lung

Large cell neuroendocrine carcinoma (LCNEC) is a rare, aggressive cancer primarily found in the lungs but can also occur in other organs. It is characterized by rapid progression and high metastatic potential. We present a case of advanced-stage LCNEC lung in a patient with a poor performance status (PS), requiring oxygen support. Imaging revealed a large right upper lobe mass, lymphadenopathy, with bronchial encasement and invasion into the superior vena cava, leading to SVC syndrome and pleural effusion. Biopsy and immunohistochemistry confirmed LCNEC. Due to the patient's poor PS, treatment began with low-dose single-agent chemotherapy (carboplatin), followed by etoposide and cisplatin after improvement. Local radiation was also administered, and the treatment plan was adjusted to include atezolizumab. After 10 cycles, the patient achieved complete remission, sustained for 6 years. This case highlights the complexities of managing advanced LCNEC in a geriatric patient and the effectiveness of a multidisciplinary approach and immunotherapy.

Lung cancer detection by electronic nose analysis of exhaled breath: a multicentre prospective external validation study

BACKGROUND

Electronic nose (eNose) analysis of exhaled breath shows potential for accurate and timely lung cancer diagnosis, yet prospective external validation studies are lacking. Our study primarily aimed to prospectively and externally validate a published eNose model for lung cancer detection in chronic obstructive pulmonary disease (COPD) patients and assess its diagnostic performance alongside a new eNose model, specifically tailored to the target population, in a more general outpatient population.

PATIENTS AND METHODS

This multicentre prospective external validation study included adults with clinical and/or radiological suspicion of lung cancer who were recruited from thoracic oncology outpatient clinics of two sites in the Netherlands. Breath profiles were collected using a cloud-connected eNose (SpiroNose®). The diagnostic performance of the original and new eNose models was assessed in various population subsets based on receiver operating characteristic-area under the curve (ROC-AUC), specificity, positive predictive value (PPV), and negative predictive value (NPV), targeting 95% sensitivity. For the new eNose model, a training cohort and a validation cohort were used.

RESULTS

Between March 2019 and November 2023, 364 participants were included. The original eNose model detected lung cancer with an ROC-AUC of 0.92 [95% confidence interval (CI) 0.85-0.99] in COPD patients (n = 98/116; 84%) and 0.80 (95% CI 0.75-0.85) in all participants (n = 216/364; 59%). At 95% sensitivity, the specificity, PPV, and NPV, were 72% and 51%, 95% and 74%, and 72% and 88%, respectively. In the validation cohort, the new eNose model identified lung cancer across all participants (n = 72/121; 60%) with an ROC-AUC of 0.83 (95% CI 0.75-0.91), sensitivity of 94%, specificity of 63%, PPV of 79%, and NPV of 89%. Notably, accurate detection was consistent across tumour characteristics, disease stage, diagnostic centres, and clinical characteristics.

CONCLUSION

This multicentre prospective external validation study confirms that eNose analysis of exhaled breath enables accurate lung cancer detection at thoracic oncology outpatient clinics, irrespective of tumour characteristics, disease stage, diagnostic centre, and clinical characteristics.

Differentiating high-grade patterns and predominant subtypes for IASLC grading in invasive pulmonary adenocarcinoma using radiomics and clinical-semantic features

OBJECTIVES

The International Association for the Study of Lung Cancer (IASLC) grading system for invasive non-mucinous adenocarcinoma (ADC) incorporates high-grade patterns (HGP) and predominant subtypes (PS). Following the system, this study aimed to explore the feasibility of predicting HGP and PS for IASLC grading.

MATERIALS AND METHODS

A total of 529 ADCs from patients who underwent radical surgical resection were randomly divided into training and validation datasets in a 7:3 ratio. A two-step model consisting of two submodels was developed for IASLC grading. One submodel assessed whether the HGP exceeded 20% for ADCs, whereas the other distinguished between lepidic and acinar/papillary PS. The predictions from both submodels determined the final IASLC grades. Two variants of this model using either radiomic or clinical-semantic features were created. Additionally, one-step models that directly assessed IASLC grades using clinical-semantic or radiomic features were developed for comparison. The area under the curve (AUC) was used for model evaluation.

