1114 Background: Breast cancer leptomeningeal metastasis (BCLM) lacks data-driven prognostic models integrating diagnostic certainty with molecular features, resulting in empirical treatment limitations. Methods: We analyzed 403 BCLM patients (Nov 2013-Nov 2025) from four centers, constructing the Breast Cancer Leptomeningeal Graded Prognostic Assessment (BC-LGPA) based on diagnostic criteria (CSF cytology, symptoms, MRI patterns) and molecular subtype, validated externally. Results: The median overall survival (OS) was 7.5 months. As the first data-driven prognostic classification for BCLM, the BC-LGPA integrates diagnostic certainty scores (0–2) and molecular scores (0–1). ECOG performance status and extracranial metastases were excluded owing to collinearity with neurological symptoms and because leptomeningeal metastasis itself constitutes the primary survival-limiting factor. The model stratifies patients into high-risk (0 points, 4.7 months), intermediate-risk (1–2 points, 8.0 months), and low-risk (3 points, 16.6 months) groups (training p=0.001; validation: 4.1 vs. 7.9 vs. 16.0 months, p=0.003). Key innovations include: (1) Granular diagnostic stratification into Class A (cytology-proven), B (clinical-radiological), and C (incidental-radiological), with subclasses A1/A2/A3, B1/B2, and C1/C2/C-special; (2) Ultra-indolent entity identification: Class C-special (localized calvarial-meningeal disease without diffuse LM) shows exceptional median OS of 68.0 months, representing a distinct clinical entity unsuitable for conventional prognostic models; (3) Treatment refinement: Intrathecal therapy improved survival in Class A and Class B-Linear subgroups, whereas focal radiotherapy demonstrated no independent benefit, including in Class C2 (31 patients, p =0.794), challenging empirical RT practices. Conclusions: BC-LGPA establishes the first data-driven BCLM prognostic framework, correcting treatment recommendations through subgroup efficacy analyses to guide precision management and clinical trial design. The scoring criteria of the BC-LGPA. Prognostic Factor Score Criteria Definition Diagnostic Certainty CSF cytology Neurological symptoms MRI Class A(Cytology- proven) 0 + + / - + / - Class B(Clinico-radiological) 1 - / NA + + Class C*(Incidental radiological) 2 - / NA - + Molecular Subtype TNBC 0 ER - PR - HER2 - non-TNBC 1 ER/PR + and/or HER2 + Total score = Diagnostic Certainty score + Molecular Subtype score NA: Not Available; * Localized calvarial-meningeal disease were excluded.

Gallium-68 (68Ga)-labeled [68Ga]Ga-NOTA-T4 immuno-positron emission tomography (immunoPET) holds great promise as a non-invasive technique for visualizing the expression of trophoblast cell-surface antigen 2 (TROP2). This approach may potentially assist in making clinical decisions regarding TROP2-targeted therapies. The present study aims to evaluate the utility of [68Ga]Ga-NOTA-T4 PET/CT in detecting TROP2 expression levels, diagnosing primary tumors and metastatic lesions. Additionally, it conducts a direct comparison with fluorine-18-labeled fluorodeoxyglucose ([18F]FDG) PET/CT. Participants with solid tumors who underwent [68Ga]Ga-NOTA-T4 PET/CT scans were prospectively recruited between October 2023 and August 2024. A subset of these participants also received [18F]FDG PET/CT. The uptake in physiological organs was quantified using the mean standardized uptake value (SUVmean). Positive lesions were identified through visual assessments and further quantified using the maximum standardized uptake value (SUVmax) and the target-to-background ratio (TBR). The TBR was calculated by dividing the SUVmax of the lesion by the SUVmean of the background, where the brain background was used for cerebral lesions and the blood pool for other lesions. TROP2 expression levels were evaluated via immunohistochemical (IHC) tumor proportion score (TPS). Biodistribution, lesion detectability, and the correlation with TROP2 were analyzed for both tracers using appropriate statistical methods. A total of 26 patients (mean age: 63 ± 10 years; 13 females) were included in the study. [68Ga]Ga-NOTA-T4 demonstrated high uptake in the kidneys, pancreas, thyroid, and submaxillary gland, while showing low uptake in the brain, muscle, and bone. Both tracers successfully detected all 19 primary/recurrent tumors. However, [68Ga]Ga-NOTA-T4 presented lower SUVmax and TBR compared to [18F]FDG (1.93 [1.36, 2.58] vs. 11.37 [6.45, 13.15], P < 0.001; 2.83 [2.17, 3.74] vs. 6.95 [5.24, 11.27], P = 0.03, respectively). [68Ga]Ga-NOTA-T4 identified fewer suspected metastases but detected two brain metastases that were missed by [18F]FDG. TROP2 TPS was positively correlated with [68Ga]Ga-NOTA-T4 SUVmax (r = 0.85, P = 0.002) and TBR (r = 0.66, P = 0.030), while no significant correlation was observed for [18F]FDG. [68Ga]Ga-NOTA-T4 PET/CT emerges as a promising non-invasive tool for assessing TROP2 expression levels and diagnosing solid tumors. In certain specific cases, it exhibits potential advantages over [18F]FDG.

