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Ruiter J, de Langen A, Monkhorst K, Veenhof A, Klomp H, Smit J, Smit E, Damhuis R, Hartemink K. Survival difference between patients with single versus multiple metastatic lymph nodes and the role of histology in pathological stage II-N1 non-small cell lung cancer. Acta Chir Belg 2024:1-9. [PMID: 38404182 DOI: 10.1080/00015458.2024.2322243] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/18/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Previous studies investigating whether metastatic lymph node count is a relevant prognostic factor in pathological N1 non-small cell lung cancer (NSCLC), showed conflicting results. Hypothesizing that outcome may also be related to histological features, we determined the prognostic impact of single versus multiple metastatic lymph nodes in different histological subtypes for patients with stage II-N1 NSCLC. METHODS We performed a retrospective cohort study using data from the Netherlands Cancer Registry, including patients treated with a surgical resection for stage II-N1 NSCLC (TNM 7th edition) in 2010-2016. Overall survival (OS) was assessed for patients with single (pN1a) and multiple (pN1b) metastatic nodes. Using multivariable analysis, we compared OS between pN1a and pN1b in different histological subtypes. RESULTS After complete resection of histologically proven stage II-N1 NSCLC, 1309 patients were analyzed, comprising 871 patients with pN1a and 438 with pN1b. The median number of pathologically examined nodes (N1 + N2) was 9 (interquartile range 6-13). Five-year OS was 53% for pN1a versus 51% for pN1b. In multivariable analysis, OS was significantly different between pN1a and pN1b (HR 1.19, 95% CI 1.01-1.40). When stratifying for histology, the prognostic impact of pN1a/b was only observed in adenocarcinoma patients (HR 1.44, 95% CI 1.15-1.81). CONCLUSION Among patients with stage II-N1 adenocarcinoma, the presence of multiple metastatic nodes had a significant impact on survival, which was not observed for other histological subtypes. If further refinement as to lymph node count will be considered for incorporation into a new staging system, evaluation of the role of histology is recommended.
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Affiliation(s)
- Julianne Ruiter
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Pulmonary Diseases, Leiden University Medical Centre, Leiden, the Netherlands
| | - Adrianus de Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Kim Monkhorst
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Alexander Veenhof
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Houke Klomp
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jasper Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Egbert Smit
- Department of Pulmonary Diseases, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Ronald Damhuis
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Koen Hartemink
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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de Ruiter J, van der Noort V, van Diessen J, Smit E, Damhuis R, Hartemink K. 99P The optimal treatment for patients with stage I non-small cell lung cancer: Minimally invasive lobectomy or stereotactic ablative radiotherapy? J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00354-4] [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: 04/04/2023]
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Van Der Sluis K, van Sandick J, van Dieren J, Vollebergh M, Chalabi M, Grootscholten C, Snaebjornsson P, van den Berg J, Hartemink K, Veenhof A, Kodach L. Assessing the impact of predictive biomarkers’ for immunotherapy on the clinical management of gastric cancer patients: a real life cohort. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.149] [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: 02/25/2023]
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Chalabi M, Verschoor Y, Van De Haar J, van den Berg J, Kodach L, van Sandick J, van Dieren J, Balduzzi S, Grootscholten M, Veenhof X, Hartemink K, Vollebergh M, Owers E, Bartels-Rutten A, den Hartog-Lievaart P, van Leerdam M, Schumacher T, Haanen J, Voest E. 1219P Neoadjuvant atezolizumab plus chemotherapy in gastric and gastroesophageal junction (G/GEJ) adenocarcinoma: The PANDA study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1337] [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: 11/01/2022] Open
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Schuler M, Cuppens K, Ploenes T, Vanbockrijck M, Wiesweg M, Darwiche K, Schramm A, Maes B, Hegedus B, Schildhaus HU, Hautzel H, Theegarten D, Baas P, Hartemink K, Du Pont B, Aigner C. LBA37 A randomized, multicentric phase II study of preoperative nivolumab plus relatlimab or nivolumab in patients with resectable non-small cell lung cancer (NEOpredict-Lung). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.034] [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: 11/01/2022] Open
