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Islam JY, Nguyen OT, Turner K, Martinez YC, Rodriguez OG, Rodriguez DI, Rajasekhara S, Chang YD, Gonzalez BD, Jim HSL, Egan KM. Concurrent substance use among cancer patients with and without a history of cannabis use since cancer diagnosis at an NCI-Designated Cancer Center in Florida. J Natl Cancer Inst Monogr 2024; 2024:224-233. [PMID: 39108241 PMCID: PMC11303859 DOI: 10.1093/jncimonographs/lgad036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/30/2023] [Accepted: 11/06/2023] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Although substance use may have adverse impacts on cancer outcomes, little is known regarding patterns of concurrent substance use with cannabis among cancer patients. Our objective was to examine predictors of concurrent substance use with cannabis among cancer patients since their cancer diagnosis and explore perceptions of cannabis among these patients. METHODS Patients treated at a National Cancer Institute-designated comprehensive cancer center were invited to participate in an electronic survey regarding medical cannabis from August to November 2021. Survey data were linked to internal data resources including electronic health records and patient intake forms to obtain history of substance use (defined as within at least 3 months of cancer diagnosis) of cigarettes, injection drugs, high levels of alcohol, or clinically unsupervised prescription drugs (total n = 1094). Concurrent substance users were defined as those with any reported substance use and cannabis use at the time of cancer diagnosis. We used descriptive statistics (χ2 or exact tests) to compare groups and estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs) to identify predictors of substance use among users and nonusers of cannabis. RESULTS Approximately 45% (n = 489) of the sample reported cannabis use since their cancer diagnosis. Of patients who reported using cannabis, 20% self-reported concurrent polysubstance use, while 8% of cannabis nonusers reported substance use (P < .001). Among patients who use cannabis, those who reported 2 or more self-reported treatment-related symptoms (eg, pain, fatigue) were more likely to have self-reported concurrent substance use (AOR = 3.15, 95% CI = 1.07 to 9.27) compared with those without any symptoms. Among nonusers, those with lower educational background were more likely to have a history of concurrent substance use (AOR = 3.74, 95% CI = 1.57 to 8.92). Patients who use cannabis with concurrent substance use were more likely to report improved sleep (P = .04), increased appetite (P = .03), and treatment of additional medical conditions (P = .04) as perceived benefits of cannabis use. CONCLUSIONS High symptom burden may be associated with concurrent substance use with cannabis among cancer patients.
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Affiliation(s)
- Jessica Y Islam
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Oliver T Nguyen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kea Turner
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Yessica C Martinez
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Omar Garcia Rodriguez
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Sahana Rajasekhara
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Young D Chang
- Department of Supportive Care Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Brian D Gonzalez
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Heather S L Jim
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kathleen M Egan
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
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Blechter B, Wong JYY, Chien LH, Shiraishi K, Shu XO, Cai Q, Zheng W, Ji BT, Hu W, Rahman ML, Jiang HF, Tsai FY, Huang WY, Gao YT, Han X, Steinwandel MD, Yang G, Daida YG, Liang SY, Gomez SL, DeRouen MC, Diver WR, Reddy AG, Patel AV, Le Marchand L, Haiman C, Kohno T, Cheng I, Chang IS, Hsiung CA, Rothman N, Lan Q. Age at lung cancer diagnosis in females versus males who never smoke by race and ethnicity. Br J Cancer 2024; 130:1286-1294. [PMID: 38388856 PMCID: PMC11014844 DOI: 10.1038/s41416-024-02592-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND We characterized age at diagnosis and estimated sex differences for lung cancer and its histological subtypes among individuals who never smoke. METHODS We analyzed the distribution of age at lung cancer diagnosis in 33,793 individuals across 8 cohort studies and two national registries from East Asia, the United States (US) and the United Kingdom (UK). Student's t-tests were used to assess the study population differences (Δ years) in age at diagnosis comparing females and males who never smoke across subgroups defined by race/ethnicity, geographic location, and histological subtypes. RESULTS We found that among Chinese individuals diagnosed with lung cancer who never smoke, females were diagnosed with lung cancer younger than males in the Taiwan Cancer Registry (n = 29,832) (Δ years = -2.2 (95% confidence interval (CI):-2.5, -1.9), in Shanghai (n = 1049) (Δ years = -1.6 (95% CI:-2.9, -0.3), and in Sutter Health and Kaiser Permanente Hawai'i in the US (n = 82) (Δ years = -11.3 (95% CI: -17.7, -4.9). While there was a suggestion of similar patterns in African American and non-Hispanic White individuals. the estimated differences were not consistent across studies and were not statistically significant. CONCLUSIONS We found evidence of sex differences for age at lung cancer diagnosis among individuals who never smoke.
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Affiliation(s)
- Batel Blechter
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | - Jason Y Y Wong
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Li-Hsin Chien
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- Department of Applied Mathematics, Chung-Yuan Christian University, Chung-Li, Taiwan
| | - Kouya Shiraishi
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan
- Department of Clinical Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Bu-Tian Ji
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Wei Hu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Mohammad L Rahman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Hsin-Fang Jiang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Fang-Yu Tsai
- National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan
| | - Wen-Yi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China
| | - Xijing Han
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mark D Steinwandel
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gong Yang
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Su-Ying Liang
- Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA, USA
| | - Scarlett L Gomez
- Greater Bay Area Cancer Registry, University of California, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Mindy C DeRouen
- Greater Bay Area Cancer Registry, University of California, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - W Ryan Diver
- Department of Population Science, American Cancer Society, Kennesaw, GA, USA
| | - Ananya G Reddy
- Department of Population Science, American Cancer Society, Kennesaw, GA, USA
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Kennesaw, GA, USA
| | | | - Christopher Haiman
- Greater Bay Area Cancer Registry, University of California, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Takashi Kohno
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan
| | - Iona Cheng
- Greater Bay Area Cancer Registry, University of California, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - I-Shou Chang
- National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan
| | - Chao Agnes Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Lai H, Liu Q, Ye Q, Liang Z, Long Z, Hu Y, Wu Q, Jiang M. Impact of smoking cessation duration on lung cancer mortality: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2024; 196:104323. [PMID: 38462148 DOI: 10.1016/j.critrevonc.2024.104323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/11/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Smoking history is a heterogeneous situation for different populations, and numerous studies suggest that smoking cessation is conducive to reduce the mortality of lung cancer. However, no quantitative meta-analysis regarding smoking cessation duration based on different populations has demonstrated it clearly. METHODS We systematically searched four electronic databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Scoups) till February 2023. Eligible studies reported the association between lung cancer survival and duration of smoking cessation. Additionally, we stratified the study population according to whether they had lung cancer at the time they quit smoking. Studies were pooled with the random-effects model. RESULTS Out of the 11,361 potential studies initially identified, we included 24 studies involving 969,560 individuals in our analysis. Lung cancer mortality varied across two groups: general quitters and peri-diagnosis quitters. For general quitters, those who had quit smoking for less than 10 years exhibited an RR of 0.64 (95% CI [0.55-0.76]), while those who quit for 10-20 years had an RR of 0.33 (0.25-0.43), over 20 years had an RR of 0.16 (0.11-0.24), and never-smokers had an RR at 0.11 (0.07-0.15). Among peri-diagnosis quitters, the 1-year Overall Survival (OS) showed an RR of 0.80 (0.67-0.96), the 2-year OS had an RR of 0.89 (0.80-0.98), the 3-year OS had an RR of 0.93 (0.84-1.03), and the 5-year OS had an RR of 0.85 (0.76-0.96). CONCLUSIONS Earlier and longer smoking cessation is associated with reduced lung cancer mortality, no matter in which cessation stage for two different populations.
