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Abstract
Introduction Pulmonary metastasis, as the most common hematogenous site in cervical cancer, has limited therapeutic options and uncertain prognosis. We analyzed clinicopathological features of patients with postoperative lung metastasis from cervical cancer to explore the risk factors for lung metastasis. Through mapping pulmonary oligometastatic transcriptomic profiles, we analyzed their molecular characteristics to find potential therapeutic targets for pulmonary metastasis.
Methods A total of 795 patients with early-stage cervical cancer who underwent radical surgery were retrospectively studied for lung metastasis, and transcriptomic analysis was performed on 22 paired primary cervical tumors and pulmonary oligometastasis.
Results A total of 48 in 795 early-stage cervical cancer patients developed lung metastasis during a median follow-up of 57 months. Lung metastasis was more frequent in patients with advanced clinical stage and those with rare histological subtypes. Twenty-two patients with pulmonary oligometastasis were subjected to lung metastasectomy with a median relapse-free survival of 20.2 months and a overall survival of 71.1 months. Immune-related genes and pathways were enriched and highly expressed in pulmonary oligometastasis compared to primary tumor. Gene set enrichment analysis revealed that the PD-1 signaling pathway was positively enriched in pulmonary oligometastatic group. Immunohistochemistry staining analysis confirmed that PD-L1 expression was upregulated in pulmonary oligometastasis compared to the corresponding primary tumor. A clinical case of postoperative lung metastasis from cervical cancer was reported, in which the patient had a partial response after immunotherapy.
Conclusion/Implications Metastasectomy is an effective strategy for cervical cancer patients with pulmonary oligometastasis. Immune checkpoint blockades may be promising for patients with lung metastases.