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Verschoor YL, Kodach L, van den Berg J, van Sandick JW, van Dieren J, Balduzzi S, Grootscholten C, Veenhof X, Hartemink K, Vollebergh MA, Owers E, Bartels-Rutten A, den Hartog P, van Leerdam ME, Schumacher T, Voest EE, Haanen JBAG, Chalabi M. Neoadjuvant atezolizumab plus docetaxel/oxaliplatin/capecitabine in non-metastatic gastric and gastroesophageal junction adenocarcinoma: The PANDA trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4059] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4059 Background: Immune checkpoint blockade improves clinical outcomes for patients with gastric and gastro-esophageal junction (GEJ) cancers, but its efficacy and impact on the tumor microenvironment in non-metastatic, resectable disease remains largely unknown. Peri-operative FLOT, the current standard-of-care, leads to pathologic complete responses (pCR) and major pathologic responses (MPR) in 16% and 37% of patients, respectively. An important open question is whether PDL-1 blockade monotherapy can prime the tumor microenvironment in a favorable manner, prior to combination with chemotherapy. Methods: We report results from the phase 2 PANDA trial (NCT03448835) of neoadjuvant atezolizumab (anti-PDL-1) plus docetaxel, oxaliplatin, and capecitabine (DOC) in patients with resectable gastric or GEJ adenocarcinoma. Patients received a single cycle of atezolizumab monotherapy, followed by 4 cycles of atezolizumab+DOC. Tumor tissue was collected at baseline, after atezolizumab monotherapy, the first atezolizumab+DOC, and at resection. The primary endpoints were safety and feasibility in 20 patients, and secondary endpoints included MPR (<10% viable tumor rest) and disease-free survival. Results: Twenty patients, of which 18 with mismatch repair (MMR) proficient and two with MMR-deficient tumors, were evaluable for safety and efficacy analyses. MPR was observed in 14/20 patients (70%; 95% CI 46–88%), including 9 pCR (45%; 95% CI 23-68%). Among patients with intestinal type adenocarcinoma, 12/15 (80%; 95% CI 52-96%) had an MPR, with 9/15 (60%; 95% CI 32-84%) pCR. Treatment was well tolerated, with two patients (10%) experiencing a grade 3 immune adverse event. At a median follow-up of 29 months (IQR 16-34), 15 patients (75%) were alive and disease-free. None of the patients with an MPR recurred. All patients underwent resections without treatment-related delays and no unexpected surgical complications were documented. Translational analyses, including baseline PDL-1 CPS score and whole exome sequencing (WES), plus CD8 T-cell infiltration and RNA sequencing at 4 timepoints will be presented at the meeting. Conclusions: Our data show that the addition of atezolizumab to neoadjuvant chemotherapy leads to promising pathologic responses in gastric/GEJ adenocarcinoma, which appears to be higher than in historical controls, with no recurrences in responders. These data should be validated in a large randomized controlled trial. Clinical trial information: NCT03448835.
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Affiliation(s)
| | | | - José van den Berg
- Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - Sara Balduzzi
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Cecile Grootscholten
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Xander Veenhof
- Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Koen Hartemink
- Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - E.C. Owers
- Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | - Peggy den Hartog
- The Netherlands Cancer Institute Amsterdam, Nieuw-Vennep, Netherlands
| | | | - Ton Schumacher
- Netherlands Cancer Institute (NKI-AVL), Amsterdam, Netherlands
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Piek M, de boer JP, Vriens M, van Leeuwaarde R, Stokkel M, Hartemink K, van Duijnhoven F, Kessels R, van der Ploeg I. 'The clinical decision making for 18FDG-PET/CT thyroid incidentaloma in cancer patients'. European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2021.12.214] [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: 10/19/2022]
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Quispel-Janssen J, van der Noort V, de Vries JF, Zimmerman M, Lalezari F, Thunnissen E, Monkhorst K, Schouten R, Schunselaar L, Disselhorst M, Klomp H, Hartemink K, Burgers S, Buikhuisen W, Baas P. Programmed Death 1 Blockade With Nivolumab in Patients With Recurrent Malignant Pleural Mesothelioma. J Thorac Oncol 2018; 13:1569-1576. [DOI: 10.1016/j.jtho.2018.05.038] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/17/2018] [Accepted: 05/20/2018] [Indexed: 02/07/2023]
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