Klempner Samuel J, Ou Sai-Hong Ignatius, Costa Daniel B, VanderLaan Paul A, Sanford Eric M, Schrock Alexa, Gay Laurie, Ali Siraj M, Miller Vincent A
Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Department of Medicine, Division of Hematology Oncology, University of California Irvine School of Medicine, Orange, CA.
Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Department of Medicine, Division of Hematology Oncology, University of California Irvine School of Medicine, Orange, CA.
Clin Lung Cancer. 2015 Sep;16(5):334-339.e1. doi: 10.1016/j.cllc.2015.03.004. Epub 2015 Mar 26.
The ability to reliably distinguish synchronous primary non-small-cell lung cancer (NSCLC) from intrapulmonary metastatic spread affects staging and treatment decisions in resected NSCLC. Adjuvant therapy for early-stage NSCLC is complicated and recommendations are primarily based on older data from trials that used now-outdated staging systems. Patients found to have 2 tumors with similar morphology in the same lobe are currently staged as pathologic T3 (pT3) but such cases represent a minority of patients in adjuvant lung cancer trials. Potentially more precise than tumor morphology alone, comprehensive genomic profiling technologies have the power to discriminate whether tumors in the same lobe represent 2 separate primary lesions or localized spread of a single lesion. In addition to lineage insights, tumor profiling simultaneously provides information on actionable genomic alterations. In this review we discuss the data that support the ability of molecular technologies to distinguish synchronous primary tumors from intrapulmonary metastases and discuss the use of molecular assays as an adjunct to current staging systems. Two cases are presented to highlight the potential immediate clinical implications of comprehensive genomic profiling.
可靠地区分同步性原发性非小细胞肺癌（NSCLC）与肺内转移扩散的能力会影响接受手术切除的NSCLC患者的分期和治疗决策。早期NSCLC的辅助治疗较为复杂，相关建议主要基于使用现已过时分期系统的试验中的旧数据。目前，在同一肺叶内发现有两个形态相似肿瘤的患者被分期为病理T3（pT3），但此类病例在辅助性肺癌试验患者中占少数。综合基因组分析技术可能比单纯的肿瘤形态学更精确，有能力区分同一肺叶内的肿瘤是代表两个独立的原发性病灶还是单个病灶的局部扩散。除了谱系见解外，肿瘤分析还能同时提供有关可操作基因组改变的信息。在本综述中，我们讨论了支持分子技术区分同步原发性肿瘤与肺内转移能力的数据，并讨论了分子检测作为当前分期系统辅助手段的应用。我们还展示了两个病例，以突出综合基因组分析可能带来的直接临床意义。
