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Gompelmann D, Sarova P, Mosleh B, Papaporfyriou A, Oberndorfer F, Idzko M, Hoda MA. PD-L1 assessment in lung cancer biopsies-pitfalls and limitations. Int J Biol Markers 2024; 39:3-8. [PMID: 38111297 DOI: 10.1177/03936155231214273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
The programmed cell death-ligand 1 (PD-L1) protein expression on tumor cells predicts the efficacy of immunotherapy in patients with non-small cell lung cancer. However, the assessment of PD-L1 expression on tumor cells has limited power for selecting patients for immunotherapy due to intra-tumoral heterogeneity and inter-tumoral heterogeneity of PD-L1 expression, the inter-observer variability in scoring PD-L1 staining, and reproducibility. These difficulties and pitfalls in interpreting the PD-L1 assessment are discussed in detail in this review.
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Affiliation(s)
- Daniela Gompelmann
- Division of Pulmonology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Pavla Sarova
- Division of Pulmonology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Berta Mosleh
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Anastasia Papaporfyriou
- Division of Pulmonology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Marco Idzko
- Division of Pulmonology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Mir Alireza Hoda
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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2
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Hammer B, Bal C, Gysan M, Zehetmayer S, Geleff S, Zech A, Kramer M, Ayazseven S, Idzko M, Mosleh B, Hoda MA, Gompelmann D. Evaluation of PD-1 T lymphocytes in bronchoalveolar lavage in lung cancer compared to benign lung diseases. Clin Exp Med 2023; 23:5177-5182. [PMID: 37535195 PMCID: PMC10725350 DOI: 10.1007/s10238-023-01146-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/16/2023] [Indexed: 08/04/2023]
Abstract
The expression of the programmed cell death protein 1 (PD-1) has been shown to be markedly increased in tumor-infiltrating lymphocytes. However, the proportion of PD-1 + T cells in the bronchoalveolar lavage (BAL) of lung cancer patients has not been sufficiently evaluated so far. In this prospective study, the proportion of PD-1 + CD4 + as well as PD-1 + CD8 + T cells in BAL samples, isolated from patients with lung cancer, asthma or interstitial lung disease (ILD), were determined via flow cytometry and compared for differences. Bronchoalveolar lavage was performed in 34 patients (14 patients with lung cancer, 10 patients with asthma, 10 patients with ILD). The highest median proportion of PD-1 + CD4 + or PD-1 + CD8 + T cells were found in patients with ILD (83.1% [IQR 72.1; 87.5] and 73.8% [IQR 60.3; 86.3]) followed by patients with lung cancer (66.4% [IQR 59; 69] and 77.1% [IQR 35.8; 82.3]) and patients with asthma (61.3% [IQR 57.4; 70.5] and 57.3% [IQR 46; 65]). Thereby, the difference in the proportion of PD-1 + CD3 + CD4 + BAL cells between ILD patients and asthmatics was significantly different (p = 0.04). The proportion of PD-1 + CD4 + and PD-1 + CD8 + T cells in the BAL of patients with lung cancer did not differ significantly to patients with benign lung diseases. The highest proportion was observed in ILD patients suggesting further research to evaluate the role of the PD-1/PD-L1 pathway in ILD patients.
