151
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Specific peripheral miRNA profiles for distinguishing lung cancer from COPD. Lung Cancer 2011; 74:41-7. [PMID: 21388703 DOI: 10.1016/j.lungcan.2011.02.003] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 12/15/2010] [Accepted: 02/07/2011] [Indexed: 11/22/2022]
Abstract
Recently we reported differential miRNA signatures in blood cells of lung cancer patients and healthy controls. With the present study we wanted to investigate if miRNA blood signatures are also suited to differentiate lung cancer patients from COPD patients. We compared the expression of 863 human miRNAs in blood cells of lung cancer patients, COPD patients, and healthy controls. The miRNA pattern from patients with lung cancer and COPD were more similar to each other than to the healthy controls. However, we were able to discriminate lung cancer patients and COPD patients with 90.4% accuracy, 89.2% specificity, and 91.7% sensitivity. In total, 140 miRNAs were significant for the comparison COPD and controls, 61 miRNAs were significant for the comparison lung cancer and controls, and 14 miRNAs were significant for the comparison lung cancer and COPD. Screening target databases yielded over 400 putative targets for those 14 miRNAs. The predicted mRNA targets of three of the 14 miRNAs were significantly up-regulated in PBMCs of lung cancer patients compared to patients with non-malignant lung diseases. In conclusion, we showed that blood miRNA signatures are suitable to distinguish lung cancer from COPD.
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152
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Rabinovich RA, MacNee W. Chronic obstructive pulmonary disease and its comorbidities. Br J Hosp Med (Lond) 2011; 72:137-45. [DOI: 10.12968/hmed.2011.72.3.137] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - William MacNee
- UoE/MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ
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153
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Reynolds HY. Bronchoalveolar lavage and other methods to define the human respiratory tract milieu in health and disease. Lung 2011; 189:87-99. [PMID: 21350888 DOI: 10.1007/s00408-011-9284-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 02/01/2011] [Indexed: 01/19/2023]
Abstract
During fiber-optic bronchoscopy (FOB), surface sampling of the human respiratory airways and alveolar unit can be done with bronchoalveolar lavage (BAL), plus selective sites can be brushed for cells and transbronchial biopsies made in adjacent tissue. This permits analysis of the respiratory tract's milieu in healthy normals, in those with disease, and in control subjects. These combined procedures have been an established approach for obtaining specimens for research and for clinical assessment for over four decades. However, now new less invasive sampling methods are emerging. This review emphasizes BAL and the cellular and noncellular components recovered in fluid that have contributed to improving knowledge of how the respiratory tree's innate immunity can protect, and how airway structures can become deranged and manifest disease. After a discussion of training for FOB and procedural issues, a spectrum of respiratory diseases studied with BAL is presented, including airway illness (asthma and chronic obstructive pulmonary disease), diffuse interstitial lung diseases [idiopathic pulmonary fibrosis, rheumatoid interstitial lung disease (ILD), granulomatous ILDs], lung infections, lung malignancy, and upper and lower tract airway problems. Some recent studies with exhaled breath condensate analyses are given.
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Affiliation(s)
- Herbert Y Reynolds
- Lung Biology and Disease Branch, Division of Lung Diseases, National Heart, Lung & Blood Institute, 6701 Rockledge Drive, Suite 10042, Two Rockledge Center, MSC 7952, Bethesda, MD 20892-7952, USA.
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154
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Butler MW, Fukui T, Salit J, Shaykhiev R, Mezey JG, Hackett NR, Crystal RG. Modulation of cystatin A expression in human airway epithelium related to genotype, smoking, COPD, and lung cancer. Cancer Res 2011; 71:2572-81. [PMID: 21325429 DOI: 10.1158/0008-5472.can-10-2046] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The cathepsin inhibitor Cystatin A (CSTA) has antiapoptotic properties linked with neoplastic changes in squamous cell epithelium, where it has been proposed as a diagnostic and prognostic marker of lung cancer. Notably, cystatin A is upregulated in dysplastic epithelium, prompting us to hypothesize that it might be modulated in chronic obstructive pulmonary disease (COPD), a small airway epithelial (SAE) disorder that is a risk factor for non-small cell lung cancer (NSCLC) in a subset of smokers. Here we report that genetic variation, smoking, and COPD can all elevate levels of CSTA expression in lung small airway epithelia, with still further upregulation in squamous cell carcinoma (SCC), an NSCLC subtype. We examined SAE gene expression in 178 individuals, including healthy nonsmokers (n = 60), healthy smokers (n = 82), and COPD smokers (n = 36), with corresponding large airway epithelium (LAE) data included in a subset of subjects (n = 52). Blood DNA was genotyped by SNP microarray. Twelve SNPs upstream of the CSTA gene were found to associate with its expression in SAE. Levels were higher in COPD smokers than in healthy smokers, who, in turn, had higher levels than nonsmokers. CSTA gene expression in LAE was also smoking-responsive. Using publicly available NSCLC expression data we also found that CSTA was upregulated in SCC versus LAE and downregulated in adenocarcinoma versus smoke-exposed SAE. All phenotypes were associated with different proportional expression of CSTA to cathepsins. Our findings establish that genetic variability, smoking, and COPD all influence CSTA expression, as does SCC, supporting the concept that CSTA may make pivotal contributions to NSCLC pathogenesis in both early and late stages of disease development.
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Affiliation(s)
- Marcus W Butler
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, USA
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155
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Yang IA, Relan V, Wright CM, Davidson MR, Sriram KB, Savarimuthu Francis SM, Clarke BE, Duhig EE, Bowman RV, Fong KM. Common pathogenic mechanisms and pathways in the development of COPD and lung cancer. Expert Opin Ther Targets 2011; 15:439-56. [PMID: 21284573 DOI: 10.1517/14728222.2011.555400] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Lung cancer and COPD commonly coexist in smokers, and the presence of COPD increases the risk of developing lung cancer. In addition to smoking cessation and preventing smoking initiation, understanding the shared mechanisms of these smoking-related lung diseases is critical, in order to develop new methods of prevention, diagnosis and treatment of lung cancer and COPD. AREAS COVERED This review discusses the common mechanisms for susceptibility to lung cancer and COPD, which in addition to cigarette smoke, may involve inflammation, epithelial-mesenchymal transition, abnormal repair, oxidative stress, and cell proliferation. Furthermore, we discuss the underlying genomic and epigenomic changes (single nucleotide polymorphisms (SNPs), copy number variation, promoter hypermethylation and microRNAs) that are likely to alter biological pathways, leading to susceptibility to lung cancer and COPD (e.g., altered nicotine receptor biology). EXPERT OPINION Strategies to study genomics, epigenomics and gene-environment interaction will yield greater insight into the shared pathogenesis of lung cancer and COPD, leading to new diagnostic and therapeutic modalities.
