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Kim SH, Seong H, Lee J, Ahn HY, Cho JS, I H, Kim YD, Lee MK, Eom JS, Kim MH. The role of local ablative therapy in patients with advanced invasive mucinous adenocarcinoma of the lung. J Cancer Res Clin Oncol 2024; 150:409. [PMID: 39230677 PMCID: PMC11374817 DOI: 10.1007/s00432-024-05931-y] [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] [Received: 07/15/2024] [Accepted: 08/22/2024] [Indexed: 09/05/2024]
Abstract
PURPOSE Invasive mucinous adenocarcinoma (IMA) of the lungs is a rare subtype of lung adenocarcinoma with a limited understanding of its prognosis, particularly in advanced stages. This study aimed to assess the prognosis of patients with advanced IMA by focusing on treatment modalities. METHODS This single-center retrospective study evaluated 33 patients with IMAs diagnosed with advanced-stage disease or disease progression after curative treatment between 2011 and 2021. The primary outcome was overall survival (OS), and the secondary outcome was progression-free survival (PFS). OS and PFS were calculated from the date of the diagnosis of advanced IMA. RESULTS The study cohort included 13 patients at the initial advanced stage and 20 patients who progressed after curative treatment. Treatment modalities included conventional chemotherapy in 24 patients (72.7%), targeted therapy in seven (21.2%), immunotherapy in 13 (39.4%), and local ablative therapy (LAT) in 13 (39.4%). The median OS was 32 months (95% confidence interval [CI], 2.9-61.0), with LAT significantly associated with improved OS compared to non-LAT treatment (not reached vs. 11.3 months, p = 0.001). However, there was no significant difference in OS based on conventional chemotherapy (p = 0.396), targeted therapy (p = 0.655), or immunotherapy (p = 0.992). In multivariate analysis, LAT remained an independent prognostic factor for OS (hazard ratio, 0.125; 95% CI, 0.026-0.608; p = 0.01). PFS was 8.6 months (95% CI, 3.6-13.7), with no significant differences observed among the treatment modalities. CONCLUSION Our findings suggest that LAT may provide favorable survival outcomes in patients with advanced IMA.
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Affiliation(s)
- Soo Han Kim
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Hayoung Seong
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Jonggeun Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyo Yeong Ahn
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jeong Su Cho
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hoseok I
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Yeong Dae Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Min Ki Lee
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Jung Seop Eom
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Mi-Hyun Kim
- Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea.
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
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Demir T, Araz M, Moloney C, Hendem E, Koçak MZ, Erman M, Baş O, Köstek O, Sever N, Karakaya S, Zeynelgil E, Chung LIY, Chae YK. Efficacy of Systemic Treatments in Patients With Metastatic Lung Invasive Mucinous Adenocarcinoma. Clin Lung Cancer 2024:S1525-7304(24)00083-4. [PMID: 38871540 DOI: 10.1016/j.cllc.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/04/2024] [Accepted: 05/14/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Invasive mucinous adenocarcinoma (IMA) is a rare histological subtype of lung invasive adenocarcinoma with unique clinical, radiological, histopathological, and genomic characteristics. There have been limited studies on the effectiveness of systemic therapy for lung IMA, with conflicting results reported. METHODS We retrospectively investigated the medical records of patients diagnosed with lung IMA. Patients who were ≥ 18 years of age and received at least 1 course of treatment for metastatic or locally advanced inoperable disease were included in the study. Archive records of 113 patients diagnosed with IMA were screened for the study. RESULTS A total of 41 patients with lung IMA were included. The targetable mutation rate was 20.6% (in 6 of 29 patients). Most patients (83.1%) had received platinum-based chemotherapy as a first-line treatment. The objective response rate (ORR) was 25.7%, and median progression-free survival (PFS) and overall survival (OS) were 8.1 months (95% CI, 5.02-11.2) and 17.5 months (95% CI, 11.7-23.3 months), respectively, in the patients who received chemotherapy. The median PFS and ORR were 20.6 (95% CI, 18.9-66.5) and 66.6%, respectively, in epidermal growth factor receptor (EGFR) mutation-positive patients (n = 3) with relevant targeted therapy. Only 1 patient used oxaliplatin and capecitabine combination (XELOX) as chemotherapy in the second-line treatment and achieved a partial response (PR) at 7.2 months. CONCLUSION Platinum-based chemotherapies moderately enhance IMA patients' survival rates. Anti-EGFR-targeted drugs are seen as potentially effective in patients with EGFR driver mutation positive. Large, prospective studies are needed to confirm our findings.
