Biological and clinical characteristics of non-small cell lung cancer non-specific subtype

Xiaohong Xie; Chen Zeng; Fei Wang; Guihuan Qiu; Ziyao Chen; Ting Liu; Xinqing Lin; Zhanhong Xie; Yinyin Qin; Yansheng Wang; Xiaodong Ma; Ming Liu; Chengzhi Zhou

doi:10.1016/j.heliyon.2024.e40092

Biological and clinical characteristics of non-small cell lung cancer non-specific subtype

Heliyon. 2024 Nov 5;10(21):e40092. doi: 10.1016/j.heliyon.2024.e40092. eCollection 2024 Nov 15.

Authors

Affiliations

¹ The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine,National Clinical Research Center for Respiratory Disease,State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, 510000, China.
² Institute for Brain Research and Rehabilitation, Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China.

Abstract

Background: Non-small cell lung cancer-not otherwise specified (NSCLC-NOS) is a rare subtype of NSCLC that cannot be classified specifically based on morphology and/or special staining. This study aimed to explore the clinical features, biological and pathological characteristics, treatment, and prognosis of NSCLC-NOS.

Methods: This retrospective study included NSCLC-NOS patients diagnosed and treated between 2010 and 2022. Clinical features, gene expression, first-line treatment, and prognosis were analyzed. Kaplan-Meier methods were calculated and log-rank tests and univariable and multivariable Cox regression analyses were performed to determine the relationship between prognostic factors and survival.

Results: Of 105 NSCLC-NOS patients, most were male (92.4 %), smokers (78.1 %), with a median age of 64 years, and advanced stage (IIIc-IV, 72.4 %). Immunohistochemical analysis showed minimal expression of p40, NapsinA, and TTF-1, whereas cytokeratin (CK) was expressed in 100 % of cases. 20.5 % of 39 patients who underwent genetic testing had driver gene mutations, including EGFR, KRAS, and ROS1. Among 69 patients with complete treatment information, 58 received platinum-based chemotherapy, with paclitaxel being the most commonly used combination chemotherapy drug (n = 25), followed by pemetrexed (n = 21). The objective response rate (ORR) of paclitaxel was found to be higher compared to pemetrexed (83.3 % vs. 54.5 %, P = 0.296). Furthermore, the combination of paclitaxel with immunotherapy demonstrated superior benefits in comparison to pemetrexed (76.9 % vs. 50.0 %, P = 0.367). The median progression-free survival (PFS) for patients treated with monotherapy paclitaxel, the paclitaxel-immunotherapy combination, and the pemetrexed-immunotherapy combination were 6.6 months (95 % CI: 1.508-11.692; P = 0.017), 15.7 months (95 % CI: 14.071-17.329; P = 0.017), and 11.8 months (95 % CI: 10.279-13.321; P = 0.324), respectively. The median overall survival (OS) was 13.6 months. Anatomic location (P = 0.026) and immunotherapy use (P = 0.003) were associated with OS. Multivariate analysis confirmed that anatomical location and immunotherapy use were factors influencing the prognosis.

Conclusion: NSCLC-NOS is common in male smokers and often diagnosed at an advanced stage with low mutation rate. Paclitaxel with immunotherapy may have better benefits as a first-line treatment. Anatomic location and immunotherapy use are prognostic factors.

Keywords: Biological characteristics; Clinical features; Non-small cell lung cancer-not otherwise specified; Prognostic factor; Treatment.