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Affiliation(s)
- Ian A Yang
- The Prince Charles Hospital, Department of Thoracic Medicine, Thoracic Research Laboratory, Brisbane, Australia.
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156
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Evaluation of an early exercise intervention after thoracotomy for non-small cell lung cancer (NSCLC), effects on quality of life, muscle strength and exercise tolerance: Randomised controlled trial. Lung Cancer 2011; 71:229-34. [DOI: 10.1016/j.lungcan.2010.04.025] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 03/02/2010] [Accepted: 04/29/2010] [Indexed: 11/17/2022]
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157
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Moghaddam SJ, Ochoa CE, Sethi S, Dickey BF. Nontypeable Haemophilus influenzae in chronic obstructive pulmonary disease and lung cancer. Int J Chron Obstruct Pulmon Dis 2011; 6:113-23. [PMID: 21407824 PMCID: PMC3048087 DOI: 10.2147/copd.s15417] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is predicted to become the third leading cause of death in the world by 2020. It is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles and gases, most commonly cigarette smoke. Among smokers with COPD, even following withdrawal of cigarette smoke, inflammation persists and lung function continues to deteriorate. One possible explanation is that bacterial colonization of smoke-damaged airways, most commonly with nontypeable Haemophilus influenzae (NTHi), perpetuates airway injury and inflammation. Furthermore, COPD has also been identified as an independent risk factor for lung cancer irrespective of concomitant cigarette smoke exposure. In this article, we review the role of NTHi in airway inflammation that may lead to COPD progression and lung cancer promotion.
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Affiliation(s)
- Seyed Javad Moghaddam
- Department of Pulmonary Medicine, the University of Texas MD Anderson Cancer Center, 2121 W. Holcombe Boulevard, Houston, TX 77030, USA.
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158
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Perez CO, Mirabolfathinejad SG, Venado AR, Evans SE, Gagea M, Evans CM, Dickey BF, Moghaddam SJ. Interleukin 6, but not T helper 2 cytokines, promotes lung carcinogenesis. Cancer Prev Res (Phila) 2011; 4:51-64. [PMID: 21098042 PMCID: PMC3058282 DOI: 10.1158/1940-6207.capr-10-0180] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Several epidemiologic studies have found that smokers with chronic obstructive pulmonary disease (COPD), an inflammatory disease of the lung, have an increased risk of lung cancer compared with smokers without COPD. We have shown a causal role for COPD-like airway inflammation in lung cancer promotion in the CCSP(Cre)/LSL-K-ras(G12D) mouse model (CC-LR). In contrast, existing epidemiologic data do not suggest any definite association between allergic airway inflammation and lung cancer. To test this, CC-LR mice were sensitized to ovalbumin (OVA) and then challenged with an OVA aerosol weekly for 8 weeks. This resulted in eosinophilic lung inflammation associated with increased levels of T helper 2 cytokines and mucous metaplasia of airway epithelium, similar to what is seen in asthmatic patients. However, this type of inflammation did not result in a significant difference in lung surface tumor number (49 ± 9 in OVA vs. 52 ± 5 in control) in contrast to a 3.2-fold increase with COPD-like inflammation. Gene expression analysis of nontypeable Haemophilus influenzae (NTHi)-treated lungs showed upregulation of a different profile of inflammatory genes, including interleukin 6 (IL-6), compared with OVA-treated lungs. Therefore, to determine the causal role of cytokines that mediate COPD-like inflammation in lung carcinogenesis, we genetically ablated IL-6 in CC-LR mice. This not only inhibited intrinsic lung cancer development (1.7-fold) but also inhibited the promoting effect of extrinsic COPD-like airway inflammation (2.6-fold). We conclude that there is a clear specificity for the nature of inflammation in lung cancer promotion, and IL-6 has an essential role in lung cancer promotion.
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Affiliation(s)
- Cesar Ochoa Perez
- Departments of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
- Tecnológico de Monterrey School of Medicine, Monterrey, Nuevo León, Mexico
| | | | - Ana Ruiz Venado
- Tecnológico de Monterrey School of Medicine, Monterrey, Nuevo León, Mexico
| | - Scott E. Evans
- Departments of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
- Institute of Biosciences and Technology, Center for Inflammation and Infection, Houston, Texas, USA
| | - Mihai Gagea
- Department of Veterinary Medicine & Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Christopher M. Evans
- Departments of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
- Institute of Biosciences and Technology, Center for Inflammation and Infection, Houston, Texas, USA
| | - Burton F. Dickey
- Departments of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
- Institute of Biosciences and Technology, Center for Inflammation and Infection, Houston, Texas, USA
| | - Seyed Javad Moghaddam
- Departments of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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159
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Rooney C, Sethi T. The Epithelial Cell and Lung Cancer: The Link between Chronic Obstructive Pulmonary Disease and Lung Cancer. Respiration 2011; 81:89-104. [DOI: 10.1159/000323946] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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160
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Aberle DR, Adams AM, Berg CD, Clapp JD, Clingan KL, Gareen IF, Lynch DA, Marcus PM, Pinsky PF. Baseline characteristics of participants in the randomized national lung screening trial. J Natl Cancer Inst 2010; 102:1771-9. [PMID: 21119104 PMCID: PMC2994863 DOI: 10.1093/jnci/djq434] [Citation(s) in RCA: 232] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background The National Lung Screening Trial (NLST), a randomized study conducted at 33 US sites, is comparing lung cancer mortality among persons screened with reduced dose helical computerized tomography and among persons screened with chest radiograph. In this article, we present characteristics of the study population. Methods Eligible participants were aged 55–74 years and were current or former smokers with a cigarette smoking history of at least 30 pack-years. Randomization was stratified by site, sex, and age. To assess representativeness of the study population, demographic characteristics of individuals from the general population who met NLST age and smoking history inclusion criteria were obtained from the Tobacco Use Supplement of the US Census Bureau Current Population Surveys. Results The NLST enrolled 53 456 persons, with 26 733 randomly assigned to chest radiograph screening and 26 723 to computerized tomography screening. Characteristics of the participants were as follows: 31 533 (59%) were men, 39 234 (73%) were younger than 65 years, 25 779 (48%) were current smokers, and 16 839 (32%) had a college or higher degree. Median cigarette exposure was 48 pack-years. Among Tobacco Use Supplement respondents who met NLST age and smoking history criteria, 59% were men, 65% were younger than 65 years, and 57% were current smokers. Median cigarette exposure among this group was 47 pack-years, and 14% had a college degree or higher. Conclusion The NLST cohort has a distribution of sex and pack-year history that is similar to the component of the general US population that meets the major NLST eligibility criteria; however, NLST participants are younger, better educated, and less likely to be current smokers.
