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Abstract
Supplemental Digital Content is available in the text. Low-dose computed tomography (LDCT) screening trials have based their risk selection algorithm on age and tobacco exposure, but never on pulmonary risk-related biomarkers. In the present study, the baseline inflammatory status, measured by C-reactive protein (CRP) level, and lung function, measured by forced expiratory volume in 1 s (FEV1), were tested as independent predictors of all-cause mortality in LDCT-screening participants. Between 2000 and 2010, 4413 volunteers were enrolled in two LDCT-screening trials, with evaluable baseline CRP and FEV1 values: 2037 were included in the discovery set and 2376 were included in the validation set. The effect of low FEV1 or high CRP alone or combined was evaluated by Kaplan–Meier mortality curves and hazard ratio (HR) with 95% confidence interval (CI) by fitting Cox proportional hazards models. The overall mortality risk was significantly higher in participants with FEV1 of up to 90% (HR: 2.13, CI: 1.43–3.17) or CRP more than 2 mg/l (HR: 3.38, CI: 1.60–3.54) and was still significant in the fully adjusted model. The cumulative 10-year probability of death was 0.03 for participants with FEV1 of more than 90% and CRP up to 2 mg/l, 0.05 with only FEV1 of up to 90% or CRP above 2 mg/l, and 0.12 with FEV1 of up to 90% and CRP above 2 mg/l. This predictive performance was confirmed in the two external validation cohorts with 10-year mortality rates of 0.06, 0.12, and 0.14, and 0.03, 0.07, and 0.14, respectively. Baseline inflammatory status and lung function reduction are independent predictors of all-cause long-term mortality in LDCT-screening participants. CRP and FEV1 could be used to select higher-risk individuals for future LDCT screening and preventive programs.
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102
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Cheng YI, Davies MPA, Liu D, Li W, Field JK. Implementation planning for lung cancer screening in China. PRECISION CLINICAL MEDICINE 2019; 2:13-44. [PMID: 35694700 PMCID: PMC8985785 DOI: 10.1093/pcmedi/pbz002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/19/2018] [Accepted: 12/24/2018] [Indexed: 02/05/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths in China, with over 690 000 lung cancer deaths estimated in 2018. The mortality has increased about five-fold from the mid-1970s to the 2000s. Lung cancer low-dose computerized tomography (LDCT) screening in smokers was shown to improve survival in the US National Lung Screening Trial, and more recently in the European NELSON trial. However, although the predominant risk factor, smoking contributes to a lower fraction of lung cancers in China than in the UK and USA. Therefore, it is necessary to establish Chinese-specific screening strategies. There have been 23 associated programmes completed or still ongoing in China since the 1980s, mainly after 2000; and one has recently been planned. Generally, their entry criteria are not smoking-stringent. Most of the Chinese programmes have reported preliminary results only, which demonstrated a different high-risk subpopulation of lung cancer in China. Evidence concerning LDCT screening implementation is based on results of randomized controlled trials outside China. LDCT screening programmes combining tobacco control would produce more benefits. Population recruitment (e.g. risk-based selection), screening protocol, nodule management and cost-effectiveness are discussed in detail. In China, the high-risk subpopulation eligible for lung cancer screening has not as yet been confirmed, as all the risk parameters have not as yet been determined. Although evidence on best practice for implementation of lung cancer screening has been accumulating in other countries, further research in China is urgently required, as China is now facing a lung cancer epidemic.
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Affiliation(s)
- Yue I Cheng
- Lung Cancer Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, United Kingdom
| | - Michael P A Davies
- Lung Cancer Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, United Kingdom
| | - Dan Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - John K Field
- Lung Cancer Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, United Kingdom
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103
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Stevens C, Smith SG, Quaife SL, Vrinten C, Waller J, Beeken RJ. Interest in lifestyle advice at lung cancer screening: Determinants and preferences. Lung Cancer 2019; 128:1-5. [PMID: 30642439 PMCID: PMC6345624 DOI: 10.1016/j.lungcan.2018.11.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lung cancer screening could be a 'teachable moment' for behaviour change. Little is known about how advice about smoking cessation, or other behavioural cancer risk factors, would be received in this setting. METHODS Using a population-based survey of 459 English adults (current smokers and recent quitters aged 50-75) we assessed willingness to receive lifestyle advice (about smoking, diet, weight, physical activity, alcohol consumption) at lung screening. Additional items assessed whether advice should be provided following abnormal screening results, the potential impact of advice on screening uptake, and preferred timing of advice. RESULTS Overall, 64% (n = 292) of participants were willing to receive lifestyle advice at lung screening. A greater proportion of participants were willing to receive advice in a scenario where results required further investigation (83%; p < 0.01). However, 14% indicated the provision of lifestyle advice would make them less willing to attend lung screening. Non-White ethnicity and greater cancer risk factor awareness were associated with willingness to receive advice (p < 0.05). Half of smokers (51%) were willing to receive cessation advice. There was also interest in advice about diet (47%), weight (43%), physical activity (32%), and alcohol consumption (17%) among people not meeting current recommendations for these behaviours. There was a preference for advice to be delivered at the screening appointment (38%, n = 108) over other time-points. CONCLUSIONS Lung screening may offer an opportunity to provide advice about behavioural cancer risk factors. Future work should consider how to deliver effective interventions in this setting to support behaviour change, without affecting screening uptake.
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Affiliation(s)
- Claire Stevens
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Samuel G Smith
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK
| | - Samantha L Quaife
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Charlotte Vrinten
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK.
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104
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Ryan BM. Lung cancer health disparities. Carcinogenesis 2019; 39:741-751. [PMID: 29547922 DOI: 10.1093/carcin/bgy047] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/13/2018] [Indexed: 12/16/2022] Open
Abstract
Compared with all other racial and ethnic groups in the United States, African Americans are disproportionally affected by lung cancer, both in terms of incidence and survival. It is likely that smoking, as the main etiological factor associated with lung cancer, contributes to these disparities, but the precise mechanism is still unclear. This paper seeks to explore the history of lung cancer disparities and review to the literature regarding the various factors that contribute to them.
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Affiliation(s)
- Bríd M Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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105
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Silvestri GA, Carpenter MJ. Smoking Trends and Lung Cancer Mortality: The Good, the Bad, and the Ugly. Ann Intern Med 2018; 169:721-722. [PMID: 30304366 DOI: 10.7326/m18-2775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Gerard A Silvestri
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (G.A.S., M.J.C.)
| | - Matthew J Carpenter
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (G.A.S., M.J.C.)
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106
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Welch LS, Dement JM, Cranford K, Shorter J, Quinn PS, Madtes DK, Ringen K. Early detection of lung cancer in a population at high risk due to occupation and smoking. Occup Environ Med 2018; 76:137-142. [PMID: 30415231 DOI: 10.1136/oemed-2018-105431] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/10/2018] [Accepted: 09/23/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The US National Comprehensive Cancer Network (NCCN) recommends two pathways for eligibility for Early Lung Cancer Detection (ELCD) programmes. Option 2 includes individuals with occupational exposures to lung carcinogens, in combination with a lesser requirement on smoking. Our objective was to determine if this algorithm resulted in a similar prevalence of lung cancer as has been found using smoking risk alone, and if so to present an approach for lung cancer screening in high-risk worker populations. METHODS We enrolled 1260 former workers meeting NCCN criteria, with modifications to account for occupational exposures in an ELCD programme. RESULTS At baseline, 1.6% had a lung cancer diagnosed, a rate similar to the National Lung Cancer Screening Trial (NLST). Among NLST participants, 59% were current smokers at the time of baseline scan or had quit smoking fewer than 15 years prior to baseline; all had a minimum of 30 pack-years of smoking. Among our population, only 24.5% were current smokers and 40.1% of our participants had smoked fewer than 30 pack-years; only 43.5% would meet entry criteria for the NLST. The most likely explanation for the high prevalence of screen-detected lung cancers in the face of a reduced risk from smoking is the addition of occupational risk factors for lung cancer. CONCLUSION Occupational exposures to lung carcinogens should be incorporated into criteria used for ELCD programmes, using the algorithm developed by NCCN or with an individualised risk assessment; current risk assessment tools can be modified to incorporate occupational risk.