癌症是一类可怕的疾病,如果它只在一个地方兴风作浪,那我们还有办法通过手术、放疗或化疗等方法消灭它.但遗憾的是,癌细胞并没有那么"老实",它就像一个贪婪而残忍的强盗,有时不会在某一块固定的"殖民地"好好待着,而是会悄悄地搬到其他地方去继续作恶,这就是我们常说的癌症转移.一旦发生转移,癌症便不再受初发部位限制,而是分散在多个部位(其中有些部位甚至难以察觉),变得难对付得多.

BACKGROUND: Leptomeningeal metastasis (LM) is a severe complication in patients with non-small-cell lung cancer (NSCLC) and the optimal treatment strategy remains a challenge. This study aimed to investigate the treatment strategies and clinical outcomes in these patients.METHODS: We retrospectively reviewed the data of 44 patients with epidermal growth factor receptor (EGFR)-mutated NSCLC with LM between 2014 and 2020 at our institute. The patient characteristics, treatment ap-proaches, LM progression-free survival (LMPFS) and overall survival (OS) after the diagnosis of LM (OSLM) were analyzed. RESULTS: The median OSLM was 16.0 months and the 3 -year OS rate was 22.5%. The PFSLM in EGFR T790M-positive NSCLC patients with leptomeingeal disease was signifi-cantly improved by initiation of third-generation tyrosine kinase inhibitors (TKIs) compared with that of patients who were T790M negative (14.0 vs. 7.0 months; P = 0.030). A significantly higher LM disease control rate was shown in patients who received third-generation TKIs compared with previous generations of TKIs (90.1% vs. 60.0%; P = 0.024). Better Eastern Cooperative Oncology Group perfor-mance status, EGFR exon 19del, and clinical improvement of LM after therapy were independently associated with better OS.CONCLUSIONS: The survival of patients with NSCLC with LM has improved in the target therapy era. Our study provided real-world clinical evidence that patients with EGFR-mutated NSCLC who developed LM from previous TKIs can be benefit from third-generation EGFR-TKIs, especially for patients with EGFR T790M-positive.

INTRODUCTION:Patients whose solid tumors (ST) show leptomeningeal metastasis (LM) have very poor prognosis and short overall survival. The aim of this study was to evaluate the efficacy of first-line programed death-1(PD-1) monoclonal antibody (mAb) treatment in these patients.METHODS:We retrospectively evaluated patients diagnosed with LM from ST who were treated with first-line PD-1 mAb at our hospital between April 1 and November 30, 2019. We analyzed their clinicopathological characteristics and response to the treatment.RESULTS:We collected and analyzed data from 6 patients with different primary ST. 5 patients received PD-1 mAb combined with chemotherapy and/or anti-angiogenic drugs, while one received only PD-1 mAb. The median (range) number of treatment cycles was 5.5 (1-21). PD-1 mAb treatment did not cause neurotoxicity. The time period of first assessment varied from 21 to 65 days after treatment. Among 5 patients who got obvious symptoms relief, 4 patients persisted for > 3 months and even showed a reduction in the number of tumor cells in cerebrosprinal fluid. Ventriculoperitoneal (VP) shunt was used to treat hydrocephalus observed beneficial in 3 patients: 2 before and 1 after PD-1 mAb treatment. The median (range) follow-up time was 214 (57-460) days. 4 patients died. The overall survival ranged from 57 days to at least 460 days. 1 of the two alive patients continued to show no worsening of symptoms after 457 days.CONCLUSIONS:Patients with LM from ST can benefit from first-line PD-1 mAb combined treatment without additional neurotoxicity. Further research is required to validate the safety and efficacy.