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Affiliation(s)
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- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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161
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García Rodríguez LA, Wallander MA, Martín-Merino E, Johansson S. Heart failure, myocardial infarction, lung cancer and death in COPD patients: A UK primary care study. Respir Med 2010; 104:1691-9. [DOI: 10.1016/j.rmed.2010.04.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 03/31/2010] [Accepted: 04/22/2010] [Indexed: 01/23/2023]
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162
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Chen X, Wan J, Liu J, Xie W, Diao X, Xu J, Zhu B, Chen Z. Increased IL-17-producing cells correlate with poor survival and lymphangiogenesis in NSCLC patients. Lung Cancer 2010; 69:348-54. [DOI: 10.1016/j.lungcan.2009.11.013] [Citation(s) in RCA: 158] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 10/12/2009] [Accepted: 11/24/2009] [Indexed: 11/27/2022]
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163
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Leung CC, Lam TH, Yew WW, Chan WM, Law WS, Tam CM. Lower lung cancer mortality in obesity. Int J Epidemiol 2010; 40:174-82. [DOI: 10.1093/ije/dyq134] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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164
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165
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Soriano JB. Mortalidad en cáncer de pulmón y en enfermedad pulmonar obstructiva crónica. Arch Bronconeumol 2010; 46:281-2; author reply 282. [DOI: 10.1016/j.arbres.2009.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 11/21/2009] [Indexed: 11/26/2022]
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166
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Maldonado F, Bartholmai BJ, Swensen SJ, Midthun DE, Decker PA, Jett JR. Are airflow obstruction and radiographic evidence of emphysema risk factors for lung cancer? A nested case-control study using quantitative emphysema analysis. Chest 2010; 138:1295-302. [PMID: 20348193 DOI: 10.1378/chest.09-2567] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Several studies have identified airflow obstruction as a risk factor for lung cancer independent of smoking history, but the risk associated with the presence of radiographic evidence of emphysema has not been extensively studied. We proposed to assess this risk using a quantitative volumetric CT scan analysis. METHODS Sixty-four cases of lung cancer were identified from a prospective cohort of 1,520 participants enrolled in a spiral CT scan lung cancer screening trial. Each case was matched to six control subjects for age, sex, and smoking history. Quantitative CT scan analysis of emphysema was performed. Spirometric measures were also conducted. Data were analyzed using conditional logistic regression making use of the 1:6 set groups of 64 cases and 377 matched control subjects. RESULTS Decreased FEV(1) and FEV(1)/FVC were significantly associated with a diagnosis of lung cancer with ORs of 1.15 (95% CI, 1.00-1.32; P = .046) and 1.29 (95% CI, 1.02-1.62; P = .031), respectively. The quantity of radiographic evidence of emphysema was not found to be a significant risk for lung cancer with OR of 1.042 (95% CI, 0.816-1.329; P = .743). Additionally, there was no significant association between severe emphysema and lung cancer with OR of 1.57 (95% CI, 0.73-3.37). CONCLUSIONS We confirm previous observations that airflow obstruction is an independent risk factor for lung cancer. The absence of a clear relationship between radiographic evidence of emphysema and lung cancer using an automated quantitative volumetric analysis may result from different population characteristics than those of prior studies, radiographic evidence of emphysema quantitation methodology, or absence of any relationship between emphysema and lung cancer risk.
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Affiliation(s)
- Fabien Maldonado
- Division of Pulmonary and Critical Care Medicine, Rochester, MN 55905, USA.
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167
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Abstract
Peter Barnes discusses the growing epidemic of chronic obstructive pulmonary disease (COPD), especially in developing countries and among nonsmokers.
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Affiliation(s)
- Peter J Barnes
- National Heart & Lung Institute, Imperial College, London, United Kingdom.
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168
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Beaver LM, Stemmy EJ, Schwartz AM, Damsker JM, Constant SL, Ceryak SM, Patierno SR. Lung inflammation, injury, and proliferative response after repetitive particulate hexavalent chromium exposure. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:1896-902. [PMID: 20049209 PMCID: PMC2799464 DOI: 10.1289/ehp.0900715] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 08/19/2009] [Indexed: 05/13/2023]
Abstract
BACKGROUND Chronic inflammation is implicated in the development of several human cancers, including lung cancer. Certain particulate hexavalent chromium [Cr(VI)] compounds are well-documented human respiratory carcinogens that release genotoxic soluble chromate and are associated with fibrosis, fibrosarcomas, adenocarcinomas, and squamous cell carcinomas of the lung. Despite this, little is known about the pathologic injury and immune responses after repetitive exposure to particulate chromates. OBJECTIVES In this study we investigated the lung injury, inflammation, proliferation, and survival signaling responses after repetitive exposure to particulate chromate. METHODS BALB/c mice were repetitively treated with particulate basic zinc chromate or saline using an intranasal exposure regimen. We assessed lungs for Cr(VI)-induced changes by bronchoalveolar lavage, histologic examination, and immunohistochemistry. RESULTS Single exposure to Cr(VI) resulted in inflammation of lung tissue that persists for up to 21 days. Repetitive Cr(VI) exposure induced a neutrophilic inflammatory airway response 24 hr after each treatment. Neutrophils were subsequently replaced by increasing numbers of macrophages by 5 days after treatment. Repetitive Cr(VI) exposure induced chronic peribronchial inflammation with alveolar and interstitial pneumonitis dominated by lymphocytes and macrophages. Moreover, chronic toxic mucosal injury was observed and accompanied by increased airway pro-matrix metalloprotease-9. Injury and inflammation correlated with airways becoming immunoreactive for phosphorylation of the survival signaling protein Akt and the proliferation marker Ki-67. We observed a reactive proliferative response in epithelial cells lining airways of chromate-exposed animals. CONCLUSIONS These data illustrate that repetitive exposure to particulate chromate induces chronic injury and an inflammatory microenvironment that may promote Cr(VI) carcinogenesis.