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Affiliation(s)
- Tarık Demir
- Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Murat Araz
- Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Carolyn Moloney
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Engin Hendem
- Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | | | - Mustafa Erman
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Onur Baş
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Osman Köstek
- Marmara University School of Medicine, Istanbul, Turkey
| | - Nadiye Sever
- Marmara University School of Medicine, Istanbul, Turkey
| | - Serdar Karakaya
- Ankara Ataturk Sanatoryum Education and Training Hospital, Ankara, Turkey
| | - Esra Zeynelgil
- Ankara Ataturk Sanatoryum Education and Training Hospital, Ankara, Turkey
| | | | - Young Kwang Chae
- Northwestern University Feinberg School of Medicine, Chicago, IL
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Ge L, Wang L, Pei D. Pulmonary mucinous adenocarcinoma: An overview of pathophysiology and advancements in treatment. Heliyon 2024; 10:e28881. [PMID: 38694119 PMCID: PMC11058725 DOI: 10.1016/j.heliyon.2024.e28881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/21/2024] [Accepted: 03/26/2024] [Indexed: 05/03/2024] Open
Abstract
Pulmonary mucinous adenocarcinoma (PMA), a distinct subtype of non-small cell lung cancer (NSCLC), is characterized by an abundance of mucin-producing cells. Although this subtype comprises a relatively small fraction of lung adenocarcinomas, PMA stands apart due to its unique clinical, pathological, and molecular features. This review comprehensively discusses the pathophysiology and etiology, clinical features, diagnostic methods, treatment strategies, prognosis, and future directions for PMA, drawing from relevant literature and existing studies. Advances in PMA treatment includes surgical intervention, targeted therapy, immunotherapy, and adjuvant therapy. Particularly, we discussed factors influencing the prognosis of PMAs, such as molecular markers, pathological features, and the impact of the latest treatment advances on prognosis. Moreover, we intended this review to be a comprehensive reference for diagnosing, treating, and assessing the prognosis of PMA, providing valuable guidance for clinical practice.
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Affiliation(s)
- Lihui Ge
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Linlin Wang
- Department of Thoracic Surgery, Shenyang Tenth People's Hospital, Shenyang, Liaoning, China
| | - Dongmei Pei
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Zhao T, Yi J, Luo D, Liu J, Fan X, Wu Q, Wang W. Prognostic factors for invasive mucinous adenocarcinoma of the lung: systematic review and meta-analysis. World J Surg Oncol 2024; 22:41. [PMID: 38303008 PMCID: PMC10835932 DOI: 10.1186/s12957-024-03326-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Invasive mucinous adenocarcinoma of the lung (IMA) is a unique and rare subtype of lung adenocarcinoma with poorly defined prognostic factors and highly controversial studies. Hence, this study aimed to comprehensively identify and summarize the prognostic factors associated with IMA. METHODS A comprehensive search of relevant literature was conducted in the PubMed, Embase, Cochrane, and Web of Science databases from their inception until June 2023. The pooled hazard ratio (HR) and corresponding 95% confidence intervals (CI) of overall survival (OS) and/or disease-free survival (DFS) were obtained to evaluate potential prognostic factors. RESULTS A total of 1062 patients from 11 studies were included. In univariate analysis, we found that gender, age, TNM stage, smoking history, lymph node metastasis, pleural metastasis, spread through air spaces (STAS), tumor size, pathological grade, computed tomography (CT) findings of consolidative-type morphology, pneumonia type, and well-defined heterogeneous ground-glass opacity (GGO) were risk factors for IMA, and spiculated margin sign was a protective factor. In multivariate analysis, smoking history, lymph node metastasis, pathological grade, STAS, tumor size, and pneumonia type sign were found to be risk factors. There was not enough evidence that epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK) mutations, CT signs of lobulated margin, and air bronchogram were related to the prognosis for IMA. CONCLUSION In this study, we comprehensively analyzed prognostic factors for invasive mucinous adenocarcinoma of the lung in univariate and multivariate analyses of OS and/or DFS. Finally, 12 risk factors and 1 protective factor were identified. These findings may help guide the clinical management of patients with invasive mucinous adenocarcinoma of the lung.
