ABSTRACT
BACKGROUND: EGFR inhibitor and immunotherapy have been approved for adjuvant treatment in resectable non-small cell lung cancer (NSCLC). Limited reports of molecular and clinical characteristics as prognostic factors in NSCLC have been published. METHODS: Medical records of patients with resectable NSCLC stage I-III diagnosed during 2015-2020 were reviewed. Real time-PCR (RT-PCR) was performed for EGFR mutations (EGFRm). Immunohistochemistry staining was conducted for ALK and PD-L1 expression. Categorical variables were compared using chi-square test and Fisher's exact test. Survival analysis was done by cox-regression method. RESULTS: Total 441 patients were included. The prevalence of EGFRm, ALK fusion, and PD-L1 expression were 57.8%, 1.9%, and 20.5% (SP263), respectively. The most common EGFRm were Del19 (43%) and L858R (41%). There was no significant difference of recurrence free survival (RFS) by EGFRm status whereas patients with PD-L1 expression (PD-L1 positive patients) had lower RFS compared to without PD-L1 expression (PD-L1 negative patients) (HR = 1.75, P = 0.036). Patients with both EGFRm and PD-L1 expression had worse RFS compared with EGFRm and PD-L1 negative patients (HR = 3.38, P = 0.001). Multivariable analysis showed higher CEA at cut-off 3.8 ng/ml, pT4, pN2, pStage II, and margin were significant poor prognostic factors for RFS in the overall population, which was similar to EGFRm population (exception of pT and pStage). Only pStage was a significant poor prognostic factor for PD-L1 positive patients. The predictive score for predicting of recurrence were 6 for all population (63% sensitivity and 86% specificity) and 5 for EGFRm population (62% sensitivity and 93% specificity). CONCLUSION: The prevalence and types of EGFRm were similar between early stage and advanced stage NSCLC. While lower prevalence of PD-L1 expression was found in early stage disease. Patients with both EGFRm and PD-L1 expression had poorer outcome. Thus PD-L1 expression would be one of the prognostic factor in EGFRm patients. Validation of the predictive score should be performed in a larger cohort.
Subject(s)
Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Humans , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/drug therapy , B7-H1 Antigen/metabolism , Prognosis , ErbB Receptors/genetics , ErbB Receptors/therapeutic use , MutationSubject(s)
Anemia, Aplastic/therapy , Antilymphocyte Serum/administration & dosage , Hematopoietic Stem Cell Transplantation , Vidarabine/analogs & derivatives , Adult , Anemia, Aplastic/diagnosis , Combined Modality Therapy , Drug Therapy, Combination , Female , Follow-Up Studies , Graft vs Host Disease/diagnosis , Graft vs Host Disease/therapy , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Male , Middle Aged , Recurrence , Treatment Outcome , Vidarabine/administration & dosage , Young AdultABSTRACT
The increased incidence of malignancies post-renal transplantation is well established. We performed a retrospective review of the 270 renal transplant patients from May 1, 1992 to April 30, 2007, including 18 cases (6.7%) of malignancy. The most common cancer in the study was transitional cell carcinoma of the urinary tract (7/18). The second most common cancer was hepatocellular carcinoma (3/18). In contrast to reports from Caucasian countries, we found only 2/18 patients had posttransplantation lymphoproliferative disease and no report of skin cancer. Among the 18 patients with malignancy, 11 died (mortality rate = 61%). We encourage a more extensive study of malignancy post-renal transplantation at multiple centers with a tumor registry in Thailand.