RESULTS

The two-step radiomic model achieved the highest AUC values of 0.95, 0.85, 0.96 for grades 1, 2, 3 among models. The two-step models outperformed the one-step models in predicting grades 2 and 3, with AUCs of 0.89 and 0.96 vs. 0.53 and 0.81 for radiomics, and 0.68 and 0.77 vs. 0.44 and 0.63 for clinical-semantics (p < 0.001). Radiomics models showed better AUCs than clinical-semantic models for grade 3 regardless of model steps.

CONCLUSIONS

Predicting HGP and PS using radiomics can achieve accurate IASLC grading in ADCs. Such a two-step radiomics model may provide precise preoperative diagnosis, thereby supporting treatment planning.

Recent advances in the role of circRNA in cisplatin resistance in tumors

Cancer remains a major threat to human health, with chemotherapy serving as one of the main treatment strategies to alleviate patient suffering. However, prolonged chemotherapy often leads to the development of drug resistance, complicating treatment outcomes. Cisplatin, a commonly utilized chemotherapeutic agent, demonstrates efficacy against a range of cancers but frequently encounters resistance, posing a significant challenge in tumor management and prognosis. Drug resistance not only facilitates tumor progression but also reduces survival rates, highlighting the urgent need for innovative strategies to overcome this issue. In recent years, non-coding RNAs, particularly circular RNAs (circRNAs), have gained attention in cancer therapy due to their stability and specificity. Moreover, an increasing number of studies have reported that circRNAs are involved in cisplatin resistance across various types of cancer. This paper primarily reviews the mechanisms and roles of circRNA in mediating cisplatin resistance over the past 3 years. These findings highlight circRNAs as promising therapeutic targets for overcoming cancer drug resistance.

Strategies to Overcome Resistance to Osimertinib in EGFR-Mutated Lung Cancer

Non-small-cell lung cancer (NSCLC) represents the most common type of lung cancer. The majority of patients with lung cancer characterized by activating mutations in the epidermal growth factor receptor (EGFR), benefit from therapies entailing tyrosine kinase inhibitors (TKIs). In this regard, osimertinib, a third-generation EGFR TKI, has greatly improved the outcome for patients with EGFR-mutated lung cancer. The AURA and FLAURA trials displayed the superiority of the third-generation TKI in both first- and second-line settings, making it the drug of choice for treating patients with EGFR-mutated lung cancer. Unfortunately, the onset of resistance is almost inevitable. On-target mechanisms of resistance include new mutations (e.g., C797S) in the kinase domain of EGFR, while among the off-target mechanisms, amplification of MET or HER2, mutations in downstream signaling molecules, oncogenic fusions, and phenotypic changes (e.g., EMT) have been described. This review focuses on the strategies that are currently being investigated, in preclinical and clinical settings, to overcome resistance to osimertinib, including the use of fourth-generation TKIs, PROTACs, bispecific antibodies, and ADCs, as monotherapy and as part of combination therapies.

Metastatic choroidal pulmonary biphasic blastoma as a unique single initial metastasis to the eye: a case report

BACKGROUND

Choroidal metastasis is the most common intraocular malignancy in adults, commonly presenting in later stages of the disease and associated with poor prognosis. This is the first case to describe choroidal involvement as the sole initial metastasis of the rare biphasic pulmonary tumor.

CASE PRESENTATION

A 42-year-old white male patient presented to the emergency department with 3 weeks of progressive temporal visual field loss in the left eye (oculus sinister) with slight discomfort to palpation. At the emergency department, he underwent computed tomography and computed tomography angiography of the brain to rule out a central nervous system etiology of his vision loss. The imaging demonstrated lentiform dependent hyperdense material with layering hypodensity within the medial aspect of the left globe, consistent with choroidal detachment. His prior medical history was significant for biphasic pulmonary blastoma cT2N2M0 stage IIIA involving the right lung, with extension into the superior vena cava, diagnosed 3 years prior to the current presentation. He was treated with chemoradiation and excision with complete response to therapy.

