Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC
Abstract
:1. Introduction
2. Materials
2.1. Study Design
2.2. Patients and Pathology Specimens
2.3. Treatments
2.4. End Points
2.5. Statistical Analysis
3. Results
3.1. Oligometastatic Non-Small Cell Lung Cancer (NSCLC) Prevalence
3.2. Metastatic Sites Prevalence
3.3. Treatments
3.3.1. Survival of Patients with Aggressive Treatment at Both Metastatic and Primary Sites Compared to Non-Aggressive Treatments
3.3.2. Survival Impact of Four Management Approaches in Oligometastatic NSCLC
3.3.3. Overall Survival (OS) and Progression-Free Survival (PFS) Analyzed by “Modified” Stage of Patients with Aggressive Treatment at Both Sites versus Other Treatments
- Stage I: The mOS for the “modified” stage I oligometastatic NSCLC, which refers to the combined stage T and N of the IASLC staging eighth edition, radically treated at both sites (Group A) was 42 months compared with 16 months for other forms of treatments (Group B) (p = 0.316). The mPFS was the same in both group (p = 0.669) (Table S2).
- Stage II: The mOS of “modified” stage II of oligometastatic NSCLC patients of Group A was 34 months vs. 6 months for group B and was statistically significant (p = 0.024). The mPFS of the “modified” stage II patients treated radically at both sites was not reached vs. 6.0 months of group B patients (p = 0.016) (Table S2).
- Stage III: The mOS and mPFS for “modified” stage III was significantly higher in Group A with an mOS of 22 months vs. 4 months for Group B (p = 0.001). The mPFS of the “modified” stage III of Groups A and B were respectively 19 months vs. 3 months (p = 0.003) (Table S2).
3.4. Epidermal Growth Factor Receptor (EGFR) Mutation Status and Anaplastic Lymphoma Kinase (ALK) Expression Profile
3.5. Programmed Cell Death Ligand 1 (PD-L1) Expression Profile
3.6. PD-L1 Status and Clinical Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Brain (n = 50) 1 Metastases (n = 37) 2 Metastases (n = 9) 3 Metastases (n = 4) | Bone (n = 4) | Adrenal (n = 6) | Liver (n = 2) | Contralateral Lung (n = 5) | Total N (n = 67) |
---|---|---|---|---|---|---|
Sex | ||||||
Male | 29 (43) | 2 (3) | 3 (5) | 2 (3) | 2 (3) | 38 (57) |
Age at diagnosis | ||||||
< 65 | 34 (51) | 3 (5) | 3 (5) | 1 (2) | 4 (6) | 45 (67) |
≥65 | 16 (24) | 1 (2) | 3 (5) | 1 (2) | 1 (2) | 22 (33) |
Smoking history | ||||||
Positive | 50 (75) | 2 (3) | 6 (9) | 2 (3) | 5 (8) | 65 (97) |
ECOG | ||||||
0 | 13 (19) | 1 (2) | 1 (2) | 0 (0) | 2 (3) | 17 (25) |
1 | 20 (30) | 3 (5) | 2 (3) | 2 (3) | 1 (2) | 28 (42) |
2 | 5 (8) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 5 (8) |
3 | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
4 | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
N/A | 12 (18) | 0 (0) | 3 (5) | 0 (0) | 2 (3) | 17 (25) |
Histology | ||||||
Adenocarcinoma | 36 (54) | 3 (5) | 4 (6) | 0 (0) | 5 (8) | 48 (2) |
Large Cell Carcinoma | 3 (5) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 3 (5) |
Squamous Cell Carcinoma | 2 (3) | 0 (0) | 2 (3) | 2 (3) | 0 (0) | 6 (9) |
Unspecified | 9 (13) | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 10 (15) |
PD-L1 status * | ||||||
Positive | 16 (41) | 0 (0) | 1 (3) | 0 (0) | 0 (0) | 17 (44) |
Negative | 18 (46) | 2 (5) | 0 (0) | 0 (0) | 2 (5) | 22 (56) |
Insufficient tissue | 16 | 2 | 5 | 2 | 3 | 28 |
EGFRstatus | ||||||
Positive | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Negative | 29 (43) | 4 (6) | 4 (6) | 1 (1) | 3 (4) | 41 (61) |
Insufficient tissue | 21 (31) | 0 (0) | 2 (4) | 1 (1) | 2 (3) | 26 (39) |
ALKstatus | ||||||
Positive | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Negative | 35 (52) | 4 (6) | 5 (7) | 1 (1) | 4 (6) | 49 (73) |
Insufficient tissue | 15 (22) | 0 | 1 (1) | 1 (1) | 1 (1) | 18 (27) |
Metastatic Site | Brain (n = 50) | Bone (n = 4) | Adrenal gland (n = 6) | Liver (n = 2) | Contralateral lung (n = 5) | Total (n = 67) |
---|---|---|---|---|---|---|
Aggressive treatment | 52 (78) | |||||
Group A | 29 (43) | |||||
