Surgeon Quality and Patient Survival After Resection for Non-Small-Cell Lung Cancer

Early potential metabolic biomarkers of T1 stage lung adenocarcinoma based on serum metabolomics

Background

This study aims to investigate serum metabolite changes in patients with early-stage (T1) lung adenocarcinoma, identify potential diagnostic biomarkers, and establish an early warning mechanism for T1 stage lung adenocarcinoma.

Methods

The study included two groups: a lung adenocarcinoma group and a healthy control group. Serum samples underwent non-targeted metabolomics analysis. Total ion chromatograms (TIC) were generated to assess system stability. Chromatographic data were analyzed using multivariate statistical methods, including principal component analysis (PCA) for dimensionality reduction. Partial least squares discriminant analysis (PLS-DA) further validated PCA findings. Variables with VIP scores >1.0 in the PLS-DA model were selected, combined with ANOVA and T-tests (P < 0.05), to identify differentially expressed metabolites. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the diagnostic performance of selected metabolites.

Results

Serum metabolites significantly differed between the lung adenocarcinoma group and the healthy control group. Multivariate statistical analysis and ROC curve evaluation identified four potential diagnostic biomarkers: Cortisol, 3-Oxo-OPC4-CoA, PE-NMe(14:1(9Z)/14:1(9Z)), and Ceramide (d18:1/9Z-18:1), with AUC values of 0.930, 0.895, 0.890, and 0.795, respectively.

Conclusion

Cortisol,3-Oxo-OPC4-CoA,PE-NMe(14:1(9Z)/14:1(9Z)), and Ceramide (d18:1/9Z-18:1) exhibit significantly altered metabolic levels in T1 stage lung adenocarcinoma patients and can serve as metabolic biomarkers. These markers may enhance the sensitivity and specificity of early diagnosis, facilitating improved detection of T1 stage lung adenocarcinoma.

Patient and hospital factors for outcomes of completely resected, node-negative nonsmall cell lung cancer

OBJECTIVES

To evaluate outcomes of early-stage nonsmall cell lung cancer (NSCLC) patients in relation to patient and hospital factors.

SUMMARY BACKGROUND DATA

Results of randomized controlled trials (RCTs) may not be applicable to daily practice.

METHODS

Outcomes of patients who had undergone curative surgery for node-negative NSCLC were retrospectively evaluated. They were either participants in an RCT (JCOG0707) or those excluded from it. "Excluded patients" were either ineligible to ("ineligible cohort") or eligible but did not participate ("eligible cohort") in the RCT. Correlations between hospital volume, study forwardness, and patient outcomes were also analyzed.

RESULTS

A total of 5921 patients, 917 in JCOG0707, were evaluated. The overall survival (OS) of the eligible cohort (n = 2616) was similar to the JCOG0707 cohort with an adjusted hazard ratio (aHR) of 1.01 (P = .90), while that of the ineligible cohort (n = 2388) was significantly worse, with an aHR of 1.67 (P < .0001). Both deaths from lung cancer and from other causes led to the inferior outcome. The OS of patients in the ineligible cohort, excluded from the trial due solely to the presence of concomitant malignancy (n = 704), was significantly worse than OS in the eligible cohort, but disease-specific survivals were not significantly different. Hospital volume did not affect OS (high vs low: aHR 0.91, P = .13), but high-volume hospitals had lower "other-cause" mortality (aHR 0.79, P = .02).

CONCLUSIONS

RCT-ineligible patients had worse OS, and their excess mortalities are mainly attributed to nonlung-cancer-specific deaths.

Correlation Between the Extent of N1 Lymph Node Station Examination and Prognosis in Stage I Non-small Cell Lung Cancer Patients: One Station is Insufficient

BACKGROUND

Examination standards for hilar and intrapulmonary (N1) lymph nodes (LNs) have been debated. The objective of this study was to assess the prognostic significance of the extent of examination for N1 LN stations in patients with pathological stage I non-small cell lung cancer (NSCLC).