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Affiliation(s)
- Ting Zhao
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital, Southwest Medical University, 646099, Luzhou, Sichuan, China
- Inflammation & Allergic Diseases Research Unit, The Affiliated Hospital, Southwest Medical University, 646099, Luzhou, Sichuan, China
| | - Jianhua Yi
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital, Southwest Medical University, 646099, Luzhou, Sichuan, China
- Inflammation & Allergic Diseases Research Unit, The Affiliated Hospital, Southwest Medical University, 646099, Luzhou, Sichuan, China
| | - Dan Luo
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital, Southwest Medical University, 646099, Luzhou, Sichuan, China
- Faculty of Chinese Medicine, State Key Laboratory of Quality Research in Chinese Medicine and University Hospital, Macau University of Science and Technology, Taipa, 999078, Macao, China
- Inflammation & Allergic Diseases Research Unit, The Affiliated Hospital, Southwest Medical University, 646099, Luzhou, Sichuan, China
| | - Junjun Liu
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital, Southwest Medical University, 646099, Luzhou, Sichuan, China
- Inflammation & Allergic Diseases Research Unit, The Affiliated Hospital, Southwest Medical University, 646099, Luzhou, Sichuan, China
| | - Xianming Fan
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital, Southwest Medical University, 646099, Luzhou, Sichuan, China.
- Inflammation & Allergic Diseases Research Unit, The Affiliated Hospital, Southwest Medical University, 646099, Luzhou, Sichuan, China.
| | - Qibiao Wu
- Faculty of Chinese Medicine, State Key Laboratory of Quality Research in Chinese Medicine and University Hospital, Macau University of Science and Technology, Taipa, 999078, Macao, China.
- Zhuhai MUST Science and Technology Research Institute, 51900, Zhuhai, Guangdong, China.
| | - Wenjun Wang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital, Southwest Medical University, 646099, Luzhou, Sichuan, China.
- Inflammation & Allergic Diseases Research Unit, The Affiliated Hospital, Southwest Medical University, 646099, Luzhou, Sichuan, China.
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Jiang H, Bu L. Progress in the treatment of lung adenocarcinoma by integrated traditional Chinese and Western medicine. Front Med (Lausanne) 2024; 10:1323344. [PMID: 38259856 PMCID: PMC10802683 DOI: 10.3389/fmed.2023.1323344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
Non-small cell lung cancer (NSCLC) overwhelmingly represents the predominant histological subtype of lung cancer, with lung adenocarcinoma emerging as the most prevalent form. Conventional Western medical treatments encompass a spectrum of modalities, including surgical interventions, cytotoxic chemotherapy, radiotherapy, targeted pharmacotherapy, and immunotherapy. In contrast, Traditional Chinese Medicine (TCM) methodologies encompass traditional Chinese medicine treatments, acupuncture therapies, and tuina treatments. While conventional Western medicine has made remarkable strides in the treatment of lung cancer, it is important to acknowledge the limitations inherent in singular treatment approaches. Consequently, the quest for a more comprehensive and integrative therapeutic paradigm becomes imperative. A deficiency of evaluation criteria specific to lung adenocarcinoma treatment in the realm of TCM represents an outstanding challenge in need of resolution. Nonetheless, in the backdrop of the continuous evolution of lung adenocarcinoma treatment modalities, the amalgamation of Chinese and Western medical approaches for treating this condition has exhibited a promising trajectory. It not only contributes to mitigating toxicity and augmenting efficacy but also serves to reduce a spectrum of postoperative complications, thereby enhancing the quality of patients' survival and extending life expectancy. This article furnishes a comprehensive survey of the research advancements in the integration of Chinese and Western medical approaches for treating lung adenocarcinoma. It elucidates the merits and demerits of individual and combined therapeutic strategies, surmounts current limitations, underscores the virtues of amalgamating Chinese and Western medical paradigms, and offers a more holistic, integrated, and efficacious treatment blueprint.