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Affiliation(s)
- Laura S Welch
- Center for Construction Research and Training, Silver Spring, Maryland, USA
| | - John M Dement
- Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University, Durham, North Carolina, USA
| | - Kim Cranford
- Zenith American Solutions, Inc, Oak Ridge, Tennessee, USA
| | - Janet Shorter
- Zenith American Solutions, Inc, Oak Ridge, Tennessee, USA
| | - Patricia S Quinn
- Center for Construction Research and Training, Silver Spring, Maryland, USA
| | - David K Madtes
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Washington, District of Columbia, USA
| | - Knut Ringen
- Center for Construction Research and Training, Silver Spring, Maryland, USA
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107
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Jenkins WD, Gilbert D, Chen LS, Carnahan LR. Finding paths with the greatest chance of success: enabling and focusing lung cancer screening and cessation in resource-constrained areas. Transl Lung Cancer Res 2018; 7:S261-S264. [PMID: 30393618 DOI: 10.21037/tlcr.2018.09.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Wiley D Jenkins
- Department of Population Science and Policy, School of Medicine, Southern Illinois University, Springfield, IL 62794, USA
| | - David Gilbert
- Department of Psychology, Southern Illinois University, Carbondale, IL 62901, USA
| | - Li-Shiun Chen
- Department of Psychiatry, Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Leslie R Carnahan
- Center for Research on Women and Gender, College of Medicine, University of Illinois at Chicago, Chicago, IL 60607, USA
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108
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Lungenkrebsscreening: Aktuelle Entwicklungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:1551-1558. [DOI: 10.1007/s00103-018-2834-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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109
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Tanner NT, Silvestri GA. Shared Decision-making and Lung Cancer Screening: Let's Get the Conversation Started. Chest 2018; 155:21-24. [PMID: 30359617 DOI: 10.1016/j.chest.2018.10.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 10/28/2022] Open
Abstract
Screening with low-dose CT scan has been shown to reduce mortality from lung cancer in those at risk based on age and smoking history. While lung cancer screening (LCS) is recommended by the United States Preventative Services Task Force and many professional societies, it has been recognized that the decision to be screened is complex due to a close balance of risk and benefit; therefore, shared decision-making is considered an essential component of effective LCS. The Centers for Medicare and Medicaid Services provides coverage for LCS following a mandated shared-decision making (SDM) visit. Here we review the concept of SDM, facilitators and barriers, evidence and knowledge gaps, and novel considerations for SDM within LCS.
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Affiliation(s)
- Nichole T Tanner
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Hospital, Charleston, SC; Department of Medicine, Thoracic Oncology Research Group, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC.
| | - Gerard A Silvestri
- Department of Medicine, Thoracic Oncology Research Group, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC
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110
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Shojaee S, Vachani A, Nana-Sinkam P. The Financial Implications of Lung Cancer Screening: Is It Worth It? J Thorac Oncol 2018; 12:1177-1179. [PMID: 28748812 DOI: 10.1016/j.jtho.2017.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 06/17/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Samira Shojaee
- Division of Pulmonary Diseases and Critical Care Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Anil Vachani
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Patrick Nana-Sinkam
- Division of Pulmonary Diseases and Critical Care Medicine, Virginia Commonwealth University, Richmond, Virginia.
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111
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Stone E, Marshall H. Tobacco cessation in lung cancer screening-do we have the evidence? Transl Lung Cancer Res 2018; 7:S270-S274. [PMID: 30393620 DOI: 10.21037/tlcr.2018.09.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine and Kinghorn Cancer Centre, St Vincent's Hospital Sydney, University of New South Wales, Sydney, Australian
| | - Henry Marshall
- University of Queensland Thoracic Research Centre, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australian
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112
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Affiliation(s)
- Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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113
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Tobacco Dependence Predicts Higher Lung Cancer and Mortality Rates and Lower Rates of Smoking Cessation in the National Lung Screening Trial. Chest 2018; 154:110-118. [PMID: 29793736 DOI: 10.1016/j.chest.2018.04.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/08/2018] [Accepted: 04/02/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Incorporating tobacco treatment within lung cancer screening programs has the potential to influence cessation in high-risk smokers. We aimed to better understand the characteristics of smokers within a screening cohort, correlate those variables with downstream outcomes, and identify predictors of continued smoking. METHODS This study is a secondary analysis of the National Lung Screening Trial randomized clinical study. Tobacco dependence was evaluated by using the Fagerstrӧm Test for Nicotine Dependence, the Heaviness of Smoking Index, and time to first cigarette (TTFC); descriptive statistics were performed. Clinical outcomes (smoking cessation, lung cancer, and mortality) were assessed with descriptive statistics and χ2 tests stratified according to nicotine dependence. Logistic and Cox regression models were used to study the influence of dependence on smoking cessation and mortality, respectively. RESULTS Patients with high dependence scores were less likely to quit smoking compared with low dependence smokers (TTFC OR, 0.50 [95% CI, 0.42-0.60]). Indicators of high dependence, as measured according to all three metrics, were associated with worsening clinical outcomes. TTFC showed that patients who smoked within 5 min of waking (indicating higher dependence) had higher rates of lung cancer (2.07% for > 60 min after waking vs 5.92% ≤ 5 min after waking; hazard ratio [HR], 2.56 [95% CI, 1.49-4.41]), all-cause mortality (5.38% for > 60 min vs 11.21% ≤ 5 min; HR, 2.19 [95% CI, 1.55-3.09]), and lung cancer-specific mortality (0.55% for > 60 min vs 2.92% for ≤ 5 min; HR, 4.46 [95% CI, 1.63-12.21]). CONCLUSIONS Using TTFC, a one-question assessment of tobacco dependence, at the time of lung cancer screening has implications for personalizing tobacco treatment and improving risk assessment.
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114
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Abstract
Despite advances in targeted treatments, lung cancer remains a common and deadly malignancy, in part owing to its typical late presentation. Recent developments in lung cancer screening and ongoing efforts aimed at early detection, treatment, and prevention are promising areas to impact the mortality from lung cancer. In the past several years, lung cancer screening with low-dose chest computed tomography (CT) was shown to have mortality benefit, and lung cancer screening programs have been implemented in some clinical settings. Biomarkers for screening, diagnosis, and monitoring of response to therapy are under development. Prevention efforts aimed at smoking cessation are as crucial as ever, and there have been encouraging findings in recent clinical trials of lung cancer chemoprevention. Here we review advancements in the field of lung cancer prevention and early malignancy and discuss future directions that we believe will result in a reduction in the mortality from lung cancer.