METHODS

A total of 1868 patients were identified and divided into 3 groups on the basis of the number of N1 stations examined: group A (≥3 stations), group B (2 stations) and group C (1 station). Moreover, we investigated the prognostic significance of each individual N1 station examined. The primary outcome was 5-year disease-free survival (DFS).

RESULTS

Overall, 1062, 607, and 199 patients were in groups A, B, and C, respectively. The baseline demographic and clinical characteristics were similar among the groups, except for the tumor side. The 5-year DFS rates were comparable between groups A and B (85.1% vs. 82.7%, P = .3), both of which were significantly greater than that of group C (74.4%) (P < .01). Similar results were observed for the corresponding 5-year overall survival rates. The number of N1 stations examined was an independent predictor in multiple analyses. Additionally, the examination of stations 10 and 13 were independent favorable predictors for 5-year DFS.

CONCLUSION

For patients with pathological stage I NSCLC, examination of only 1 N1 station is insufficient. Examinations of a minimum of two N1 stations, including stations 10 and 13, is recommended to obtain the optimal survival benefit.

Prevalence of Epidermal Growth Factor Receptor and Programmed Death Ligand 1 Testing in a Population-Based Lung Cancer Surgical Resection Cohort from 2018 to 2022

BACKGROUND

Biomarker-directed therapy requires biomarker testing. We assessed the patterns of epidermal growth factor receptor (EGFR) and programmed death ligand 1 (PDL1) testing in a non-small cell lung cancer (NSCLC) resection cohort. We hypothesized that testing would increase but be unevenly distributed across patient-, provider- and institution-level demographics.

METHODS

We examined the population-based Mid-South Quality of Surgical Resection (MS-QSR) cohort of NSCLC resections. We evaluated the proportions receiving EGFR and PDL1 testing before and after approval of biomarker-directed adjuvant therapy (2018-2020 vs. 2021-2022). We used association tests and logistic regression to compare factors.

RESULTS

From 2018 to 2022, 1,687 patients had NSCLC resection across 12 MS-QSR institutions: 1,045 (62%) from 2018 to 2020 and 642 (38%) from 2021 to 2022. From 2018 to 2020, 11% had EGFR testing versus 38% in 2021 to 2022 (56% in those meeting ADAURA trial inclusion criteria, P < 0.0001). From 2018 to 2020, 8% had PDL1 testing versus 20% in 2021 to 2022 (P < 0.0001). EGFR testing did not significantly differ by age (P = 0.07), sex (P = 0.99), race (P = 0.33), or smoking history (P = 0.28); PDL1 testing did not differ significantly by age (P = 0.47), sex (P = 0.41), race (P = 0.51), or health insurance (P = 0.07). Testing was significantly less likely in nonteaching and non-Commission on Cancer-accredited hospitals and after resection by cardiothoracic or general surgeons (vs. general thoracic surgeons; all P < 0.05).

CONCLUSIONS

EGFR and PDL1 testing increased after approval of biomarker-directed adjuvant therapies. However, testing rates were still suboptimal and differed by institutional- and provider-level factors.

IMPACT

The association of institutional, pathologist, and surgeon characteristics with differences in testing demonstrate the need for more standardization in testing processes.

Challenges and controversies in resectable non-small cell lung cancer: a clinician's perspective

The treatment landscape of resectable early-stage non-small cell lung cancer (NSCLC) is transforming due to the approval of novel adjuvant and neoadjuvant systemic treatments. The European Medicines Agency (EMA) recently approved adjuvant osimertinib, adjuvant atezolizumab, adjuvant pembrolizumab, and neoadjuvant nivolumab combined with chemotherapy, and the approval of other agents or new indications may follow soon. Despite encouraging results, many unaddressed questions remain. Moreover, the transformed treatment paradigm in resectable NSCLC can pose major challenges to healthcare systems and magnify existing disparities in care as differences in reimbursement may vary across different European countries. This Viewpoint discusses the challenges and controversies in resectable early-stage NSCLC and how existing inequalities in access to these treatments could be addressed.