Primary tumor location in lung cancer: the evaluation and administration.

ABSTRACT: Lung cancer continues to be the leading cause of cancer-related death in the world, which is classically subgrouped into two major histological types: Non-small cell lung cancer (NSCLC) (85% of patients) and small-cell lung cancer (SCLC) (15%). Tumor location has been reported to be associated with the prognosis of various solid tumors. Several types of cancer often occur in a specific region and are more prone to spread to predilection locations, including colorectal cancer, prostate cancer, gastric cancer, ovarian cancer, cervical cancer, bladder cancer, lung tumor, and so on. Besides, tumor location is also considered as a risk factor for lung neoplasm with chronic obstructive pulmonary disease/emphysema. Additionally, the primary lung cancer location is associated with specific lymph node metastasis. And the recent analysis has shown that the primary location may affect metastasis pattern in metastatic NSCLC based on a large population. Numerous studies have enrolled the "location" factor in the risk model. Anatomy location and lobe-specific location are both important in prognosis. Therefore, it is important for us to clarify the characteristics about tumor location according to various definitions. However, the inconsistent definitions about tumor location among different articles are controversial. It is also a significant guidance in multimode therapy in the present time. In this review, we mainly aim to provide a new insight about tumor location, including anatomy, clinicopathology, and prognosis in patients with lung neoplasm.

Predictive Value of let-7a for Cancer Cell Repopulation between Chemotherapy and Long-Term Survival: A Prospective Study.

OBJECTIVE: Repopulation during radiation is a classic theory in radiobiology. The long intervals between cycles of chemotherapy provide better micro-circumstance than radiation for the repopulation of cancer cells. METHODS: Patients with inoperable stage III and stage IV lung cancer were enrolled prospectively. Peripheral blood and tumor tissues were obtained before treatment and each cycle of chemotherapy to detect the serum let-7a expression and Ki-67 index. RESULTS: Fifty-two consecutive consenting patients were enrolled prospectively. The median follow-up was 13 months (range: 2-62 months). A strong correlation was found between the Ki-67 index and serum let-7a before treatment (r =-0.667, P<0.001). The serum let-7a expression levels were upregulated or downregulated significantly during chemotherapy. Patients with relatively low baseline let-7a expression levels had significantly worse overall survival (OS) and progression-free survival (PFS) than patients with relatively high baseline serum let-7a levels (P<0.001, P=0.005, respectively). CONCLUSION: This prospective study demonstrated that let-7a was correlated with tumor proliferation in lung cancer, with high prognostic value. Furthermore, it showed that repopulation, as correlated with let-7a, may exist during chemotherapy, which would give us a new perspective in overcoming the chemoresistance of lung cancer and would help in determining individual treatment strategies.

Prognostic value of the neutrophil-to-lymphocyte ratio and primary tumor location in epidermal growth factor receptor-mutated metastatic non-small cell lung cancer.

Context: Few studies have reported on the relationship between complete blood count (CBC) parameters and progression-free survival (PFS) in nonsmall cell lung cancer (NSCLC) treated with tyrosine kinase inhibitors (TKIs). Aims: Evaluate the prognostic value of pretreatment in patient CBC with advanced NSCLC when treated with epidermal growth factor receptor-TKIs as first-line to third-line therapy. Settings and Design: We retrospectively analyzed 190 patients receiving TKIs with metastatic NSCLC harboring an exon del19, 21 L858R mutations, or other rare mutations. Materials and Methods: Pretreatment blood data were obtained from electronic medical records. Patient imaging results were used to identify tumor location. Methods: Baseline clinical characteristics were compared by Pearson's Chi-square and Student's t-tests. Cox regression analyses were used to evaluate the prognostic value of peripheral blood parameters on PFS. All prognostic factors were explored with multivariable regression. Results: Patients with high Neu% (13.0 vs. 18.8 months, P= 0.003), Neu (12.0 vs. 14.5 months, P = 0.014), and neutrophil-to-lymphocyte ratio (NLR) (7.0 vs. 15.2 months, P < 0.001) had worse PFS. In contrast, patients with higher Lym (13.0 vs. 16.5 months, P = 0.012) and Lym% (8.8 vs. 15.3 months, P < 0.001) showed better PFS. In addition, tumor location was also an important factor for prognosis (11.6 vs. 14.3 months, P = 0.003). Discussion: Our data indicated that Lym, LLym%, HNeu, HNeu%, and HNLR were associated with poor prognosis in NSCLC patients treated with TKIs. NLR and primary tumor location were both identified as independent risk indicators for worse PFS based on multivariate analysis.

EGFR inhibitors as adjuvant therapy for resected non-small cell lung cancer harboring EGFR mutations.

OBJECTIVES: Cisplatin-based chemotherapy as an adjuvant therapy for resected non-small cell lung cancer (NSCLC) has reached its plateau, and it is limited by a high risk of recurrence and significant toxicities. The clinical value of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in resected NSCLC harboring EGFR mutations remains controversial. In this study, we performed a meta-analysis to evaluate the role of EGFR inhibitors as an adjuvant therapy for targeted patients. MATERIALS AND METHODS: Studies were identified via electronic search. The pooled odds ratio (OR) for disease-free survival (DFS) and overall survival (OS) were calculated for the meta-analysis. RESULTS: There were 11 trials (1,152 resected NSCLC patients with EGFR sensitive mutations) in this meta-analysis. The results showed that adjuvant treatment with EGFR-TKIs can prolong both the OS and DFS when compared to treatment without TKIs as an adjuvant therapy (OS: OR, 0.63; 95% CI, 0.46 to 0.87, P = 0.004; heterogeneity I2 = 61%, P = 0.008; DFS: OR, 0.56; 95% CI, 0.43 to 0.72, P < 0.00001; heterogeneity I2 = 37%, P = 0.10). The results of the predefined subgroup analyses in this meta-analysis suggested a greater DFS with the mono EGFR-TKIs compared with chemotherapy, whereas the OS benefit failed to show a similar difference between the two arms (p = 0.30). We also found that treatment with EGFR-TKIs plus chemotherapy was associated with a significantly longer DFS and OS compared to mono chemotherapy in patients with completely resected EGFR-mutant NSCLC (DFS: OR, 0.48; 95% CI, 0.34-0.68; P < 0.0001; heterogeneity I2 = 47%, P = 0.07; OS: OR, 0.50; 95% CI, 0.31-0.78; P = 0.003; heterogeneity I2 = 57%, P = 0.05). Additionally, less severe adverse events (SAEs) were observed in the TKIs group (OR, 0.22; 95% CI, 0.14 to 0.37, P < 0.00001; heterogeneity I2 = 22%, P = 0.28). CONCLUSION: The addition of EGFR-TKIs to adjuvant chemotherapy can prolong the OS and PFS for resected NSCLC. Adjuvant EGFR-TKIs may be a potential treatment option compared to adjuvant chemotherapy in completely resected patients with EGFR mutation-positive NSCLC. STATEMENT OF SIGNIFICANCE: The clinical value of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in resected non-small cell lung cancer (NSCLC) harboring EGFR mutations remains controversial. This study demonstrates that EGFR-TKIs as an adjuvant therapy could prolong the DFS and potentially prolong the OS in postoperative patients. Therefore, this therapy paves the way for EGFR-TKIs to be an adjuvant treatment for NSCLC.