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Affiliation(s)
- Laura M. Beaver
- Department of Pharmacology and Physiology
- Institute of Biomedical Sciences
| | - Erik J. Stemmy
- Institute of Biomedical Sciences
- Department of Microbiology, Immunology, and Tropical Medicine
| | | | - Jesse M. Damsker
- Institute of Biomedical Sciences
- Department of Microbiology, Immunology, and Tropical Medicine
| | - Stephanie L. Constant
- Institute of Biomedical Sciences
- Department of Microbiology, Immunology, and Tropical Medicine
| | - Susan M. Ceryak
- Department of Pharmacology and Physiology
- Institute of Biomedical Sciences
- Department of Medicine and
- GW Cancer Institute, George Washington University Medical Center, Washington, DC, USA
| | - Steven R. Patierno
- Department of Pharmacology and Physiology
- Institute of Biomedical Sciences
- GW Cancer Institute, George Washington University Medical Center, Washington, DC, USA
- Address correspondence to S.R. Patierno, Department of Pharmacology and Physiology, George Washington University Medical Center, 2300 I St. NW, Washington, DC 20037 USA. Telephone: (202) 994-3286. Fax: (202) 994-2870. E-mail:
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169
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Gibbons MA, Sethi T. Chronic obstructive pulmonary disease and lung cancer: inflammation, the missing link. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/thy.09.77] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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170
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Koshiol J, Rotunno M, Consonni D, Pesatori AC, De Matteis S, Goldstein AM, Chaturvedi AK, Wacholder S, Landi MT, Lubin JH, Caporaso NE. Chronic obstructive pulmonary disease and altered risk of lung cancer in a population-based case-control study. PLoS One 2009; 4:e7380. [PMID: 19812684 PMCID: PMC2753644 DOI: 10.1371/journal.pone.0007380] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 09/15/2009] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) has been consistently associated with increased risk of lung cancer. However, previous studies have had limited ability to determine whether the association is due to smoking. METHODOLOGY/PRINCIPAL FINDINGS The Environment And Genetics in Lung cancer Etiology (EAGLE) population-based case-control study recruited 2100 cases and 2120 controls, of whom 1934 cases and 2108 controls reported about diagnosis of chronic bronchitis, emphysema, COPD (chronic bronchitis and/or emphysema), or asthma more than 1 year before enrollment. We estimated odds ratios (OR) and 95% confidence intervals (CI) using logistic regression. After adjustment for smoking, other previous lung diseases, and study design variables, lung cancer risk was elevated among individuals with a history of chronic bronchitis (OR = 2.0, 95% CI = 1.5-2.5), emphysema (OR = 1.9, 95% CI = 1.4-2.8), or COPD (OR = 2.5, 95% CI = 2.0-3.1). Among current smokers, association between chronic bronchitis and lung cancer was strongest among lighter smokers. Asthma was associated with a decreased risk of lung cancer in males (OR = 0.48, 95% CI = 0.30-0.78). CONCLUSIONS/SIGNIFICANCE These results suggest that the associations of personal history of chronic bronchitis, emphysema, and COPD with increased risk of lung cancer are not entirely due to smoking. Inflammatory processes may both contribute to COPD and be important for lung carcinogenesis.
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Affiliation(s)
- Jill Koshiol
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, United States of America.
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171
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Lawless MW, O'Byrne KJ, Gray SG. Oxidative stress induced lung cancer and COPD: opportunities for epigenetic therapy. J Cell Mol Med 2009; 13:2800-21. [PMID: 19602054 PMCID: PMC4498937 DOI: 10.1111/j.1582-4934.2009.00845.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Reactive oxygen species (ROS) form as a natural by-product of the normal metabolism of oxygen and play important roles within the cell. Under normal circumstances the cell is able to maintain an adequate homeostasis between the formation of ROS and its removal through particular enzymatic pathways or via antioxidants. If however, this balance is disturbed a situation called oxidative stress occurs. Critically, oxidative stress plays important roles in the pathogenesis of many diseases, including cancer. Epigenetics is a process where gene expression is regulated by heritable mechanisms that do not cause any direct changes to the DNA sequence itself, and disruption of epigenetic mechanisms has important implications in disease. Evidence is emerging that histone deacetylases (HDACs) play decisive roles in regulating important cellular oxidative stress pathways including those involved with sensing oxidative stress and those involved with regulating the cellular response to oxidative stress. In particular aberrant regulation of these pathways by HDACs may play critical roles in cancer progression. In this review we discuss the current evidence linking epigenetics and oxidative stress and cancer, using chronic obstructive pulmonary disease and non-small cell lung cancer to illustrate the importance of epigenetics on these pathways within these disease settings.