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Affiliation(s)
- Hongxin Jiang
- The College of Life Sciences, Northwest University, Xi’an, Shaanxi, China
| | - Lina Bu
- Department of Respiratory and Critical Care Medicine, Xi’an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi’an, China
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Andrini E, Federico AD, Sisi M, Rosellini M, Palladini A, Lamberti G, Giglio AD, Gelsomino F. Immune checkpoint inhibitors in lung tumors with rare histologies and other thoracic malignancies. Immunotherapy 2022; 14:1329-1340. [DOI: 10.2217/imt-2022-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In recent years, immunotherapy has significantly changed the treatment of locally advanced/metastatic non-small-cell lung cancer (NSCLC). Conversely, the role of immunotherapy in NSCLC with uncommon histologies remains unclear, while in other rare thoracic malignancies, such as malignant pleural mesothelioma and thymic epithelial tumors, the use of immune checkpoint inhibitors is modifying therapeutic strategies with solid hopes for the future. However, larger prospective studies are urgently needed to define the best treatment strategies and the role of immunotherapy in these orphan tumors. This review provides a comprehensive overview of the emerging role of immunotherapy in the treatment of patients affected by these rare thoracic malignancies.
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Affiliation(s)
- Elisa Andrini
- Department of Experimental, Diagnostic & Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandro Di Federico
- Department of Experimental, Diagnostic & Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Monia Sisi
- Department of Experimental, Diagnostic & Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Matteo Rosellini
- Department of Experimental, Diagnostic & Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Giuseppe Lamberti
- Department of Experimental, Diagnostic & Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pietro Albertoni, 15, Bologna, 40138, Italy
| | - Andrea De Giglio
- Department of Experimental, Diagnostic & Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pietro Albertoni, 15, Bologna, 40138, Italy
| | - Francesco Gelsomino
- Department of Experimental, Diagnostic & Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pietro Albertoni, 15, Bologna, 40138, Italy
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PD-L1 Expression in Non-Small Cell Lung Cancer Specimens: Association with Clinicopathological Factors and Molecular Alterations. Int J Mol Sci 2022; 23:ijms23094517. [PMID: 35562908 PMCID: PMC9101150 DOI: 10.3390/ijms23094517] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 12/11/2022] Open
Abstract
Immune checkpoint inhibitors (ICI) targeting programmed cell death-1 or its ligand (PD-L1) have improved outcomes in non-small cell lung cancer (NSCLC). High tumor PD-L1 expression, detected by immunohistochemistry (IHC) typically on formalin-fixed paraffin-embedded (FFPE) histological specimens, is linked to better response. Following our previous investigation on PD-L1 in cytological samples, the aim of this study was to further explore the potential impacts of various clinicopathological and molecular factors on PD-L1 expression. Two retrospective NSCLC cohorts of 1131 and 651 specimens, respectively, were investigated for PD-L1 expression (<1%/1−49%/≥50%), sample type, sample site, histological type, and oncogenic driver status. In both cohorts, PD-L1 was positive (≥1%) in 55% of the cases. Adenocarcinomas exhibited lower PD-L1 expression than squamous cell carcinomas (p < 0.0001), while there was no difference between sample types, tumor locations, or between the two cohorts in multivariate analysis (all p ≥ 0.28). Mutational status correlated significantly with PD-L1 expression (p < 0.0001), with the highest expression for KRAS-mutated cases, the lowest for EGFR-mutated, and the KRAS/EGFR wild-type cases in between. There was no difference in PD-L1 levels between different prevalent KRAS mutations (all p ≥ 0.44), while mucinous KRAS-mutated adenocarcinomas exhibited much lower PD-L1 expression than non-mucinous (p < 0.0001). Our data indicate that cytological and histological specimens are comparable for PD-L1 evaluation. Given the impact of KRAS mutations and the mucinous growth pattern on PD-L1 expression, these factors should be further investigated in studies on ICI response.
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