Effects of Pre-operative Biopsy on Recurrence and Survival in Stage I Lung Adenocarcinoma Patients in China

Overview

Journal ERJ Open Res

Specialty Pulmonary Medicine

Date 2023 Aug 16

PMID 37583968

Authors

Yuan Zhang

Yi Hu

Shu Zhang

Min Zhu

Jun Lu

Bin Hu

Xiaojuan Guo

Yuhui Zhang

Affiliations

Soon will be listed here.

Abstract

Background: Whether pre-operative biopsy affects post-operative recurrence and metastasis of lung cancer patients is still controversial.

Methods: In order to clarify these disputes, we collected relevant literature to conduct a meta-analysis. To validate the results of the meta-analysis, we retrospectively analysed 575 patients with stage I lung adenocarcinoma who underwent surgical resection at our centre from 2010 to 2018 using propensity score matching and competing risk models.

Results: 5509 lung cancer patients from 11 articles were included in the meta-analysis. Summary analysis showed that the total recurrence rate of the biopsy group was higher than that of the nonbiopsy group (risk ratio 1.690, 95% CI 1.220-2.330; p=0.001). After propensity score matching, we found that there was no significant correlation between biopsy and total recurrence (risk ratio 1.070, 95% CI 0.540-2.120; p=0.850). In our cohort, of 575 stage I lung adenocarcinomas, 113 (19.7%) patients underwent pre-operative biopsy. During a median (interquartile range) follow-up of 71 (57-93) months, multivariable analyses showed pre-operative biopsy in the overall observation cohort (subdistribution hazard ratio (SHR) 1.522, 95% CI 0.997-2.320; p=0.051) and in the propensity score-matched cohort (SHR 1.134, 95% CI 0.709-1.810; p=0.600) was not significantly correlated with the risk of recurrence and metastasis. Moreover, the pre-operative biopsy did not affect disease-free survival (SHR 0.853, 95% CI 0.572-1.273; p=0.438) or overall survival (SHR 0.647, 95% CI 0.352-1.189; p=0.161).

Conclusion: Pre-operative biopsy might not increase the risk of recurrence and metastasis, suggesting that these procedures might be safe for patients with stage I lung adenocarcinoma whose diagnosis is difficult to determine before surgery.

References

Hung J, Jeng W, Hsu W, Chou T, Huang B, Wu Y . Predictors of death, local recurrence, and distant metastasis in completely resected pathological stage-I non-small-cell lung cancer. J Thorac Oncol. 2012; 7(7):1115-23. DOI: 10.1097/JTO.0b013e31824cbad8. View

Lee G, Yoon S, Ahn B, Kim H, Jang S, Hwang H . Blood Vessel Invasion Predicts Postoperative Survival Outcomes and Systemic Recurrence Regardless of Location or Blood Vessel Type in Patients with Lung Adenocarcinoma. Ann Surg Oncol. 2021; 28(12):7279-7290. DOI: 10.1245/s10434-021-10122-x. View

Huang C, Hsu P, Chen C, Yeh Y, Chen H, Wu M . Preoperative biopsy and tumor recurrence of stage I adenocarcinoma of the lung. Surg Today. 2019; 50(7):673-684. DOI: 10.1007/s00595-019-01941-3. View

Karimi S, Chattopadhyay S, Chakraborty N . Manipulation of regulatory T cells and antigen-specific cytotoxic T lymphocyte-based tumour immunotherapy. Immunology. 2014; 144(2):186-96. PMC: 4298413. DOI: 10.1111/imm.12387. View

Hu X, Chow L . Fine needle aspiration may shed breast cells into peripheral blood as determined by RT-PCR. Oncology. 2000; 59(3):217-22. DOI: 10.1159/000012164. View

Tomiyama N, Yasuhara Y, Nakajima Y, Adachi S, Arai Y, Kusumoto M . CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol. 2006; 59(1):60-4. DOI: 10.1016/j.ejrad.2006.02.001. View

Sawabata N, Ohta M, Maeda H . Fine-needle aspiration cytologic technique for lung cancer has a high potential of malignant cell spread through the tract. Chest. 2000; 118(4):936-9. DOI: 10.1378/chest.118.4.936. View