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Affiliation(s)
- Hongkun Lai
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Quanzhen Liu
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Nanshan College, Guangzhou Medical University, Guangzhou, Guangdong 510180, China
| | - Qianxian Ye
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Ziyang Liang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Zhiwei Long
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Yinghong Hu
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Qianlong Wu
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Mei Jiang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China.
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Wharram CE, Kyko JM, Ruterbusch JJ, Beebe-Dimmer JL, Schwartz AG, Cote ML. Use of electronic cigarettes among African American cancer survivors. Cancer 2023; 129:3334-3345. [PMID: 37395113 DOI: 10.1002/cncr.34933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/04/2023] [Accepted: 05/15/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The use of electronic cigarettes (e-cigarettes) is increasing rapidly in the United States, although the negative health outcomes associated with these products are still unknown. Emerging research has examined the use of e-cigarettes in the cancer survivor population as a whole, yet none has focused on e-cigarette use in the African American (AA) cancer survivor population. METHODS The authors used data from the Detroit Research on Cancer Survivors cohort study, comprised of AA adult cancer survivors. Logistic regression models were used to evaluate factors potentially associated with e-cigarette ever use and current use. RESULTS Of 4443 cancer survivors who completed a baseline interview, 8.3% (n = 370) reported ever using e-cigarettes, and 16.5% (n = 61) of those reporting ever use also reported current use of e-cigarettes. Ever users and current users were on average younger than those who did not use e-cigarettes (57.5 vs. 61.2 years; p < .001). Current cigarette smokers were >20 times more likely (odds ratio, 20.75; 95% confidence interval, 12.84-33.55) and former smokers were almost 10 times more likely (odds ratio, 9.50; 95% confidence interval, 6.03-14.97) to have ever used e-cigarettes than never-smokers. Preliminary data suggested that ever use of e-cigarettes is associated with later stage at diagnosis for breast and colorectal cancers. CONCLUSIONS As the use of e-cigarettes increases in the general population, it is important to continue to monitor their use in cancer survivors and to gain more insight as it pertains to the AA cancer survivor population. Elucidation of the factors associated with e-cigarette use in this population may help inform comprehensive cancer survivorship recommendations and interventions.
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Affiliation(s)
| | - Jaclyn M Kyko
- Department of Oncology, School of Medicine, Detroit, Michigan, USA
| | | | - Jennifer L Beebe-Dimmer
- Department of Oncology, School of Medicine, Detroit, Michigan, USA
- Population Sciences and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Ann G Schwartz
- Department of Oncology, School of Medicine, Detroit, Michigan, USA
- Population Sciences and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Michele L Cote
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
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5
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Fares AF, Li Y, Jiang M, Brown MC, Lam ACL, Aggarwal R, Schmid S, Leighl NB, Shepherd FA, Wang Z, Diao N, Wenzlaff AS, Xie J, Kohno T, Caporaso NE, Harris C, Ma H, Barnett MJ, Leal LF, Fernandez-Tardon G, Pérez-Ríos M, Davies MPA, Taylor F, Schöttker B, Brennan P, Zaridze D, Holcatova I, Lissowska J, Świątkowska B, Mates D, Savic M, Brenner H, Andrew A, Cox A, Field JK, Ruano-Ravina A, Shete SS, Tardon A, Wang Y, Le Marchand L, Reis RM, Schabath MB, Chen C, Shen H, Ryan BM, Landi MT, Shiraishi K, Zhang J, Schwartz AG, Tsao MS, Christiani DC, Yang P, Hung RJ, Xu W, Liu G. Association between duration of smoking abstinence before non-small-cell lung cancer diagnosis and survival: a retrospective, pooled analysis of cohort studies. Lancet Public Health 2023; 8:e691-e700. [PMID: 37633678 PMCID: PMC10540150 DOI: 10.1016/s2468-2667(23)00131-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The association between duration of smoking abstinence before non-small-cell lung cancer (NSCLC) diagnosis and subsequent survival can influence public health messaging delivered in lung-cancer screening. We aimed to assess whether the duration of smoking abstinence before diagnosis of NSCLC is associated with improved survival. METHODS In this retrospective, pooled analysis of cohort studies, we used 26 cohorts participating in Clinical Outcomes Studies of the International Lung Cancer Consortium (COS-ILCCO) at 23 hospitals. 16 (62%) were from North America, six (23%) were from Europe, three (12%) were from Asia, and one (4%) was from South America. Patients enrolled were diagnosed between June 1, 1983, and Dec 31, 2019. Eligible patients had smoking data before NSCLC diagnosis, epidemiological data at diagnosis (obtained largely from patient questionnaires), and clinical information (retrieved from medical records). Kaplan-Meier curves and multivariable Cox models (ie, adjusted hazard ratios [aHRs]) were generated with individual, harmonised patient data from the consortium database. We estimated overall survival for all causes, measured in years from diagnosis date until the date of the last follow-up or death due to any cause and NSCLC-specific survival. FINDINGS Of 42 087 patients with NSCLC in the COS-ILCCO database, 21 893 (52·0%) of whom were male and 20 194 (48·0%) of whom were female, we excluded 4474 (10·6%) with missing data. Compared with current smokers (15 036 [40·0%] of 37 613), patients with 1-3 years of smoking abstinence before NSCLC diagnosis (2890 [7·7%]) had an overall survival aHR of 0·92 (95% CI 0·87-0·97), patients with 3-5 years of smoking abstinence (1114 [3·0%]) had an overall survival aHR of 0·90 (0·83-0·97), and patients with more than 5 years of smoking abstinence (10 841 [28·8%]) had an overall survival aHR of 0·90 (0·87-0·93). Improved NSCLC-specific survival was observed in 4301 (44%) of 9727 patients who had quit cigarette smoking and was significant at abstinence durations of more than 5 years (aHR 0·87, 95% CI 0·81-0·93). Results were consistent across age, sex, histology, and disease-stage distributions. INTERPRETATION In this large, pooled analysis of cohort studies across Asia, Europe, North America, and South America, overall survival was improved in patients with NSCLC whose duration of smoking abstinence before diagnosis was as short as 1 year. These findings suggest that quitting smoking can improve overall survival, even if NSCLC is diagnosed at a later lung-cancer screening visit. These findings also support the implementation of public health smoking cessation strategies at any time. FUNDING The Alan B Brown Chair, The Posluns Family Fund, The Lusi Wong Fund, and the Princess Margaret Cancer Foundation.