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Affiliation(s)
- Melissa New
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Robert Keith
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.,VA Eastern Colorado Health Care System, Denver, Colorado, USA.,University of Colorado Denver, Aurora, Colorado, USA
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115
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Zhang MY, Liu XX, Li H, Li R, Liu X, Qu YQ. Elevated mRNA Levels of AURKA, CDC20 and TPX2 are associated with poor prognosis of smoking related lung adenocarcinoma using bioinformatics analysis. Int J Med Sci 2018; 15:1676-1685. [PMID: 30588191 PMCID: PMC6299412 DOI: 10.7150/ijms.28728] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/11/2018] [Indexed: 01/10/2023] Open
Abstract
Background and aim: Adenocarcinoma is a very common pathological subtype for lung cancer. We aimed to identify the gene signature associated with the prognosis of smoking related lung adenocarcinoma using bioinformatics analysis. Methods: A total of five gene expression profiles (GSE31210, GSE32863, GSE40791, GSE43458 and GSE75037) have been identified from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were analyzed using GEO2R software and functional and pathway enrichment analysis. Furthermore, the overall survival (OS) and recurrence-free survival (RFS) have been validated using an independent cohort from the Cancer Genome Atlas (TCGA) database. Results: We identified a total of 58 DEGs which mainly enriched in ECM-receptor interaction, platelet activation and PPAR signaling pathway. Then according to the enrichment analysis results, we selected three genes (AURKA, CDC20 and TPX2) for their roles in regulating tumor cell cycle and cell division. The results showed that the hazard ratio (HR) of the mRNA expression of AURKA for OS was 1.588 with (1.127-2.237) 95% confidence interval (CI) (P=0.009). The mRNA levels of CDC20 (HR 1.530, 95% CI 1.086-2.115, P=0.016) and TPX2 (HR 1.777, 95%CI 1.262-2.503, P=0.001) were also significantly associated with the OS. Expression of these three genes were not associated with RFS, suggesting that there might be many factors affect RFS. Conclusion: The mRNA signature of AURKA, CDC20 and TPX2 were potential biomarkers for predicting poor prognosis of smoking related lung adenocarcinoma.
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Affiliation(s)
- Meng-Yu Zhang
- Department of Respiratory Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Xiao-Xia Liu
- Department of Respiratory Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Hao Li
- Department of Respiratory Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Rui Li
- Department of Respiratory Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Xiao Liu
- Department of Respiratory Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Yi-Qing Qu
- Department of Respiratory Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
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116
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Primary Care Provider and Patient Perspectives on Lung Cancer Screening. A Qualitative Study. Ann Am Thorac Soc 2017; 13:1977-1982. [PMID: 27676369 DOI: 10.1513/annalsats.201604-286oc] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The U.S. Preventive Services Task Force recommends annual low-dose computed tomography (LDCT) for lung cancer screening in high-risk individuals. Preventive healthcare is provided predominantly by primary care providers (PCPs). Successful implementation of a screening program requires acceptance and participation by both providers and patients, with available collaboration with pulmonologists. OBJECTIVES To identify perceptions of and perspectives on lung cancer screening and implementation among PCPs and eligible veteran patients at high risk for lung cancer. METHODS We conducted a qualitative study using grounded theory in which 28 veterans and 13 PCPs completed a questionnaire and participated in focus groups. Sessions were recorded, transcribed verbatim, and analyzed with NVivo 10 software. Counts and percentages were used to report questionnaire results. MEASUREMENTS AND MAIN RESULTS While 58% percent of providers were aware of lung cancer screening guidelines, many could not recall the exact patient eligibility criteria. Most patients were willing to undergo LDCT screening and identified smoking as a risk factor for lung cancer, but they did not recall their PCP explaining the reason for the testing. All providers assessed smoking behavior, but only 23% referred active smokers for formal cessation services. Patients volunteered information regarding their hurdles with smoking cessation while discussing risk factors for cancer. PCPs cited time constraints as a reason for lack of appropriate counseling and shared decision making. Both parties were willing to explore modalities and decision aid tools to improve shared decision making; however, while patients were interested in individual risk prediction, few PCPs believed statistical approaches to counseling would confuse patients. CONCLUSIONS While patients and providers are receptive to LDCT screening, efforts are needed to improve guideline knowledge and adherence among providers. System-level interventions are necessary to facilitate time and resources for shared decision making and smoking cessation counseling and treatment. Further research is needed to identify optimal strategies for effective lung cancer screening in the community.
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117
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van der Aalst CM, Ten Haaf K, de Koning HJ. Lung cancer screening: latest developments and unanswered questions. THE LANCET RESPIRATORY MEDICINE 2017; 4:749-761. [PMID: 27599248 DOI: 10.1016/s2213-2600(16)30200-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/29/2016] [Accepted: 07/04/2016] [Indexed: 12/13/2022]
Abstract
The US National Lung Screening Trial showed that individuals randomly assigned to screening with low-dose CT scans had 20% lower lung cancer mortality than did those screened with conventional chest radiography. On the basis of a review of the literature and a modelling study, the US Preventive Services Task Force recommends annual screening for lung cancer for individuals aged 55-80 years who have a 30 pack-year smoking history and either currently smoke or quit smoking within the past 15 years. However, the balance between benefits and harms of lung cancer screening is still greatly debated. The large number of false-positive results and the potential for overdiagnosis are causes for concern. Some investigators suggest the ratio between benefits and harms could be improved through various means. Nevertheless, many questions remain with regard to the implementation of lung cancer screening. This paper highlights the latest developments in CT lung cancer screening and provides an overview of the main unanswered questions.
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Affiliation(s)
- Carlijn M van der Aalst
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands.
| | - Kevin Ten Haaf
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
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118
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Carreras G, Gorini G. Challenges of quitting smoking and lung cancer screening. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:488. [PMID: 29299450 DOI: 10.21037/atm.2017.09.40] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Giulia Carreras
- Cancer Prevention and Research Institute (ISPO), Florence, Italy
| | - Giuseppe Gorini
- Cancer Prevention and Research Institute (ISPO), Florence, Italy
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119
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Onaitis MW, Furnary AP, Kosinski AS, Kim S, Boffa D, Tong BC, Cowper P, Jacobs JP, Wright CD, Putnam JB, Fernandez FG. Prediction of Long-Term Survival After Lung Cancer Surgery for Elderly Patients in The Society of Thoracic Surgeons General Thoracic Surgery Database. Ann Thorac Surg 2017; 105:309-316. [PMID: 29174391 DOI: 10.1016/j.athoracsur.2017.06.071] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/23/2017] [Accepted: 06/28/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Prior risk models using the STS General Thoracic Surgery database (STS-GTSD) have been limited to 30-day outcomes. We have now linked STS data to Medicare data and sought to create a risk prediction model for long-term mortality after lung cancer resection in patients older than 65 years. METHODS The STS-GTSD was linked to Medicare data for lung cancer resections from 2002 to 2013 as previously reported. Successful linkage was performed in 29,899 lung cancer resection patients. Cox proportional hazards modeling was used to create a long-term survival model. Variable selection was performed using statistically significant univariate factors and known clinical predictors of outcome. Calibration was assessed by dividing the cohort into deciles of predicted survival and discrimination assessed with a C-statistic corrected for optimism via 1,000 bootstrap replications. RESULTS Median age was 73 years (interquartile range, 68 to 78 years), and 48% of the patients were male. Of the 29,094 patients with nonmissing pathologic stage, 69% were stage I, 18% stage II, 11% stage III, and 2% stage IV. Procedure performed was lobectomy in 69%, bilobectomy in 3%, pneumonectomy in 3%, segmentectomy in 7%, sleeve lobectomy in 1%, and wedge resection in 17%. Thoracoscopic approach was performed in 47% of resections. The final Cox model reveals that stage and age are the strongest predictors of long-term survival. Even after controlling for stage, wedge resection, segmentectomy, bilobectomy, and pneumonectomy are all associated with increased hazard of death in comparison with lobectomy. Thoracoscopic approach is associated with improved long-term survival in comparison with thoracotomy. Other modifiable predictive factors include smoking and low body mass index. Calibration of the model demonstrates excellent performance across all survival deciles and a C-statistic of 0.694. CONCLUSIONS The STS-GTSD-Medicare long-term risk model includes several novel factors associated with mortality. Although medical factors predict long-term survival, age and stage are the strong predictors. Despite this, procedure choice and thoracoscopic/open approach are potentially modifiable predictors of long-term survival after lung cancer resection.