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Affiliation(s)
- B Hammer
- Division of Pulmonology, Department of Internal Medicine II, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- DZL Laboratory for Experimental Microbiome Research, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Research Center Borstel, Borstel, Germany
| | - C Bal
- Division of Pulmonology, Department of Internal Medicine II, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - M Gysan
- Division of Pulmonology, Department of Internal Medicine II, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - S Zehetmayer
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - S Geleff
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - A Zech
- Division of Pulmonology, Department of Internal Medicine II, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - M Kramer
- Division of Pulmonology, Department of Internal Medicine II, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - S Ayazseven
- Division of Pulmonology, Department of Internal Medicine II, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - M Idzko
- Division of Pulmonology, Department of Internal Medicine II, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - B Mosleh
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - M A Hoda
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - D Gompelmann
- Division of Pulmonology, Department of Internal Medicine II, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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3
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Mosleh B, Schelch K, Mohr T, Klikovits T, Wagner C, Ratzinger L, Dong Y, Sinn K, Ries A, Berger W, Grasl‐Kraupp B, Hoetzenecker K, Laszlo V, Dome B, Hegedus B, Jakopovic M, Hoda MA, Grusch M. Circulating FGF18 is decreased in pleural mesothelioma but not correlated with disease prognosis. Thorac Cancer 2023; 14:2177-2186. [PMID: 37340889 PMCID: PMC10396789 DOI: 10.1111/1759-7714.15004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Pleural mesothelioma (PM) is a relatively rare malignancy with limited treatment options and dismal prognosis. We have previously found elevated FGF18 expression in PM tissue specimens compared with normal mesothelium. The objective of the current study was to further explore the role of FGF18 in PM and evaluate its suitability as a circulating biomarker. METHODS FGF18 mRNA expression was analyzed by real-time PCR in cell lines and in silico in datasets from the Cancer Genome Atlas (TCGA). Cell lines overexpressing FGF18 were generated by retroviral transduction and cell behavior was investigated by clonogenic growth and transwell assays. Plasma was collected from 40 PM patients, six patients with pleural fibrosis, and 40 healthy controls. Circulating FGF18 was measured by ELISA and correlated to clinicopathological parameters. RESULTS FGF18 showed high mRNA expression in PM and PM-derived cell lines. PM patients with high FGF18 mRNA expression showed a trend toward longer overall survival (OS) in the TCGA dataset. In PM cells with low endogenous FGF18 expression, forced overexpression of FGF18 resulted in reduced growth but increased migration. Surprisingly, despite the high FGF18 mRNA levels observed in PM, circulating FGF18 protein was significantly lower in PM patients and patients with pleural fibrosis than in healthy controls. No significant association of circulating FGF18 with OS or other disease parameters of PM patients was observed. CONCLUSIONS FGF18 is not a prognostic biomarker in PM. Its role in PM tumor biology and the clinical significance of decreased plasma FGF18 in PM patients warrant further investigation.
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Affiliation(s)
- Berta Mosleh
- Department of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Karin Schelch
- Department of Thoracic SurgeryMedical University of ViennaViennaAustria
- Center for Cancer ResearchMedical University of ViennaViennaAustria
| | - Thomas Mohr
- Center for Cancer ResearchMedical University of ViennaViennaAustria
| | - Thomas Klikovits
- Department of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Christina Wagner
- Center for Cancer ResearchMedical University of ViennaViennaAustria
| | - Lukas Ratzinger
- Center for Cancer ResearchMedical University of ViennaViennaAustria
| | - Yawen Dong
- Department of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Katharina Sinn
- Department of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Alexander Ries
- Center for Cancer ResearchMedical University of ViennaViennaAustria
| | - Walter Berger
- Center for Cancer ResearchMedical University of ViennaViennaAustria
| | | | | | - Viktoria Laszlo
- Department of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Balazs Dome
- Department of Thoracic SurgeryMedical University of ViennaViennaAustria
- National Koranyi Institute of PulmonologyBudapestHungary
- Department of Thoracic SurgeryNational Institute of Oncology‐Semmelweis UniversityBudapestHungary
| | - Balazs Hegedus
- Department of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Marko Jakopovic
- Department for Respiratory Diseases JordanovacUniversity of Zagreb School of Medicine, University Hospital Centre ZagrebZagrebCroatia
| | - Mir Alireza Hoda
- Department of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Michael Grusch
- Center for Cancer ResearchMedical University of ViennaViennaAustria
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4