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Affiliation(s)
- Aline F Fares
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; Division of Medical Oncology, Faculty of Medicine of São José do Rio Preto, São Paulo, Brazil
| | - Yao Li
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mei Jiang
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - M Catherine Brown
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andrew C L Lam
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Reenika Aggarwal
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sabine Schmid
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; Universitätsklinik für Medizinische Onkologie, Inselspital Bern, Bern, Switzerland
| | - Natasha B Leighl
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Zhichao Wang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Division of Pulmonary and Critical Care Medicine, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Nancy Diao
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Angela S Wenzlaff
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Juntao Xie
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Takashi Kohno
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan
| | - Neil E Caporaso
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Curtis Harris
- Laboratory of Human Carcinogenesis, Centre for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Hongxia Ma
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Matthew J Barnett
- Public Health Sciences, Biostatistics Program, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Leticia Ferro Leal
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | - G Fernandez-Tardon
- University Institute of Oncology of Asturias-Cajastur Social Programme, University of Oviedo, Oviedo, Spain; Health Research Institute of Asturias, Oviedo, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Oviedo, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Michael P A Davies
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Fiona Taylor
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK; Weston Park Cancer Centre, Sheffield Teaching Hospital Foundation Trust, Sheffield, UK
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network of Aging Research, Heidelberg University, Heidelberg, Germany
| | - Paul Brennan
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - David Zaridze
- N N Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - Ivana Holcatova
- Institute of Public Health and Preventive Medicine and Department of Oncology, Second Faculty of Medicine and University Hospital Motol, Charles University, Prague, Czech Republic
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, M Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | - Milan Savic
- Department of Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center, Heidelberg, Germany; National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | | | - Angela Cox
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - John K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Sanjay S Shete
- M D Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Adonina Tardon
- University Institute of Oncology of Asturias-Cajastur Social Programme, University of Oviedo, Oviedo, Spain; Health Research Institute of Asturias, Oviedo, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Oviedo, Spain
| | - Ying Wang
- American Cancer Society, Atlanta, GA, USA
| | - Loic Le Marchand
- University of Hawai'i Cancer Centre, University of Hawai'i, Honolulu, HI, USA
| | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil; Life and Health Sciences Research Institute, Medical School, University of Minho, Braga, Portugal; Life and Health Sciences Research Institute-Biomaterials, Biodegradables and Biomimetics Research Group Associate Laboratory, Braga, Portugal
| | | | - Chu Chen
- Program in Epidemiology, Cancer Prevention Program, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Hongbing Shen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Brid M Ryan
- Laboratory of Human Carcinogenesis, Centre for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Maria Teresa Landi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kouya Shiraishi
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan; Department of Clinical Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Jie Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ann G Schwartz
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Ming S Tsao
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - David C Christiani
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ping Yang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Rayjean J Hung
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, ON, Canada
| | - Wei Xu
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Geoffrey Liu
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Yu J, Zhang Y, Liu Z, He Y, Pei Y, Zhang R, Peng X, Fang F. Association of smoking with the survival of patients with brain metastasis of lung cancer. Front Neurol 2023; 14:1036387. [PMID: 36994380 PMCID: PMC10040669 DOI: 10.3389/fneur.2023.1036387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
BackgroundSmoking is associated with increased mortality in patients with cancer. However, there are limited data on the impact of smoking on the survival of patients with brain metastases. Therefore, this study aimed to evaluate whether smoking was associated with survival and whether smoking cessation was beneficial to these patients.MethodsThis study used lung cancer with a brain metastasis cohort of the West China Hospital of Sichuan University from 2013 to 2021. Patients were stratified according to smoking history; the distribution, clinical characteristics, and survival data of each group were estimated. Kaplan-Meier analysis and risk analysis were performed for the survival endpoint.ResultsOf the 2,647 patients included in the analysis, the median age was 57.8 years, and 55.4% were men. Among them, 67.1% had no smoking history, 18.9% still smoked, and 14% reported quitting smoking. Compared with never smokers, current smokers [HR, 1.51 (95% CI, 1.35-1.69), p < 0.01] and former smokers [HR, 1.32 (95% CI, 1.16-1.49), p<0.01] had an increased risk of death. However, quitting smoking was not associated with improved survival [HR, 0.90 (95% CI, 0.77-1.04), p = 0.16]. The overall survival increased with the increase of smoking cessation years.ConclusionsIn lung cancer patients with brain metastases, smoking was associated with an increased risk of death, but quitting smoking was not associated with improved survival.
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Affiliation(s)
- Jiayi Yu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Zhang
- Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Zheran Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yan He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yiyan Pei
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Renjie Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xingchen Peng
| | - Fang Fang
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Fang Fang
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Noelle H, Pérol O, Pérol M, Avrillon V, Belladame E, Fayette J, Fournié F, Swalduz A, Dessemon J, Blay JY, Neidhardt EM, Saintigny P, Tabutin M, Boussageon M, Praud D, Charbotel B, Fervers B. Occupational asbestos exposure and survival among lung cancer patients. Lung Cancer 2023; 179:107182. [PMID: 37001440 DOI: 10.1016/j.lungcan.2023.107182] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/21/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE This study investigated the association between occupational asbestos exposure (OAE) and survival in patients with histologically confirmed lung cancer (LC). METHODS This monocentric study was conducted in the Comprehensive Cancer Centre Léon Bérard, Lyon, France. A systematic screening has been in place since 2014 for occupational exposure to carcinogens using a self-assessment questionnaire sent to all patients newly diagnosed with histologically confirmed LC identified through the multidisciplinary LC board from 2014 to 2019. When the physician suspected a work-related exposure from the questionnaire including job history, an occupational cancer consultation was carried out to detail carcinogen exposures and assess if the LC was work-related. Demographics, clinical characteristics and survival data were extracted from medical records. The association between asbestos exposure and overall survival (hazard ratio and 95% confidence intervals) was estimated by Cox proportional hazards regression. RESULTS Overall, 702 patients were eligible to the present study, including 180 patients with OAE. In the crude analysis, LCs assessed as moderately or highly attributable to OAE were associated with decreased overall survival (HR = 1.32, 95 %CI 1.04-1.67) compared to LC without OAE or with a low degree of imputability to OAE (median follow-up 28.8 months). After adjustment for confounding (age at diagnosis, smoking status, stage, brain metastasis at diagnosis, and histology), the association of OAE with overall survival was no longer statistically significant (HR = 1.21, 95 %CI 0.94-1.56). CONCLUSION Overall survival in occupationally asbestos exposed LC patients may be decreased in comparison with non-exposed LC patients, warranting further investigations in larger studies.
