Wait-and-See Treatment Strategy Could be Considered for Lung Adenocarcinoma with Special Pleural Dissemination Lesions,
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ORIGINAL ARTICLE – THORACIC ONCOLOGY
Wait-and-See Treatment Strategy Could be Considered for Lung Adenocarcinoma with Special Pleural Dissemination Lesions, and Low Genomic Instability Correlates with Better Survival Ying Chen, MD1, Wen-Fang Tang, MD1,2, Huan Lin, MD3, Hua Bao, PhD4, Wei Li, MD1, Ao Wang, MSc4, Xue Wu, PhD4, Jian Su, PhD1, Jie-Shan Lin, MD2, Yang W. Shao, PhD4,5, Xue-Ning Yang, PhD1, Yi-Long Wu, PhD1, and Wen-Zhao Zhong, PhD1 1
Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People’s Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China; 2Shantou University Medical College, Shantou, China; 3The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; 4Translational Medicine Research Institute, Geneseeq Technology Inc, Toronto, ON, Canada; 5School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
ABSTRACT Background. This study aimed to evaluate the feasibility of a wait-and-see strategy for non-small cell lung cancer (NSCLC) patients with special pleural dissemination lesions (r-pM1a and s-pM1a). Furthermore, the study characterized genomic alternations about disease progression. Methods. For this study, 131 NSCLC patients with a diagnosis of pM1a were retrospectively selected. Survival differences were evaluated among patients treated with three different initial postoperative treatments: chemotherapy, targeted therapy, and wait-and-see strategy. Whole-exome sequencing (WES) was performed on primary and metastatic tumors of 10 patients with dramatic progression and 13 patients with gradual progression. Results. The wait-and-see group showed better progression-free survival (PFS) than the chemotherapy group
Ying Chen and Wen-Fang Tang have contributed equally to this paper.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08400-1) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 2 June 2019 W.-Z. Zhong, PhD e-mail: [email protected]
(p \ 0.001) but PFS similar to that of targeted group (p = 0.984). This pattern persisted in epidermal growth factor receptor (EGFR)-positive patients. For patients with EGFR-negative/unknown status, PFS was longer in the wait-and-see group than in the two treatment groups. Furthermore, better overall survival (OS) was observed for the patients who received chemotherapy or targeted therapy after the wait-and-see strategy than for those who received chemotherapy or targeted therapy immediately. Lymph node status was an independent prognostic factor for PFS and OS. Finally, WES analysis showed that a high genomic instability index (GIS) and chromosome 18q loss were more common in metastatic tumors, and low GIS was significantly associated with better PFS (p = 0.016). Conclusions. The wait-and-see strategy could be considered for special pM1a patients without lymph nodes metastas
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