Differential diagnosis of lung cancer, its metastasis and chronic obstructive pulmonary disease based on serum Vegf, Il-8 and MMP-9

Chronic obstructive pulmonary disease (COPD) patients are at higher risk of developing lung cancer and its metastasis, but no suitable biomarker has been reported for differential diagnosis of these patients. Levels of serum biomarkers (VEGF, IL-8, MMP-9 and MMP-2) were analyzed in these patients, which were compared with healthy donors (HD). Levels of VEGF (P < 0.005) and MMP-9 (P < 0.05) were significantly higher in COPD patients than HD. Compared to HD, a decrease in IL-8 (~8.1 folds; P < 0.0001) but an increase in MMP-9 (~1.6 folds; P < 0.05) levels were observed in the lung cancer patients. Cancer patients showed significantly (P < 0.005) lower levels of serum VEGF (1.9 folds) and IL-8 (~9 folds) than the COPD patients. VEGF level was significantly higher (2.6 folds; P < 0.0005) in metastatic than non-metastatic cancer patients. However, MMP-2 didn't show significant variation in these patients. The Youden's index (YI) values for lung cancer diagnosis in HD using IL-8 was 0.55 with 83.3% overall accuracy. VEGF was able to diagnose COPD in HD with better YI (0.38) and overall accuracy (70.6%). IL-8 was able to diagnose cancer in COPD patients and HD with YI values of 0.35, 0.55 with 71% and 83.3% overall accuracy, respectively.

Treatment results in advanced stage Hodgkin's lymphoma: a retrospective study

BACKGROUND

Hodgkin's lymphoma displays distinct epidemiological attributes in Asian population thus making it relevant to study whether there are any differences in treatment outcomes too when treated with current standard of care.

AIM

To evaluate the treatment outcomes of de-novo advanced stage HL in adults.

MATERIALS AND METHODS

This retrospective study included de-novo advanced stage HL patients (≥15 years) registered at our center from January 2004 to December 2007. Treatment outcomes were measured in terms of response rates, overall survival (OS) and progression-free survival (PFS). Overall and PFS were calculated with Kaplan-Meier methodology and Cox-proportional hazards model was used for multivariate analysis to identify prognostic factors.

RESULTS

There were 125 patients (males 77%) who received minimum one cycle of chemotherapy with median age of 32 years (Range 15-65 years). Stage IV disease was seen in (46 patients) 37%; 75% (94 patients) patients had B symptoms. International prognostic score (IPS) ≤4 was seen in 95/112 (85%) patients. ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) chemotherapy was given to 94%. Radiation to residual/bulky sites was given to 36% (45 patients). Response data was available for 112 patients; complete response in 76%; partial response in 10 % and progressive disease in 3 patients. Nineteen deaths (progressive disease-7, toxicity-8, unrelated cause-4) were observed. At median follow-up of 28 months, estimated 5-year OS and PFS were 60% and 58%, respectively. On multivariate analysis, IPS and response to treatment were significant factors for both OS and PFS.

CONCLUSIONS

The treatment outcomes in this study are comparable with the published literature with limited follow-up data.

Local therapy in non-metastatic primary Ewing sarcoma of the mandible and maxilla in children

Ewing sarcoma (ES) of the jaw bones comprises a small fraction of ES at all sites. Due to their rarity, a specific policy for local treatment is lacking. The aim of this study was to evaluate the local therapy for ES and recommend measures to individualize treatment options. Patients with primary non-metastatic ES of the jaw bones treated between August 2005 and February 2015 were analyzed. All patients received primary induction chemotherapy, following which lesions amenable to resection based on specific radiological criteria were resected; those with unresectable lesions were offered definitive radiotherapy. The maxilla was the primary site in 13 patients and the mandible in eight. The median age of patients was 11.6 years (range 5-17 years). Overall, surgery was performed in 17 patients and definitive radiotherapy was used in four patients. Postoperative radiotherapy was administered to 12 patients and was avoided in five patients with 100% tumour necrosis. The 3-year overall survival, event-free survival, and local control were 68.1%, 63.6%, and 80.2%, respectively. Mandible primary and a histological response to chemotherapy were significant prognostic factors. The stratification of patients based on radiological criteria aids in selecting local therapy. In eligible patients, surgery with contemporary reconstruction results in optimal oncological and functional outcomes. Surgery also has the added advantage of identifying patients who may not need radiotherapy.

Role of ATF-2 in regulation of epithelial–mesenchymal transition and radio-sensitivity of A549 cells mediated by secreted soluble factors

Introduction

Epithelial–mesenchymal transition (EMT) is known to be a crucial event whereby cancer cells acquire the traits needed to execute multiple steps of metastasis [ 1 ]. Intriguingly, epithelial cancer cells undergoing EMT also exhibit increased radioresistance [ 2 ]. EMT is a dynamic process and is triggered by various micro-environmental stimuli, out of which secreted soluble factors play a major role [ 3 ]. Herein, we have investigated the effect of self-conditioned medium (CM) on the human lung carcinoma A549 cells and the underlying mechanism.

