CHICAGO--Cellular tumor bio-markers may be able to identify patients
with N1 non-small-cell lung adenocarcin-oma who could achieve better survival
and control of metastasis through aggressive adjuvant therapy, Ritsuko
Komaki, MD, said at the Radiological Society of North America meeting.
Dr. Komaki and her colleagues at M.D. Anderson Cancer Center studied
137 patients with N1 non-small-cell lung cancer (NSCLC) and hilar lymph
node involvement whose primary lung tumors exhibited six biomarkers before
treatment--mitotic and apoptotic indexes, DNA and S+G2M cell cycle profiles,
and Ki67 and p53 positivity.
She then assessed the ability of each biomarker to predict the outcome
of treatment in terms of five-year survival, disease-free survival, and
control of metastasis.
The rates of cellular production, proliferation, and loss, as measured
by mitosis, DNA profile, and apoptosis, were the most indicative of the
eventual outcome of therapy, but they were "more predictive of treatment
outcome in patients with adenocarcinoma than squamous cell carcinoma,"
In patients with adenocarcinoma, a high pretreatment mitotic index was
associated with greater distant spread of metastasis. High apoptotic index
predicted increased distant metastases and worse disease-free survival.
High DNA index was prognostic for poorer local control, increased metastasis,
and poorer disease-free survival.
For patients with squamous cell lung carcinoma, high mitotic index predicted
better overall survival, and a high S+G2M cell fraction and increased Ki67
positivity were associated with better local control of disease. None of
these relationships was statistically significant, however. In addition,
the apoptosis index and DNA profile had no predictive value in patients
with this form of lung cancer.
Assessment of mitosis, apoptosis, and DNA biological tumor markers before
treatment nevertheless could help improve the dismal overall 30% to 50%
five-year survival rate for the adenocar-cinoma subgroup of patients with
N1 NSCLC that has involved the hilar lymph nodes, Dr. Komaki said.
"Patients with N1 adenocarcinoma and higher mitosis, apoptosis,
and DNA index might get more beneficial outcomes by having adjuvant therapy,"
she said. "I think these are patients we can target to be cured by
giving some sort of adjuvant therapy."