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Benej M, Klikovits T, Krajc T, Bohanes T, Schulte L, Hochmair MJ, Watzka S, Mosleh B, Hoetzenecker K, Aigner C, Hoda MA, Mueller MR. Lymph Node Log-Odds Ratio Accurately Defines Prognosis in Resectable Non-Small Cell Lung Cancer. Cancers (Basel) 2023; 15:cancers15072082. [PMID: 37046743 PMCID: PMC10093675 DOI: 10.3390/cancers15072082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/08/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Objectives: The ratio of positive and resected lymph nodes (LN ratio) has been shown to be prognostic in non-small cell lung cancer (NSCLC). Contrary to the LN ratio, calculating the LN log-odds ratio (LN-LOR) additionally considers the total number of resected lymph nodes. We aim to evaluate LN-LOR between positive and resected lymph nodes as a prognostic factor in operable NSCLC. Methods: Patients with NSCLC who underwent curative intent lobectomy treated at two high-volume centers were retrospectively studied. LN-LOR was dichotomized according to impact on OS and further combined with N descriptors and correlated with clinical variables and survival. Results: 944 patients were included. Cut-off analysis revealed that an LN-LOR of −0.34 significantly discriminated patients according to OS (p < 0.001, chi-squared test 41.26). When combined with N1 and N2 descriptors, LN-LOR low risk (median OS not reached and 83 months) and LN-LOR high-risk patients (median OS 50 and 59 months) had similar survival irrespective of the anatomical location of the positive lymph nodes. Multivariable Cox regression analysis revealed that age (HR 1.02, 95% CI 1.001–1.032), sex (male, HR 1.65, 95% CI 1.25–2.19), histological subtype (HR 2.11, 95% CI 1.35–3.29), pathological stage (HR 1.23, 95% CI 1.01–1.45) and LN-LOR risk groups (low risk, HR 0.48, 95% CI 0.32–0.72) were independent prognostic factors for OS. Conclusions: This retrospective two-center analysis shows that LN-LOR is significantly associated with OS in resectable NSCLC and might better reflect the biological behavior of the disease, regardless of anatomical lymph node locations. This finding may additionally support the value of extensive LN dissection.
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Affiliation(s)
- Michal Benej
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Thomas Klikovits
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Tibor Krajc
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Tomas Bohanes
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Lisa Schulte
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Maximilian Johannes Hochmair
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Stefan Watzka
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Berta Mosleh
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Clemens Aigner
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Mir Alireza Hoda
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Michael Rolf Mueller
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
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5
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Ries A, Flehberger D, Slany A, Pirker C, Mader JC, Mohr T, Schelch K, Sinn K, Mosleh B, Hoda MA, Dome B, Dolznig H, Krupitza G, Müllauer L, Gerner C, Berger W, Grusch M. Mesothelioma-associated fibroblasts enhance proliferation and migration of pleural mesothelioma cells via c-Met/PI3K and WNT signaling but do not protect against cisplatin. J Exp Clin Cancer Res 2023; 42:27. [PMID: 36683050 PMCID: PMC9869633 DOI: 10.1186/s13046-022-02582-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/24/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Pleural mesothelioma (PM) is an aggressive malignancy with poor prognosis. Unlike many other cancers, PM is mostly characterized by inactivation of tumor suppressor genes. Its highly malignant nature in absence of tumor driving oncogene mutations indicates an extrinsic supply of stimulating signals by cells of the tumor microenvironment (TME). Cancer-associated fibroblasts (CAFs) are an abundant cell type of the TME and have been shown to drive the progression of several malignancies. The aim of the current study was to isolate and characterize patient-derived mesothelioma-associated fibroblasts (Meso-CAFs), and evaluate their impact on PM cells. METHODS Meso-CAFs were isolated from surgical specimens of PM patients and analyzed by array comparative genomic hybridization, next generation sequencing, transcriptomics and proteomics. Human PM cell lines were retrovirally transduced with GFP. The impact of Meso-CAFs on tumor cell growth, migration, as well as the response to small molecule inhibitors, cisplatin and pemetrexed treatment was investigated in 2D and 3D co-culture models by videomicroscopy and automated image analysis. RESULTS Meso-CAFs show a normal diploid genotype without gene copy number aberrations typical for PM cells. They express CAF markers and lack PM marker expression. Their proteome and secretome profiles clearly differ from normal lung fibroblasts with particularly strong differences in actively secreted proteins. The presence of Meso-CAFs in co-culture resulted in significantly increased proliferation and migration of PM cells. A similar effect on PM cell growth and migration was induced by Meso-CAF-conditioned medium. Inhibition of c-Met with crizotinib, PI3K with LY-2940002 or WNT signaling with WNT-C59 significantly impaired the Meso-CAF-mediated growth stimulation of PM cells in co-culture at concentrations not affecting the PM cells alone. Meso-CAFs did not provide protection of PM cells against cisplatin but showed significant protection against the EGFR inhibitor erlotinib. CONCLUSIONS Our study provides the first characterization of human patient-derived Meso-CAFs and demonstrates a strong impact of Meso-CAFs on PM cell growth and migration, two key characteristics of PM aggressiveness, indicating a major role of Meso-CAFs in driving PM progression. Moreover, we identify signaling pathways required for Meso-CAF-mediated growth stimulation. These data could be relevant for novel therapeutic strategies against PM.