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Affiliation(s)
- Mark W Onaitis
- Department of Surgery, University of California-San Diego, La Jolla, California.
| | | | - Andrzej S Kosinski
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Sunghee Kim
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Daniel Boffa
- Department of Surgery, Yale University, New Haven, Connecticut
| | - Betty C Tong
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Patricia Cowper
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Jeffrey P Jacobs
- Department of Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, Florida
| | - Cameron D Wright
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Joe B Putnam
- Department of Surgery, Baptist MD Anderson Cancer Center, Jacksonville, Florida
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Arenberg D. "Quick, Where Is My Cigarette?": Mining Tobacco History for More Information on Risk. J Thorac Oncol 2017; 12:1606-1607. [PMID: 29074206 DOI: 10.1016/j.jtho.2017.09.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Douglas Arenberg
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan.
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Abstract
CLINICAL/METHODICAL ISSUE Attempts at the early detection of lung cancer using imaging methods began as far back as the 1950s. STANDARD RADIOLOGICAL METHODS Several studies attempted to demonstrate a reduction of lung cancer mortality by chest radiography screening but all were unsuccessful. METHODICAL INNOVATIONS Even the first small screening studies using computed tomography (CT) could not demonstrate a reduction in lung cancer-specific mortality until in 2011 the results of the largest randomized controlled low-dose CT screening study in the USA (NLST) were published. The NLST results could show a significant 20 % reduction of lung cancer mortality in elderly and heavy smokers using CT. PERFORMANCE Confirmation of the NLST results are urgently needed so that the data of the largest European study (NELSON) are eagerly awaited. ACHIEVEMENTS Pooled with the data from several smaller European studies these results will provide important information and evidence for the establishment of future CT screening programs in Europe. PRACTICAL RECOMMENDATIONS Randomized controlled trials are the basis of evidence-based medicine; therefore, the positive results of the methodologically very good NLST study cannot be ignored, even if it is the only such study completed so far with highly convincing conclusions. The NLST results clearly demonstrate that positive effects for the health of the population can only be expected if the processes are clearly defined and the quality is assured.
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Ruparel M, Navani N. Young at Heart: Is That Good Enough for Computed Tomography Screening? Am J Respir Crit Care Med 2017; 196:539-541. [PMID: 28806529 DOI: 10.1164/rccm.201707-1504ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Mamta Ruparel
- 1 Lungs for Living Research Centre University College London London, United Kingdom and
| | - Neal Navani
- 2 University College London Hospital London, United Kingdom
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Zhang J, Jiang H, Sun M, Chen J. Association between periodontal disease and mortality in people with CKD: a meta-analysis of cohort studies. BMC Nephrol 2017; 18:269. [PMID: 28814274 PMCID: PMC5558661 DOI: 10.1186/s12882-017-0680-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 07/28/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Periodontal disease occurs relatively prevalently in people with chronic kidney disease (CKD), but it remains indeterminate whether periodontal disease is an independent risk factor for premature death in this population. Interventions to reduce mortality in CKD population consistently yield to unsatisfactory results and new targets are necessitated. So this meta-analysis aimed to evaluate the association between periodontal disease and mortality in the CKD population. METHODS Pubmed, Embase, Web of Science, Scopus and abstracts from recent relevant meeting were searched by two authors independently. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated for overall and subgroup meta-analyses. Statistical heterogeneity was explored by chi-square test and quantified by the I2 statistic. RESULTS Eight cohort studies comprising 5477 individuals with CKD were incorporated. The overall pooled data demonstrated that periodontal disease was associated with all-cause death in CKD population (RR, 1.254; 95% CI 1.046-1.503; P = 0.005), with a moderate heterogeneity, I2 = 52.2%. However, no evident association was observed between periodontal disease and cardiovascular mortality (RR, 1.30, 95% CI, 0.82-2.06; P = 0.259). Besides, statistical heterogeneity was substantial (I2 = 72.5%; P = 0.012). Associations for mortality were similar between subgroups, such as the different stages of CKD, adjustment for confounding factors. Specific to all-cause death, sensitivity and cumulative analyses both suggested that our results were robust. As for cardiovascular mortality, the association with periodontal disease needs to be further strengthened. CONCLUSIONS We demonstrated that periodontal disease was associated with an increased risk of all-cause death in CKD people. Yet no adequate evidence suggested periodontal disease was also at elevated risk for cardiovascular death.
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Affiliation(s)
- Jian Zhang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China
- Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of PR China, Hangzhou, People's Republic of China
- Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Key Laboratory of Nephropathy, Hangzhou, Zhejiang Province, People's Republic of China
| | - Hong Jiang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China.
- Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of PR China, Hangzhou, People's Republic of China.
- Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Key Laboratory of Nephropathy, Hangzhou, Zhejiang Province, People's Republic of China.
| | - Min Sun
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China.
- Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of PR China, Hangzhou, People's Republic of China.
- Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Key Laboratory of Nephropathy, Hangzhou, Zhejiang Province, People's Republic of China.
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Gu F, Cheung LC, Freedman ND, Katki HA, Caporaso NE. Potential Impact of Including Time to First Cigarette in Risk Models for Selecting Ever-Smokers for Lung Cancer Screening. J Thorac Oncol 2017; 12:1646-1653. [PMID: 28818607 DOI: 10.1016/j.jtho.2017.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Selecting individuals on the basis of model-predicted risks has been reported to improve lung cancer screening efficiency. On the basis of case-control studies, time to first cigarette (TTFC), a nicotine dependency measurement, has been a strong independent predictor of lung cancer risk. Our objective was to verify the TTFC-lung cancer association in the prospective National Lung Screening Trial and evaluate whether adding TTFC can improve lung cancer risk-prediction models. METHODS Using Cox models, we examined associations between TTFC (≤5, 6-14, 15-29, 30-59, and ≥60 minutes) and lung cancer incidence and death in 18,729 National Lung Screening Trial participants, adjusting for smoking and other lung cancer risk factors comprehensively. We estimated 5-year individual lung cancer incidence by using models without and with TTFC and dichotomized into screening or no-screening groups based on risk thresholds of 1% and 2%. Area under the receiver operating curve values were calculated for models without and with TTFC. RESULTS Smokers with a TTFC of 60 minutes or more had a much lower standardized 5-year lung cancer incidence risk-1.54% (1.52%-1.56%) for TTFC 60 minutes or more versus 4.07% (4.04%-4.09%) for TTFC 5 minutes or less-and lung cancer death risk-0.59% (0.57%-0.61%) for TTFC 60 minutes or more versus 2.26% (2.23%-2.28%) for TTFC 5 minutes or less (p trend < 0.001). Adding TTFC to the lung cancer incidence model improved the area under the receiver operating curve by 0.0079 (95% confidence interval = 0.0019-0.0138 [p = 0.0085]). Among 8994 smokers without a lung cancer diagnosis, 180 (2.00%) and 155 (1.67%) more people would be assigned to the no-screening group by adding TTFC to the model (p values for percent changes <0.001) at the 1% and 2% risk thresholds, respectively. CONCLUSION Including TTFC, which can be elicited by a single question at very low cost and noninvasively question, into risk models might better identify smokers with lower risk and could therefore be a safe, convenient tool to improve identification of those who benefit less from lung cancer screening.
