Impacts of thoracoscopic surgery and high grade histologic subtypes on spread through air spaces in small stage I lung adenocarcinomas

Song, Tao; Jiang, Lili; Zhuo, Ze-Guo; Luo, Jun; Alai, Gu-Ha; Xu, Shuchang; Lin, Yi‐Dan

doi:10.1007/s00432-019-02972-6

Cited by 11 publications

(9 citation statements)

References 18 publications

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“…However, a prior prospective study by Blaauwgeers et al [35] demonstrated no different incidences of loose fragments in different procedure groups (thoracotomy vs. thoracoscopic surgery). A recent study found higher incidence of STAS in lobectomy than limited resection [36]. Several other studies did not show significant relationship between STAS and surgical procedure (radical surgery vs. limited surgery) [12,37].…”

Section: Discussionmentioning

confidence: 91%

An individual nomogram can reliably predict tumor spread through air spaces in non-small-cell lung cancer

et al. 2022

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Background Tumor spread through air spaces (STAS) has been shown to adversely affect the prognosis of lung cancer. The correlation between clinicopathological and genetic features and STAS remains unclear. Method We retrospectively reviewed 3075 NSCLC patients between2017-2019. We evaluated the relationship between STAS and patients’ clinicopathological and molecular features. The chi-square test was performed to compare categorical variables. Univariate analysis and multivariate logistic regression analysis were performed to investigate the association of clinical factors with STAS. A nomogram was formulated to predict the presence of STAS. Results STAS was identified in 617 of 3075 patients (20.07%). STAS was significantly related to sex (p < 0.001), smoking (p < 0.001), CEA (p < 0.001), differentiation (p < 0.001), histopathological type (p < 0.001), lymphatic vessel invasion (p < 0.001), pleural invasion (p < 0.001), T stage (p < 0.001), N stage (p < 0.001), M stage (p < 0.001), and TNM stage (p < 0.001). STAS was frequently found in tumors with wild-type EGFR (p < 0.001), KRAS mutations (p < 0.001), ALK rearrangements (p < 0.001) or ROS1 rearrangements (p < 0.001). For programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1), STAS was associated with PD-L1 expression level in tumor cells (p < 0.001) or stromal cells (p < 0.001), while PD-1 only in stromal cells (p < 0.001). Multivariable analyses demonstrated significant correlations between STAS and CEA level (p < 0.001), pathological grade (p < 0.001), lymphatic vessel invasion (p < 0.001), pleural invasion (p = 0.001), and TNM stage (p = 0.002). A nomogram was formulated based on the results of the multivariable analysis. Conclusions Tumor STAS was associated with several invasive clinicopathological features. A nomogram was established to predict the presence of STAS in patients with NSCLC.

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Section: Discussionmentioning

confidence: 91%

An individual nomogram can reliably predict tumor spread through air spaces in non-small-cell lung cancer

et al. 2022

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“…We believe that intratumoral heterogeneity also exists in early stage NSCLC, 31 which may be attributed to the micropapillary and solid components. STAS was recognized as a new pattern of invasion in lung adenocarcinoma by the WHO in 2015, showing poor prognosis 32 . Numerous studies have revealed the poor prognostic significance of VPI, which was also shown by the International Association for the Study of Lung Cancer even after adjusting for tumor size 21,33 .…”

Section: Discussionmentioning

confidence: 97%

Clinical efficacy and safety of adjuvant EGFR‐TKIs for resected stage IB lung adenocarcinoma: A real‐world study based on propensity score matching