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Affiliation(s)
- Alexander Ries
- Center for Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria
| | - Daniela Flehberger
- Center for Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria
| | - Astrid Slany
- Department of Analytical Chemistry, University of Vienna, Waehringer Straße 38, 1090, Vienna, Austria
| | - Christine Pirker
- Center for Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria
| | - Johanna C Mader
- Department of Analytical Chemistry, University of Vienna, Waehringer Straße 38, 1090, Vienna, Austria
| | - Thomas Mohr
- Center for Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria
- Department of Analytical Chemistry, University of Vienna, Waehringer Straße 38, 1090, Vienna, Austria
- Joint Metabolome Facility, University of Vienna and Medical University of Vienna, Waehringer Guertel 38, 1090, Vienna, Austria
- ScienceConsult - DI Thomas Mohr KG, Enzianweg 10a, 2353, Guntramsdorf, Austria
| | - Karin Schelch
- Center for Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria
- Department of Thoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Katharina Sinn
- Department of Thoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Berta Mosleh
- Department of Thoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Mir Alireza Hoda
- Department of Thoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Balazs Dome
- Department of Thoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
- National Korányi Institute of Pulmonology, Korányi Frigyes u. 1, Budapest, 1122, Hungary
- Department of Thoracic Surgery, National Institute of Oncology, Semmelweis University, Rath Gyorgy u. 7-9, Budapest, 1122, Hungary
| | - Helmut Dolznig
- Institute of Medical Genetics, Medical University of Vienna, Waehringer Straße 10, 1090, Vienna, Austria
| | - Georg Krupitza
- Department of Clinical Pathology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Leonhard Müllauer
- Department of Clinical Pathology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christopher Gerner
- Department of Analytical Chemistry, University of Vienna, Waehringer Straße 38, 1090, Vienna, Austria
| | - Walter Berger
- Center for Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria
| | - Michael Grusch
- Center for Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria.
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6
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Sinn K, Mosleh B, Grusch M, Klepetko W, Hoetzenecker K, Klikovits T, Gompelmann D, Hoda MA. Impact of fibrinogen levels and modified Glasgow prognostic score on survival of stage III/N2 non-small cell lung cancer patients treated with neoadjuvant therapy and radical resection. BMC Cancer 2022; 22:1197. [DOI: 10.1186/s12885-022-10298-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/09/2022] [Indexed: 11/20/2022] Open
Abstract
Abstract
Purpose
The prognostic value of pretreatment and preoperative fibrinogen plasma levels and the modified Glasgow prognostic score (mGPS) in stage III/N2 non-small cell lung cancer (NSCLC) patients who receive neoadjuvant treatment followed by radical surgery is yet unclear.
Methods
Fibrinogen levels and mGPS of 84 patients with initial stage III/N2 NSCLC, who received neoadjuvant therapy followed by complete surgical resection from 2002 to 2014 were retrospectively analyzed and correlated with clinical parameters and overall survival (OS). Data were analyzed using log-rank and Cox regression analysis adjusted for clinical and pathological factors.
Results
Median serum fibrinogen level after neoadjuvant treatment was 439 mg/dL (IQR 158 mg/dL). Elevated fibrinogen levels (> 400 mg/dL) after neoadjuvant treatment were significantly associated with poorer OS (28.2 months vs. 60.9 months, HR 0.562, p = 0.048). Importantly, a decrease in fibrinogen levels after neoadjuvant treatment (n = 34) was found to be an independent predictor for favorable OS in multivariate analysis (HR 0.994, p = 0.025). Out of 80 patients, 55, 19 and 6 patients had a mGPS of 0, 1 and 2, respectively. Moreover, elevated mGPS after neoadjuvant treatment (mGPS 1–2) showed a non-significant trend for poorer OS compared to mGPS 0 (28.2 vs. 46.5 months, HR 0.587, p = 0.066).