Lee S, Park C, Lee K, Bahn Y, Kim J, Goo J . C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: clinical experience in 1108 patients. Radiology. 2014; 271(1):291-300. DOI: 10.1148/radiol.13131265. View

Abe J, Okazaki T, Kikuchi N, Takahashi S, Sakurada A, Okada Y . Preoperative bronchoscopic cancer confirmation does not increase risk of recurrence in stage1A non-small cell lung cancer. Gen Thorac Cardiovasc Surg. 2018; 66(5):284-290. DOI: 10.1007/s11748-018-0909-y. View

10.

Blumenthaler A, Hofstetter W, Mehran R, Rajaram R, Rice D, Roth J . Preoperative Maximum Standardized Uptake Value Associated With Recurrence Risk in Early Lung Cancer. Ann Thorac Surg. 2021; 113(6):1835-1844. PMC: 8742841. DOI: 10.1016/j.athoracsur.2021.06.017. View

11.

Hu C, Jiang J, Li Y, Zhang C, Zhang W, Jiang H . Recurrence risk after preoperative biopsy in patients with resected early-stage non-small-cell lung cancer: a retrospective study. Cancer Manag Res. 2018; 10:1927-1934. PMC: 6038855. DOI: 10.2147/CMAR.S166930. View

12.

Senthi S, Lagerwaard F, Haasbeek C, Slotman B, Senan S . Patterns of disease recurrence after stereotactic ablative radiotherapy for early stage non-small-cell lung cancer: a retrospective analysis. Lancet Oncol. 2012; 13(8):802-9. DOI: 10.1016/S1470-2045(12)70242-5. View

13.

Taniguchi Y, Fukumoto K, Matsui H, Saito T, Murakawa T . Preoperative biopsy does not affect postoperative outcomes of resectable non-small cell lung cancer. Gen Thorac Cardiovasc Surg. 2019; 67(7):615-623. DOI: 10.1007/s11748-019-01062-1. View

14.

Shih A, Mino-Kenudson M . Updates on spread through air spaces (STAS) in lung cancer. Histopathology. 2020; 77(2):173-180. DOI: 10.1111/his.14062. View

15.

Yotsukura M, Asamura H, Motoi N, Kashima J, Yoshida Y, Nakagawa K . Long-Term Prognosis of Patients With Resected Adenocarcinoma In Situ and Minimally Invasive Adenocarcinoma of the Lung. J Thorac Oncol. 2021; 16(8):1312-1320. DOI: 10.1016/j.jtho.2021.04.007. View

16.

Louha M, Nicolet J, Zylberberg H, Sabile A, Vons C, Vona G . Liver resection and needle liver biopsy cause hematogenous dissemination of liver cells. Hepatology. 1999; 29(3):879-82. DOI: 10.1002/hep.510290348. View

17.

Buchheit C, Weigel K, Schafer Z . Cancer cell survival during detachment from the ECM: multiple barriers to tumour progression. Nat Rev Cancer. 2014; 14(9):632-41. DOI: 10.1038/nrc3789. View

18.

Toyoda T, Suzuki H, Hata A, Yamamoto T, Morimoto J, Sakairi Y . Is needle biopsy a risk factor of pleural recurrence after surgery for non-small cell lung cancer?. J Thorac Dis. 2020; 12(5):2635-2643. PMC: 7330316. DOI: 10.21037/jtd.2020.03.16. View

19.

Dong H, Liang X, Gao Y, Cai Y, Li X, Miao J . Postoperative venous thromboembolism after surgery for stage IA non-small-cell lung cancer: A single-center, prospective cohort study. Thorac Cancer. 2022; 13(9):1258-1266. PMC: 9058304. DOI: 10.1111/1759-7714.14373. View

20.

Knutson K, Disis M, Salazar L . CD4 regulatory T cells in human cancer pathogenesis. Cancer Immunol Immunother. 2006; 56(3):271-85. PMC: 11030088. DOI: 10.1007/s00262-006-0194-y. View