Abstract
Accurate classification of lung cancer subtypes has become critical in tailoring lung cancer treatment. Our study aimed to evaluate changes in diagnostic testing and pathologic subtyping of advanced non-small-cell lung cancer (nsclc) over time at a major cancer centre. In a review of patients diagnosed with advanced nsclc at Princess Margaret Cancer Centre between 2007-2009 and 2013-2015, diagnostic method, sample type and site, pathologic subtype, and use of immunohistochemistry (ihc) staining and molecular testing were abstracted. The review identified 238 patients in 2007-2009 and 283 patients in 2013-2015. Over time, the proportion of patients diagnosed with adenocarcinoma increased to 73.1% from 60.9%, and diagnoses of nsclc not otherwise specified (nos) decreased to 6.4% from 18.9%, p < 0.0001. Use of diagnostic bronchoscopy decreased (26.9% vs. 18.4%), and mediastinal sampling procedures, including endobronchial ultrasonography, increased (9.2% vs. 20.5%, p = 0.0001). Use of ihc increased over time to 76.3% from 41.6% (p < 0.0001). Larger surgical or core biopsy samples and those for which ihc was performed were more likely to undergo biomarker testing (both p < 0.01). Customizing treatment based on pathologic subtype and molecular genotype has become key in treating patients with advanced lung cancer. Greater accuracy of pathology diagnosis is being achieved, including through the routine use of ihc.
Highlights
Lung cancer is the leading cause of cancer-related mortality worldwide[1]
The proportion of patients diagnosed with adenocarcinoma increased to 73.1% from 60.9%, and diagnoses of nsclc not otherwise specified decreased to 6.4% from 18.9%, p < 0.0001
Customizing treatment based on pathologic subtype and molecular genotype has become key in treating patients with advanced lung cancer
Summary
Treatment selection and outcomes rely on accurate diagnostic subtyping of non-small-cell lung cancer (nsclc), including molecular testing[2,3,4,5,6,7,8,9]. In patients with nonsquamous histology, the introduction of targeted therapy agents such as gefitinib, alectinib, and crizotinib for the treatment of oncogene-addicted lung cancer has made genomic testing an essential component of the diagnostic algorithm in nsclc[3,4,8,9]. All patients with nonsquamous histology should routinely undergo profiling[11] Those diagnosed with pure squamous, small-cell, or neuroendocrine subtypes have a lower likelihood of EGFR, ALK, or ROS1 aberration. Our study aimed to evaluate changes in diagnostic testing and pathologic subtyping of advanced non-small-cell lung cancer (nsclc) over time at a major cancer centre
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