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8
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Hsu EC, Wu KL, Tsai YM, Lee MH, Tsai MJ, Kuo CY, Liu YC, Liang FW, Yang CJ, Hung JY. Real-world treatment pattern and prognostic factors of stage IV lung squamous cell carcinoma patients. Kaohsiung J Med Sci 2022; 38:1001-1011. [PMID: 36214468 DOI: 10.1002/kjm2.12599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 06/16/2023] Open
Abstract
Lung squamous cell carcinoma (LUSC) represents a minor proportion of nonsmall cell lung cancer (NSCLC) harboring a poor prognosis. Herein, retrospective medical record research was performed to investigate real-world treatment patterns and identify the prognostic factors among LUSC patients. A total of 173 patients with a median age of 68 years were enrolled for analysis. Males were predominant (n = 143, 83%) and current or ex-smokers contributed to 78% of the entire cohort. Pleura and lung were the most common metastatic sites, whereas brain metastasis was only 7%. After diagnosis, however, only 107 patients (62%) had received first-line chemotherapy. In the chemotherapy cohort, median progression-free survival (PFS) and overall survival (OS) were 3.9 and 11.1 months, respectively. After multivariable analysis, bone metastasis and the use of first-line single-agent chemotherapy independently predicted shorter PFS. For baseline characteristics, male sex, metastasis to lung, pleura, liver, and bone independently predicted worse OS. Regarding the treatment pattern, patients who had undergone standard first-line doublet therapy and employed targeted therapies after disease progression linked to longer OS. In the real world, even those who underwent chemotherapy still had poor outcome. The findings may help clinicians to orchestrate the treatment strategies for LUSC patients and provide further direction of large-scale studies.
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Affiliation(s)
- En-Chi Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuan-Li Wu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Ming Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Hsuan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yu Kuo
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Chuan Liu
- Clinical Trial Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fu-Wen Liang
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Jen Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jen-Yu Hung
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Bian T, Wang Y, Botello JF, Hu Q, Jiang Y, Zingone A, Ding H, Wu Y, Zahra Aly F, Salloum RG, Warren G, Huo Z, Ryan BM, Jin L, Xing C. LKB1 phosphorylation and deactivation in lung cancer by NNAL, a metabolite of tobacco-specific carcinogen, in an isomer-dependent manner. Oncogene 2022; 41:4042-4054. [PMID: 35835853 DOI: 10.1038/s41388-022-02410-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/09/2022]
Abstract
LKB1 loss of function is one key oncogenic event in lung cancer. Clinical data suggest that LKB1 loss of function is associated with patients' smoking status. The responsible ingredients and molecular mechanisms in tobacco for LKB1 loss of function, however, are not defined. In this study, we reported that NNAL, a major metabolite of a tobacco-specific carcinogen NNK, induces LKB1 phosphorylation and its loss of function via the β-AR/PKA signaling pathway in an isomer-dependent manner in human lung cancer cells. NNAL exposure also resulted in enhanced lung cancer cell migration and chemoresistance in an LKB1-dependent manner. A 120-day NNAL exposure in lung cancer cells, mimicking its chronic exposure among smokers, resulted in more prominent LKB1 phosphorylation, cell migration, and chemoresistance even in the absence of NNAL, indicating the long-lasting LKB1 loss of function although such an effect eventually disappeared after NNAL was removed for two months. These observations were confirmed in a lung cancer xenograft model. More importantly, human lung cancer tissues revealed elevated LKB1 phosphorylation in comparison to the paired normal lung tissues. These results suggest that LKB1 loss of function in human lung cancer could be extended to its phosphorylation, which may be mediated by NNAL from tobacco smoke in an isomer-dependent manner via the β-AR/PKA signaling pathway.
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Affiliation(s)
- Tengfei Bian
- Department of Medicinal Chemistry, Center for Natural Products, Drug Discovery and Development (CNPD3), University of Florida, Gainesville, FL, 32610, USA
| | - Yuzhi Wang
- Department of Medicinal Chemistry, Center for Natural Products, Drug Discovery and Development (CNPD3), University of Florida, Gainesville, FL, 32610, USA
| | - Jordy F Botello
- Department of Medicinal Chemistry, Center for Natural Products, Drug Discovery and Development (CNPD3), University of Florida, Gainesville, FL, 32610, USA
| | - Qi Hu
- Department of Medicinal Chemistry, Center for Natural Products, Drug Discovery and Development (CNPD3), University of Florida, Gainesville, FL, 32610, USA
| | - Yunhan Jiang
- Department of Molecular Medicine, UT Health San Antonio, San Antonio, TX, 78229, USA
| | - Adriana Zingone
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Haocheng Ding
- Department of Biostatistics, College of Public Health & Health Professions, College of Medicine, University of Florida, Gainesville, FL, 32610, USA
| | - Yougen Wu
- Department of Medicinal Chemistry, Center for Natural Products, Drug Discovery and Development (CNPD3), University of Florida, Gainesville, FL, 32610, USA
- College of Tropical Agriculture and Forestry, Hainan University, 58 Renmin Avenue, Haikou, 570228, China
| | - F Zahra Aly
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, 1345 Center Drive, Gainesville, FL, 32610, USA
| | - Ramzi G Salloum
- Department of Health Outcome & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, 32610, USA
| | - Graham Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health & Health Professions, College of Medicine, University of Florida, Gainesville, FL, 32610, USA
| | - Bríd M Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Lingtao Jin
- Department of Molecular Medicine, UT Health San Antonio, San Antonio, TX, 78229, USA
| | - Chengguo Xing
- Department of Medicinal Chemistry, Center for Natural Products, Drug Discovery and Development (CNPD3), University of Florida, Gainesville, FL, 32610, USA.
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10
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Reinhardt C, Harden M, Herrmann-Lingen C, Rittmeyer A, Andreas S. Smoking cessation by combined medication and counselling: a feasibility study in lung cancer patients. BMC Pulm Med 2022; 22:252. [PMID: 35761222 PMCID: PMC9235273 DOI: 10.1186/s12890-022-02048-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Smoking cessation in patients with diagnosed lung cancer has positive effects on cancer therapy and overall prognosis. Despite this, knowledge on smoking cessation in lung cancer patients is sparse. Methods This is an observational single centre, 12-week, prospective, single-arm trial at a tertiary lung cancer centre. Responsive patients were enrolled following confirmed lung cancer diagnosis. Smoking cessation intervention included counselling as well as pharmacotherapy. The primary endpoint was the point prevalence abstinence rate at week 12 based on biochemical verification. Secondary endpoints were the abstinence rate at week 26, quality of life and side effects. Results 80 patients were enrolled. Mean age was 62.6 ± 7.9 years. Most patients (63%) were treated with chemotherapy or radiochemotherapy. 39 patients used nicotine replacement therapy, 35 varenicline whereas six patients did not use pharmacotherapy. During the study period 13 patients died. Data were available in 72 patients after 12 weeks and 57 patients at week 24. Point prevalence abstinence rates were 37.5% (95% CI 26.4–49.7%) at week 12 and 32.8% (95% CI 21.8–45.4%) at week 26, respectively. Quality of life and side effects were not significantly affected by pharmacotherapy. Conclusion In conclusion, our results suggest that smoking cessation is feasible in patients with newly diagnosed lung cancer. The observed abstinence rate is comparable to other patient cohorts. Furthermore, pharmacotherapy in addition to cancer therapy was safe and did not show novel side effects in these seriously ill patients. Thus, smoking cessation should be an integral part of lung cancer treatment. Trial registration The study was conducted in accordance with good clinical practice standards (GCP) and approved by the local ethics committee (16/3/14), the European PAS registry (EUPAS8748) and the German BfArM (NIS-Studien-Nr. 5508). All patients provided written informed consent before study enrollment. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02048-1.
