Current Cancer Reports

Background: Accurate pre-operative clinical staging is vital for guiding treatment decisions in resectable non-small cell lung cancer (NSCLC). Discrepancies between clinical and pathological stages raise concerns about treatment appropriateness.
Objective: The objective of the study is to determine the accuracy of the pre-operative clinical stage (cTN) with the post-operative pathological stage (pTN), examine factors predictive of inaccurate staging and explore the impacts on survival.
Patient and Methods: This retrospective cohort study in Melbourne, Australia, analyzed stage I-IIIA NSCLC patients between 2011-2020. Primary exposures were pre-operative clinical stage (CT, PET, nodal evaluation) and post-operative pathological stage. The primary outcome was stage concordance between clinical and pathological stages of resected NSCLC. Various patient, tumour and surgical characteristics and quality of care metrics were collected from medical records. Logistic regression and COX proportional hazards regression assessed factors influencing staging concordance and survival.
Results: Among 221 patients, 58% showed overall staging concordance. Discordance (42%) frequently led to upstaging (23.9%) or downstaging (17.2%) at pathology. Nodal stage concordance was influenced by female sex, SUV max, histology, and timing between CT and surgery. Nodal stage discordance independently correlated with higher mortality risk (p = 0.002, HR 2.37).
Conclusions: The results of our study indicate inconsistencies between clinical methods of staging and pathological stages of NSCLC. Further optimization of clinical staging is essential for patients to receive guideline-concordant treatment. Pathological upstaging provides a significant safety risk and can result in adverse survival outcomes.

Background: Tumor cells are characterized by a higher production of ribosomes, which are necessary for maintaining enhanced cell growth and subsequent cell division.
Aim: The study aimed to develop a prognostic ‌RPL score‌ for hepatocellular carcinoma (HCC) and explore its association with immune evasion mechanisms mediated by tumor microenvironment alterations.
Methods: Using single-sample gene set enrichment analysis (ssGSEA), an RPLscore was constructed to estimate the dysregulation of ribosomal protein large (RPL) genes. The expression of RPL genes and their association with clinical outcomes and the tumor microenvironment (TME) were systematically investigated using bulk-seq and single-cell RNA-seq (scRNA-seq).
Results: High expression levels of RPL in HCC were associated with poorer overall survival (OS) (P < 0.001). The RPL score evaluated the RPL gene and verified its independent prognostic value for both OS and relapse-free survival (P = 0.0074 and P < 0.001, respectively). TME analysis indicated that RPL gene dysregulation was closely associated with T cell exhaustion, myeloid-derived suppressor cell (MDSC) infiltration, and vascular dysplasia may be promoted by arginine deficiency (P = 7.6 × 10^-10). The scRNA-seq data suggested that the RPL score was positively and significantly associated with the tumor biodiversity score (ITH score).
Conclusion: The study highlights the prognostic value of the RPL score and its potential role in mediating immune evasion of HCC, which may provide an impetus for the development of new targets for the treatment of HCC.