Table 2.
Characteristics of the Treatment-Naive Cohort
| Clinicopathological Features | Stage I 103 Patients |
Stage II 40 Patients |
Stage III 111 Patientsc |
Stage IV 261 Patients |
Stage Unknownf 4 Patients |
All 519 Patients | |||
|---|---|---|---|---|---|---|---|---|---|
| IA 63 Patients | IB 40 Patients | IIA 17 Patients | IIB 23 Patients | IIIA 75 Patients | IIIB 36 Patients | ||||
| Median follow-up time, y | 2.6 | 2.5 | 2.7 | 2.5 | 3.1 | 2.3 | |||
| Age, y; median (range) | 72 (55–87) | 71 (54–85) | 70 (51–91) | 71 (39–86) | 71 (43–92) | 68 (47–84) | 70 (32–93) | 71 (69–84) | 70 (32–93) |
| Sex | |||||||||
| Female | 38 | 23 | 9 | 13 | 33 | 21 | 129 | 2 | 268 |
| Male | 25 | 17 | 8 | 10 | 42 | 15 | 132 | 2 | 251 |
| Performance status | |||||||||
| 0–1 | 57 | 38 | 14 | 20 | 66 | 28 | 171 | 4 | 398 |
| ≥2 | 6 | 2 | 3 | 3 | 9 | 8 | 90 | 0 | 121 |
| Smoking history | |||||||||
| Current | 25 | 21 | 6 | 6 | 31 | 18 | 106 | 0 | 213 |
| Former | 32 | 17 | 10 | 14 | 35 | 14 | 110 | 3 | 235 |
| Smoking cessation time unknown | 0 | 0 | 0 | 0 | 0 | 0 | 7 | 0 | 7 |
| Never | 5 | 2 | 1 | 3 | 9 | 4 | 34 | 1 | 59 |
| Unknown | 1 | 0 | 0 | 0 | 0 | 0 | 4 | 0 | 5 |
| Patients with synchronous tumors | 6a | 3 | 0 | 2 | 3c | 1 | 0 | - | 15 |
| Histologic diagnosis | |||||||||
| AC | 47 | 28 | 12 | 14 | 37 | 19 | 191 | 2 | 350 |
| SqCC | 7 | 8 | 5 | 6 | 23 | 11 | 23 | 1 | 84 |
| NSCLC not further specified | 1 | 0 | 0 | 0 | 6 | 1 | 18 | 0 | 26 |
| NSCLC marker null/LCC | 1 | 1 | 0 | 1 | 4 | 3 | 25 | 0 | 35 |
| Pleomorphic carcinoma/NSCLC with spindle cells | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 1 |
| Adenosquamous/NSCLC possibly adenosquamous | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 3 |
| LCNEC/possibly LCNEC | 1 | 0 | 0 | 0 | 2 | 0 | 2 | 0 | 5 |
| Patients with synchronous tumors | 6a | 3 | 0 | 2 | 3c | 1 | 0 | - | 15 |
| Metastases at baseline (stage IV) | |||||||||
| Pericardium, pleura, contralateral lung | - | - | - | - | - | - | 154 | - | 154 |
| Skeletal | - | - | - | - | - | - | 112 | - | 112 |
| Liver | - | - | - | - | - | - | 44 | - | 44 |
| CNS | - | - | - | - | - | - | 54 | - | 54 |
| Adrenal glands | - | - | - | - | - | - | 47 | - | 47 |
| Other | - | - | - | - | - | - | 53d | - | 53d |
| Single metastases | - | - | - | - | - | - | 29e | - | 29e |
| Initial treatment | |||||||||
| No oncological treatment ± local palliative treatment | 1 | 0 | 1 | 2 | 9 | 6 | 78 | 2 | 99 |
| Radiotherapy lung tumor ± lgll | 18 | 2 | 2 | 2 | 4 | 4 | 4 | 0 | 36 |
| Operation | 37 | 35 | 11 | 12 | 32 | 3 | 0 | 0 | 130 |
| Neoadjuvant | 0 | 0 | 0 | 2 | 13 | 1 | 0 | 0 | 16 |
| Adjuvant | 0 | 9 | 6 | 7 | 15 | 1 | 0 | 0 | 38 |
| Chemotherapy ± local palliative treatment | 0 | 0 | 2 | 1 | 7 | 7 | 151 | 1 | 169 |
| Concomittant CRT | 0 | 0 | 1 | 1 | 5 | 3 | 0 | 0 | 10 |
| Sequential CRT | 0 | 0 | 0 | 3 | 14 | 11 | 0 | 0 | 28 |
| TKI ± local palliative treatment | 1 | 0 | 0 | 0 | 1 | 1 | 28 | 1 | 32 |
| Treatment synchronous tumors | |||||||||
| Operation ± adjuvant | 3 | 3 | 0 | 2b | 2 | 1 | 0 | 0 | 11 |
| Operation and radiotherapy | 1 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 2 |
| Radiotherapy | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 |
Clinicopathological features of the 519 patients with MPS testing as part of primary diagnostic procedure. Most frequent alterations, clinicopathologic data, and co-occurring alterations are summarized for tumors with driver mutations as detected by the TST 26. ALK status (available for 90% of the tumors) is shown for comparison.
AC, adenocarcinoma; ALK, anaplastic lymphoma kinase; CNS, central nervous system; CRT, conformal radiation therapy; IHC, immunohistochemistry; FISH, fluorescence in situ hybridization; LCC, large-cell carcinoma; LNEC, large-cell neuroendocrine carcinoma; MPS, massive parallel sequencing; SqCC, squamous cell carcinoma; TKI, tyrosine kinas inhibitors; TST, TruSight Tumor.
One patient with a synchronous tumor and a previous metachronous tumor, all three tumors were tested by MPS.
Operation of one of the two tumors. Radiotherapy was planned against the other tumor, but fatal postoperative complications occurred.
One patient with multiple tumors in one lung. Three tumors (AC) were sequenced by MPS, displaying different mutational profiles. One of the other tumors had a different histologic diagnosis (LCNEC) and was considered a synchronous tumor. In addition, there were two more AC, either metastases or synchronous tumors. No known lymph node dissemination. If all tumors are considered , highest stage will be IB, and if some of the lesions are considered metastases, the most advanced stage will be IIIA.
Two patients with clinically considered disseminated lung cancer (pleural and skeletal metastasis and skeletal metastasis respectively) had a suspicious lesion in a kidney. Because of disseminated lung cancer, no further diagnostics on the kidney lesions were performed. These two patients are not included in metastasis category “other.”
Two patients were excluded because of uncertainties regarding metastases: one patient with a kidney lesion (explained above) and one skeletal metastasis and one patient with a presumed thyroid metastasis (examination revealed malignancy, not suspected to be a primary thyroid cancer) and radiologically a lesion in the breast without further diagnosis that could be a metastasis or a primary breast cancer.
In one of these patients, it cannot be excluded that dissemination in lungs represented metastatic spread from another primary tumor. Another patient previously described had either two different tumor components or two synchronous tumors. In addition, a third patient had either two synchronous tumors or a stage IV disease with one lung metastasis in the contralateral lung, deceased in infection shortly after diagnostic bronchoscopy. The fourth patient was diagnosed with a second primary lung tumor and metastases that could have originated from any of the two tumors.