Editorial: Factors that impact the survival of non-small cell lung cancer

COPYRIGHT © 2023 Hegi-Johnson and Higgins. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. TYPE Editorial PUBLISHED 09 February 2023 DOI 10.3389/fonc.2023.1148340

demonstrating and appears to drive the development of an immunosuppressive tumour microenvironment dominated by CD4+. T-Helper(TH)1, TH2 and TREG cells. Imaging biomarkers continue to evolve, and offer the promise of non-invasive, multiple time-point assessments of tumour biology. Although, as pointed out by O'Connor et al. (4) CT-based radiomics still requires refinement and the use of large scale training datasets before a validated methodology is established it is encouraging to see work that employs large cohorts of patients with uniform biology to develop tools that are specific to the East Asian adenocarcinoma population (Wang et al.). Similarly, Jiang et al. review the correlations between EGFR mutation status and 18-F-FDG avidity, which also has useful real world applications for disease monitoring in patients being treated with tyrosine kinase inhibitors (TKIs).
The collection also captures the truly multidisciplinary nature of NSCLC management, and deals not only with improving survival but also with treatment and prognostication in patients with pleural effusions ( In early stage disease, useful data is explored that looks at disease and treatment characteristics influencing survival in both surgical (Huang et al.) and radiotherapy(Yang et al., Li et al.) patients with both adenocarcinoma and squamous histologies. Given the paucity of clinical trial data that is specific to the histological subtypes of adenocarcinoma and squamous cell carcinomas, these retrospective analyses provide some useful guidance to support changes that are occurring in clinical practice to de-intensify local treatment approaches, such as the movement towards segmentectomy rather than lobectomy.
The efficient and rapid evaluation of emerging treatment strategies in clinical trials is handled in a different way by a paper exploring the value of early-stage endpoints as surrogate markers for later endpoints of durable response such as long-term progression free and overall survival (Shameer et al.). As the authors point out the sue of early end-point surrogates, permitting the assessment of survival outcomes at 4 or 6 months holds great promise to reduce the cost of clinical trials but needs significant future work in this area before these strategies can be validated for wider clinical use.
Finally, to underscore the importance of prevention, an increasing body of data underscores the importance of smoking cessation on both cancer causation and mortality after diagnosis. As Koshiaris (5) and Jha (6) have pointed out smoking accounts continues to account for an enormous proportion of cancer deaths, with an increasing burden falling on low-and middle-income countries. However, there is relatively little data on the interplay between smoking and response to therapies. Given the high levels of both EGFR expression and the high incidence of smoking in the East Asian population it is encouraging to see the exploration of this relationship, although the finding that smoking is a less powerful driver of response to TKI's than gender raises further intriguing biological questions to be explored in future work (Xiao et al.).
In summary, the future is bright for non-small lung cancer, as the thoracic oncology community continues to work together to advance the science for our patients.

Author contributions
FH-J and KH have drafted and reviewed this manuscript prior to submission. All authors contributed to the article and approved the submitted version