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Affiliation(s)
- Matthew W Lawless
- Centre for Liver Disease, School of Medicine and Medical Science, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
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172
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Gao Y, Goldstein AM, Consonni D, Pesatori AC, Wacholder S, Tucker MA, Caporaso NE, Goldin L, Landi MT. Family history of cancer and nonmalignant lung diseases as risk factors for lung cancer. Int J Cancer 2009; 125:146-52. [PMID: 19350630 PMCID: PMC2865851 DOI: 10.1002/ijc.24283] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Family history (FH) of lung cancer is an established risk factor for lung cancer, but the modifying effect of smoking in relatives has been rarely examined. Also, the role of FH of nonmalignant lung diseases on lung cancer risk is not well known. We examined the role of FH of cancer and nonmalignant lung diseases in lung cancer risk overall, and by personal smoking, FH of smoking and histology in 1,946 cases and 2,116 population-based controls within the Environment And Genetics in Lung cancer Etiology (EAGLE) study. Odds ratios (ORs) and 95% CI from logistic regression were calculated adjusting for age, gender, residence, education and cigarette smoking. FH of lung cancer in any family member was associated with increased lung cancer risk (OR = 1.57, 95% CI = 1.25-1.98). The odds associated with fathers', mothers' and siblings' history of lung cancer were 1.41, 2.14 and 1.53, respectively. The associations were generally stronger in never smokers, younger subjects and for the adenocarcinoma and squamous cell carcinoma subtypes. FH of chronic bronchitis and pneumonia was associated with increased (OR = 1.49, 95% CI = 1.23-1.80) and decreased (OR = 0.73, 95% CI = 0.61-0.87) lung cancer risk, respectively. FH of lung cancer and nonmalignant lung diseases affected lung cancer risk independently, and did not appear to be modified by FH of smoking.
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Affiliation(s)
- Ying Gao
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland, USA
| | - Alisa M. Goldstein
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland, USA
| | - Dario Consonni
- EPOCA, Epidemiology Research Center, University of Milan, and Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena
| | - Angela C. Pesatori
- EPOCA, Epidemiology Research Center, University of Milan, and Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena
| | - Sholom Wacholder
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland, USA
| | - Margaret A. Tucker
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland, USA
| | - Neil E. Caporaso
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland, USA
| | - Lynn Goldin
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland, USA
| | - Maria Teresa Landi
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland, USA
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173
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Hecht SS, Kassie F, Hatsukami DK. Chemoprevention of lung carcinogenesis in addicted smokers and ex-smokers. Nat Rev Cancer 2009; 9:476-88. [PMID: 19550424 PMCID: PMC3876956 DOI: 10.1038/nrc2674] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chemoprevention of lung carcinogenesis is one approach to controlling the epidemic of lung cancer caused by cigarette smoking. The target for chemoprevention should be the activities of the multiple carcinogens, toxicants, co-carcinogens, tumour promoters and inflammatory compounds in cigarette smoke. At present there are many agents, both synthetic and naturally occurring, that prevent lung tumour development in well-established animal models. It seems likely that logically constructed mixtures of these agents, developed from the ground up, will be necessary for the prevention of lung carcinogenesis.
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Affiliation(s)
- Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Mayo Mail Code 806, 420 Delaware Street South East, Minneapolis, Minnesota 55455, USA.
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174
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Chronic obstructive lung diseases and risk of non-small cell lung cancer in women. J Thorac Oncol 2009; 4:291-9. [PMID: 19190518 DOI: 10.1097/jto.0b013e3181951cd1] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The link between lung cancer and chronic obstructive lung diseases (COPD) has not been well studied in women even though lung cancer and COPD account for significant and growing morbidity and mortality among women. METHODS We evaluated the relationship between COPD and non-small cell lung cancer in a population-based case-control study of women and constructed a time course of chronic lung diseases in relation to onset of lung cancer. Five hundred sixty-two women aged 18 to 74, diagnosed with non-small cell lung cancer and 564 population-based controls matched on race and age participated. Multivariable unconditional logistic regression models were used to estimate risk associated with a history of COPD, chronic bronchitis, or emphysema. RESULTS Lung cancer risk increased significantly for white women with a history of COPD (odds ratios [OR] = 1.85; 95% confidence intervals [CI]: 1.21-2.81), but this was not seen in African American women. Risk associated with a history of chronic bronchitis was strongest when diagnosed at age 25 or earlier (OR = 2.35, 95% CI: 1.17-4.72); emphysema diagnosed within 9 years of lung cancer was also associated with substantial risk (OR = 6.36, 95% CI: 2.36-17.13). Race, pack-years of smoking, exposure to environmental tobacco smoke as an adult, childhood asthma, and exposure to asbestos were associated with a history of COPD among lung cancer cases. CONCLUSIONS In women, COPD is associated with risk of lung cancer differentially by race. Untangling whether COPD is in the causal pathway or simply shares risk factors will require future studies to focus on specific COPD features, while exploring underlying genetic susceptibility to these diseases.
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175
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Lam B, Lam SY, Wong MP, Ooi CG, Fong DY, Lam DC, Lai AY, Tam CM, Pang CB, Ip MS, Lam WK. Sputum cytology examination followed by autofluorescence bronchoscopy: A practical way of identifying early stage lung cancer in central airway. Lung Cancer 2009; 64:289-94. [PMID: 19010567 DOI: 10.1016/j.lungcan.2008.09.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 09/30/2008] [Accepted: 09/30/2008] [Indexed: 10/21/2022]
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Abstract
Lung disease in advanced stages is often accompanied by multiple comorbidities. Often, these processes lead to significant morbidity and occasionally mortality. Symptoms of pulmonary comorbidities, including pulmonary embolus, pulmonary hypertension, sleep-disordered breathing, and lung malignancy, may be intertwined with symptoms of advancing lung disease. However, the occurrence of extrapulmonary processes, including depression, diabetes mellitus, osteoporosis, and gastroesophageal reflux disease, may be subtle. Clinicians caring for advanced lung disease should be aware of the many comorbid processes that may accompany advancing lung disease.
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Affiliation(s)
- Joel Anthony Nations
- Pulmonary and Critical Care Medicine, National Naval Medicine Center, Bethesda, MD, USA.