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Affiliation(s)
- Fangyi Gu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland; Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York.
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Neil E Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Abstract
Lung cancer is the leading cause of cancer death in the United States. More than 80% of these deaths are attributed to tobacco use, and primary prevention can effectively reduce the cancer burden. The National Lung Screening Trial showed that low-dose computed tomography (LDCT) screening could reduce lung cancer mortality in high-risk patients by 20% compared with chest radiography. The US Preventive Services Task Force recommends annual LDCT screening for persons aged 55 to 80 years with a 30-pack-year smoking history, either currently smoking or having quit within 15 years.
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Affiliation(s)
- Richard M Hoffman
- Department of Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive SE 618 GH, Iowa City, IA 52242, USA.
| | - Rolando Sanchez
- Department of Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive C325 GH, Iowa City, IA 52242, USA
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Cressman S, Peacock SJ, Tammemägi MC, Evans WK, Leighl NB, Goffin JR, Tremblay A, Liu G, Manos D, MacEachern P, Bhatia R, Puksa S, Nicholas G, McWilliams A, Mayo JR, Yee J, English JC, Pataky R, McPherson E, Atkar-Khattra S, Johnston MR, Schmidt H, Shepherd FA, Soghrati K, Amjadi K, Burrowes P, Couture C, Sekhon HS, Yasufuku K, Goss G, Ionescu DN, Hwang DM, Martel S, Sin DD, Tan WC, Urbanski S, Xu Z, Tsao MS, Lam S. The Cost-Effectiveness of High-Risk Lung Cancer Screening and Drivers of Program Efficiency. J Thorac Oncol 2017; 12:1210-1222. [PMID: 28499861 DOI: 10.1016/j.jtho.2017.04.021] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Lung cancer risk prediction models have the potential to make programs more affordable; however, the economic evidence is limited. METHODS Participants in the National Lung Cancer Screening Trial (NLST) were retrospectively identified with the risk prediction tool developed from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. The high-risk subgroup was assessed for lung cancer incidence and demographic characteristics compared with those in the low-risk subgroup and the Pan-Canadian Early Detection of Lung Cancer Study (PanCan), which is an observational study that was high-risk-selected in Canada. A comparison of high-risk screening versus standard care was made with a decision-analytic model using data from the NLST with Canadian cost data from screening and treatment in the PanCan study. Probabilistic and deterministic sensitivity analyses were undertaken to assess uncertainty and identify drivers of program efficiency. RESULTS Use of the risk prediction tool developed from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial with a threshold set at 2% over 6 years would have reduced the number of individuals who needed to be screened in the NLST by 81%. High-risk screening participants in the NLST had more adverse demographic characteristics than their counterparts in the PanCan study. High-risk screening would cost $20,724 (in 2015 Canadian dollars) per quality-adjusted life-year gained and would be considered cost-effective at a willingness-to-pay threshold of $100,000 in Canadian dollars per quality-adjusted life-year gained with a probability of 0.62. Cost-effectiveness was driven primarily by non-lung cancer outcomes. Higher noncurative drug costs or current costs for immunotherapy and targeted therapies in the United States would render lung cancer screening a cost-saving intervention. CONCLUSIONS Non-lung cancer outcomes drive screening efficiency in diverse, tobacco-exposed populations. Use of risk selection can reduce the budget impact, and screening may even offer cost savings if noncurative treatment costs continue to rise.
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Affiliation(s)
- Sonya Cressman
- The Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada; The British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
| | - Stuart J Peacock
- The Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada; The British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Simon Fraser University, Vancouver, British Columbia, Canada
| | | | - William K Evans
- Cancer Care Ontario, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Natasha B Leighl
- University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John R Goffin
- McMaster University, Hamilton, Ontario, Canada; The Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada
| | - Alain Tremblay
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Geoffrey Liu
- University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Daria Manos
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul MacEachern
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada; Foothills Medical Centre, Calgary, Alberta, Canada
| | - Rick Bhatia
- Memorial University, St. John's, Newfoundland, Canada
| | - Serge Puksa
- McMaster University, Hamilton, Ontario, Canada; The Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada
| | - Garth Nicholas
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Annette McWilliams
- Fiona Stanley Hospital, Perth, Western Australia, Australia; University of Western Australia, Perth, Western Australia, Australia
| | - John R Mayo
- The University of British Columbia, Vancouver, British Columbia, Canada; The Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - John Yee
- The University of British Columbia, Vancouver, British Columbia, Canada; The Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - John C English
- The University of British Columbia, Vancouver, British Columbia, Canada; The Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Reka Pataky
- The Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada; The British Columbia Cancer Agency, Vancouver, British Columbia, Canada; The University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Michael R Johnston
- Beatrice Hunter Cancer Research Institute, Halifax, Nova Scotia, Canada; Dalhousie University, Halifax, Nova Scotia, Canada
| | - Heidi Schmidt
- Joint Department of Medical Imaging (University Health Network, Sinai Health Systems, Women's College Hospital) Toronto, Ontario, Canada
| | - Frances A Shepherd
- University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kam Soghrati
- Trillium Health Partners, Mississauga, Ontario, Canada
| | - Kayvan Amjadi
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | | | | | - Glenwood Goss
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Diana N Ionescu
- The British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | - Don D Sin
- Centre for Heart Lung Innovation, Institute for Heart and Lung Health, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, Institute for Heart and Lung Health, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Zhaolin Xu
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ming-Sound Tsao
- University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Stephen Lam
- The British Columbia Cancer Agency, Vancouver, British Columbia, Canada; The University of British Columbia, Vancouver, British Columbia, Canada
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Verri C, Borzi C, Holscher T, Dugo M, Devecchi A, Drake K, Sestini S, Suatoni P, Romeo E, Sozzi G, Pastorino U, Boeri M. Mutational Profile from Targeted NGS Predicts Survival in LDCT Screening-Detected Lung Cancers. J Thorac Oncol 2017; 12:922-931. [PMID: 28302568 PMCID: PMC6832691 DOI: 10.1016/j.jtho.2017.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/27/2017] [Accepted: 03/02/2017] [Indexed: 12/17/2022]
Abstract
Background: The issue of overdiagnosis in low-dose computed tomography (LDCT) screening trials could be addressed by the development of complementary bio-markers able to improve detection of aggressive disease. The mutation profile of LDCT screening–detected lung tumors is currently unknown. Methods: Targeted next-generation sequencing was performed on 94 LDCT screening–detected lung tumors. Associations with clinicopathologic features, survival, and the risk profile of a plasma microRNA signature classifier were analyzed. Results: The mutational spectrum and frequency observed in screening series was similar to that reported in public data sets, although a larger number of tumors without mutations in driver genes was detected. The 5-year overall survival (OS) rates of patients with and without mutations in the tumors were 66% and 100%, respectively (p = 0.015). By combining the mutational status with the microRNA signature classifier risk profile, patients were stratified into three groups with 5-year OS rates ranging from 42% to 97% (p < 0.0001) and the prognostic value was significant after controlling for stage (p = 0.02). Conclusion: Tumor mutational status along with a microRNA-based liquid biopsy can provide additional information in planning clinical follow-up in lung cancer LDCT screening programs.
