本期胸小星将为大家带来整合模型预测IIIA期NSCLC对新辅助免疫疗法的反应；隐匿性淋巴结阳性的临床IA期肺癌患者行肺段切除术的结局，一起来看看吧！
2017·EATTS
01
Predicting therapeutic response to neoadjuvant immunotherapy based on an integration model in resectable stage IIIA (N2) non–small cell lung cancer
Long Xu1, Haojie Si1, Fenghui Zhuang1, Chongwu Li1, Lei Zhang1, Yue Zhao1, Tao Chen1, Yichen Dong1, Tingting Wang2, Likun Hou3, Tao Hu4, Tianlin Sun4, Yunlang She1, Xuefei Hu1, Dong Xie1, Junqi Wu1, Chunyan Wu3, Deping Zhao5, Chang Chen6
1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
2 Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
3 Department of Pathology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
4 Department of Medicine, Amoy Diagnostics Co, Ltd, Xiamen, China.
5 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
6 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Objective:
Accurately predicting response during neoadjuvant chemoimmunotherapy for resectable non–small cell lung cancer remains clinically challenging. In this study, we investigated the effectiveness of blood-based tumor mutational burden (bTMB) and a deep learning (DL) model in predicting major pathologic response (MPR) and survival from a phase 2 trial.
Methods:
Blood samples were prospectively collected from 45 patients with stage IIIA (N2) non–small cell lung cancer undergoing neoadjuvant chemoimmunotherapy. An integrated model, combining the computed tomography–based DL score, bTMB, and clinical factors, was developed to predict tumor response to neoadjuvant chemoimmunotherapy.
Results:
At baseline, bTMB were detected in 77.8% (35 of 45) of patients. Baseline bTMB ≥11 mutations/megabase was associated with significantly greater MPR rates (77.8% vs 38.5%, P = 0.042), and longer disease-free survival (P = 0.043), but not overall survival (P = 0.131), compared with bTMB <11 mutations/megabase in 35 patients with bTMB available. The developed DL model achieved an area under the curve of 0.703 in all patients. Importantly, the predictive performance of the integrated model improved to an area under the curve of 0.820 when combining the DL score with bTMB and clinical factors. Baseline circulating tumor DNA (ctDNA) status was not associated with pathologic response and survival. Compared with ctDNA residual, ctDNA clearance before surgery was associated with significantly greater MPR rates (88.2% vs 11.1%, P < 0.001) and improved disease-free survival (P = 0.010).
Conclusion:
The integrated model shows promise as a predictor of tumor response to neoadjuvant chemoimmunotherapy. Serial ctDNA dynamics provide a reliable tool for monitoring tumor response.
[CITATION]: Xu L, Si H, Zhuang F, et al Predicting therapeutic response to neoadjuvant immunotherapy based on an integration model in resectable stage IIIA (N2) non-small cell lung cancer. J Thorac Cardiovasc Surg. 2024 May 17:S0022-5223(24)00437-9.
[DOI]: 10.1016/j.jtcvs.2024.05.006.
[IF]: 4.9
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基于整合模型预测可切除IIIA(N2)期非小细胞肺癌对新辅助免疫疗法的治疗反应
胸“星”外科学术团队兴趣小队成员 刘宋杰 译
目的
方法
结果
结论
Figure 3. Predictive performance of DL and integration model for predicting MPR.
Figure 5. bTMB and DL model is a promising predictor of neoadjuvant immunotherapy, and tumor response may be well monitored by ctDNA dynamics.
2017·EATTS
02
Outcomes of Patients Undergoing Segmentectomy for Occult Node-Positive Clinical Stage IA Lung Cancer
Tamar B Nobel1, Kay See Tan2, Prasad S Adusumilli1, Manjit S Bains1, Robert J Downey1, Katherine Gray1, James Huang1, James M Isbell1, Daniela Molena1, Bernard J Park1, Gaetano Rocco1, Valerie W Rusch1, Smita Sihag1, David R Jones1, Matthew J Bott3
1Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
2Biostatics Division, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
3Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Background:
Results of recent clinical trials suggest segmentectomy may be an acceptable alternative to lobectomy for selected patients with early-stage non-small cell lung cancer (NSCLC). Increased use of segmentectomy may result in a concomitant increase in occult node-positive (N+) disease on surgical pathology. The optimal management for such patients remains unknown.
Metheds:
Clinicopathologic data were abstracted from a prospective institutional database to identify patients with pathologic N+ disease after segmentectomy for cT1N0M0 NSCLC. Propensity score matching identified a comparable lobectomy cohort for assessment of cumulative incidence of recurrence and overall survival (OS).
Results:
Of 759 included patients, 27 (4%) had nodal upstaging on final pathology. Of these, 4 (15%) had skip metastasis to N2 stations, and 20 (74%) received adjuvant therapy; no completion lobectomies were performed. Ten patients (37%) had recurrence: 3 isolated locoregional (11%) and 7 distant (26%). The median time to recurrence among patients with recurrence was 1.8 years; OS after recurrence was 3.4 years. After 5:1 matching with 109 lobectomy patients, all variables were balanced between the groups, except pathologic N2 stage and open surgical approach. Five-year cumulative incidence of recurrence was not significantly different between segmentectomy and lobectomy (42% vs 52%; Gray’s P=0.1). Five-year OS (63% and 50%) and rate of locoregional recurrence (12% vs. 13%) were not statistically different between the groups.
Conclusions:
Patients with occult N+ disease after segmentectomy for cT1N0M0 NSCLC had limited isolated locoregional recurrences and similar outcomes as patients who underwent lobectomy. Lobectomy may not provide an advantage in these patients.
[CITATION]: Nobel TB, Tan KS, Adusumilli PS, et al. Outcomes of Patients Undergoing Segmentectomy for Occult Node-Positive Clinical Stage IA Lung Cancer. Ann Thorac Surg. 2024 Jun 10:S0003-4975(24)00448-X.
[DOI]: 10.1016/j.athoracsur.2024.05.031
[IF]: 4.6
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隐匿性淋巴结阳性的临床IA期肺癌患者行肺段切除术的结局
胸“星”外科学术团队兴趣小队成员 孙可蒙 译
背景
方法
结果
结论
Table 3. Univariable and multivariable Cox models for overall survival in the propensity score matched cohort
Table 4. Univariable and multivariable competing risk regression models for recurrence in the propensity score matched cohort
Figure 1. Comparison of outcomes between lobectomy and segmentectomy in the propensity score matched cohort. (A) Overall survival. (B) Cumulative incidence of recurrence.
2017·EATTS
