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Wait-and-See Treatment Strategy Could be Considered for Lung Adenocarcinoma with Special Pleural Dissemination Lesions, and Low Genomic Instability Correlates with Better Survival

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to evaluate the feasibility of a wait-and-see strategy for non-small cell lung cancer (NSCLC) patients with special pleural dissemination lesions (r-pM1a and s-pM1a). Furthermore, the study characterized genomic alternations about disease progression.

Methods

For this study, 131 NSCLC patients with a diagnosis of pM1a were retrospectively selected. Survival differences were evaluated among patients treated with three different initial postoperative treatments: chemotherapy, targeted therapy, and wait-and-see strategy. Whole-exome sequencing (WES) was performed on primary and metastatic tumors of 10 patients with dramatic progression and 13 patients with gradual progression.

Results

The wait-and-see group showed better progression-free survival (PFS) than the chemotherapy group (p < 0.001) but PFS similar to that of targeted group (p = 0.984). This pattern persisted in epidermal growth factor receptor (EGFR)-positive patients. For patients with EGFR-negative/unknown status, PFS was longer in the wait-and-see group than in the two treatment groups. Furthermore, better overall survival (OS) was observed for the patients who received chemotherapy or targeted therapy after the wait-and-see strategy than for those who received chemotherapy or targeted therapy immediately. Lymph node status was an independent prognostic factor for PFS and OS. Finally, WES analysis showed that a high genomic instability index (GIS) and chromosome 18q loss were more common in metastatic tumors, and low GIS was significantly associated with better PFS (p = 0.016).

Conclusions

The wait-and-see strategy could be considered for special pM1a patients without lymph nodes metastasis, and patients with a low GIS may be suitable for this strategy.

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Acknowledgment

This work was supported by Key Lab System Project of Guangdong Science and Technology Department–Guangdong Provincial Key Lab of Translational Medicine in Lung Cancer (Grant No. 2017B030314120), Project of National Natural Science Foundation (Grant Nos. 81673031, 81872510), Research Fund from Guangzhou Science and Technology Bureau (Grant No. 201704020161), High-Level Hospital Construction Project (Grant No. DFJH201801), and Guangdong Provincial People’s Hospital Young Talent Project (Grant No. GDPPHYTP201902).

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Author notes

  1. Ying Chen and Wen-Fang Tang have contributed equally to this paper.

Authors and Affiliations

  1. Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People’s Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China

    Ying Chen MD, Wen-Fang Tang MD, Wei Li MD, Jian Su PhD, Xue-Ning Yang PhD, Yi-Long Wu PhD & Wen-Zhao Zhong PhD

  2. Shantou University Medical College, Shantou, China

    Wen-Fang Tang MD & Jie-Shan Lin MD

  3. The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China

    Huan Lin MD

  4. Translational Medicine Research Institute, Geneseeq Technology Inc, Toronto, ON, Canada

    Hua Bao PhD, Ao Wang MSc, Xue Wu PhD & Yang W. Shao PhD

  5. School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China

    Yang W. Shao PhD

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  1. Ying Chen MD
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  2. Wen-Fang Tang MD
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Corresponding author

Correspondence to Wen-Zhao Zhong PhD.

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Disclosure

Yi-Long Wu received honoraria from AstraZeneca, Eli Lilly, Roche, Pierre Fabre, Pfizer, and Sanofi; served in a consulting or advisory role with AstraZeneca, Roche, Merck, and Boehringer Ingelheim; and had research funding to the institution from Boehringer Ingelheim and Roche. Hua Bao, Ao Wang, Xue Wu and Yang W. Shao worked as employee of Geneseeq Technology Inc for statistical analysis of whole-exome sequencing (WES) in this manuscript. The remaining authors have no conflicts of interest.

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Chen, Y., Tang, WF., Lin, H. et al. Wait-and-See Treatment Strategy Could be Considered for Lung Adenocarcinoma with Special Pleural Dissemination Lesions, and Low Genomic Instability Correlates with Better Survival. Ann Surg Oncol 27, 3808–3818 (2020). https://doi.org/10.1245/s10434-020-08400-1

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  • DOI: https://doi.org/10.1245/s10434-020-08400-1

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