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177
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Dubey S, Powell CA. Update in lung cancer 2008. Am J Respir Crit Care Med 2009; 179:860-8. [PMID: 19423719 PMCID: PMC2720086 DOI: 10.1164/rccm.200902-0289up] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 02/23/2009] [Indexed: 12/31/2022] Open
Affiliation(s)
- Sarita Dubey
- Division of Hematology and Oncology, University of California, San Francisco, California, USA
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178
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179
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Punturieri A, Szabo E, Croxton TL, Shapiro SD, Dubinett SM. Lung cancer and chronic obstructive pulmonary disease: needs and opportunities for integrated research. J Natl Cancer Inst 2009; 101:554-9. [PMID: 19351920 DOI: 10.1093/jnci/djp023] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Lung cancer and chronic obstructive pulmonary disease (COPD) are leading causes of morbidity and mortality in the United States and worldwide. They share a common environmental risk factor in cigarette smoke exposure and a genetic predisposition represented by the incidence of these diseases in only a fraction of smokers. The presence of COPD increases the risk of lung cancer up to 4.5-fold. To investigate commonalities in disease mechanisms and perspectives for disease chemoprevention, the National Heart, Lung, and Blood Institute (NHLBI) and the National Cancer Institute (NCI) held a workshop. The participants identified four research objectives: 1) clarify common epidemiological characteristics of lung cancer and COPD; 2) identify shared genetic and epigenetic risk factors; 3) identify and validate biomarkers, molecular signatures, and imaging-derived measurements of each disease; and 4) determine common and disparate pathogenetic mechanisms. These objectives should be reached via four research approaches: 1) identify, publicize, and enable the evaluation and analysis of existing datasets and repositories of biospecimens; 2) obtain phenotypic and outcome data and biospecimens from large studies of subjects with and/or at risk for COPD and lung cancer; 3) develop and use animal and other preclinical models to investigate pathogenetic links between the diseases; and 4) conduct early-phase clinical trials of potential chemopreventive agents. To foster much needed research interactions, two final recommendations were made by the participants: 1) incorporate baseline phenotyping and outcome measures for both diseases in future longitudinal studies of each disease and 2) expand collaborative efforts between the NCI and NHLBI.
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Affiliation(s)
- Antonello Punturieri
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Bethesda, MD 20892-7952, USA.
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180
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Abstract
OBJECTIVE To examine associations between occupation and lung cancer by gender and race. METHODS We used data from the Maryland Lung Cancer Study of nonsmall cell lung carcinoma (NSCLC), a multicenter case control study, to estimate odds ratios (ORs) of NSCLC in different occupations. RESULTS After adjusting for smoking, environmental tobacco smoke, and other covariates, NSCLC ORs among women but not men were elevated in clerical-sales, service, and transportation-material handling occupations; ORs were significantly increased in all three categories (OR [95% confidence interval]: 4.07 [1.44 to 11.48]; 5.15 [1.62 to 16.34]; 7.82 [1.08 to 56.25], respectively), among black women, but only in transportation-material handling occupations (OR [95% confidence interval[: 3.43 [1.02 to 11.50]) among white women. CONCLUSIONS Women, especially black women, in certain occupations had increased NSCLC ORs.
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181
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Mizuno S, Takiguchi Y, Fujikawa A, Motoori K, Tada Y, Kurosu K, Sekine Y, Yanagawa N, Hiroshima K, Muraoka K, Mitsushima T, Niki N, Tanabe N, Tatsumi K, Kuriyama T. Chronic obstructive pulmonary disease and interstitial lung disease in patients with lung cancer. Respirology 2009; 14:377-83. [PMID: 19192220 DOI: 10.1111/j.1440-1843.2008.01477.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Although lung cancer is frequently accompanied by COPD and interstitial lung disease (ILD), the precise coincidence of these diseases with lung cancer is not well understood. The objectives of this study were to determine the prevalence of abnormal CT and spirometric findings suggestive of COPD or ILD in a population of patients with untreated lung cancer, and to estimate the lung cancer risk in this population. METHODS The study population consisted of 256 patients with untreated lung cancer and 947 subjects participating in a CT screening programme for lung cancer. Semi-quantitative analysis of low attenuation area (LAA), fibrosis and ground glass attenuation (GGA) on CT was performed by scoring. Gender- and age-matched subpopulations, with stratification by smoking status, were compared using the Mantel-Haenszel projection method. RESULTS Inter-observer consistency was excellent for LAA, but not as good for fibrosis or GGA scores. Pooled odds ratios for lung cancer risk using LAA, fibrosis, GGA scores and reduced FEV(1)/FVC and %VC were 3.63, 5.10, 2.71, 7.17 and 4.73, respectively (P < 0.0001 for all parameters). Multivariate regression analyses confirmed these results. CONCLUSION Abnormal CT and spirometric parameters suggestive of COPD and ILD were strong risk factors for lung cancer, even after adjusting for gender, age and smoking status.
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Affiliation(s)
- Satoko Mizuno
- Department of Respirology, Graduaet School of Medicine, Chiba University, Chiba, Japan
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182
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Bliss A, Cobb N, Solomon T, Cravatt K, Jim MA, Marshall L, Campbell J. Lung cancer incidence among American Indians and Alaska Natives in the United States, 1999-2004. Cancer 2008; 113:1168-78. [PMID: 18720387 DOI: 10.1002/cncr.23738] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Lung cancer incidence rates among American Indians and Alaska Natives (AI/ANs) in the United States have not been described well, primarily because of race misclassification and, until the 1990s, incomplete coverage of their population by cancer registries. Smoking, the predominant cause of lung cancer, is particularly prevalent among this population. METHODS Data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program were combined to estimate age-adjusted incidence rates of lung cancer during 1999 through 2004. Cases were linked to Indian Health Service (IHS) registration databases to identify AI/ANs whose race may have been misclassified. Age-adjusted rates were calculated for Contract Health Service Delivery Area (CHSDA) counties and for all counties by IHS region, and comparisons were made between AI/ANs and non-Hispanic whites (NHWs). RESULTS Among populations living in CHSDA counties, NHWs overall had higher rates of lung cancer than AI/ANs. However, the rates (per 100,000 population) among AI/ANs varied substantially between IHS regions from 14.9 (Southwest) to 87.1 (Southern Plains), 93.2 (Alaska), and 104.3 (Northern Plains). Approximately 41.6% of AI/AN lung cancer cases were diagnosed before age 65 years compared with approximately 29.8% of NHW lung cancer cases. The overall percentage stage distribution was not different between AI/ANs and NHWs. Squamous cell carcinomas were slightly more common and adenocarcinomas were less common among AI/ANs than among NHWs. Lung cancer rates were not decreasing for AI/ANs as they were for NHWs. CONCLUSIONS Data from this study clarified the need for culturally appropriate tobacco prevention and control policies and resources for AI/ANs in all regions, and especially in the Plains and Alaska.