软脑膜转移是晚期非小细胞肺癌（non-small-cell-lung-cancer，NSCLC）患者的严重并发症之一。患者一旦发生脑膜转移，预后差，治疗策略存在巨大挑战。本研究旨在探讨合并脑膜转移的表皮生长因子受体（epidermal growth factor receptor，EGFR）突变NSCLC患者在靶向治疗时代的生存情况。肺癌脑膜转移预后差，未经治疗的脑膜转移癌生存期仅1~3个月，在靶向药物面世之前放化疗对其生存期的延长非常有限 ［1］。随着靶向治疗时代的来临，第1代EGFR-TKI改善了EGFR突变肺癌患者的预后 ［2］，而随着患者生存期延长，脑膜转移的发生也明显增加 ［3］。肺癌合并脑膜转移的患者是否也能从TKI中获益？第1代TKI哪种疗效更好？第1代TKI使用过程中发生的脑膜转移换用第3代TKI疗效如何？这篇来自复旦大学附属华山医院单中心真实世界的回顾性分析数据给到了这些问题的部分答案。脑膜转移后中位生存时间达16.0个月，3年总生存率达23%，远远超越了靶向治疗前时代，并且同既往的研究报道相符 ［4］；而第3代TKI疗效优于第1代TKI也与既往临床研究结论相符 ［5, 6］；第1代TKI耐药后发生的脑膜转移，如果耐药原因是T790M突变，换用第3代TKI可以有效改善脑膜转移症状 ［7］。

Cystic brain metastases (CBM) in patients with breast cancer are rare. They have a worse prognosis than solid brain metastases, and they are less sensitive to radiotherapy. We report a case of hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer with CBM. The patient underwent treatment with docetaxel combined with capecitabine for 5 months, followed by anastrozole maintenance therapy for 10 months, and palbociclib combined with exemestane for 22 months. CBM emerged and bone metastases increased in number. A missense mutation in PIK3CA (exon 10, c.1633G>A [p.Glu545Lys]) was detected by whole-exome next-generation sequencing from peripheral blood samples. After whole-brain radiotherapy (40 Gy/20 fx) combined with 3 months of treatment with everolimus and fulvestrant, CBM demonstrated partial remission (PR), but extracranial bone metastases continued to increase in number. Thus, the patient underwent fourth-line treatment with abemaciclib (100 mg bid) combined with fulvestrant (500 mg). Three months later, CBM significantly demonstrated PR and extracranial bone metastases were stable. At present, the patient has above 9 months of progression-free survival time without obvious adverse effects. This is the first report of abemaciclib combined with fulvestrant in the treatment of CBM in a patient with HR+/HER2− breast cancer.

目的:探讨抗程序性死亡受体配体1（PD-L1）单抗阿替利珠单抗联合抗血管生成药物及化疗治疗三阴性乳腺癌（TNBC）脑膜转移的效果。方法:回顾性分析复旦大学附属华山医院2020年11月收治的1例合并脑、脑膜转移TNBC患者的临床资料。治疗方案为阿替利珠单抗、贝伐珠单抗联合含铂双药化疗。按实体瘤疗效评价标准1.1以及患者中枢神经系统（CNS）症状的缓解情况及脑脊液细胞学评价临床疗效，并结合文献复习。结果:经过联合治疗，患者颅内病灶、CNS症状明显缓解，持续缓解时间达到7个月，超过了既往文献报道的TNBC脑膜转移患者的平均无进展生存时间，且未见明显不良反应。结论:对于合并脑、脑膜转移的TNBC患者，化疗基础上联合靶向PD-L1的免疫治疗及抗血管生成治疗有望改善患者的CNS症状，提高患者生命质量。

