Integrated evaluation of clinical, pathological and radiological prognostic factors in squamous cell carcinoma of the lung

English version

Autoři: Kyowon Gu ^aff001; Ho Yun Lee ^aff001; Kyungjong Lee ^aff002; Joon Young Choi ^aff003; Sook Young Woo ^aff004; Insuk Sohn ^aff004; Hong Kwan Kim ^aff005; Yong Soo Choi ^aff005; Jhingook Kim ^aff005; Jae Ill Zo ^aff005; Young Mog Shim ^aff005
Působiště autorů: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea ^aff001; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea ^aff002; Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea ^aff003; Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea ^aff004; Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea ^aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0223298

Souhrn

Objective

Little is known about prognostic factors for lung squamous cell carcinoma (SCC). We aimed to explore radiologic and clinical factors affecting prognosis and to compare the prognosis of both central and peripheral lung SCCs.

Materials and methods

Radiologic, clinical, and pathologic profiles of surgically confirmed SCCs from 382 patients were retrospectively reviewed. Tumor location, enhancement, necrosis, the presence of obstructive pneumonitis/atelectasis and underlying lung disease were evaluated on chest CT examination. Age, pulmonary function, tumor marker, and cancer stage were also assessed. Univariate and multivariate Cox regression analyses were performed to identify any correlation to overall survival (OS) and disease-free survival (DFS). Hazard rate estimation and competing risk analysis were done to evaluate recurrence pattern.

Results

The median follow-up period was 56.2 months. Tumors were located centrally in 230 patients (60.2%) and peripherally in 152 patients (39.8%). Age (p = 0.002, hazard ratio [HR] 1.03, 95% confidence interval [CI] = [1.01, 1.06]) and interstitial lung abnormalities (ILAs) (p<0.001, HR 5.41, 95% CI = [3.08, 9.52]) were associated with poor OS on multivariate analysis. ILAs also had a strong association to DFS (p<0.001, HR 4.25, 95% CI = [3.08, 9.52]). Central cancers had two peaks of local recurrence development at 15 and 60 months after surgery, and peripheral tumors showed rising curves for metastasis development at 60 months.

Conclusions

CT-determined ILAs are a strong biomarker predicting poor outcome. Prognosis may not vary according to tumor location, but the two groups exhibited different recurrence patterns.

Klíčová slova:

Surgical and invasive medical procedures – Lung and intrathoracic tumors – Computed axial tomography – Necrosis – Metastasis – Surgical oncology – Secondary lung tumors – Squamous cell lung carcinoma

Zdroje

1. Youlden DR, Cramb SM, Baade PD. The International Epidemiology of Lung Cancer: geographical distribution and secular trends. J Thorac Oncol. 2008;3(8):819–31. Epub 2008/08/02. doi: 10.1097/JTO.0b013e31818020eb 18670299.

2. Cancer Genome Atlas Research Network. Comprehensive genomic characterization of squamous cell lung cancers. Nature. 2012;489(7417):519–25. Epub 2012/09/11. doi: 10.1038/nature11404 22960745; PubMed Central PMCID: PMC3466113.

3. Langer CJ, Obasaju C, Bunn P, Bonomi P, Gandara D, Hirsch FR, et al. Incremental Innovation and Progress in Advanced Squamous Cell Lung Cancer: Current Status and Future Impact of Treatment. J Thorac Oncol. 2016;11(12):2066–81. doi: 10.1016/j.jtho.2016.08.138 27575423.

4. Weichert W, Kossakowski C, Harms A, Schirmacher P, Muley T, Dienemann H, et al. Proposal of a prognostically relevant grading scheme for pulmonary squamous cell carcinoma. Eur Respir J. 2016;47(3):938–46. doi: 10.1183/13993003.00937-2015 26541540.

5. Bass AJ, Watanabe H, Mermel CH, Yu S, Perner S, Verhaak RG, et al. SOX2 is an amplified lineage-survival oncogene in lung and esophageal squamous cell carcinomas. Nat Genet. 2009;41(11):1238–42. Epub 2009/10/06. doi: 10.1038/ng.465 19801978; PubMed Central PMCID: PMC2783775.

6. Derman BA, Mileham KF, Bonomi PD, Batus M, Fidler MJ. Treatment of advanced squamous cell carcinoma of the lung: a review. Transl Lung Cancer Res. 2015;4(5):524–32. Epub 2015/12/03. doi: 10.3978/j.issn.2218-6751.2015.06.07 26629421; PubMed Central PMCID: PMC4630512.

7. Pilotto S, Sperduti I, Novello S, Peretti U, Milella M, Facciolo F, et al. Risk Stratification Model for Resected Squamous-Cell Lung Cancer Patients According to Clinical and Pathological Factors. J Thorac Oncol. 2015;10(9):1341–8. doi: 10.1097/JTO.0000000000000628 26200453.

8. Saijo T, Ishii G, Nagai K, Funai K, Nitadori J, Tsuta K, et al. Differences in clinicopathological and biological features between central-type and peripheral-type squamous cell carcinoma of the lung. Lung Cancer. 2006;52(1):37–45. doi: 10.1016/j.lungcan.2005.12.006 16497410.

9. Funai K, Yokose T, Ishii G, Araki K, Yoshida J, Nishimura M, et al. Clinicopathologic characteristics of peripheral squamous cell carcinoma of the lung. Am J Surg Pathol. 2003;27(7):978–84. doi: 10.1097/00000478-200307000-00013 12826890.

10. Putman RK, Hatabu H, Araki T, Gudmundsson G, Gao W, Nishino M, et al. Association Between Interstitial Lung Abnormalities and All-Cause Mortality. JAMA. 2016;315(7):672–81. doi: 10.1001/jama.2016.0518 26881370; PubMed Central PMCID: PMC4828973.

11. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010.

12. Lee J, Kim HK, Park BJ, Cho JH, Choi YS, Zo JI, et al. Recurrence dynamics after trimodality therapy (Neoadjuvant concurrent chemoradiotherapy and surgery) in patients with stage IIIA (N2) lung cancer. Lung Cancer. 2018;115:89–96. doi: 10.1016/j.lungcan.2017.11.020 29290268.

13. Subramanian J, Morgensztern D, Goodgame B, Baggstrom MQ, Gao F, Piccirillo J, et al. Distinctive characteristics of non-small cell lung cancer (NSCLC) in the young: a surveillance, epidemiology, and end results (SEER) analysis. J Thorac Oncol. 2010;5(1):23–8. doi: 10.1097/JTO.0b013e3181c41e8d 19934774.

14. Hunninghake GM, Hatabu H, Okajima Y, Gao W, Dupuis J, Latourelle JC, et al. MUC5B promoter polymorphism and interstitial lung abnormalities. N Engl J Med. 2013;368(23):2192–200. doi: 10.1056/NEJMoa1216076 23692170; PubMed Central PMCID: PMC3747636.

15. Washko GR, Hunninghake GM, Fernandez IE, Nishino M, Okajima Y, Yamashiro T, et al. Lung volumes and emphysema in smokers with interstitial lung abnormalities. N Engl J Med. 2011;364(10):897–906. doi: 10.1056/NEJMoa1007285 21388308; PubMed Central PMCID: PMC3074462.

16. Smith BM, Schwartzman K, Kovacina B, Taylor J, Kasymjanova G, Brandao G, et al. Lung cancer histologies associated with emphysema on computed tomography. Lung Cancer. 2012;76(1):61–6. doi: 10.1016/j.lungcan.2011.09.003 21945657.

17. Kato E, Takayanagi N, Takaku Y, Kagiyama N, Kanauchi T, Ishiguro T, et al. Incidence and predictive factors of lung cancer in patients with idiopathic pulmonary fibrosis. ERJ open research. 2018;4(1). doi: 10.1183/23120541.00111–2016 29410958; PubMed Central PMCID: PMC5795191.

18. Gao L, Xie S, Liu H, Liu P, Xiong Y, Da J, et al. Lung cancer in patients with combined pulmonary fibrosis and emphysema revisited with the 2015 World Health Organization classification of lung tumors. The clinical respiratory journal. 2018;12(2):652–8. doi: 10.1111/crj.12575 27768836.

19. Takenaka T, Furuya K, Yamazaki K, Miura N, Tsutsui K, Takeo S. The prognostic impact of combined pulmonary fibrosis and emphysema in patients with clinical stage IA non-small cell lung cancer. Surgery today. 2018;48(2):229–35. doi: 10.1007/s00595-017-1577-8 28821979.

20. Li C, Wu W, Chen N, Song H, Lu T, Yang Z, et al. Clinical characteristics and outcomes of lung cancer patients with combined pulmonary fibrosis and emphysema: a systematic review and meta-analysis of 13 studies. Journal of thoracic disease. 2017;9(12):5322–34. doi: 10.21037/jtd.2017.12.72 29312742; PubMed Central PMCID: PMC5756974.

21. Gurel D, Ulukus C, Karacam V, Ellidokuz H, Umay C, Oztop I, et al. The prognostic value of morphologic findings for lung squamous cell carcinoma patients. Pathol Res Pract. 2016;212(1):1–9. doi: 10.1016/j.prp.2015.10.006 26608418.

22. Inoue M, Takakuwa T, Minami M, Shiono H, Utsumi T, Kadota Y, et al. Clinicopathologic factors influencing postoperative prognosis in patients with small-sized adenocarcinoma of the lung. J Thorac Cardiovasc Surg. 2008;135(4):830–6. Epub 2008/04/01. doi: 10.1016/j.jtcvs.2007.10.034 18374763.

23. Kilicgun A, Turna A, Sayar A, Solak O, Urer N, Gurses A. Very important histopathological factors in patients with resected non-small cell lung cancer: necrosis and perineural invasion. Thorac Cardiovasc Surg. 2010;58(2):93–7. Epub 2010/03/25. doi: 10.1055/s-0029-1186240 20333571.

24. Swinson DE, Jones JL, Richardson D, Cox G, Edwards JG, O'Byrne KJ. Tumour necrosis is an independent prognostic marker in non-small cell lung cancer: correlation with biological variables. Lung Cancer. 2002;37(3):235–40. Epub 2002/09/18. doi: 10.1016/s0169-5002(02)00172-1 12234691.

25. Kinoshita T, Ohtsuka T, Hato T, Goto T, Kamiyama I, Tajima A, et al. Prognostic factors based on clinicopathological data among the patients with resected peripheral squamous cell carcinomas of the lung. J Thorac Oncol. 2014;9(12):1779–87. doi: 10.1097/JTO.0000000000000338 25226427.

26. Nwogu CE, Groman A, Fahey D, Yendamuri S, Dexter E, Demmy TL, et al. Number of lymph nodes and metastatic lymph node ratio are associated with survival in lung cancer. Ann Thorac Surg. 2012;93(5):1614–9; discussion 9–20. doi: 10.1016/j.athoracsur.2012.01.065 22440365.

27. Urban D, Bar J, Solomon B, Ball D. Lymph node ratio may predict the benefit of postoperative radiotherapy in non-small-cell lung cancer. J Thorac Oncol. 2013;8(7):940–6. doi: 10.1097/JTO.0b013e318292c53e 23695418.