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Affiliation(s)
- Carla Verri
- Department of Experimental Oncology and Molecular Medicine, Unit of Tumour Genomics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Borzi
- Department of Experimental Oncology and Molecular Medicine, Unit of Tumour Genomics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Todd Holscher
- Gensignia Life Sciences, Inc., San Diego, California
| | - Matteo Dugo
- Department of Experimental Oncology and Molecular Medicine, Unit of Functional Genomics and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Devecchi
- Department of Experimental Oncology and Molecular Medicine, Unit of Functional Genomics and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Stefano Sestini
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Suatoni
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisa Romeo
- Gensignia Life Sciences, Inc., San Diego, California
| | - Gabriella Sozzi
- Department of Experimental Oncology and Molecular Medicine, Unit of Tumour Genomics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Ugo Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mattia Boeri
- Department of Experimental Oncology and Molecular Medicine, Unit of Tumour Genomics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Chronic Obstructive Pulmonary Disease as a Lung Cancer Risk: Worth Its Weight in “GOLD”. Ann Am Thorac Soc 2017; 14:309-310. [DOI: 10.1513/annalsats.201701-008ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Evaluations of Implementation at Early-Adopting Lung Cancer Screening Programs: Lessons Learned. Chest 2017; 152:70-80. [PMID: 28223153 DOI: 10.1016/j.chest.2017.02.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/24/2016] [Accepted: 02/01/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Guidelines recommend lung cancer screening (LCS), and it is currently being adopted nationwide. The American College of Chest Physicians advises inclusion of specific programmatic components to ensure high-quality screening. However, little is known about how LCS has been implemented in practice. We sought to evaluate the experience of early-adopting programs, characterize barriers faced, and identify strategies to achieve successful implementation. METHODS We performed qualitative evaluations of LCS implementation at three Veterans Administration facilities, conducting semistructured interviews with key staff (n = 29). Guided by the Promoting Action on Research Implementation in Health Services framework, we analyzed transcripts using principals of grounded theory. RESULTS Programs successfully incorporated most recommended elements of LCS, although varying in approaches to patient selection, tobacco treatment, and quality audits. Barriers to implementation included managing workload to ensure appropriate evaluation of pulmonary nodules detected by screening and difficulty obtaining primary care "buy-in." To manage workload, programs used nurse coordinators to actively maintain screening registries, held multidisciplinary conferences that generated explicit management recommendations, and rolled out implementation in a staged fashion. Successful strategies to engage primary care providers included educational sessions, audit and feedback of local outcomes, and assisting with and assigning clear responsibility for nodule evaluation. Capitalizing on pre-existing relationships and including a designated program champion helped facilitate intradisciplinary communication. CONCLUSIONS Lung cancer screening implementation is a complex undertaking requiring coordination at many levels. The insight gained from evaluation of these early-adopting programs may inform subsequent design and implementation of LCS programs.
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Zingone A, Brown D, Bowman ED, Vidal O, Sage J, Neal J, Ryan BM. Relationship between anti-depressant use and lung cancer survival. Cancer Treat Res Commun 2017; 10:33-39. [PMID: 28944316 PMCID: PMC5603309 DOI: 10.1016/j.ctarc.2017.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES In recent years, the anti-cancer properties of several commonly used drugs have been explored, with drugs such as aspirin and beta-blockers associated with improved cancer outcomes. Previous preclinical work demonstrated that tricyclic anti-depressants have antitumor efficacy in lung cancer. Our goal was to examine the association between anti-depressant use and survival in lung cancer. MATERIALS AND METHODS We examined the association between use of common anti-depressants and survival in 1,097 lung cancer patients from the NCI-Maryland lung cancer study. The types of anti-depressants included in the study were norepinephrine and dopamine reuptake inhibitors, serotonin reuptake inhibitors, selective serotonin reuptake inhibitors, non-selective serotonin reuptake inhibitors, and tricyclic anti-depressants. Anti-depressant use was extracted from the medical history section of a detailed interviewer-administered questionnaire. Specific use in the three months before a lung cancer diagnosis was determined. Cox portioned hazards modeling was used to estimate the association between anti-depressant use with lung cancer-specific death with adjustment for potential confounding co-factors. RESULTS Anti-depressant use was associated with extended lung cancer-specific survival. In an analysis of specific classes of anti-depressant use, NDRIs and TCAs were associated with improved survival. Importantly, the extended survival associated with anti-depressants was maintained after adjustment for the clinical indications for these drugs, suggestive of a direct effect on lung cancer biology. CONCLUSIONS Considering the manageable and largely tolerable side effects of anti-depressants, and the low cost of these drugs, these results indicate that evaluation of anti-depressants as adjunct therapeutics with chemotherapy may have a translational effect for lung cancer patients.
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Affiliation(s)
- Adriana Zingone
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - Derek Brown
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - Elise D. Bowman
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - Oscar Vidal
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
| | - Julien Sage
- Departments of Pediatrics and Genetics, Stanford University, Stanford CA, 94305
| | - Joel Neal
- Department of Medicine, Division of Oncology
| | - Bríd M. Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892
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Baldwin D, Callister M. What is the Optimum Screening Strategy for the Early Detection of Lung Cancer. Clin Oncol (R Coll Radiol) 2016; 28:672-681. [DOI: 10.1016/j.clon.2016.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/04/2016] [Accepted: 07/11/2016] [Indexed: 01/26/2023]
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Cheng TYD, Cramb SM, Baade PD, Youlden DR, Nwogu C, Reid ME. The International Epidemiology of Lung Cancer: Latest Trends, Disparities, and Tumor Characteristics. J Thorac Oncol 2016; 11:1653-71. [PMID: 27364315 PMCID: PMC5512876 DOI: 10.1016/j.jtho.2016.05.021] [Citation(s) in RCA: 400] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 05/13/2016] [Accepted: 05/26/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Our aim was to update global lung cancer epidemiology and describe changing trends and disparities. METHODS We presented country-specific incidence and mortality from GLOBOCAN 2012 by region and socioeconomic factors via the Human Development Index (HDI). Between- and within-country incidence by histological type was analyzed by using International Agency for Research on Cancer data on cancer incidence on five continents. Trend analyses including data from the International Agency for Research on Cancer, cancer registries, and the WHO mortality database were conducted using joinpoint regression. Survival was compared between and within countries and by histological type. RESULTS In 2012, there were 1.82 and 1.59 million new lung cancer cases and deaths worldwide, respectively. Incidence was highest in countries with a very high HDI and lowest in countries with a low HDI (42.2 versus 7.9 in 100,000 for males and 21.8 versus 3.1 in 100,000 for females, respectively). In most countries with a very high HDI, as incidence in males decreased gradually (ranging from -0.3% in Spain to -2.5% in the United States each year), incidence in females continued to increase (with the increase ranging from 1.4% each year in Australia to 6.1% in recent years in Spain). Although histological type varied between countries, adenocarcinoma was more common than squamous cell carcinoma, particularly among females (e.g., in Chinese females, the adenocarcinoma-to-squamous cell carcinoma ratio was 6.6). Five-year relative survival varied from 2% (Libya) to 30% (Japan), with substantial within-country differences. CONCLUSIONS Lung cancer will continue to be a major health problem well through the first half of this century. Preventive strategies, particularly tobacco control, tailored to populations at highest risk are key to reducing the global burden of lung cancer.
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Affiliation(s)
- Ting-Yuan David Cheng
- Department of Cancer Prevention and Control, Roswell Park Cancer Institutes, Buffalo, New York
| | - Susanna M Cramb
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Danny R Youlden
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Chukwumere Nwogu
- Department of Thoracic Surgery, Roswell Park Cancer Institutes, Buffalo, New York
| | - Mary E Reid
- Department of Medicine, Roswell Park Cancer Institutes, Buffalo, New York.