目的 观察一线使用含纳武利尤单抗的方案联合治疗脑膜转移癌(meningeal carcinomatosis,MC)的临床效果.方法 收集2019年4月1日至10月1日在复旦大学附属华山医院肿瘤科经脑脊液(cerebrospinal fluid,CSF)细胞学确诊的4例MC患者,一线给予含纳武利尤单抗的联合治疗方案,总结CSF肿瘤负荷(tumor burden,TB)、软脑膜强化、脑积水和中枢神经系统(central nervous system,CNS)症状等临床特征,分析其与近期疗效和远期疗效的相关性.结果 原发灶包括2例多线靶向治疗后失败的肺癌、1例胆管细胞癌和1例原发灶不明.2例患者CSF TB低,2例CSF TB高且合并脑积水行CSF分流术挽救治疗.纳武利尤单抗联合化疗和/或抗血管生成药物治疗中位疗程5.5(5～33)个,截至2022年5月1日末次随访,4位患者中位随访610(153～947)天,1例无进展,2例仍存活,所有患者均未观察到CNS毒性.治疗后首次评估中位时间为46(37～65)天,4位患者CNS症状均缓解,3例CSF TB下降,CNS无进展生存期(progression free survival,PFS)分别为108天、134天和>944天;1例CSF TB无变化,PFS仅76天.CSF TB低相较于高的患者总生存期(overall survival,OS)更长(>947天和>944天vs.153天和275天).结论 一线含纳武利尤单抗联合治疗MC患者,CSF TB短期内下降可能预示CNS PFS更长,CSF TB低可能预示OS更长,其疗效值得进一步验证.

Myeloid-derived suppressor cells (MDSCs), one of the major orchestrators of the immunosuppressive network, are associated with immune suppression and considered a prime target for cancer immunotherapy. At present, various strategies have been explored to deplete and/or inactivate MDSCs in vivo. In this study, we investigated the effect of arsenic trioxide (ATO) on MDSCs derived from tumor-bearing mice. This study examined the in vitro and in vivo effects of ATO administration on MDSCs from C57/j mice bearing either the B16 or H22 tumor. The MDSCs were then characterized for phenotype, gene expression and function. Administration with ATO in vitro significantly induced MDSC differentiation, inhibited their proliferation and triggered apoptosis. Treatment with ATO in these murine tumor models significantly inhibited tumor growth and splenomegaly, decreased the percentages of MDSCs in the spleen, promoted their differentiation, reduced tumor necrosis factor-α and interleukin-10 levels and weakened the immune inhibition activity of MDSCs on T cells. In addition, we observed the underlying mechanism involved in the regulation of MDSCs by ATO, which included a panel of cytokines and signaling pathways. The findings showed the immunoregulatory effects of ATO by inducing apoptosis, promoting differentiation and inhibiting the function of MDSCs, suggesting that ATO has potential clinical benefit as it selectively attenuates MDSC-induced immunosuppression.

Myeloid-derived suppressor cells (MDSCs) are a group of heterogeneous myeloid cells that can suppress antitumor immunity. MDSCs are divided into granulocytic (G‑MDSCs) and monocytic subsets. In the present study, the microRNA profiles of the G‑MDSCs were determined and the differential expression of microRNAs between G‑MDSCs from tumor‑bearing mice and tumor‑free mice was examined. The number of G‑MDSCs in spleens of Lewis lung carcinoma (LLC)‑bearing mice was ~6‑fold higher than in spleens of normal mice (13.54±1.74% vs. 2.14±1.44%; P<0.01) and G‑MDSCs account for about 72.9% of all MDSCs. The microRNA (miRNA) profiles of the G‑MDSCs from spleen of LLC‑bearing mice were obtained using a microRNA microarray and compared with their counterparts from spleens of tumor‑free mice. A total of 43 miRNAs with >1.3‑fold increased or decreased change were differentially expressed between the experimental and control group mice. The levels of nine of these differentially expressed miRNAs, miRNA‑468 (miR‑486), miR‑192, miR‑128, miR‑125a, miR‑149, miR‑27a, miR‑125b, miR‑350 and miR‑328, were also analyzed by RT‑qPCR to validate the microarray data. The concordance rate between the results tested by the two methods was 88.9%. Bioinformatics analyses revealed that these miRNAs may act on various target genes, including Adar, Pik3r1, Rybp and Rabgap1, to regulate the survival, differentiation and the function of tumor‑induced granulocytic MDSCs. The results revealed microRNAs and potential targets that may be vital for regulating survival, differentiation and function of G‑MDSCs induced by LLC. Further investigation should be performed to clarify the roles of these microRNAs in regulating LLC‑induced granulocytic MDSCs and the target genes that mediate their functions.

