Baak Jan P A, Li Hegen, Guo Huiru
Department of Pathology, Stavanger University Hospital, Stavanger, Norway.
Medical Practice Dr. Med Jan Baak AS, Tananger, Norway.
Front Oncol. 2022 Feb 2;12:837419. doi: 10.3389/fonc.2022.837419. eCollection 2022.
Worldwide, 18.1 million new invasive cancers and 9.9 million cancer deaths occurred in 2020. Lung cancer is the second most frequent (11.4%) and, with 1.8 million deaths, remains the leading cause of cancer mortality. About 1.7 million of lung cancers are of the non-small cell lung cancer (NSCLC) subtype, and of these, 60%-70% are in advanced stage IV at the time of diagnosis. Thus, the annual worldwide number of new NSCLC stage IV patients is about 1 million, and they have a very poor prognosis. Indeed, 25%-30% die within 3 months of diagnosis. However, the survival duration of the remaining 700,000 new patients per year surviving >3 months varies enormously. Surprisingly, little research has been done to explain these survival differences, but recently it was found that classical patient, tumour and treatment features cannot accurately distinguish short- and very long-term survivors. What then are the causes of these bewildering survival variations amongst "the same cancers"? Clonality, proliferation differences, neovascularization, intra-tumour heterogeneity, genetic inhomogeneity and other cancer hallmarks play important roles. Considering each of these, single or combined, can greatly improve our understanding. Another technique is analysis of the survival curve of a seemingly homogeneous group of cancer patients. This can give valuable information about the existence of subgroups and their biological characteristics. Different basic survival curves and what their shapes tell about the biological properties of these invasive cancers are discussed. Application of this analysis technique to the survival curve of 690 stage IV NSCLC patients with a 3.2-120.0-month survival suggests that this seemingly homogeneously group of patients probably consists of 4-8 subgroups with a very different survival. A subsequent detailed mathematical analysis shows that a model of 8 subgroups gives a very good match with the original survival curve of the whole group. In conclusion, the survival curve of a seemingly homogeneous group of cancer patients can give valuable information about the existence of subgroups and their biological characteristics. Application of this technique to 690 NSCLC Stage IV patients makes it probable that 8 different subgroups with very different survival rates exist in this group of cancers.
2020年，全球新增1810万例侵袭性癌症病例，990万人死于癌症。肺癌是第二常见的癌症（占11.4%），死亡人数达180万，仍是癌症死亡的主要原因。约170万例肺癌属于非小细胞肺癌（NSCLC）亚型，其中60%-70%在诊断时已处于晚期IV期。因此，全球每年新增的IV期非小细胞肺癌患者约为100万，他们的预后非常差。事实上，25%-30%的患者在诊断后3个月内死亡。然而，每年其余70万存活超过3个月的新患者的生存期差异极大。令人惊讶的是，很少有研究来解释这些生存差异，但最近发现，经典的患者、肿瘤和治疗特征无法准确区分短期和长期幸存者。那么，这些“相同癌症”患者令人困惑的生存差异的原因是什么呢？克隆性、增殖差异、新生血管形成、肿瘤内异质性、基因异质性和其他癌症特征起着重要作用。考虑这些因素中的每一个，单独或组合起来，都能极大地增进我们的理解。另一种技术是分析一组看似同质的癌症患者的生存曲线。这可以提供有关亚组的存在及其生物学特征的有价值信息。本文讨论了不同的基本生存曲线及其形状所揭示的这些侵袭性癌症的生物学特性。将该分析技术应用于690例生存期为3.2-120.0个月的IV期非小细胞肺癌患者的生存曲线，结果表明，这组看似同质的患者可能由4-8个生存期差异很大的亚组组成。随后的详细数学分析表明，一个8亚组的模型与整个组的原始生存曲线非常匹配。总之，一组看似同质的癌症患者的生存曲线可以提供有关亚组的存在及其生物学特征的有价值信息。将该技术应用于690例IV期非小细胞肺癌患者后发现，这组癌症患者中可能存在8个生存率差异很大的不同亚组。