CONCLUSION

As the survival rates for cancer patients are increasing owing to better quality and more available treatments, choroidal metastasis may become more common. Early diagnosis and effective treatment of these lesions is crucial for better patient outcomes.

Study on the Material Basis and Mechanisms of Achyrocline satureioides in the Treatment of Nonsmall Cell Lung Cancer Based on Network Pharmacology and Spatial Metabolomics

Achyrocline satureioides have good therapeutic effects on nonsmall cell lung cancer (NSCLC). Nevertheless, it is still challenging to elucidate the active ingredients and mechanism of action due to their complex chemical composition. To address this, we innovatively combined network pharmacology with spatial metabolomics to comprehensively investigate the active components and the action mechanism in the present study. First, metabolomics of cells treated with the methanol extract of A. satureioides (ASM) utilizing high-resolution ultrahigh-performance liquid chromatography tandem mass spectrometry (HR-UHPLC-MS/MS) revealed 32 changed metabolites and 7 enriched metabolic pathways, confirming the anti-NSCLC effect of ASM and its impact on endogenous metabolites at the cellular level. Then, 69 chemical components in the ASM were identified using HR-UHPLC-MS/MS, followed by the screening of 6 core components and 10 core targets of anti-NSCLC with the help of network pharmacology and molecular docking. Lastly, quercetin, the most abundant compound among the six core active ingredients, was chosen for evaluating its anti-NSCLC effect and the potential mechanism using matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI). 51 altered endogenous metabolites were screened, and pathway enrichment analysis results were consistent with cell metabolomics, corroborating our network pharmacology predictions. In addition, we also observed the accumulation of three metabolites of quercetin in the tumor tissues. Network pharmacology combined with MSI elucidated the metabolic mechanisms by which A. satureioides treats NSCLC, offering new insights into herbal cancer therapies.

Safety Profile and Hepatotoxicity of Anaplastic Lymphoma Kinase Tyrosine Kinase Inhibitors: A Disproportionality Analysis Based on FDA Adverse Event Reporting System Database

Anaplastic lymphoma kinase tyrosine kinase inhibitors (ALK-TKIs) have become first-line therapies for advanced non-small cell lung cancer (NSCLC) with ALK rearrangements. This study investigates ALK-TKI-associated adverse events (AEs), focusing on identifying hepatotoxicity signals and previously undocumented safety concerns. Using disproportionality analysis of 56,864 reports from the FDA Adverse Event Reporting System (FAERS) database, we systematically classified AEs via the Medical Dictionary for Regulatory Activities (MedDRA). At the System Organ Class (SOC) level, crizotinib exhibited a significantly stronger signal for eye disorders, ceritinib was uniquely linked to gastrointestinal disorders, and loratinib was predominantly associated with metabolism and nutrition disorders. Several AEs previously undocumented in drug labels were identified, including pericardial effusion, elevated C-reactive protein, hemolytic anemia, hemoptysis, and decreased hemoglobin. Furthermore, crizotinib, ceritinib, and alectinib were significantly associated with hepatotoxicity, marked by elevated alanine aminotransferase, aspartate aminotransferase, and hepatic enzyme levels. These findings highlight the need for vigilant monitoring of unlabeled AEs and potential label updates, particularly for hepatotoxicity risks associated with crizotinib, ceritinib, and alectinib.

Favorable trends in lung cancer incidence with unfavorable survival prognosis: A spatiotemporal analysis by histology in Córdoba, Argentina

Lung cancer (LC) represents the leading cause of cancer-related death and the third in incidence in Argentina. Survival rates are low.

OBJECTIVE

To analyze the spatial distribution of LC incidence in Córdoba-Argentina (2004-2014), explore trends in histological types, and estimate the probability of survival.