OBJECTIVE Medullary breast carcinoma is a rare breast carcinoma with good prognosis. Although it has been established that axillary lymph node metastasis is a poor prognostic factor, little is known about the relationship between axillary lymph node metastasis and clinicopathological characteristics of medullary breast carcinoma patients. The aim of this study was to identify factors that predict occurrence of axillary lymph node metastasis in medullary breast carcinoma patients. METHODS We performed a retrospective study of axillary lymph node status and the relevant clinicopathological characteristics in 49 triple-negative medullary breast carcinoma patients with axillary lymph node dissection between November 2004 and July 2011. RESULTS A total of 49 patients were enrolled in the study. Fourteen patients (28.6%) had axillary lymph node metastasis that was confirmed pathologically. Axillary lymph node metastasis was not associated with age, menopausal status, primary tumor size or its location, the degree of inflammation within the tumor or mitotic count. However, we found a statistically significant association between axillary lymph node metastasis and Ki67 labeling index in primary tumors (P < 0.001). CONCLUSIONS There is a positive association between Ki67 labeling index in the primary tumor and axillary lymph node metastasis in triple-negative medullary breast carcinoma patients.

Objective:To investigate the ultrasonography and mammography characteristics and pathological features of typical medullary breast carcinoma (TMBC) in China.Methods:A retrospective analysis of imaging characteristics and pathological features of 80 TMBC patients during January 2004 and April 2011 was conducted. All patients accepted the examinations of ultrasonography and mammography before breast radical operation.Results:Mammography found more masses with calciifcation than ultrasonography. The highest grade of breast masses according to Breast Imaging Reporting and Data System (BI-RADS) classification scored above grade 4 when ultrasonography was combined with mammography. Ultrasonography detected more enlarged ipsilateral axillary lymph nodes (ALNs) than mammography before operation, but only 48.4% patients with enlarged ALNs were confirmed to have metastasis by postoperative pathology. Up to 87.5% patients with enlarged ALNs found both by ultrasonography and mammography were conifrmed to have metastasis. When the primary tumors were located in the upper outer quadrant, only 83.3% patients with enlarged ALNs were conifrmed to have metastasis. When estrogen receptor (ER) was negative, only 85.7% patients with enlarged ALNs were conifrmed to have metastasis.Conclusion:TMBC patients were not easily missed by combination of ultrasonography and mammography before operation. Enlarged ipsilateral ALNs shown by both ultrasonography and mammography indicate the high possibility of metastasis, which is needed to be cautious for patients with primary tumors located in the upper outer quadrant or with negative ER.

Recently the recruitment/migration of myeloid derived suppressor cells (MDSCs) to tumor microenvironment after chemotherapy has attracted much attention. To determine the detailed mechanism for the responses of MDSCs to these chemotherapies, we investigated the changes of galectin-3 and MDSCs in response to cisplatin(0.4 mg/kg, 4 mg/kg) treatment both in vivo and ex vivo. In the process of cisplatin, we assessed levels of galectin-3 and MDSCs in the Lewis lung cancer (LLC) bearing mice using immunohistochemistry, enzyme-linked immunosorbent assay (ELISA), immunofluorence and flow cytometry (FCM). The expression and changes of galectin-3 in the LLC cell line were detected by western blot, immunofluorence and ELISA. The ligand for galectin-3 on MDSCs and the chemotaxis of galectin-3 to MDSCs were confirmed using FCM and transwell. Parallel increased level of galectin-3 with the number of MDSCs in vivo was detected after cisplatin treatment. LLC cells expressed galectin-3 and cisplatin increased galectin-3 level in the culture medium. Furthermore, MDSCs were detected to express CD98, the ligand of galectin-3, and could be recruited by galectin-3. Our results suggested that the elevated expression of gelectin-3 in LLC tumor cells may contribute to the migration of MDSCs to the tumor microenvironment in response to cisplatin.

Purpose This study analyzed the clinicopathologic characteristics of typical medullary breast carcinoma (TMBC) in a cohort of Chinese patients. Methods We conducted a retrospective review of clinical data including general information, pathologic results, treatment regimens, and patient survival in cases of TMBC diagnosed between February 2004 and April 2011. Results A total of 117 patients were enrolled, with a median age of 52 years (range, 28∼92 years). Stage I and II disease accounted for 31.6% and 61.6% of the cases, respectively. Hormonal receptor negative disease (estrogen receptor negative, 68.4%; progestogen receptor negative, 86.3%) was more prevalent in this population. Human epidermal growth factor receptor-2 (HER-2) positivity was 20.5%, while equivocal and HER-2 negative cases represented 16.2% and 63.2% of the cohort. The triple-negative, luminal, and HER-2 overexpressing subtypes constituted 44.4%, 31.6%, and 15.4% of the cases, respectively. The various TMBC subtypes showed no differences regarding tumor size, rates of lymph node(s) metastasis, TNM staging, treatment regimens, and 2-year recurrence rates. However, patients with triple-negative disease were more likely to be younger, when compared to those with luminal disease (P = 0.002). At a median follow-up of 56 months (range, 2–112 months), the 2-year disease-free survival and overall survival rates were 99.1% and 98.2%, respectively. Conclusion Early stage disease dominated the study cohort, and at two years after surgery, recurrence was extremely low. The heterogeneity of molecular subtypes was clearly shown, and no apparent differences were found among the clinicopathologic characteristics of the triple-negative, luminal, and HER-2 overexpressing subtypes.