Conclusion
Elevated fibrinogen levels after neoadjuvant therapy prior to surgery in stage III/N2 NSCLC patients are associated with significant disadvantage for OS. A decrease in fibrinogen levels after neoadjuvant therapy was found to be a predictor for superior OS in this retrospective patient cohort.
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7
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Mosleh B, Schelch K, Klikovits T, Sinn K, Hoetzenecker K, Dome B, Jakopovic M, Hoda M, Grusch M. EP07.02-001 Evaluation of FGF18 as a Contributing Factor in Malignant Pleural Mesothelioma Growth and Its Role as a Potential Biomarker. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Sinn K, Mosleh B, Grusch M, Hoetzenecker K, Klikovits T, Gompelmann D, Hoda M. EP05.02-007 Impact Of Fibrinogen Levels and mGPS on Survival of Stage III/N2 NSCLC Patients Treated with Neoadjuvant Therapy and Radical Surgery. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gompelmann D, Sinn K, Brugger J, Bernitzky D, Mosleh B, Prosch H, Geleff S, Blessing A, Tiefenbacher A, Hoetzenecker K, Idzko M, Hoda MA. Correlation of PD-L1 expression on tumour cells between diagnostic biopsies and surgical specimens of lung cancer in real life with respect to biopsy techniques and neoadjuvant treatment. J Cancer Res Clin Oncol 2022; 149:1747-1754. [PMID: 35708777 PMCID: PMC10097774 DOI: 10.1007/s00432-022-04080-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/19/2022] [Indexed: 12/25/2022]
Abstract
PURPOSES Programmed death-ligand 1 (PD-L1) testing is performed mainly on biopsy specimens in patients with advanced lung cancer. It is questionable whether the small amount of tissue analysed in biopsies may represent the true PD-L1 expression of a tumour. METHODS In this retrospective study, PD-L1 expression on tumour cells derived from bronchoscopy brush cytology, endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA), endobronchial biopsy, transbronchial biopsy (TBB) and computed tomography (CT)-guided transthoracic biopsy was compared to the PD-L1 expression of the corresponding surgical resection in lung cancer patients with regard to neoadjuvant treatment in-between. RESULTS A quantitative comparison between the diagnostic biopsy of the primary tumour with corresponding resected surgical specimens in a total of 113 lung cancer patients (60% male, mean age 65 ± 9 years) revealed a statistically significant correlation of PD-L1 expression on tumour cells (r = 0.58, p< 0.001), for patients without neoadjuvant treatment in-between and for patients who underwent neoadjuvant treatment (both p < 0.001). Using a cut-off value of ≥ 50% PD-L1 TPS for comparing the biopsy samples and resected specimens, the concordance rate was 78% with a Cohen's Kappa of 0.45. CONCLUSION A statistically significant concordance for PD-L1 expression on tumour cells between biopsies from primary lung tumour and resected specimen was found, but of uncertain clinical accuracy. The use of a cut-off value of ≥ 50% PD-L1 TPS resulted only in a moderate agreement. Therefore, the interpretation of the PD-L1 determined form biopsy specimens status should only be considered with caution for treatment decisionsQuery.