et al. 2023

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BackgroundAdjuvant therapy for stage IB non‐small cell lung cancer remains debatable. In this real‐world study, we evaluate the efficacy and safety of adjuvant epidermal growth factor receptor tyrosine kinase inhibitors (EGFR‐TKIs) for resected stage IB lung adenocarcinoma.MethodsThis real‐world study recruited 249 patients diagnosed with stage IB disease after surgical resection between January 2013 and September 2021. Sixty‐six (26.5%) patients received adjuvant targeted therapy (TKIs group), and 183 (73.5%) were enrolled in the clinical observation (CO) group. Propensity scores were matched to minimize the observed confounder effects between the two groups, and 59 patient pairs were matched. The primary endpoint was disease‐free survival (DFS).ResultsIn the TKI group, 38 (64.4%) patients chose to receive icotinib, 27.1% (16/59) received gefitinib, and 5 patients (8.5%) chose osimertinib. The median follow‐up time was 30.8 months (range: 7–107 months). Two (3.4%) patients in the TKI group and 10 (16.9%) in the CO group experienced disease relapse. The 3‐year DFS rates were 98.3% in the TKI group and 83.0% in the CO group (HR: 0.10; 95% CI: 0.01–0.78; p = 0.008). DFS differences were found in the entire cohort (p = 0.005) and the matched cohort (p = 0.024) between the two groups. Multivariate analysis showed that adjuvant EGFR‐TKIs was an independent factor for DFS (HR: 0.211; 95% CI: 0.045–0.979; p = 0.047), along with poor cell differentiation (HR: 5.256; 95% CI: 1.648–16.769; p = 0.005), and spread through air spaces (HR: 5.612; 95% CI: 1.137–27.700; p = 0.034). None of the patients discontinued EGFR‐TKIs owing to the low occurrence rate of treatment‐related serious adverse events.ConclusionAdjuvant EGFR‐TKIs could significantly improve DFS among patients with stage IB lung adenocarcinoma compared with CO, with a safe and tolerable profile.

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“…STAS had been recognized as a new pattern of invasion in lung adenocarcinoma by WHO in 2015 and possessed a poor prognosis. [33] Numerous studies have revealed the poor prognostic signi cance of VPI and the International Association for the Study of Lung Cancer (IASLC) also marked the presence of VPI as a worse prognosis even when adjusting by tumor size. [21,34] Thus, most patients enrolled in our study had one or more high-risk factors including VPI, STAS, micropapillary component and solid component.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy and safety of adjuvant EGFR-TKIs for resected stage IB lung adenocarcinoma: A real-world study based on propensity score matching

Shen

Guo

Zhang

et al. 2022

Preprint

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Background Adjuvant therapy for stage IB non-small cell lung cancer (NSCLC) remains debatable. In this real-world study, we evaluate the efficacy and safety of adjuvant epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) for resected stage IB lung adenocaicinoma. Methods This real-world study recruited 249 patients diagnosed as stage IB after surgical resection from January 2013 to September 2021. Sixty-six (26.5%) patients received adjuvant targeted therapy (TKIs group) and 183 (73.5%) patients were enrolled to clinical observation (CO) group. Propensity score matching was applied to minimize the effects of observed confounders between the two groups, and 59 pairs of patients were matched. The primary endpoint was disease-free survival (DFS). Results Among the adjuvant TKIs group, 38 (64.4%) patients chose to receive icotinib, 27.1% (16/59) of patients took gefitinib, and Osimertinib was 5 patients’(8.5%) option. Median follow-up time was 30.8 months (range: 7–107 months). Two (3.4%) patients in the TKIs group and 10 (16.9%) patients in the CO group had disease relapse. The 3-year DFS rates were 98.3% in the TKIs group and 83.0% in the CO group (HR: 0.10, 95%CI 0.01–0.78; P = 0.008). DFS differences could be found in the entire cohort (P = 0.005) and matched cohort (P = 0.024) between the two groups. The multivariate analysis showed that adjuvant EGFR-TKIs was an independent factor for DFS (HR, 0.211; 95%CI, 0.045–0.979; P = 0.047), together with poor cell differentiation (HR, 5.256; 95%CI, 1.648–16.769; P = 0.005) and spread through air spaces (HR, 5.612; 95%CI, 1.137–27.700; P = 0.034). No patients discontinued the EGFR-TKIs due to the low occurrence rate of treatment-related serious adverse events. Conclusion Adjuvant EGFR-TKIs could significantly improve DFS among patients with stage IB lung adenocarcinoma than clinical observation, with a safe and tolerable profile. Retrospectively registered study: The Chinese Clinical Trial Registry (www.chictr.org.cn) indentifier was ChiCTR2200060931.

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Impacts of thoracoscopic surgery and high grade histologic subtypes on spread through air spaces in small stage I lung adenocarcinomas

Cited by 11 publications

References 18 publications

An individual nomogram can reliably predict tumor spread through air spaces in non-small-cell lung cancer

An individual nomogram can reliably predict tumor spread through air spaces in non-small-cell lung cancer

Clinical efficacy and safety of adjuvant EGFR‐TKIs for resected stage IB lung adenocarcinoma: A real‐world study based on propensity score matching

Clinical efficacy and safety of adjuvant EGFR-TKIs for resected stage IB lung adenocarcinoma: A real-world study based on propensity score matching

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