Targeted Next-Generation Sequencing Analysis for Recurrence in Early-Stage Lung Adenocarcinoma

Abstract

Background Despite surgical resection, early lung adenocarcinoma has a recurrence rate of 20–50%. No clear predictive markers for recurrence of early lung adenocarcinoma are available. Targeted next-generation sequencing (NGS) is rarely used to identify recurrence-related genes. We aimed to identify genetic alterations that can predict recurrence, by comparing the molecular profiles of patient groups with and without recurrence. Methods Tissues from 230 patients with resected stage I–II lung adenocarcinoma (median follow-up: 49 months) were analyzed via targeted NGS for 207 cancer-related genes. The recurrence-free survival according to the number and type of mutation was estimated using the Kaplan–Meier method. Independent predictive biomarkers related to recurrence were identified using the Cox proportional hazards model. Results Recurrence was observed in 64 patients (27.8%). In multivariate analysis adjusted for age, sex, smoking history, stage, surgical mode, and visceral pleural invasion, the CTNNB1 mutation and fusion genes (ALK, ROS1, RET) were negative prognostic factors for recurrence in early-stage lung adenocarcinoma (HR 4.47, p = 0.001; HR 2.73, p = 0.009). EGFR mutation was a favorable factor (HR 0.51, p = 0.016), but the CTNNB1/EGFR co-mutations were negative predictors (HR 19.2, p < 0.001). TP53 mutation was a negative predictor compared with EGFR mutation for recurrence (HR 5.24, p = 0.02). Conclusions: Targeted NGS can provide valuable information to predict recurrence and identify patients at high recurrence risk, facilitating selection of the treatment strategy among close monitoring and adjuvant-targeted therapy. Larger datasets are required to validate these findings.

Cancer in the Shadow of COVID: Early-Stage Breast and Prostate Cancer Patient Perspectives on Surgical Delays Due to COVID-19

“…In addition, oncologic treatment is multidisciplinary, meaning that surgical delays not only have ramifications for locoregional control, but also for systemic treatment planning. 2 Little, if any, prospective data existed to guide cancer care in such a situation, and professional societies were tasked with developing alternative treatment plans grounded in common sense and expert consensus. Among those cancers for which surgical delay was considered to be reasonable included ductal carcinoma in situ (DCIS), early-stage, hormone-receptor-positive (HR+) breast cancer and early-stage prostate cancer.…”

“…The first surge of COVID-19 presented unprecedented barriers to oncologic care, but it also represented an extreme example of a competing health-related stressor that our patients must contend with on a regular basis. Although society recommendations advocated that clear, consistent messaging and reassurance be provided when discussing treatment delays or alternative treatment strategies with patients, there was limited practical guidance available regarding alleviating patient anxieties 2 Our objective was to explore the lived experience of cancer patients who experienced surgical delays during the first wave of the pandemic, to understand how a significant competing health-related stressor changed their relationship to their cancer-related worry, and to identify opportunities to improve care.…”

EGFR Status Assessment for Better Care of Early Stage Non-Small Cell Lung Carcinoma: What Is Changing in the Daily Practice of Pathologists?

“…Nonetheless, interest in performing an NGS test can be strongly debated. In fact, several co-mutations associated with mutations in EGFR have been shown to bring about a lower efficacy to EGFR TKIs, to give tumor resistance to these molecules, and to result in a poorer prognosis [34,[71][72][73][74][75]. This notably concerns mutations in TP53, RB, CTNNB1, RBM10, FAT1, ABCB1, PI3KA, and ARID1A [72,[76][77][78][79][80].…”

Elective Surgical Experience During COVID Pandemic at a Tertiary Cancer Care Centre in India: A Retrospective Analysis

“…No age is immune for malignant disease but majority of the cancer patients belong to elderly age group, prevalence of other comorbidities makes them more susceptible for contracting infectious diseases. Administration of chemotherapeutic drugs to an individual suffering from cancer also diminishes/alters their immune response, making them much more susceptible to infections [ 4 ].…”

“…India has grown as a top healthcare destination for patients around the world seeking world-class treatment at an economical price [ 4 ]. The strict lockdown, travel restrictions and increase in COVID cases over the months have created a panic situation in both domestic and international cancer patients.…”