Premalignant Changes in the Bronchial Epithelium Are Prognostic Factors of Distant Metastasis in Non-Small Cell Lung Cancer Patients.

Olga V Pankova,Evgeny O Rodionov,Marina V Zavyalova,Evgeny V Denisov,Liubov A Tashireva,Sergey A Tuzikov,Vladimir M Perelmuter,Sergey V Miller,Sergey V Vtorushin,Tatiana S Gerashchenko,Dmitry S Pismenny

doi:10.3389/fonc.2021.771802

Abstract

BackgroundThe study assessed the possibility of dividing patients into groups based on the assessment of morphological changes in the epithelium of small-caliber bronchi located near the primary tumor in order to predict high and low risks of distant metastasis of non-small cell lung cancer.MethodsIn 171 patients with non-small cell lung cancer (T1-4N0-3M0) in small-caliber bronchi taken at a distance of 3–5 cm from the tumor, various variants of morphological changes in the bronchial epithelium (basal cell hyperplasia (BCH), squamous cell metaplasia (SM), and dysplasia (D)) were assessed. Long-term results of treatment, namely, distant metastasis, were assessed after 2 and 5 years.ResultsDuring the follow-up period, distant metastases were found in 35.1% (60/171) of patients. Most often, they were observed in patients of the high-risk group: BCH+SM−D− (51.6%, 40/95) and BCH−SM+D+ (54.4%, 6/11). Less often, distant metastases were observed in low-risk group patients: BCH+SM+D− (6.7%, 3/45) and BCH−SM−D− (10.0%, 2/20). Tumor size, grade, and stage were significant predictors of metastasis only in the high-risk group. The 5-year metastasis-free survival was better in the low-risk group of distant metastases.ConclusionsIsolated BCH or dysplasia in small bronchi distant from foci of tumor is associated with a high-risk distant metastasis and less 5-year metastasis-free survival.

Highlights

The most common cause of cancer death in 2020 was lung cancer [1]
In 171 patients with non-small cell lung cancer (T1-4N0-3M0) in small-caliber bronchi taken at a distance of 3–5 cm from the tumor, various variants of morphological changes in the bronchial epithelium (basal cell hyperplasia (BCH), squamous cell metaplasia (SM), and dysplasia (D)) were assessed
The 5-year metastasis-free survival was better in the low-risk group of distant metastases

Summary

Introduction

The most common cause of cancer death in 2020 was lung cancer [1]. High mortality is associated with the progression of the tumor process. The most important factors associated with progression of NSCLC and predicting survival are tumor stage, histologic structure, grade, and biological aggressiveness [2,3,4,5]. These factors are not always effective in predicting the outcome of the tumor process. We considered the association of different variants of morphological changes of the respiratory epithelium of small bronchi adjacent to the tumor as risk factors for distant metastasis. The study assessed the possibility of dividing patients into groups based on the assessment of morphological changes in the epithelium of small-caliber bronchi located near the primary tumor in order to predict high and low risks of distant metastasis of non-small cell lung cancer

Methods

Results

Conclusion