METHODS

A longitudinal ecological study was conducted using data from the Provincial Cancer Registry. Age-specific and standardized incidence rates for LC (ICD-10: C33-34) were calculated, truncated (35-84 years), and stratified by sex, year (2004-2014), and histology (small cell carcinoma and non-small cell: adenocarcinoma, squamous cells, large cells, and other carcinomas). Temporal analysis employed Joinpoint regression models, estimating annual percentage changes (APC). Median times estimated survival curves and semiparametric Cox regression models were employed for survival. Statistical significance: log-rank tests and proportional hazards tests. Software: Joinpoint-Regression-Program and Stata17.

RESULTS

From 2004-2014, 8246 LC cases were diagnosed in individuals aged 35-84. The highest incidence occurred in males aged 75-79 and females aged 80-84. The Age-standardized incidence rates for males and females were 57.9 and 23.6 cases per 100,000 person-years, respectively. In both sexes, the temporal incidence trend was decreasing (APC -3.21 %; p = 0.001), more pronounced in males (APC -3.99 %, p = 0.011), with negative APCs in all histological subtypes. The probability of survival decreased to 32 % (95 %CI: 31 %-34 %) within just 12 months (38 % in females, 30 % in males). The risk of death increased proportionally with age (males HR: 1.007, (95 %CI: 1.004-1.01, p = 0.000); females HR: 1.005, (95 %CI: 1.00-1.01, p = 0.031)) and across all histological types, with lower proportional risks in females and disparities based on histology: in males, the highest risk was in large cells (p = 0.008) and SMCC, while in females, it was SCLC (p = 0.055).

CONCLUSIONS

Despite estimating a favorable trend in LC incidence since 2004, the survival prognosis remains unfavorable one-year post-diagnosis, dependent on sex, age, and histological type.

Genomic profiling of aggressive pathologic features in lung adenocarcinoma

INTRODUCTION

Pathologic features involving LVI (lympho-vascular invasion), PNI (perineural invasion), STAS (spread through air spaces), and Grade 3 pattern (from the International Association for the Study of Lung Cancer grading system) are related to having an aggressive phenotype and linked to poor prognosis. However, few studies have conducted in-depth analyses of these features simultaneously with genomic profiling.

METHODS

A total of 1559 sequencing of adenocarcinoma samples were included in the common driver mutations analysis, 1306 samples were brought into genomic mapping analysis. OncoSG's East Asian ancestry dataset was implemented for Tumor-Node-Metastasis-Biomarker (TNMB) classification and prognostic assessment.

RESULTS

EGFR was more significantly prevalent in LVI negativity (P = 0.021), STAS negativity (P = 0.002), and moderate grade (P < 0.001). ALK was significantly interrelated with LVI (P = 0.028), STAS (P < 0.001), and poor grade (P < 0.001); ROS1 and STAS positivity (P = 0.031), poor grade (P = 0.016) were significantly related. KRAS (P = 0.003) and BRAF-V600E (P = 0.002) were only significantly intertwined with poor grade. Apart from common driver mutations, TP53, CHEK2, KEAP1, PTEN, RB1, NF1 were significantly enriched in LVI samples (P < 0.05). TP53, PTEN, CTNNB1, HGF, NF1 were more prominent in STAS (P < 0.01). TP53, LRP1B, NF1 were significantly more prevalent in Grade 3 pattern (P < 0.001). The mixture of STK11, PTEN, and TOP2A generated by exclusive mutations may be a potential predictor of TNMB categorization towards survival. The HR of stage II compared I of TNMB was 2.28 (95 % CI 1.36-3.86, P < 0.001), while stage III compared II was 1.95 (95 % CI 1.04-3.21, P = 0.031).

CONCLUSIONS

This analysis demonstrated the correlation of pathologic features with common driver mutations, key mutations and canonical oncogenic signaling pathways. The data highlighted the similarities and differences among these features horizontally, and provide new insights in TNMB classification and prognostic assessment.