Clinically validated model predicts the effect of intratumoral heterogeneity on overall survival for non-small cell lung cancer (NSCLC) patients

Abstract Background Dissociated responses (DR) are phenomena in which some tumors shrink, whereas others progress during treatment of patients with cancer. The purpose of the present study was to evaluate the frequency and prognosis of DR in non-small cell lung cancer (NSCLC) patients treated with anti-program cell death-1/ligand 1 (anti-PD-1/L1) inhibitors. Methods This retrospective study included NSCLC patients who received anti-PD-1/L1 inhibitor as second- or later-line treatment. We excluded patients without radiological evaluation, including brain imaging within 28 days prior to the treatment, and those without measurable lesions. We evaluated all measurable lesions in each organ. We defined DR as a disease with some shrinking lesions as well as growing or emerging new lesions in patients who showed progressive disease (PD), according to the RECIST 1.1 at the initial CT evaluation. Cases not classified as DR were defined as ‘true PD’. Overall survival was compared between patients with DR and those with true PD using Cox proportional hazards models. Results The present study included 62 NSCLC patients aged 27–82 years (median: 65 years). DR and true PD were observed in 11 and 51 patients, respectively. Nivolumab, pembrolizumab, and atezolizumab were administered to 45, 7, and 10 patients, respectively. Median overall survival was significantly longer in patients with DR versus true PD (14.0 vs. 6.6 months; hazard ratio for death: 0.40; 95% confidence interval: 0.17–0.94). Conclusions The frequency of DR in NSCLC patients who showed PD to anti-PD-1/L1 was 17.7%. Patients with DR exhibited a relatively favorable prognosis.

Download Full-text

The association of aspirin use with overall survival of patients with inoperable non-small cell lung cancer: a retrospective study

BMC Cancer ◽

10.1186/s12885-021-08999-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Min-Chun Chuang ◽

Yao-Hsu Yang ◽

Meng-Jer Hsieh ◽

Yu-Ching Lin ◽

Tsung-Ming Yang ◽

...

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Propensity Score ◽

Small Cell Lung Cancer ◽

Propensity Score Matching ◽

Cell Lung Cancer ◽

Small Cell ◽

Time Dependent ◽

Small Cell Lung ◽

Nsclc Patients

Abstract Background Studies have indicated that individuals taking aspirin have a reduced risk of cancers and have also established chemo-preventive benefit of aspirin in colorectal cancer. However, research on the association between aspirin use and the survival in patients with lung cancer has revealed inconsistent results. In this study, we investigated the effect of aspirin use on the survival of inoperable non-small cell lung cancer (NSCLC) patients. Methods We identified a cohort of 38,842 patients diagnosed with NSCLC between 2000 and 2012 using the Taiwan’s National Health Insurance Research Database and used propensity score matching to reduce possible confounding factors. In total, 9864 patients (4932 matched pairs) were included in the matched cohort. Aspirin exposure was analyzed to identify a possible association with mortality in patients with inoperable NSCLC. Time-dependent Cox regression models were used to calculate the hazard ratios (HRs) and the 95% confidence intervals (95% CIs) that corresponded with aspirin exposure. Results A total of 4979 patients used aspirin at the time of diagnosis of NSCLC. The median overall survival (OS) of the aspirin users was 1.73 (interquartile range, 0.94–3.53) years compared with the 1.30 (interquartile range, 0.69–2.62) years of the non-aspirin users. The Cox proportional hazard model with the time-dependent covariate revealed that aspirin use was associated with a significantly longer OS (HR: 0.83, 95.0% CI: 0.80–0.86). After controlling the sociodemographic characteristics (age, sex, income, and level of urbanization) and lung cancer treatments by propensity score matching, the aspirin users still had a significantly longer OS than the non-aspirin users (HR: 0.79, 95.0% CI: 0.75–0.83). Conclusion Aspirin use is associated with a longer OS in patients with inoperable NSCLC, suggesting that aspirin has a potential anticancer effect. These results warrant further randomized clinical trials to evaluate the actual role of aspirin in the treatment of NSCLC patients.

Download Full-text

Second-line therapy to improve overall survival in primary refractory non small-cell lung cancer (NSCLC) patients.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.15_suppl.e21069 ◽

2018 ◽

Vol 36 (15_suppl) ◽

pp. e21069-e21069

Author(s):

Sacha Rothschild ◽

Rebecca Nachbur ◽

Natascha Herzog ◽

Jakob Passweg ◽

Miklos Pless

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Small Cell ◽

Second Line ◽

Small Cell Lung ◽

Second Line Therapy ◽

Line Therapy ◽

Nsclc Patients

Download Full-text

A nomogram for predicting overall survival in resected non-small cell lung cancer with chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e21064 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e21064-e21064

Author(s):

Yuan Zeng ◽

Wenhua Liang ◽

Jianxing He

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Small Cell ◽

Seer Database ◽

Small Cell Lung ◽

Lymph Node Count ◽

Resected Nsclc ◽

Nsclc Patients

e21064 Background: Chemotherapy is very common for resected Non-Small-Cell Lung Cancer (NSCLC) patients. However, models for predicting the survival outcomes of resected NSCLC patients with chemotherapy are scarce. The aim of this study was to develop a clinical nomogram for predicting overall survival in these patients. Methods: A total of 16661 resected NSCLC with chemotherapy were cases extracted from the Surveillance, Epidemiology, and End Results (SEER) database. We identified and integrated the prognostic factors to build a nomogram.The model was subjected to bootstrap internal validation with the SEER database and external validations with 1108 patients from China. The predictive accuracy and discriminative ability were illustrated by calibration, concordance index (C-index) and risk group stratification. Results: On multivariate analysis independent factors for OS were age, sex, examined lymph node count, extent of surgery, N stage, T stage and grade which were then integrated into the nomogram. The calibration curves for probability of 1-, 3-, and 5-year OS showed excellent agreement between nomogram prediction and actual observation. The C-index of the nomogram was higher than that of AJCC 8th edition system for predicting OS (training cohort, 0.61 vs. 0.58; P < 0.01; validation cohort, 0.66 vs. 0.63, P = 0.56). The stratification into different risk groups allowed significant distinction between survival curves. Conclusions: We established a nomogram that can provide individual prediction of OS for resected NSCLC patients with chemotherapy. This practical prognostic model may help clinicians for treatment planning and to guide future studies.

Download Full-text