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Effects of Implementation of Lung Cancer Screening at One Veterans Affairs Medical Center. Chest 2016; 150:1023-1029. [PMID: 27568228 DOI: 10.1016/j.chest.2016.08.1431] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/06/2016] [Accepted: 08/01/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lung cancer screening recommendations have been developed, but none are focused on veterans. We report the results of the lung cancer screening program at our Veterans Affairs medical center and compare them with historic results. METHODS All veterans between 55 and 74 years who were current smokers or quit within the past 15 years and had at least a 30-pack-year smoking history were invited to receive an annual low-dose chest CT scan beginning in December 2013. Demographics, CT scan results, and pathologic data of screened patients were recorded retrospectively. Overall results during the screening period were compared with results in veterans who received diagnoses from January 2011 to December 2013 (prescreening period). RESULTS From December 2013 through December 2014 (screening period), 1,832 patients obtained a screening CT scan. Their mean age was 65 years. A lung nodule was present in 439 of 1,832 patients (24%). Lung cancer was diagnosed in 55 of 1,832 screened patients (3.0%). During the prescreening period, 37% of every lung cancer detected at our center (30 of 82) was stage I or stage II. After implementation of the screening program that percentage rose to 60% (52 of 87; P < .01). During the screening period, 55 of the 87 diagnosed lung cancers (63%) were detected through the screening program. The number of lung cancers detected per month rose from 2.4 to 6.7 after implementation of the screening program (P < .01). CONCLUSIONS Implementation of lung cancer screening in the veteran population leads to detection of an increased number and proportion of early-stage lung cancers. Lung cancer screening in veterans may also increase the rate of lung cancer diagnoses in the immediate postimplementation period.
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Chianello Nicolau M, Pinto LFR, Nicolau-Neto P, de Pinho PRA, Rossini A, de Almeida Simão T, Soares Lima SC. Nicotinic cholinergic receptors in esophagus: Early alteration during carcinogenesis and prognostic value. World J Gastroenterol 2016; 22:7146-7156. [PMID: 27610024 PMCID: PMC4988301 DOI: 10.3748/wjg.v22.i31.7146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/15/2016] [Accepted: 05/04/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare expression of nicotinic cholinergic receptors (CHRNs) in healthy and squamous cell carcinoma-affected esophagus and determine the prognostic value.
METHODS: We performed RT-qPCR to measure the expression of CHRNs in 44 esophageal samples from healthy individuals and in matched normal surrounding mucosa, and in tumors from 28 patients diagnosed with esophageal squamous cell carcinoma (ESCC). Next, we performed correlation analysis for the detected expression of these receptors with the habits and clinico-pathological characteristics of all study participants. In order to investigate the possible correlations between the expression of the different CHRN subunits in both healthy esophagus and tissues from ESCC patients, correlation matrices were generated. Subsequently, we evaluated whether the detected alterations in expression of the various CHRNs could precede histopathological modifications during the esophageal carcinogenic processes by using receiver operating characteristic curve analysis. Finally, we evaluated the impact of CHRNA5 and CHRNA7 expression on overall survival by using multivariate analysis.
RESULTS: CHRNA3, CHRNA5, CHRNA7 and CHRNB4, but not CHRNA1, CHRNA4, CHRNA9 or CHRNA10, were found to be expressed in normal (healthy) esophageal mucosa. In ESCC, CHRNA5 and CHRNA7 were overexpressed as compared with patient-matched surrounding non-tumor mucosa (ESCC-adjacent mucosa; P < 0.0001 and P = 0.0091, respectively). Positive correlations were observed between CHRNA3 and CHRNB4 expression in all samples analyzed. Additionally, CHRNB4 was found to be differentially expressed in the healthy esophagus and the normal-appearing ESCC-adjacent mucosa, allowing for distinguishment between these tissues with a sensitivity of 75.86% and a specificity of 78.95% (P = 0.0002). Finally, CHRNA5 expression was identified as an independent prognostic factor in ESCC; patients with high CHRNA5 expression showed an increased overall survival, in comparison with those with low expression. The corresponding age- and tumor stage-adjusted hazard ratio was 0.2684 (95%CI: 0.075-0.97, P = 0.0448).
CONCLUSION: Expression of CHRNs is homogeneous along healthy esophagus and deregulated in ESCC, suggesting a pathogenic role for these receptors in ESCC development and progression.
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Makinson A, Le Moing V, Reynes J, Ferry T, Lavole A, Poizot-Martin I, Pujol JL, Spano JP, Milleron B. Lung Cancer Screening with Chest Computed Tomography in People Living with HIV: A Review by the Multidisciplinary CANCERVIH Working Group. J Thorac Oncol 2016; 11:1644-52. [PMID: 27449803 DOI: 10.1016/j.jtho.2016.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/16/2016] [Accepted: 06/27/2016] [Indexed: 01/16/2023]
Abstract
A shift in mortality and morbidity has been observed in people living with human immunodeficiency virus (PLWHIV) from acquired immunodeficiency syndrome (AIDS) to non-AIDS diseases. Lung cancer has the highest incidence rates among all the non-AIDS-defining malignancies and is associated with mortality rates that exceed those of other cancers. Strategies to increase lung cancer survival in PLWHIV are needed. Lung cancer screening with chest LDCT has been shown to be efficient in the general population at risk. The objective of this review is to discuss lung cancer screening with chest computed tomography in PLWHIV. Lung cancer screening in PLWHIV is feasible. Whether PLWHIV could benefit from an age threshold for screening that is earlier than the minimum age of 55 years usually required in the general population still needs further investigation. Studies evaluating smoking cessation programs and how they could be articulated with lung cancer screening programs are also needed in PLWHIV.
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Affiliation(s)
- Alain Makinson
- Department of Infectious and Tropical Diseases, U1175-National Institute of Health and Medical Research/Mixt International Department 233, Development Research Institute, University Montpellier, Montpellier, France.