Brain metastasis as the first symptom of lung cancer is a unique clinical entity. We conducted a retrospective study to investigate the clinical characteristics and survival of patients with lung cancer whose first symptom was brain metastases in an Asian population.

PURPOSE:A preliminary analysis on the risk factors of liver dysfunction was made after the investigation of hepatitis B prevalence and chemotherapy-related hepatic dysfunction occurrence for patients with lung cancer.PATIENTS AND METHODS:Consecutively diagnosed 950 lung cancer patients treated in Huashan Hospital, Fudan University from 1999 to 2009 were enrolled in the study. We investigated hepatitis B (HB) prevalence and analyzed chemotherapy-related hepatic dysfunction occurrence and its influencing factors. Liver dysfunction was considered when alanine transaminase, aspartate aminotransferase, and serum bilirubin levels exceeded at least 1.25-fold of normal levels, and HB statuses were categorized into diagnosed HB, previous HB infection, HB immunity, and no HB infection.RESULTS:Among the 950 lung cancer patients, 632 accepted the HB serum marker tests: 8.4 % (53/632) were HB surface antigen positive, and 37.2 % (235/632) were HB core antibody positive. A number of 281 patients received liver function follow-up examinations after they underwent a total of 774 chemotherapy courses, and 34 liver dysfunctions were detected. A logistic regression analysis showed that younger age at diagnosis (≤60 years; P = 0.029) and abnormal liver function before chemotherapy (P = 0.000) were the risk factors for liver dysfunctions after chemotherapy, but HB status had no influence.CONCLUSIONS:The screening rates for serum HB marker and HB prevalence in patients with lung cancer were high in mainland China. Lung cancer patients with abnormal liver function before chemotherapy and in younger ages had higher risks for liver dysfunctions after chemotherapies, whereas HB status before the first chemotherapy is not an independent impact factor for post-treatment liver dysfunctions.

The aim was to compare the efficacy between doublets of third-generation agents (non-platinum) and doublets of platinum plus a third-generation agent (platinum-based) for chemotherapy-naïve advanced non-small-cell lung cancer (NSCLC).

It is hypothesized that high expression of the excision repair cross-complementation group 1 (ERCC1) gene might be a positive prognostic factor, but predict decreased sensitivity to platinum-based chemotherapy. Results from the published data are inconsistent. To derive a more precise estimation of the relationship between ERCC1 and the prognosis and predictive response to chemotherapy of non-small cell lung cancer (NSCLC), a meta-analysis was performed. An electronic search of the PubMed and Embase database was performed. Hazard ratio (HR) for overall survival (OS) was pooled in early stage patients received surgery alone to analyze the prognosis of ERCC1 on NSCLC. HRs for OS in patients received surgery plus adjuvant chemotherapy and in patients received palliative chemotherapy and relative risk (RR) for overall response to chemotherapy were aggregated to analyze the prediction of ERCC1 on NSCLC. The pooled HR indicated that high ERCC1 levels were associated with longer survival in early stage patients received surgery alone (HR, 0.69; 95% confidence interval (CI), 0.58-0.83; P = 0.000). There was no difference in survival between high and low ERCC1 levels in patients received surgery plus adjuvant chemotherapy (HR, 1.41; 95% CI, 0.93-2.12; P = 0.106). However, high ERCC1 levels were associated with shorter survival and lower response to chemotherapy in advanced NSCLC patients received palliative chemotherapy (HR, 1.75; 95% CI, 1.39-2.22; P = 0.000; RR, 0.77; 95% CI, 0.64-0.93; P = 0.007; respectively). The meta-analysis indicated that high ERCC1 expression might be a favourable prognostic and a drug resistance predictive factor for NSCLC.