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Affiliation(s)
- Anne Bliss
- Chronic Disease Services, Oklahoma State Department of Health, Oklahoma City, Oklahoma, USA
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183
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Dragonieri S, Annema JT, Schot R, van der Schee MPC, Spanevello A, Carratú P, Resta O, Rabe KF, Sterk PJ. An electronic nose in the discrimination of patients with non-small cell lung cancer and COPD. Lung Cancer 2008; 64:166-70. [PMID: 18834643 DOI: 10.1016/j.lungcan.2008.08.008] [Citation(s) in RCA: 238] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 06/03/2008] [Accepted: 08/02/2008] [Indexed: 01/28/2023]
Abstract
BACKGROUND Exhaled breath contains thousands of gaseous volatile organic compounds (VOCs) that may be used as non-invasive markers of lung disease. The electronic nose analyzes VOCs by composite nano-sensor arrays with learning algorithms. It has been shown that an electronic nose can distinguish the VOCs pattern in exhaled breath of lung cancer patients from healthy controls. We hypothesized that an electronic nose can discriminate patients with lung cancer from COPD patients and healthy controls by analyzing the VOC-profile in exhaled breath. METHODS 30 subjects participated in a cross-sectional study: 10 patients with non-small cell lung cancer (NSCLC, [age 66.4+/-9.0, FEV(1) 86.3+/-20.7]), 10 patients with COPD (age 61.4+/-5.5, FEV(1) 70.0+/-14.8) and 10 healthy controls (age 58.3+/-8.1, FEV(1) 108.9+/-14.6). After 5 min tidal breathing through a non-rebreathing valve with inspiratory VOC-filter, subjects performed a single vital capacity maneuver to collect dried exhaled air into a Tedlar bag. The bag was connected to the electronic nose (Cyranose 320) within 10 min, with VOC-filtered room air as baseline. The smellprints were analyzed by onboard statistical software. RESULTS Smellprints from NSCLC patients clustered distinctly from those of COPD subjects (cross validation value [CVV]: 85%; M-distance: 3.73). NSCLC patients could also be discriminated from healthy controls in duplicate measurements (CVV: 90% and 80%, respectively; M-distance: 2.96 and 2.26). CONCLUSION VOC-patterns of exhaled breath discriminates patients with lung cancer from COPD patients as well as healthy controls. The electronic nose may qualify as a non-invasive diagnostic tool for lung cancer in the future.
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Affiliation(s)
- Silvano Dragonieri
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands.
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184
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Abstract
Chronic obstructive pulmonary disease (COPD) is now recognized as a major source of ill health around the world with an important impact on both developed and developing economies. The emphasis in research has shifted from a purely physiological focus that mainly considered how airway smooth muscle tone can be modulated to improve lung emptying. Although long-acting inhaled beta-agonist and antimuscarinic antagonists have improved clinical management for many symptomatic patents, there is increasing attention being paid to the inflammatory component of COPD in the airways and lung parenchyma and to its close association with other diseases, which cannot simply be attributed to their having a common risk factor such as tobacco smoking. This clinical review is intended to identify not only those areas where pharmacological treatment has been successful or has offered particular insights into COPD but also to consider where existing treatment is falling short and new opportunities exist to conduct original investigations. A picture of considerable complexity emerges with a range of clinical patterns leading to several common end points such as exacerbations, exercise impairment and mortality. Defining subsets of patients responsive to more specific interventions is the major challenge for the next decade in this field.
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185
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Kiri VA, Fabbri LM, Davis KJ, Soriano JB. Inhaled corticosteroids and risk of lung cancer among COPD patients who quit smoking. Respir Med 2008; 103:85-90. [PMID: 18793832 DOI: 10.1016/j.rmed.2008.07.024] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 07/23/2008] [Accepted: 07/27/2008] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES COPD is associated with an increased risk of lung cancer. We examined whether inhaled corticosteroids (ICS) used concomitantly with long-acting beta(2)-agonists (LABA) were associated with reduction in lung cancer risk in COPD patients. METHODS We conducted a retrospective cohort study of patients with a first-time diagnosis of COPD (index date) between 1989 and 2003 who were initially free of lung cancer, had quit smoking, were aged >or=50 years at time of diagnosis, and were regular users of ICS, ICS/LABA concomitantly, or short-acting bronchodilators (SABD). A nested case-control design was applied to overcome the time-varying nature of treatment. RESULTS We identified 7079 COPD patients who were regular users of the therapies of interest, of whom 127 subsequently had lung cancer and were matched to 1470 controls of same gender and age. Lung cancer was diagnosed in 6.0% of concomitant ICS/LABA users compared with 7.3% of ICS and 10.9% of SABD users. In multivariate analyses, reductions in lung cancer risk were observed, with hazard ratio (HR) 0.50 (95% confidence interval, 0.27-0.90) in ICS/LABA users and 0.64 (0.42-0.98) in ICS users, compared with SABD users. In assessing 'dose-response' relationships, we found risk reductions: HR of 0.75 (0.33-1.75) and 0.39 (0.19-0.79) in ICS/LABA users with 1-2 and 3+ prescriptions/year, respectively, and 0.88 (0.51-1.52) and 0.51 (0.30-0.84) in ICS users with 1-2 and 3+ prescriptions/year, respectively. CONCLUSIONS Regular use of ICS, with and without LABA, may reduce the risk of lung cancer among former smokers with diagnosed COPD.
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Affiliation(s)
- Victor A Kiri
- Worldwide Epidemiology, GlaxoSmithKline R&D, Greenford, UK.