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Affiliation(s)
- D Gompelmann
- Division of Pulmonology, Department of Internal Medicine II, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - K Sinn
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - J Brugger
- Department for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - D Bernitzky
- Division of Pulmonology, Department of Internal Medicine II, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - B Mosleh
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - H Prosch
- Department for Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - S Geleff
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - A Blessing
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - A Tiefenbacher
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - K Hoetzenecker
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - M Idzko
- Division of Pulmonology, Department of Internal Medicine II, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - M A Hoda
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
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10
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Sinn K, Mosleh B, Steindl A, Zoechbauer-Mueller S, Dieckmann K, Widder J, Steiner E, Klepetko W, Hoetzenecker K, Laszlo V, Doeme B, Klikovits T, Hoda MA. Neoadjuvant chemoradiotherapy is superior to chemotherapy alone in surgically treated stage III/N2 non-small-cell lung cancer: a retrospective single-center cohort study. ESMO Open 2022; 7:100466. [PMID: 35397435 PMCID: PMC9058885 DOI: 10.1016/j.esmoop.2022.100466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 02/23/2022] [Accepted: 03/10/2022] [Indexed: 12/25/2022] Open
Abstract
Background There is lack of consensus whether neoadjuvant chemoradiotherapy (CHT/RT) is superior to neoadjuvant chemotherapy (CHT) alone in patients with potentially resectable stage III/N2 non-small-cell lung cancer (NSCLC). Patients and methods We retrospectively evaluated clinical parameters and outcomes in patients with clinical stage III/N2 NSCLC treated with neoadjuvant CHT/RT versus CHT followed by surgery. Nearest-neighbor propensity score (PS) matching was used to correct for pretreatment differences. Results A total of 84 patients were enrolled. Thirty-four (40%) and 50 (60%) patients received CHT/RT or CHT followed by curative-intent surgery, respectively. Overall 90-day mortality and morbidity were 0% versus 0.04% and 21% versus 18%, respectively, with no significant difference between the CHT/RT and the CHT-alone cohorts (P = 0.51 and P = 0.70). In the PS-matched cohort, complete pathological response was recorded in 25% after CHT/RT versus 0% after CHT at the time of surgery. Patients receiving neoadjuvant CHT/RT exhibited significantly better 5-year disease-free survival (DFS) [45% versus 16% CHT group; hazard ratio (HR) 0.43, P = 0.04]; 5-year overall survival (OS) was 75% after CHT/RT and 21% after CHT (HR 0.37, P = 0.001). CHT/RT more often induced pathological mediastinal downstaging (P = 0.007), but CHT/RT remained the only independent factor for DFS and OS and did not depend on mediastinal downstaging. Conclusions In this retrospective PS-matched long-term analysis, neoadjuvant CHT/RT conferred improved DFS and OS compared with CHT alone in stage III/N2 NSCLC. These highly challenging results require confirmation in well-designed randomized controlled trials conducted at highly specialized thoracic oncology centers. Neoadjuvant CHT/RT yielded survival advantage in stage III/N2 NSCLC patients undergoing curative-intent pulmonary resection. PS matching. Pneumonectomy is safe after neoadjuvant CHT/RT without increased peri- or post-operative morbidity or mortality.
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Affiliation(s)
- K Sinn
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - B Mosleh
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - A Steindl
- Division of Oncology, Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - S Zoechbauer-Mueller
- Division of Oncology, Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - K Dieckmann
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - J Widder
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - E Steiner
- Department of Radiation Oncology and Radiotherapy, Landesklinikum Wr. Neustadt, Wiener Neustadt, Austria
| | - W Klepetko
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - K Hoetzenecker
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - V Laszlo
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - B Doeme
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - T Klikovits
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria.