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11
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Caini S, Del Riccio M, Vettori V, Scotti V, Martinoli C, Raimondi S, Cammarata G, Palli D, Banini M, Masala G, Gandini S. Quitting Smoking At or Around Diagnosis Improves the Overall Survival of Lung Cancer Patients: A Systematic Review and Meta-Analysis. J Thorac Oncol 2022; 17:623-636. [PMID: 34995798 DOI: 10.1016/j.jtho.2021.12.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Lung cancer (LC) remains a disease with poor prognosis despite recent advances in treatments. Here, we aimed at summarizing the current scientific evidence on whether quitting smoking at or around diagnosis has a beneficial effect on the survival of LC patients. METHODS We searched MEDLINE and EMBASE for articles published until 31st October, 2021, that quantified the impact on LC patients' survival of quitting smoking at or around diagnosis or during treatment. Study-specific data were pooled into summary relative risk (SRR) and corresponding 95% confidence intervals (CI) using random effect meta-analysis models. RESULTS Twenty-one articles published between 1980 and 2021 were included, which encompassed a total of over 10,000 LC patients. There was substantial variability across studies in terms of design, patients' characteristics, treatments received, criteria used to define smoking status (quitters or continued), and duration of follow-up. Quitting smoking at or around diagnosis was significantly associated with improved overall survival (SRR 0.71, 95% CI 0.64-0.80), consistently among patients with non-small cell LC (SRR 0.77, 95% CI 0.66-0.90, n studies = 8), small cell LC (SRR 0.75, 95% CI 0.57-0.99, n studies = 4), or LC of both or unspecified histological type (SRR 0.81, 95% CI 0.68-0.96, n studies = 6). CONCLUSIONS Quitting smoking at or around diagnosis is associated with a beneficial effect on the survival of LC patients. Treating physicians should educate LC patients about the benefits of quitting smoking even after diagnosis and provide them with the necessary smoking cessation support.
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Affiliation(s)
- Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Marco Del Riccio
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Virginia Vettori
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Department of Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Chiara Martinoli
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sara Raimondi
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giulio Cammarata
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Domenico Palli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Marco Banini
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Giovanna Masala
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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12
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Mack PC, Klein MI, Ayers KL, Zhou X, Guin S, Fink M, Rossi M, AI-Kateb H, O’Connell T, Hantash FM, Oh WK, Newman S, Schadt EE, Chen R, Hirsch FR. OUP accepted manuscript. Oncologist 2022; 27:476-486. [PMID: 35298662 PMCID: PMC9177106 DOI: 10.1093/oncolo/oyac035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/16/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Methods Results Conclusion
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Affiliation(s)
- Philip C Mack
- Corresponding author: Philip C. Mack, Center for Thoracic Oncology, Tisch Cancer Institute, Mount Sinai Health System, One Gustave L. Levy Place, New York, NY 10029, USA. Tel: 212 241-0776;
| | | | | | | | | | | | | | | | | | - Feras M Hantash
- Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine, Mount Sinai, New York, NY, USA
- Sema4, Stamford, CT, USA
| | - William K Oh
- Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine, Mount Sinai, New York, NY, USA
- Sema4, Stamford, CT, USA
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13
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Hung A, Lee KM, Lynch JA, Li Y, Poonnen P, Efimova OV, Hintze BJ, Buckingham T, Yong C, Seal B, Kelley MJ, Reed SD. Chemoradiation treatment patterns among United States Veteran Health Administration patients with unresectable stage III non-small cell lung cancer. BMC Cancer 2021; 21:824. [PMID: 34271861 PMCID: PMC8285779 DOI: 10.1186/s12885-021-08577-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/09/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The Veterans Health Administration (VHA) is the largest integrated health care system in the United States (US). Among VHA patients, the rate of use of concurrent chemoradiation therapy (CCRT) among those with unresectable, stage III non-small cell lung cancer (NSCLC) is unknown. The objective was to report recent CCRT treatment patterns in VHA patients and identify characteristics associated with receipt of CCRT. METHODS Using Department of Veteran Affairs (VA) Cancer Registry System data linked to VA electronic medical records, we determined rates of CCRT, sequential CRT (SCRT), radiation therapy (RT) only, chemotherapy (CT) only, and neither treatment. RESULTS Among 4054 VHA patients who met study criteria, CCRT rates slightly increased from 44 to 50% between 2013 and 2017. Factors associated with decreased odds of CCRT receipt compared to any other treatment included increasing age (adjusted odds ratio [aOR] per 10 years = 0.67; 95% CI: 0.60-0.76) and Charlson-Deyo comorbidity score (aOR = 0.94; 95% CI: 0.91-0.97). White race was associated with increased odds of CCRT receipt (aOR = 1.24; 95% CI: 1.004-1.53). In a chart review sample of 200 patients, less than half (n = 85) had a documented reason for not receiving CCRT. Among these, 29% declined treatment, and 71% did not receive CCRT due to "not being a candidate" for reasons related to frailty or lung nodules being too far apart for radiation therapy. CONCLUSIONS CCRT rates among VHA patients with unresectable, stage III NSCLC slightly increased from 2013 to 2017; however in 2017, only half were receiving CCRT. Older patients and those with multiple comorbidities were less likely to receive CCRT and even when controlling for these factors, non-white patients were less likely to receive CCRT.
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Affiliation(s)
- Anna Hung
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
- Department of Veteran Affairs Medical Center, Durham, NC, USA.
| | - Kyung Min Lee
- Department of Veteran Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Julie A Lynch
- Department of Veteran Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Yanhong Li
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Veteran Affairs Medical Center, Durham, NC, USA
| | - Pradeep Poonnen
- Department of Veteran Affairs Medical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Olga V Efimova
- Department of Veteran Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Bradley J Hintze
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Veteran Affairs Medical Center, Durham, NC, USA
| | | | | | | | - Michael J Kelley
- Department of Veteran Affairs Medical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Shelby D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Veteran Affairs Medical Center, Durham, NC, USA
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14
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Combining radiomic phenotypes of non-small cell lung cancer with liquid biopsy data may improve prediction of response to EGFR inhibitors. Sci Rep 2021; 11:9984. [PMID: 33976268 PMCID: PMC8113313 DOI: 10.1038/s41598-021-88239-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/09/2021] [Indexed: 12/13/2022] Open
Abstract
Among non-small cell lung cancer (NSCLC) patients with therapeutically targetable tumor mutations in epidermal growth factor receptor (EGFR), not all patients respond to targeted therapy. Combining circulating-tumor DNA (ctDNA), clinical variables, and radiomic phenotypes may improve prediction of EGFR-targeted therapy outcomes for NSCLC. This single-center retrospective study included 40 EGFR-mutant advanced NSCLC patients treated with EGFR-targeted therapy. ctDNA data included number of mutations and detection of EGFR T790M. Clinical data included age, smoking status, and ECOG performance status. Baseline chest CT scans were analyzed to extract 429 radiomic features from each primary tumor. Unsupervised hierarchical clustering was used to group tumors into phenotypes. Kaplan–Meier (K–M) curves and Cox proportional hazards regression were modeled for progression-free survival (PFS) and overall survival (OS). Likelihood ratio test (LRT) was used to compare fit between models. Among 40 patients (73% women, median age 62 years), consensus clustering identified two radiomic phenotypes. For PFS, the model combining radiomic phenotypes with ctDNA and clinical variables had c-statistic of 0.77 and a better fit (LRT p = 0.01) than the model with clinical and ctDNA variables alone with a c-statistic of 0.73. For OS, adding radiomic phenotypes resulted in c-statistic of 0.83 versus 0.80 when using clinical and ctDNA variables (LRT p = 0.08). Both models showed separation of K–M curves dichotomized by median prognostic score (p < 0.005). Combining radiomic phenotypes, ctDNA, and clinical variables may enhance precision oncology approaches to managing advanced non-small cell lung cancer with EGFR mutations.