Metastatic site + Primary site + Adjuvant chemotherapy (Group A1) | 4 (6) | 1 (2) | 0 (0.0) | 1 (2) | 1 (2) | 7 (10) |
Metastatic site + Primary sites (Group A2) | 21 (31) | 0 (0.0) | 1 (2) | 0 (0) | 0 (0) | 22 (33) |
Group B1 | 4 (6) | |||||
Primary site only | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (2) |
Primary site + adjuvant chemotherapy | 0 (0) | 1 (2) | 0 (0) | 0 (0) | 2 (3) | 3 (5) |
Group B2 | 19 (28) | |||||
Metastatic site only | 11 (16) | 0 (0) | 0 (0) | 0 (0) | 1 (2) | 12 (18) |
Metastatic site + palliative chemotherapy +/− palliative RT | 6 (9) | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 7 (10) |
Palliative treatment (Group B3) | 15 (22) | |||||
Watch & Wait | 0 (0) | 0 (0) | 2 (3) | 0 (0) | 0 (0) | 2 (3) |
Palliative chemotherapy | 0 (0) | 0 (0) | 2 (3) | 1 (2) | 1 (2) | 4 (6) |
Palliative tyrosine-kinase inhibitor | 0 (0) | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 1 (2) |
Palliative chemotherapy + RT | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (2) |
Palliative RT | 6 (9) | 0 (0) | 1 (2) | 0 (0) | 0 (0) | 7 (10) |
Staging by metastatic site | ||||||
8th IASLC classification TN staging (p = 0.053) | ||||||
T1–4 N0 | 22 (33) | 2 (3) | 2 (3) | 2 (3) | 3 (5) | 31(46) |
T1–4 N1 | 3 (5) | 0 (0) | 0 (0) | 0 (0) | 1 (2) | 4 (6) |
T1–4 N2 | 17 (25) | 2 (3) | 3 (5) | 0 (0) | 1 (2) | 23 (34) |
T1–4 N3 | 8 (12) | 0 (0) | 1 (2) | 0 (0) | 0 (0) | 9 (13) |
“Modified” Stage based on the combined 8th IASLC Edition T and N stages (p = 0.142) | ||||||
Stage I (T1–2 N0 M1b) | 13 (20) | 2 (3) | 0 (0) | 1 (2) | 2 (3) | 18 (27) |
Stage II (T1–2 N1 M1b and T3–4 N0 M1b) | 10 (15) | 0 (0) | 0 (0) | 1 (2) | 2 (3) | 13 (19) |
Stage III (T1–2 N2 M1b and T3–4 N1 M1b) | 27 (40) | 2 (3) | 6 (9) | 0 (0) | 1 (2) | 36 (54) |
Demographic and Tumoral Characteristics | Subgroup | PD-L1 Positive (≥25%) n (%) | PD-L1 Negative (<25%) n (%) | p-value |
---|---|---|---|---|
Sex | Men | 8 (21) | 13 (33) | 0.455 |
Women | 9 (23) | 9 (23) | ||
Age at diagnosis | ≥50 y.o. | 15 (38) | 19 (49) | 0.862 |
<50 y.o. | 2 (5) | 3 (8) | ||
Smoking history | ≤25 pack-years | 2 (5) | 2 (8) | 0.371 |
>25 to <50 pack-years | 8 (21) | 14 (36) | ||
≥50 pack-years | 5 (13) | 6 (15) | ||
N/A | 2 (5) | 0 | ||
ECOG at diagnosis | 0 | 3 (8) | 7 (18) | 0.719 |
1 | 6 (15) | 8 (21) | ||
2 | 1 (3) | 1 (3) | ||
N/A | 7 (18) | 6 (15) | ||
T staging | 1 | 1 (3) | 9 (23) | 0.065 |
2 | 6 (15) | 8 (21) | ||
3 | 4 (10) | 2 (5) | ||
4 | 4 (10) | 2 (5) | ||
N/A | 2 (5) | 1 (3) | ||
N staging | 0 | 8 (21) | 15 (38) | 0.470 |
1 | 1 (3) | 1 (3) | ||
2 | 5 (13) | 5 (13) | ||
3 | 3 (8) | 1 (3) | ||
Histology | Adenocarcinoma | 11 (28) | 17 (44) | 0.849 |
Squamous Cell Carcinoma | 1 (3) | 1 (3) | ||
Large Cell Carcinoma | 1 (3) | 1 (3) | ||
Poorly Differentiated | 4 (10) | 3 (8) |
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Gauvin, C.; Krishnan, V.; Kaci, I.; Tran-Thanh, D.; Bédard, K.; Albadine, R.; Leduc, C.; Gaboury, L.; Blais, N.; Tehfe, M.; et al. Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC. Curr. Oncol. 2021, 28, 593-605. https://doi.org/10.3390/curroncol28010059
Gauvin C, Krishnan V, Kaci I, Tran-Thanh D, Bédard K, Albadine R, Leduc C, Gaboury L, Blais N, Tehfe M, et al. Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC. Current Oncology. 2021; 28(1):593-605. https://doi.org/10.3390/curroncol28010059
Chicago/Turabian StyleGauvin, Camille, Vimal Krishnan, Imane Kaci, Danh Tran-Thanh, Karine Bédard, Roula Albadine, Charles Leduc, Louis Gaboury, Normand Blais, Mustapha Tehfe, and et al. 2021. "Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC" Current Oncology 28, no. 1: 593-605. https://doi.org/10.3390/curroncol28010059
APA StyleGauvin, C., Krishnan, V., Kaci, I., Tran-Thanh, D., Bédard, K., Albadine, R., Leduc, C., Gaboury, L., Blais, N., Tehfe, M., Routy, B., & Florescu, M. (2021). Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC. Current Oncology, 28(1), 593-605. https://doi.org/10.3390/curroncol28010059