Prediction of distant recurrence in resected stage I and II lung adenocarcinoma. (November 2016)

• Record Type: Journal Article
• Authors: Aramini, Beatrice; Casali, Christian; Stefani, Alessandro; Bettelli, Stefania; Wagner, Susanne; Sangale, Zaina; Hughes, Elisha; Lanchbury, Jerry S.; Maiorana, Antonino; Morandi, Uliano
• Is Part Of: Lung cancer. Volume 101(2016)
• Page Start: 82
• Page End: 87
• Publication Date: 2016-11
• Subjects: Lung adenocarcinoma -- Biomarkers -- Prognosis -- Post-surgical treatment -- Surveillance; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2016.09.005
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: The CCP score provides a molecular score of proliferation. Resected lung adenocarcinomas vary widely in CCP scores. CCP scores predict risk of distant recurrence in lung adenocarcinoma. Adding a CCP score to pathological stage improves recurrence risk prediction. Stratification by CCP score can facilitate trial design in stage I patients. Abstract: Objectives: Optimal procedures for adjuvant treatment and post-surgical surveillance of resected non-small-cell lung cancer remain under discussion. Pathological features are the main determinant of follow-up therapy but have limited ability to identify patients at risk of recurrence. Increasingly, molecular markers are incorporated into clinical decision-making, including measures of tumor growth. The CCP score is a quantitative, molecular measure of proliferation derived from the RNA expression of 31 cell cycle genes and a component of the molecular prognostic score (mPS). The mPS score is a linear combination of CCP score and pathological stage. CCP score and mPS are independent predictors of survival in resected lung adenocarcinoma. Materials and methods: CCP scores were determined by RT-qPCR for 318 patients diagnosed with stage I–II lung adenocarcinoma. Association of mPS and CCP score with distant recurrence and lung-cancer specific survival was assessed in Cox proportional hazards regression models adjusted for age, gender, tumor size, pathological stage and pleural invasion. Distant recurrence-free survival and lung-cancer specific survival by mPS risk group were calculated by Kaplan-Meier survival analysis. Results: CCP scores were obtained for 205 stage I and 84 stage II patients. CCP score and mPS were independent markers of distant recurrence (CCP: HR 1.62, 95%CI 1.15-2.29, p = 0.0055; mPS: HR 2.22, 95%CI 1.11-4.44, p = 0.023). Patients with low mPS tumors were at significantly reduced risk of distant recurrence (log-rank p = 4.2 × 10 −5 ). Among stage I patients, stratification by mPS identified a patient group with increased risk of distant recurrence (36%, 95%CI 28–46%, log-rank p = 0.0011) Conclusions: The molecular prognostic score stratifies early-stage, resected lung cancer patients for risk of distant recurrence and could be useful to inform treatment and surveillance decisions.