| | - M A Hoda
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
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Brcic L, Klikovits T, Megyesfalvi Z, Mosleh B, Sinn K, Hritcu R, Laszlo V, Cufer T, Rozman A, Kern I, Mohorcic K, Jakopovic M, Samarzija M, Seiwerth S, Kolek V, Fischer O, Jakubec P, Škarda J, Gieszer B, Hegedus B, Fillinger J, Renyi-Vamos F, Buder A, Bilecz A, Berger W, Grusch M, Hoetzenecker K, Klepetko W, Hoda MA, Filipits M, Dome B. Prognostic impact of PD-1 and PD-L1 expression in malignant pleural mesothelioma: an international multicenter study. Transl Lung Cancer Res 2021; 10:1594-1607. [PMID: 34012777 PMCID: PMC8107750 DOI: 10.21037/tlcr-20-1114] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/28/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Programmed cell death 1/programmed death ligand 1 (PD-1/PD-L1) immune-checkpoint blockade is a promising new therapeutic strategy in cancer. However, expression patterns and prognostic significance of PD-L1 and PD-1 are still controversial in human malignant pleural mesothelioma (MPM). METHODS Formalin-fixed paraffin-embedded (FFPE) tumor samples from 203 MPM patients receiving standard treatment without immunotherapy were collected from 5 European centers. PD-L1 and PD-1 expression of tumor cells (TCs) and tumor-infiltrating lymphocytes (TILs) were measured by immunohistochemistry and correlated with clinical parameters and long-term outcome. RESULTS High (>10%) PD-L1 TC and PD-1 TILs expressions were found in 18 (8%) and 39 (24%) patients, respectively. PD-L1 was rarely expressed by TILs [≥1%, n=13 (8%); >10%, n=1]. No significant associations were found between the PD-L1 or PD-1 expression of TCs or TILs and clinicopathological parameters such as stage or histological subtype. Notably, patients with high (>10%) TC-specific PD-L1 expression exhibited significantly worse median overall survival (OS) (6.3 vs. 15.1 months of those with low TC PD-L1 expression; HR: 2.51, P<0.001). In multivariate cox regression analysis adjusted for clinical parameters, high TC PD-L1 expression (>10%) proved to be an independent negative prognostic factor for OS (HR: 2.486, P=0.005). There was no significant correlation between PD-L1 or PD-1 expression of TILs and OS. CONCLUSIONS In this multicenter cohort study, we demonstrate that high (>10%) PD-L1 expression of TCs independently predicts worse OS in MPM. Further studies are warranted to investigate the value of PD-L1/PD-1 expression as a marker for treatment response in MPM patients receiving immunotherapy.
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Affiliation(s)
- Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Thomas Klikovits
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Zsolt Megyesfalvi
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Berta Mosleh
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Katharina Sinn
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Richard Hritcu
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Viktoria Laszlo
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Tanja Cufer
- University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Ales Rozman
- University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Izidor Kern
- University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Katja Mohorcic
- University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Marko Jakopovic
- Department for Respiratory Diseases Jordanovac, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Miroslav Samarzija
- Department for Respiratory Diseases Jordanovac, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Sven Seiwerth
- Department of Pathology, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Vitezslav Kolek
- Department of Respiratory Diseases and Tuberculosis, University Hospital Olomouc, Olomouc, Czech Republic
| | - Ondřej Fischer
- Department of Respiratory Diseases and Tuberculosis, University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Jakubec
- Department of Respiratory Diseases and Tuberculosis, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jozef Škarda
- Institute of Clinical and Molecular Pathology, Medical Faculty, Palacky University Olomouc, Olomouc, Czech Republic
- Department of Pathology, University Hospital Ostrava and Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
| | - Balazs Gieszer
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary
| | - Balazs Hegedus
- Department of Thoracic Surgery, University Duisburg-Essen, Ruhrlandklinik, Essen, Germany
| | - Janos Fillinger
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Ferenc Renyi-Vamos
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Anna Buder
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Agnes Bilecz
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Walter Berger
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Grusch
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Mir Alireza Hoda
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Balazs Dome
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary
- National Koranyi Institute of Pulmonology, Budapest, Hungary
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Sinn K, Hritcu R, Mosleh B, Köstler W, Taghavi S, Klepetko W, Hoda MA, Klikovits T. Long-term Survival After Salvage Surgery for a Giant Primary Rib Osteosarcoma. Ann Thorac Surg 2020; 111:e45-e47. [PMID: 32553768 DOI: 10.1016/j.athoracsur.2020.04.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/27/2020] [Indexed: 12/01/2022]
Abstract
A 29-year-old woman with a primary rib osteosarcoma declined treatment and was readmitted 20 months later in life-threatening condition caused by major local tumor progression with severe mediastinal shifting, and without distant metastases. She underwent extended tumor resection with palliative intent and recovered well after a prolonged course with post-pneumonectomy empyema. Further treatment was declined, and she presented again 4.5 years later with local chest wall recurrence that was completely resected. Currently, 7 years after diagnosis, the patient is free from disease. In this rare case, salvage surgery was associated with an unexpected favorable long-term outcome.
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Affiliation(s)
- Katharina Sinn
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Richard Hritcu
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Berta Mosleh
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Köstler
- Division of Oncology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Shahrokh Taghavi
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Mir Alireza Hoda
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Thomas Klikovits
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.
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