Surgical treatment for primary pulmonary lymphoepithelioma-like carcinoma

Lin, Zhichao; Situ, Dongrong; Chang, X.-Y.; Liang, Wenhua; Zhao, Meiling; Cai, Chengjie; Liu, Yang; He, Jianxing

doi:10.1093/icvts/ivw064

Cited by 39 publications

(69 citation statements)

References 10 publications

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“…Similar to a report from Lin et al, adjuvant chemotherapy after radical dissection did not improve DFS and OS in our study (23). However, in other larger cohort, postoperative adjuvant chemotherapy could prolong OS of patients with stage IIIa cancer (2).…”

Section: Discussionsupporting

confidence: 89%

Correlation and prognostic significance of PD-L1 and P53 expression in resected primary pulmonary lymphoepithelioma-like carcinoma

Zhang

Wang

et al. 2018

J. Thorac. Dis.

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Background: Aberrant expression of programmed cell death-ligand 1 (PD-L1) and protein 53 (P53) has been observed in various malignancies, and recently, the mechanism of PD-L1 regulation by P53 has been elucidated. We aimed to explore possible correlations between PD-L1 and P53 expression and the prognosis of patients with resected pulmonary lymphoepithelioma-like carcinoma (LELC). Methods: A total of 67 consecutive patients with primary pulmonary LELC who underwent radical resection from January 2003 to December 2014 were enrolled in our study. Membranous PD-L1 and nuclear P53 expression were detected by immunohistochemical staining (IHC). Results: Positive expression of PD-L1 in tumor cells (TCs), PD-L1 in tumor-infiltrating lymphocytes (TILs) and P53 was investigated in 44 patients (65.7%), 37 patients (55.2%), and 34 patients (50.7%), respectively. Using univariate and multivariable analysis, both PD-L1 (+) in TCs and P53 (+) were observed to be significantly independent prognostic factors associated with longer disease-free survival (DFS, P=0.037 and 0.039, respectively), along with early stage LELC (P=0.037), but had no association with overall survival (OS) (P>0.05). In the P53 (+) group, the rate of patients with PD-L1 (+) in TCs was significantly higher than in the P53 (−) group (85.3% vs. 45.5%, P=0.001). In addition, among the 45 patients who underwent adjuvant chemotherapy, DFS was significantly longer in patients with either PD-L1 (+) in TCs or P53 (+) (P=0.036 and 0.044, respectively).Conclusions: PD-L1 and P53 may be potential therapeutic targets for primary pulmonary LELC. PD-L1 (+) in TCs and P53 (+) were reliable predictors for longer DFS and benefits from adjuvant therapy in resected cases. Routine detection of these two indices in lung LELC may be warranted.

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Section: Discussionsupporting

confidence: 89%

Correlation and prognostic significance of PD-L1 and P53 expression in resected primary pulmonary lymphoepithelioma-like carcinoma

Zhang

Wang

et al. 2018

J. Thorac. Dis.

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“…In contrast with other subtypes of lung cancer, all results showed that LELC of the lung had a better prognosis 3, 6, 7, 8. Similarly, the above tendency was also obtained from our study.…”

Section: Discussionsupporting

confidence: 87%

Prognosis and distribution of lymph nodes metastases in resectable primary pulmonary lymphoepithelioma‐like carcinoma: A large cohort from a single center

Wen

Qin

et al. 2018

Thoracic Cancer

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BackgroundPrimary pulmonary lymphoepithelioma‐like carcinoma is a rare subtype of lung cancer. Until now, the characteristics of lymph nodes metastases in resectable cases have not yet been reported.MethodsIn this study, a total of 87 consecutive patients with primary pulmonary lymphoepithelioma‐like carcinoma that received surgical treatment were investigated from October 1999 to August 2016. The clinical and radiological data and follow‐up information were extracted from hospital records in detail.ResultsIn a univariate analysis, those patients with an early pathological stage (I–II), low rate of lymph node metastases (<30%) and a low number of positive lymph nodes (<5) showed longer recurrence‐free survival and overall survival (all P < 0.05). However, the early pathological stage was identified as the only factor independently associated with recurrence‐free survival by multivariate analysis (P = 0.038). In a preoperative lymph nodes evaluation, the accuracy and specificity of computed tomography alone were 52.9% (46/87) and 88% (302/343), respectively, and 73.2% of these cases with incorrect nodal staging (30/41) were upstaged. Skipping metastases were more frequent in operated stage N2 cases (71.4%), whereas whether or not those patients showed skipping metastasis did not affect their recurrence‐free survival or overall survival (P > 0.05). The highest metastasis frequencies for specific lobes with primary lymphoepithelioma‐like carcinoma are as follows: #5 left upper lobe (21.4%); #7 left lower lobe (40.7%); #2R (28.6%) and/or #4R (14.3%) right upper lobe; #7 (42.9%) right lower lobe; #7 (28%) and/or superior mediastinal nodes (36%) right middle lobe.ConclusionBased on accurate staging and uncertain survival benefit, complete mediastinal lymph nodes dissection is still required for curative resection.