| | - Vincent Le Moing
- Department of Infectious and Tropical Diseases, U1175-National Institute of Health and Medical Research/Mixt International Department 233, Development Research Institute, University Montpellier, Montpellier, France
| | - Jacques Reynes
- Department of Infectious and Tropical Diseases, U1175-National Institute of Health and Medical Research/Mixt International Department 233, Development Research Institute, University Montpellier, Montpellier, France
| | - Tristan Ferry
- Infectious and Tropical Disease Unit, University Hospital de la Croix Rousse, Lyon, France
| | - Armelle Lavole
- Department of Pneumology and Reanimation, Hôpital Tenon, Public Assistance-Parisian Hospitals, and Faculté de Médecine Pierre and Marie Curie, University Paris VI, Paris, France
| | - Isabelle Poizot-Martin
- Clinical Immunohaematology Service, University Aix-Marseille, Public Assistance-Hospitals of Marseille Sainte-Marguerite, National Institute of Health and Medical Research, U912 (Economical and Social Sciences of Health and Treatment of Medical Information), Marseille, France
| | - Jean-Louis Pujol
- Thoracic Oncology Unit, University Hospital Montpellier, Montpellier, French Cooperative Thoracic Intergroup, Paris, France
| | - Jean-Philippe Spano
- Department of Medical Oncology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Public Assistance-Parisian Hospitals, National Institute of Health and Medical Research, Mixt Research Department_S 1136, Institute Pierre Louis Epidemiology and of Public Health, Sorbonne University, University Pierre Marie Curie University Paris 06, Paris, France
| | - Bernard Milleron
- Respiratory Disease Department, Tenon Hospital APHP, Paris VI University, French Cooperative Thoracic Intergroup, Paris, France
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Smoking cessation interventions within the context of Low-Dose Computed Tomography lung cancer screening: A systematic review. Lung Cancer 2016; 98:91-98. [PMID: 27393513 DOI: 10.1016/j.lungcan.2016.05.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/19/2016] [Accepted: 05/29/2016] [Indexed: 12/17/2022]
Abstract
The integration of smoking cessation interventions (SCIs) within the context of lung cancer screening programs is strongly recommended by screening guidelines, and is a requirement for Medicare coverage of screening in the US. In Europe, there are no lung cancer screening guidelines, however, research trials are ongoing, and prominent professional societies have begun to recommend lung cancer screening. Little is known about the types and efficacy of SCIs among patients receiving low-dose computed tomography (LDCT) screening. This review addresses this gap. Based on a systematic search, we identified six empirical studies published prior to July 1, 2015, that met inclusion criteria for our review: English language, SCI for LDCT patients, and reported smoking-related outcomes. Three randomized studies and three single-arm studies were identified. Two randomized controlled trials (RCTs) evaluated self-help SCIs, whereas one pilot RCT evaluated the timing (before or after the LDCT scan) of a combined (counseling and pharmacotherapy) SCI. Among the single-arm trials, two observational studies evaluated the efficacy of combined SCI, and one retrospectively assessed the efficacy of clinician-delivered smoking assessment, advice, and assistance. Given the limited research to date, and particularly the lack of studies reporting results from RCTs, assumptions that SCIs would be effective among this population should be made with caution. Findings from this review suggest that participation in a lung screening trial promotes smoking cessation and may represent a teachable moment to quit smoking. Findings also suggest that providers can take advantage of this potentially teachable moment, and that SCIs have been successfully implemented in screening settings. Continued systematic and methodologically sound research in this area will help improve the knowledge base and implementation of interventions for this population of smokers at risk for chronic disease.
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Adamek M, Wachuła E, Szabłowska-Siwik S, Boratyn-Nowicka A, Czyżewski D. Risk factors assessment and risk prediction models in lung cancer screening candidates. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:151. [PMID: 27195269 DOI: 10.21037/atm.2016.04.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
From February 2015, low-dose computed tomography (LDCT) screening entered the armamentarium of diagnostic tools broadly available to individuals at high-risk of developing lung cancer. While a huge number of pulmonary nodules are identified, only a small fraction turns out to be early lung cancers. The majority of them constitute a variety of benign lesions. Although it entails a burden of the diagnostic work-up, the undisputable benefit emerges from: (I) lung cancer diagnosis at earlier stages (stage shift); (II) additional findings enabling the implementation of a preventive action beyond the realm of thoracic oncology. This review presents how to utilize the risk factors from distinct categories such as epidemiology, radiology and biomarkers to target the fraction of population, which may benefit most from the introduced screening modality.
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Affiliation(s)
- Mariusz Adamek
- 1 The Chair and Department of Thoracic Surgery, The Professor S. Szyszko Teaching Hospital No. 1, Zabrze, Poland ; 2 Department of Clinical Oncology, Medical University of Silesia, Katowice, Poland
| | - Ewa Wachuła
- 1 The Chair and Department of Thoracic Surgery, The Professor S. Szyszko Teaching Hospital No. 1, Zabrze, Poland ; 2 Department of Clinical Oncology, Medical University of Silesia, Katowice, Poland
| | - Sylwia Szabłowska-Siwik
- 1 The Chair and Department of Thoracic Surgery, The Professor S. Szyszko Teaching Hospital No. 1, Zabrze, Poland ; 2 Department of Clinical Oncology, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Boratyn-Nowicka
- 1 The Chair and Department of Thoracic Surgery, The Professor S. Szyszko Teaching Hospital No. 1, Zabrze, Poland ; 2 Department of Clinical Oncology, Medical University of Silesia, Katowice, Poland
| | - Damian Czyżewski
- 1 The Chair and Department of Thoracic Surgery, The Professor S. Szyszko Teaching Hospital No. 1, Zabrze, Poland ; 2 Department of Clinical Oncology, Medical University of Silesia, Katowice, Poland
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Scientific Advances in Lung Cancer 2015. J Thorac Oncol 2016; 11:613-638. [DOI: 10.1016/j.jtho.2016.03.012] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 02/07/2023]
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Fucito LM, Czabafy S, Hendricks PS, Kotsen C, Richardson D, Toll BA. Pairing smoking-cessation services with lung cancer screening: A clinical guideline from the Association for the Treatment of Tobacco Use and Dependence and the Society for Research on Nicotine and Tobacco. Cancer 2016; 122:1150-9. [PMID: 26916412 PMCID: PMC4828323 DOI: 10.1002/cncr.29926] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/12/2016] [Accepted: 01/21/2016] [Indexed: 12/17/2022]
Abstract
Smoking cessation is crucial for reducing cancer risk and premature mortality. The US Preventive Services Task Force (USPSTF) has recommended annual lung cancer screening with low-dose computed tomography (LDCT), and the Center for Medicare and Medicaid Services recently approved lung screening as a benefit for patients ages 55 to 77 years who have a 30 pack-year history. The Society for Research on Nicotine and Tobacco (SRNT) and the Association for the Treatment of Tobacco Use and Dependence (ATTUD) developed the guideline described in this commentary based on an illustrative literature review to present the evidence for smoking-cessation health benefits in this high-risk group and to provide clinical recommendations for integrating evidence-based smoking-cessation treatment with lung cancer screening. Unfortunately, extant data on lung cancer screening participants were scarce at the time this guideline was written. However, in this review, the authors summarize the sufficient evidence on the benefits of smoking cessation and the efficacy of smoking-cessation interventions for smokers ages 55 to 77 years to provide smoking-cessation interventions for smokers who seek lung cancer screening. It is concluded that smokers who present for lung cancer screening should be encouraged to quit smoking at each visit. Access to evidence-based smoking-cessation interventions should be provided to all smokers regardless of scan results, and motivation to quit should not be a necessary precondition for treatment. Follow-up contacts to support smoking-cessation efforts should be arranged for smokers. Evidence-based behavioral strategies should be used at each visit to motivate smokers who are unwilling to try quitting/reducing smoking or to try evidence-based treatments that may lead to eventual cessation.
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Affiliation(s)
- Lisa M. Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Smilow Cancer Hospital at Yale-New Haven, New Haven, Connecticut
- Yale Cancer Center, New Haven, Connecticut
| | - Sharon Czabafy
- Wellspan Ephrata Community Hospital Wellness Center, Stevens, Pennsylvania
| | - Peter S. Hendricks
- Department of Human Behavior, School of Public Health, University of Alabama, Birmingham, Alabama
| | - Chris Kotsen
- Tobacco Quitcenter, Lung Cancer Institute, Steeplechase Cancer Center, Robert Wood Johnson University Hospital, Somerville, New Jersey
| | - Donna Richardson
- Tobacco Dependence Program, Cancer Institute of New Jersey, School of Public Health, Robert Wood Johnson Medical School at Rutgers, New Brunswick, New Jersey
| | - Benjamin A. Toll
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
- Hollings Cancer Center, Charleston, South Carolina
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Berg CD. Just Say No! Smoking Abstinence Works. Am J Respir Crit Care Med 2016; 193:476-7. [DOI: 10.1164/rccm.201511-2270ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Christine D. Berg
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins MedicineBaltimore, Marylandand
- Division of Cancer Epidemiology and PreventionNational Cancer InstituteBethesda, Maryland
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