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186
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Wilson DO, Weissfeld JL, Balkan A, Schragin JG, Fuhrman CR, Fisher SN, Wilson J, Leader JK, Siegfried JM, Shapiro SD, Sciurba FC. Association of radiographic emphysema and airflow obstruction with lung cancer. Am J Respir Crit Care Med 2008; 178:738-44. [PMID: 18565949 DOI: 10.1164/rccm.200803-435oc] [Citation(s) in RCA: 366] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE To study the relationship between emphysema and/or airflow obstruction and lung cancer in a high-risk population. OBJECTIVE We studied lung cancer related to radiographic emphysema and spirometric airflow obstruction in tobacco-exposed persons who were screened for lung cancer using chest computed tomography (CT). METHODS Subjects completed questionnaires, spirometry, and low-dose helical chest CT. CT scans were scored for emphysema based on National Emphysema Treatment Trial criteria. Multiple logistic regressions estimated the independent associations between various factors, including radiographic emphysema and airflow obstruction, and subsequent lung cancer diagnosis. MEASUREMENTS AND MAIN RESULTS Among 3,638 subjects, 57.5, 18.8, 14.6, and 9.1% had no, trace, mild, and moderate-severe emphysema, and 57.3, 13.6, 22.8, and 6.4% had no, mild (Global Initiative for Chronic Obstructive Lung Disease [GOLD] I), moderate (GOLD II), and severe (GOLD III-IV) airflow obstruction. Of 3,638 subjects, 99 (2.7%) received a lung cancer diagnosis. Adjusting for sex, age, years of cigarette smoking, and number of cigarettes smoked daily, logistic regression showed the expected lung cancer association with the presence of airflow obstruction (GOLD I-IV, odds ratio [OR], 2.09; 95% confidence interval [CI], 1.33-3.27). A second logistic regression showed lung cancer related to emphysema (OR, 3.56; 95% CI, 2.21-5.73). After additional adjustments for GOLD class, emphysema remained a strong and statistically significant factor related to lung cancer (OR, 3.14; 95% CI, 1.91-5.15). CONCLUSIONS Emphysema on CT scan and airflow obstruction on spirometry are related to lung cancer in a high-risk population. Emphysema is independently related to lung cancer. Both radiographic emphysema and airflow obstruction should be considered when assessing lung cancer risk.
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Affiliation(s)
- David O Wilson
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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187
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Nicotine and oxidative cigarette smoke constituents induce immune-modulatory and pro-inflammatory dendritic cell responses. Mol Immunol 2008; 45:3321-9. [PMID: 18533267 DOI: 10.1016/j.molimm.2008.04.014] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 04/23/2008] [Accepted: 04/24/2008] [Indexed: 01/28/2023]
Abstract
Chronic airway inflammation is a cardinal feature of chronic obstructive pulmonary disease (COPD), a destructive cigarette smoke-induced lung disease. Although it is apparent that dendritic cells (DCs) are an important constituent of the chronic inflammatory cell influx found in airways of COPD patients, the functional roles of DCs in the pathogenesis of smoking-induced emphysema are unknown. We postulated that DCs activated by cigarette smoke constituents directly participate in the chronic inflammation that characterizes COPD airways. Concordant with this hypothesis, we observed that incubation of DCs with cigarette smoke extract (CSE), and chronic exposure of mice to cigarette smoke, both augmented the generation of neutrophilic chemokines by immature and lipopolysaccharide (LPS) or CD40L-matured DCs. The generation of interleukin-8 (CXCL8/IL-8) by human DCs conditioned with CSE was suppressed by the anti-oxidant n-acetyl cysteine (NAC), implying the involvement of oxidant sensitive pathways as a primary mechanism involved in the enhanced CXCL8/IL-8 generation. Cigarette smoke extract and nicotine also augment the production of secreted prostaglandin-E2 and intra-cellular cyclo-oxygenase-2 (COX-2) in maturing DCs. Whereas NAC suppressed production of CXCL8 by CSE-conditioned DCs, it augmented production of PGE2 and cellular COX-2 levels in maturing DCs. These studies indicate that the stimulation of DCs by cigarette smoke-induced oxidative stress and nicotine promote the generation of pro-inflammatory responses that promote chronic inflammation in smokers. Certain pharmacologic strategies such as anti-oxidant therapy may be only partially effective in mitigating cigarette smoke-induced pro-inflammatory DC-mediated responses in smokers.
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188
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Dubey S, Powell CA. Update in lung cancer 2007. Am J Respir Crit Care Med 2008; 177:941-6. [PMID: 18434333 PMCID: PMC2720127 DOI: 10.1164/rccm.200801-107up] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 02/05/2008] [Indexed: 01/27/2023] Open
Affiliation(s)
- Sarita Dubey
- Division of Hematology and Oncology, University of California, San Francisco, San Francisco, California, USA
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189
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Impact of cancers and cardiovascular diseases in chronic obstructive pulmonary disease. Curr Opin Pulm Med 2008; 14:115-21. [DOI: 10.1097/mcp.0b013e3282f45ffb] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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190
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de Torres JP, Bastarrika G, Wisnivesky JP, Alcaide AB, Campo A, Seijo LM, Pueyo JC, Villanueva A, Lozano MD, Montes U, Montuenga L, Zulueta JJ. Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest. Chest 2008; 132:1932-8. [PMID: 18079226 DOI: 10.1378/chest.07-1490] [Citation(s) in RCA: 312] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Identification of risk factors for lung cancer can help in selecting patients who may benefit the most from smoking cessation interventions, early detection, or chemoprevention. OBJECTIVE To evaluate whether the presence of emphysema on low-radiation-dose CT (LDCT) of the chest is an independent risk factor for lung cancer. METHODS The study used data from a prospective cohort of 1,166 former and current smokers participating in a lung cancer screening study. All individuals underwent a baseline LDCT and spirometry followed by yearly repeat LDCT studies. The incidence density of lung cancer among patients with and without emphysema on LDCT was estimated. Stratified and multiple regression analyses were used to assess whether emphysema is an independent risk factor for lung cancer after adjusting for age, gender, smoking history, and the presence of airway obstruction on spirometry. RESULTS On univariate analysis, the incidence density of lung cancer among individuals with and without emphysema on LDCT was 25.0 per 1,000 person-years and 7.5 per 1,000 person-years, respectively (risk ratio [RR], 3.33; 95% confidence interval [CI], 1.41 to 7.85). Emphysema was also associated with increased risk of lung cancer when the analysis was limited to individuals without airway obstruction on spirometry (RR, 4.33; 95% CI, 1.04 to 18.16). Multivariate analysis showed that the presence of emphysema (RR, 2.51; 95% CI, 1.01 to 6.23) on LDCT but not airway obstruction (RR, 2.10; 95% CI, 0.79 to 5.58) was associated with increased risk of lung cancer after adjusting for potential cofounders. CONCLUSIONS Results suggest that the presence of emphysema on LDCT is an independent risk factor for lung cancer.
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Affiliation(s)
- Juan P de Torres
- Department of Respiratory Diseases, University Clinic of Navarra, University of Navarra, Navarra, Spain
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