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“…Pulmonary lymphoepithelioma-like carcinoma is a rare and distinct subtype of non-small-cell lung cancer with an incidence of~0.7% of all non-small cell lung cancer cases. Pulmonary lymphoepithelioma-like carcinoma tends to affect young, non-smoking patients of Asian ethnicity [3][4][5][6][7][8][9]. It was previously classified as a variant of large cell carcinoma [10] but has recently been reclassified under other and unclassified carcinomas in the 2015 World Health Organization (WHO) classification of lung tumors [11].…”

Section: Introductionmentioning

confidence: 99%

“…Since most patients are diagnosed at an early stage, the prognosis for pulmonary lymphoepithelioma-like carcinoma patients is more favorable compared with other types of lung cancer, with a median overall survival of about 107 months vs. 13 months for non-pulmonary lymphoepithelioma-like carcinoma patients and a 5-year survival of about 60% [5,7]. The main treatment strategy for earlystage disease is surgery [3,6,7]. Unresectable patients often undergo multimodal therapy, primarily consisting of chemotherapy and radiotherapy with better prognosis than other types of non-small-cell lung cancer [19].…”

Section: Introductionmentioning

confidence: 99%

A multicenter analysis of genomic profiles and PD-L1 expression of primary lymphoepithelioma-like carcinoma of the lung

et al. 2020

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To understand the molecular mechanism of tumorigenesis of pulmonary lymphoepithelioma-like carcinoma and explore potential therapeutic strategies, we investigated the genomic profiles and PD-L1 expression of 29 Chinese pulmonary lymphoepithelioma-like carcinoma patients at various stages. We performed capture-based targeted sequencing on tissue samples collected from 27 patients with sufficient samples using a panel consisting of 520 cancer-related genes, spanning 1.64 Mb of the human genome. We identified 184 somatic mutations in 109 genes from 26 patients. One patient had no mutations detected by this panel. Copy number variations were detected in 52% (14/27) of the patients, with a majority having advancedstage disease (10/14). Except for the detection of ERBB2 amplification and KRAS mutation in two patients, no other classic lung cancer driver mutations were detected. Interestingly, 78% (21/27) of the patients had mutations in epigenetic regulators. Of the 184 mutations identified, 51 occurred in 29 epigenetics-related genes. Furthermore, we performed PD-L1 immunohistochemistry staining using the Dako 22C3 assay and demonstrated that 69% (20/29) of the cohort had positive PD-L1 expression, of which three patients received and benefited from a PD-1 inhibitor. In conclusion, we elucidated a distinct genomic landscape associated with pulmonary lymphoepithelioma-like carcinoma with no classic lung cancer driver mutation but an enrichment of mutations in epigenetic regulators. The detection of high PD-L1 expression and lack of any canonical druggable driver mutations raises the potential of checkpoint immunotherapy for pulmonary lymphoepithelioma-like carcinoma.

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Surgical treatment for primary pulmonary lymphoepithelioma-like carcinoma

Abstract: Primary lung LELC is closely associated with Epstein-Bar virus infection but not involved in EGFR mutation pathway. Radical surgery could achieve a good outcome for resectable pulmonary LELC, and regional lymph node status is a vital prognostic factor.

Cited by 39 publications

References 10 publications

Correlation and prognostic significance of PD-L1 and P53 expression in resected primary pulmonary lymphoepithelioma-like carcinoma

Correlation and prognostic significance of PD-L1 and P53 expression in resected primary pulmonary lymphoepithelioma-like carcinoma

Prognosis and distribution of lymph nodes metastases in resectable primary pulmonary lymphoepithelioma‐like carcinoma: A large cohort from a single center

A multicenter analysis of genomic profiles and PD-L1 expression of primary lymphoepithelioma-like carcinoma of the lung

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