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Kumar R, Al-Turjman F, Anand L, Kumar A, Magesh S, Vengatesan K, Sitharthan R, Rajesh M. Genomic sequence analysis of lung infections using artificial intelligence technique. Interdiscip Sci 2021; 13:192-200. [PMID: 33558984 DOI: 10.1007/s12539-020-00414-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 02/04/2023]
Abstract
Attributable to the modernization of Artificial Intelligence (AI) procedures in healthcare services, various developments including Support Vector Machine (SVM), and profound learning. For example, Convolutional Neural systems (CNN) have prevalently engaged in a significant job of various classificational investigation in lung malignant growth, and different infections. In this paper, Parallel based SVM (P-SVM) and IoT has been utilized to examine the ideal order of lung infections caused by genomic sequence. The proposed method develops a new methodology to locate the ideal characterization of lung sicknesses and determine its growth in its early stages, to control the growth and prevent lung sickness. Further, in the investigation, the P-SVM calculation has been created for arranging high-dimensional distinctive lung ailment datasets. The data used in the assessment has been fetched from real-time data through cloud and IoT. The acquired outcome demonstrates that the developed P-SVM calculation has 83% higher accuracy and 88% precision in characterization with ideal informational collections when contrasted with other learning methods.
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Affiliation(s)
- R Kumar
- Department of Electronics and Instrumentation Engineering, National Institute of Technology, Chumkedima, Dimapur, Nagaland, 797103, India
| | - Fadi Al-Turjman
- Research Centre for AI and IoT, Near East University, Nicosia, Mersin 10, Turkey
| | - L Anand
- School Computing Science and Engineering, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Tamil Nadu, India
| | - Abhishek Kumar
- School of Computer science and IT, JAIN (Deemed to be University), Banglore, Karnataka, India
| | - S Magesh
- Maruthi Technocrat E Services, Chennai, India
| | - K Vengatesan
- Department of Computer Science, Sanjivani College of Engineering, Kopargaon, India
| | - R Sitharthan
- Department of Electrical Engineering, School of Electrical Engineering, Vellore Institute of Technology and Science, Vellore, 632014, India.
| | - M Rajesh
- Department of Computer Science, Sanjivani College of Engineering, Kopargaon, India
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Azagba S, Shan L, Manzione L. Cigarette, E-cigarette, Alcohol, and Marijuana Use by Cancer Diagnosis Status: A Longitudinal Analysis. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 14:1178221820980470. [PMID: 33424226 PMCID: PMC7756047 DOI: 10.1177/1178221820980470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022]
Abstract
Background: Cancer is the second leading cause of death in the United States. Lifestyle choices such as substance abuse can impact a survivor’s health and overall quality of life. Methods: We used longitudinal data from the Wave 1-3 Population Assessment of Tobacco and Health data to examine sociodemographic characteristics and substance use behaviors (current cigarette, e-cigarette, alcohol, and marijuana use) by cancer diagnosis status. A generalized estimating equation model was used to examine the population-averaged effects of sociodemographic factors on substance use. Results: Among 1527 participants diagnosed with cancer, 14.5% used cigarettes, 3.8% used e-cigarettes, 49.1% used alcohol, and 4.2% used marijuana in the prior 30 days in Wave 1. While the prevalence of cigarette use among those with no cancer history decreased significantly between Wave 1 (21.9%) and Wave 3 (20.2%), it increased significantly among participants diagnosed with cancer from 14.5% to 16.0%. E-cigarette use decreased for both groups, whereas alcohol and marijuana use increased. Results showed that substance use among people diagnosed with cancer significantly varied by sociodemographic characteristics. Age, sex, race-ethnicity, education, income, and region of residence were significantly associated with substance use among patients diagnosed with cancer. Conclusion: Overall, substance use is lower among participants diagnosed with cancer than those with no cancer history. Substance use varies by sociodemographic characteristics among people diagnosed with cancer. More focus on substance use prevention among patients diagnosed with cancer could be beneficial in terms of improving the overall well-being of this population.
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Affiliation(s)
- Sunday Azagba
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lingpeng Shan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lauren Manzione
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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17
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A comparison of inflammation markers for predicting oncological outcomes after surgical resection of non-small-cell lung cancer: a validated analysis of 2,066 patients. Sci Rep 2020; 10:19523. [PMID: 33177603 PMCID: PMC7658207 DOI: 10.1038/s41598-020-76644-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
Clinical and pathological predictors have proved to be insufficient in identifying high-risk patients who develop cancer recurrence after tumour resection. We aimed to compare the prognostic ability of various inflammation markers in patients undergoing surgical resection of lung cancer. We consecutively included 2,066 patients with stage I-III non-small-cell lung cancer undergoing surgical resection at the center between 2005 and 2015. We evaluated prognostic nutritional index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio along with their perioperative changes. We conducted stepwise backward variable elimination and internal validation to compare the selected markers' predictive performance for postoperative recurrence-free survival and overall survival. Preoperative neutrophil-to-lymphocyte ratio independently predicts recurrence-free survival (HR: 1.267, 95% CI 1.064-1.509, p = 0.0079, on base-2 logarithmic scale) and overall survival (HR: 1.357, 95% CI 1.070-1.721, p = 0.0117, on base-2 logarithmic scale). The cut-off value is 2.3 for predicting both recurrence (sensitivity: 46.1% and specificity: 66.7%) and mortality (sensitivity: 84.2% and specificity: 40.4%). Advanced cancer stage, poor tumour differentiation, and presence of perineural infiltration were significantly correlated with higher preoperative neutrophil-to-lymphocyte ratio. We concluded that preoperative neutrophil-to-lymphocyte ratio is superior to prognostic nutritional index and platelet-to-lymphocyte ratio in predicting postoperative recurrence and mortality of patients undergoing surgical resection of non-small-cell lung cancer.