Material and methods

A549 cells were obtained from National Centre for Cell Sciences, Pune, and cultured in DMEM with 10% FCS and antibiotics at 37°C in 5% CO2/air. To get CM, 1 × 106 A549 cells were grown in complete medium. After 48 h of incubation, media were harvested referred as CM. Media alone without cells were incubated under the same conditions served as control termed as plain medium (PM) [ 4 ]. A549 cells grown in PM/CM subjected to immunofluorescence staining for E-cadherin, vimentin and actin. Motility scratch assay and matrigel invasion assay were performed to study the invasiveness of A549 cells in PM/CM. In some cases, cells were pretreated with inhibitors against MAPKs. To pinpoint the soluble factor(s) in CM responsible for initiating the invasiveness in A549 cells, CM was pretreated with neutralizing antibodies against IL-8, VEGF and IL-1β.

Results and discussion

We found that CM induced a series of changes associated with EMT in A549 cells such as change in shape from cuboidal to elongated spindle shape, decrease in E-cadherin, increase in vimentin and enhanced actin polymerization with decreased cell–cell contact. CM also promoted motility, invasion and anchorage-independent growth in A549 cells. Neutralizing IL-8, IL-1β and VEGF in CM significantly inhibited motility and invasion. Moreover, JNK and p38 activated by CM in A549 cells played important role in invasiveness. In downstream signalling, CM activated ATF-2 by phosphorylating it at Thr69 and 71. Knockdown of ATF-2 using siRNA abrogated the CM-enhanced motility and invasion. It has been reported that EMT not only accelerates cancer metastasis but may also result in resistance against therapeutic agents [ 2 , 5 ]. We therefore investigated the effect of CM on radioresistance of A549 cells. Our results showed that A549 cells grown in CM followed by gamma irradiation exhibited higher clonogenic survival and lower DNA damage measured in terms of gamma-H2AX foci. Interestingly, these CM-treated A549 cells in response to radiation showed phosphorylation of ATF-2 at Ser 490/498 (not at Thr69/71), which was co-localized with gamma-H2AX foci. These studies suggest the dual role of ATF-2, i.e. as EMT potentiating transcription factor and DNA damage response protein in lung cancer cells stimulated with soluble factors, which can be exploited as potential therapeutic target for cancer radiotherapy.

A retrospective audit of clinicopathological attributes and treatment outcomes of adolescent and young adult non-Hodgkin lymphomas from a tertiary care center

Background:

The uniqueness of adolescent and young adult (AYA) non-Hodgkin lymphomas (NHL) with respect to biology and treatment have largely remained unanswered due to marked heterogeneity in treatment, paucity of prospective, or retrospective studies and poor representation of AYA in clinical trials. This audit attempts to put forward the clinicopathological attributes and treatment outcomes of AYA NHL treated with both pediatric and adult protocols from a single centre in a developing country.

Patients and Methods:

Hospital records of all consecutive NHL patients registered in lymphoma clinic from January 2007 to May 2010 were reviewed for information on demography, clinical features, histology subtype, staging, treatment regimen, response rates, toxicities, and follow up. Two-year progression-free (PFS) and overall survival (OS) were calculated with Kaplan-Meier method.

Results:

AYA NHL constituted 4% of all lymphomas. Diffuse large B-cell (DLBL) was the most frequent subtype. Following were the 2-year PFS and OS - DLBL 64%, 76.9%, Burkitt's lymphoma: 56%, 56%, lymphoblastic lymphoma: 33.2%, 44%. Our results did not show any improvement in outcome of DLBL with the use of Burkitt's lymphoma like regimen.

Conclusions:

This study highlights some of the key features of AYA NHL occurring in developing world.

The outcome of the treatment of diaphyseal primary bone sarcoma by resection, irradiation and re-implantation of the host bone

We analysed the outcome of patients with primary non-metastatic diaphyseal sarcomas who had en bloc resection with preservation of the adjoining joints and reconstruction with re-implantation of sterilised tumour bone after extracorporeal radiation (50 Gy). Between March 2005 and September 2009, 32 patients (16 Ewing’s sarcoma and 16 osteogenic sarcoma) with a mean age of 15 years (2 to 35) underwent this procedure. The femur was the most common site in 17 patients, followed by the tibia in 11, humerus in three and ulna in one. The mean resected length of bone was 19 cm (10 to 26). A total of 31 patients were available at a mean follow-up of 34 months (12 to 74). The mean time to union for all osteotomy sites was 7.3 months (3 to 28): metaphyseal osteotomy sites united quicker than diaphyseal osteotomy sites (5.8 months (3 to 10) versus 9.5 months (4 to 28)). There were three local recurrences, all in soft-tissue away from irradiated graft. At the time of final follow-up, 19 patients were free of disease, one was alive with disease and 11 had died of disease. The mean Musculoskeletal Tumor Society Score for 29 patients evaluated at the last follow-up was 26 (9 to 30).

Extracorporeal irradiation is an oncologically safe and inexpensive technique for limb salvage in diaphyseal sarcomas and has good functional results.