Increased levels of tumor-infiltrating lymphocytes are associated with improved recurrence-free survival in stage 1A non-small-cell lung cancer.

Tumor-infiltrating lymphocytes (TILs) have been found to increase survival in many forms of cancer, including, endometrial, bile ductal, colonic, esophageal, and urothelial cancers, as well as melanoma and follicular lymphoma. The relevance of TILs in the prognosis of non-small-cell lung cancer (NSCLC), however, still remains controversial. We compared the outcomes of stage 1A NSCLC with and without tumor infiltrating lymphocytes to evaluate the effects of TILs on recurrence and survival patterns. From 2000 to 2009, 273 anatomic segmentectomies and lobectomies were performed on stage 1A NSCLC. Patients were stratified into TIL- and TIL+ cohorts based on pathologic evaluation. Further investigation was conducted on the effects of TILs in patients with and without angiolymphatic invasion. Variables analyzed include overall survival, recurrence-free survival, and type of recurrence. Overall 5-y survival was not affected by TIL status (65% versus 60%, P = 0.469). Five-year recurrence-free survival (RFS) was significantly increased in the TIL+ group versus the TIL- group (87% versus 73%, P = 0.011), most significantly in women (P = 0.016). The presence of angiolymphatic invasion (ALI) was associated with decreased 5-y RFS versus patients without ALI (61% versus 85%, P < 0.001). Interestingly, in the ALI negative group, TIL+ patients experienced a significantly increased 5-y recurrence-free survival versus TIL- patients (93% versus 80%, P = 0.036). High levels of intratumoral TILs are associated with improved recurrence-free survival in stage 1A NSCLC patients as well as a reduced likelihood of systemic recurrence. When angiolymphatic invasion is not present, the beneficial effects of TILs become even more profound.

Horne ZD ，Jack R ，Gray ZT ，Siegfried JM ，Wilson DO ，Yousem SA ，Nason KS ，Landreneau RJ ，Luketich JD ，Schuchert MJ ... -  《-》

Impact of tumor size on outcomes after anatomic lung resection for stage 1A non-small cell lung cancer based on the current staging system.

Anatomic segmentectomy may achieve results comparable to lobectomy for early-stage non-small cell lung cancer. The 7th edition of the AJCC Cancer Staging Handbook stratified the previous T1 tumor designation into T1a and T1b subsets, which still define stage 1A node-negative non-small cell lung cancer. We are left to hypothesize whether this classification may aid in directing the extent of surgical resection. We retrospectively reviewed our anatomic segmentectomy and lobectomy management of stage 1A non-small cell lung cancer to determine differences in survival and local recurrence rates based on the new stratification. We performed a retrospective review of 429 patients undergoing resection of pathologically confirmed stage 1A non-small cell lung cancer via lobectomy or anatomic segmentectomy. Primary outcome variables included mortality, recurrence, and survival. Recurrence-free and cancer-specific survivals were estimated using the Kaplan-Meier method. Patients undergoing segmentectomy were older than patients undergoing lobectomy (mean age 69.2 vs 66.8 years, P < .006). The mean preoperative forced expiratory volume in 1 second was significantly lower in the segmentectomy group than in the lobectomy group (71.8% vs 81.1%, P = .02). Mortality was similar after segmentectomy (1.1%) and lobectomy (1.2%). There was no difference in mortality, recurrence rates (14.0% vs 14.7%, P = 1.00), or 5-year cancer-specific survival (T1a: 90% vs 91%, P = .984; T1b: 82% vs 78%, P = .892) when comparing segmentectomy and lobectomy for pathologic stage 1A non-small cell lung cancer, when stratified by T stage. Anatomic segmentectomy may achieve equivalent recurrence and survival compared with lobectomy for patients with stage 1A non-small cell lung cancer. Prospective studies will be necessary to delineate the potential merits of anatomic segmentectomy in this setting.

Carr SR ，Schuchert MJ ，Pennathur A ，Wilson DO ，Siegfried JM ，Luketich JD ，Landreneau RJ ... -  《-》

Density of tumor-infiltrating lymphocytes correlates with disease recurrence and survival in patients with large non-small-cell lung cancer tumors.

The density of tumor-infiltrating lymphocytes (TIL) in lung cancer is variable and may have an impact on disease course. We reviewed the histology of lobectomy specimens from patients with pathologic stage IA-IB non-small-cell lung cancer to determine the impact of TILs on recurrence and survival. Two hundred nineteen lobectomies performed between 2002 and 2005 for stage IA-IB non-small-cell lung cancer were reviewed. Patients were stratified according to tumor size. Infiltrating patterns were graded as follows: group 1 (none to mild infiltrate) or group 2 (moderate to severe infiltrate). Recurrence rates and disease-free survival were compared between groups in each tumor size cohort. A higher density of TILs was associated with lower disease recurrence (60%, group 1 versus 21%, group 2, P=0.02) and improved 5-y disease-free survival (35.9%, group 1 versus 75.6%, group 2, P=0.04) in patients with tumors 5 cm or greater in diameter. There were no correlations in patients with smaller tumors. A higher degree of TILs within large node-negative non-small-cell lung cancer correlates with decreased risk of disease recurrence and improved disease-free survival. This subset of patients with tumor infiltration needs to be examined more closely with regards to outcomes of adjuvant chemotherapy.

Kilic A ，Landreneau RJ ，Luketich JD ，Pennathur A ，Schuchert MJ ... -  《-》

Prognostic value of tumor-infiltrating lymphocytes for patients with completely resected stage IIIA(N2) non-small cell lung cancer.

Feng W ，Li Y ，Shen L ，Cai XW ，Zhu ZF ，Chang JH ，Xiang JQ ，Zhang YW ，Chen HQ ，Fu XL ... -  《Oncotarget》

Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer.

Schuchert MJ ，Pettiford BL ，Keeley S ，D'Amato TA ，Kilic A ，Close J ，Pennathur A ，Santos R ，Fernando HC ，Landreneau JR ，Luketich JD ，Landreneau RJ ... -  《-》