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18
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Garrana SH, Dagogo-Jack I, Cobb R, Kuo AH, Mendoza DP, Zhang EW, Heeger A, Sequist LV, Digumarthy SR. Clinical and Imaging Features of Non-Small-Cell Lung Cancer in Young Patients. Clin Lung Cancer 2020; 22:23-31. [PMID: 33189594 DOI: 10.1016/j.cllc.2020.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Non-small-cell lung cancer (NSCLC) in young adult patients is rare, with scarce data available in patients aged < 40 years and even less in those aged < 35 years. Our goal was to determine the presenting symptoms, clinicopathologic characteristics, and imaging features of young patients with NSCLC at time of diagnosis and compare them to those of older adults. PATIENTS AND METHODS We retrospectively analyzed the medical records and imaging of young patients (≤ 40 years old) with NSCLC treated at our institution between 1998 and 2018. Patients < 35 years old were compared to those between 35 and 40 years old. Characteristics of patients ≤ 40 years old were compared to older patients (> 40 years) from publicly available data sets. RESULTS We identified 166 young patients with NSCLC (median age, 36.6 years; range, 18-40 years). Most presented with nonspecific respiratory symptoms and were diagnosed with pneumonia (84/136, 62%). Compared to patients < 35 years old, patients 35-40 years old were more likely to have malignancy detected incidentally (15% vs. 5%, P = .04). Patients < 35 years old were more likely to have central tumors (55% vs. 33%, P = .02) and to have bone (38% vs. 19%, P = .007) and lung (39% vs. 24%, P = .03) metastases. Compared to older patients (> 40 years), young patients were more likely to be never smokers (65.0% vs. 14.7%, P < .001) and to have advanced disease (88% vs. 66%, P < .001). CONCLUSION Young patients with NSCLC often present with nonspecific symptoms and have advanced disease at diagnosis, often mimicking other pathologies. Awareness of the clinical presentation and imaging features of NSCLC in young patients may help minimize delays in diagnoses.
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Affiliation(s)
- Sherief H Garrana
- Harvard Medical School, Boston, MA; Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Ibiayi Dagogo-Jack
- Harvard Medical School, Boston, MA; Department of Medicine, Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Rosemary Cobb
- Harvard Medical School, Boston, MA; Department of Medicine, Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Anderson H Kuo
- Harvard Medical School, Boston, MA; Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Dexter P Mendoza
- Harvard Medical School, Boston, MA; Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Eric W Zhang
- Harvard Medical School, Boston, MA; Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Allen Heeger
- Harvard Medical School, Boston, MA; Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Lecia V Sequist
- Harvard Medical School, Boston, MA; Department of Medicine, Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Subba R Digumarthy
- Harvard Medical School, Boston, MA; Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA.
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19
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Heo JW, Kang HS, Park CK, Kim SK, Kim JS, Kim JW, Kim SJ, Lee SH, Yeo CD. Regional emphysema score is associated with tumor location and poor prognosis in completely resected NSCLC patients. BMC Pulm Med 2020; 20:242. [PMID: 32917179 PMCID: PMC7488536 DOI: 10.1186/s12890-020-01268-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/19/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Lung cancer is a frequent comorbidity of chronic obstructive pulmonary disease (COPD). However, the local risk of developing lung cancer related to regional emphysema distribution and clinical outcome has not been investigated. Our aim was to evaluate the impact of regional emphysema score (RES) on tumor location and prognosis in non-small cell lung cancer (NSCLC) patients. METHODS We enrolled 457 patients who underwent curative surgery for NSCLC at seven hospitals at The Catholic University of Korea from 2014 to 2018. Emphysema was visually assessed for each lobe, with the lingula as a separate lobe. Semi-quantitative emphysema scoring was classified as follows: 0 = none, 0.5 = 1 to 10%, 1 = 11 to 25%, 2 = 26 to 50%, 3 = 51 to 75%, and 4 = 76 to 100%. An RES was given to each of the six lung zone: the upper, middle, and lower lobes in the right and left lungs. RESULTS There were 145 patients in the high RES (≥ 3) group and 312 in the low RES (< 3) group. The mean RES in each lobe with cancer was significantly higher than that in other lobes without cancer (0.51 vs. 0.37, P < 0.001). This group showed significantly shorter disease-free survival (P < 0.001), in addition, presence of COPD, low diffusing capacity of the lung for carbon monoxide (< 80), smoking status, and poor differentiation were more frequent in this group. Also, cancer in a lobe with a higher RES (odds ratio (OR) = 1.56; 95% confidence interval (CI:1.01-2.42; P = 0.04), pathologic stage ≥ III (OR = 2.23; 95% CI: 1.28-3.89; P < 0.001), and poor differentiation (OR = 1.99; 95% CI: 1.22-3.21; P < 0.001) were independent factors for tumor recurrence. CONCLUSIONS The regional severity of emphysema by visual qualification was associated with the location of lung cancer, and was an independently poor prognostic factor for tumor recurrence in completely resected NSCLC patients.
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Affiliation(s)
- Jung Won Heo
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Hye Seon Kang
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kwon Park
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Kyoung Kim
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Sang Kim
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Woo Kim
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Joon Kim
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Chang Dong Yeo
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea.
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20
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Ban WH, Yeo CD, Han S, Kang HS, Park CK, Kim JS, Kim JW, Kim SJ, Lee SH, Kim SK. Impact of smoking amount on clinicopathological features and survival in non-small cell lung cancer. BMC Cancer 2020; 20:848. [PMID: 32883225 PMCID: PMC7469911 DOI: 10.1186/s12885-020-07358-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 08/27/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Screening for early detection of lung cancer has been performed in high-risk individuals with smoking history. However, researches on the distribution, clinical characteristics, and prognosis of these high-risk individuals in an actual cohort are lacking. Thus, the objective of this study was to retrospectively review characteristics and prognosis of patients with smoking history in an actual lung cancer cohort. METHODS The present study used the lung cancer cohort of the Catholic Medical Centers at the Catholic University of Korea from 2014 to 2017. Patients with non-small cell lung cancer were enrolled. They were categorized into high and low-risk groups based on their smoking history using the national lung screening trial guideline. Distribution, clinical characteristics, and survival data of each group were estimated. RESULTS Of 439 patients, 223 (50.8%) patients were in the high-risk group. Patients in the high-risk group had unfavorable clinical characteristics and tumor biologic features. Overall survival of the high-risk group was significantly shorter than that of the low-risk group with both early (I, II) and advanced stages (III, IV). In multivariate analysis, heavy smoking remained one of the most important poor clinical prognostic factors in patients with lung cancer. It showed a dose-dependent relationship with patients' survival. CONCLUSIONS High-risk individuals had poor clinical outcomes. Patients' prognosis seemed to be deteriorated as smoking amount increased. Therefore, active screening and clinical attention are needed for high-risk individuals.
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Affiliation(s)
- Woo Ho Ban
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Dong Yeo
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Solji Han
- Department of Applied Statistics, Yonsei University, Seoul, Republic of Korea
| | - Hye Seon Kang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kwon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Sang Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Woo Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Joon Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,The Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,The Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Kyoung Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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21
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Xiao J, Zhou L, He B, Chen Q. Impact of Sex and Smoking on the Efficacy of EGFR-TKIs in Terms of Overall Survival in Non-small-Cell Lung Cancer: A Meta-Analysis. Front Oncol 2020; 10:1531. [PMID: 32984005 PMCID: PMC7477328 DOI: 10.3389/fonc.2020.01531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 07/16/2020] [Indexed: 11/23/2022] Open
Abstract
Background: To comprehensively understand the impact of sex and smoking on the efficacy of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy in terms of overall survival (OS) in non-small-cell lung cancer (NSCLC). Methods: PubMed, Cochrane Library, Embase, and Scopus were searched from inception to March 17, 2019. OS was analyzed based on hazard ratios (HRs) and 95% confidence intervals (CIs) and estimated using the random effects model. Results: Our meta-analysis included 22 studies involving 11,874 patients. In the primary analysis, we found no statistically significant efficacy difference for EGFR-TKI intervention between females and males (pooled HR 0.95, 95% CI 0.87–1.04, P = 0.30) and no obvious efficacy difference between never smokers and ever smokers (pooled HR 0.91, 95% CI 0.76–1.09, P = 0.31). In the subgroup analysis of placebo control treatment, we found that female NSCLC patients who received EGFR-TKI therapy had a longer OS than male patients (pooled HR 0.86, 95% CI 0.75–1.00, P = 0.04), while smoking status showed no significant effect on the efficacy of EGFR-TKI treatment in terms of the OS of NSCLC patients in all subgroup analyses. Conclusion: The efficacy of EGFR-TKI therapy for NSCLC patients is independent of smoking status but dependent on sex, and females have a longer OS than males.
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Affiliation(s)
- Jian Xiao
- Department of Geriatrics, Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Liang Zhou
- Department of Critical Care Medicine, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China.,Department of Geriatrics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China.,Ningxia Geriatrics Center, Yinchuan, China
| | - Bixiu He
- Department of Geriatrics, Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Qiong Chen
- Department of Geriatrics, Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
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22
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Strategies for Referring Cancer Patients in a Smoking Cessation Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176089. [PMID: 32825665 PMCID: PMC7503502 DOI: 10.3390/ijerph17176089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 01/30/2023]
Abstract
Most people who smoke and develop cancer are unable to quit smoking. To address this, many cancer centers have now opened smoking cessation programs specifically designed to help cancer patients to quit. An important question has now emerged—what is the most effective approach for engaging smokers within a cancer center in these smoking cessation programs? We report outcomes from a retrospective observational study comparing three referral methods—traditional referral, best practice advisory (BPA), and direct outreach—on utilization of the Duke Cancer Center Smoking Cessation Program. We found that program utilization rate was higher for direct outreach (5.4%) than traditional referral (0.8%), p < 0.001, and BPA (0.2%); p < 0.001. Program utilization was 6.4% for all methods combined. Inferring a causal relationship between referral method and program utilization was not possible because the study did not use a randomized design. Innovation is needed to generate higher utilization rates for cancer center smoking cessation programs.
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23
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Passaro A, Attili I, Morganti S, Del Signore E, Gianoncelli L, Spitaleri G, Stati V, Catania C, Curigliano G, de Marinis F. Clinical features affecting survival in metastatic NSCLC treated with immunotherapy: A critical review of published data. Cancer Treat Rev 2020; 89:102085. [PMID: 32771858 DOI: 10.1016/j.ctrv.2020.102085] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/26/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022]
Abstract
Immune checkpoint inhibitors (ICIs) represent one of the main steps forward for the treatment of advanced or metastatic non-small-cell lung cancer (NSCLC), without oncogenic driver alterations. Despite this recent progress, only a minority of patients achieve a broad and durable benefit and another proportion report poor survival and sometimes fast disease progression, confirming the need to optimise the patient's selection. To date, several issues are unsolved about how to personalise the immunotherapy treatment for individual patients. In this review, analysing data from pivotal randomised clinical trials (RCTs), we discuss patient baseline clinical and demographic features, including sex, age, ECOG performance status, smoking habit and specific site of metastases (liver, bone and brain) that may influence the efficacy outcomes in patients treated with ICIs. The high performance of the ICIs blurred the vision on different efficacy-limiting factors, which require extensive evaluation to improve the understanding ofthe tumour-specificimmune response, in which clinical drivers could be useful for better patient stratification.
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Affiliation(s)
- Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Ilaria Attili
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Stefania Morganti
- Division of Early Drug Development for Innovative Therapies, IEO European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ester Del Signore
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Letizia Gianoncelli
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Stati
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Catania
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapies, IEO European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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24
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Zhou Y, Zhang Y. Inhibition of LncRNAH19 has the effect of anti-tumour and enhancing sensitivity to Gefitinib and Chemotherapy in Non-small-cell lung cancer in vivo. J Cell Mol Med 2020; 24:5811-5816. [PMID: 32281297 PMCID: PMC7214165 DOI: 10.1111/jcmm.15245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 03/19/2020] [Indexed: 12/21/2022] Open
Abstract
Lung cancer is one of the most common malignant diseases, which ranked first in both men and women malignancies worldwide. The survival rate of non-small-cell lung cancer (NSCLC) has been limited with distant metastasis and shortage of effective chemotherapeutics in recent years. Thus, novel therapeutic strategies for NSCLC are urgently explored. Here, we showed that inhibition of H19 effectively inhibited the progression of NSCLC. Moreover, down-regulation of H19 treatment significantly enhanced the levels of PTEN and PDCD4, while suppressed the expressions of NFIB in NSCLC. Furthermore, down-regulation of H19 combined with Gefitinib treatment significantly increased the levels of PTEN and PDCD4, while decreased the expression levels of NFIB. Moreover, the results showed that Gefitinib treatment significantly reduced the shH19-mediated miR-21 expression levels. Our results showed that down-regulation of H19 combined with Gefitinib administration significantly improved the effect of shH19 treatment alone on the progression of NSCLC, which was involved in the activation of PTEN signalling pathway in NSCLC in vivo. Therefore, these findings might indicate a novel molecular mechanism, which could provide a new potential combination of therapeutic method in NSCLC.
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Affiliation(s)
- Yaodong Zhou
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai Jiaotong University, Shanghai, China
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25
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Yang Z, Lin X, Zhang P, Liu Y, Liu Z, Qian B, Liu X, Shao G. RETRACTED: Long non-coding RNA LINC00525 promotes the non-small cell lung cancer progression by targeting miR-338-3p/IRS2 axis. Biomed Pharmacother 2020; 124:109858. [PMID: 31991382 DOI: 10.1016/j.biopha.2020.109858] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 02/04/2023] Open
Abstract
This article has been retracted at the request of the Editor-in-Chief. The corresponding author notified the journal that in vivo and transwell invasion experimental results reported in this study were not reproducible. As the results were unreliable the authors requested its retraction. The journal was also alerted to several suspected image similarities within Figures 3B and 6D, that appear to be present in other publications, as detailed here: https://pubpeer.com/publications/9F5D26FDF83E716B615F407B35ED8B#. The journal requested the authors provide explanations and source data relating to these affected figures. Authors were not able to satisfy this request. The Editor-in-Chief assessed this case and decided to retract the article.
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Affiliation(s)
- Zhiguang Yang
- Department of Thoracic Surgery, The First Hospital of Jilin University, #71 Xinmin Street, Chaoyang District, Changchun, 130021, Jilin, China
| | - Xingyu Lin
- Department of Thoracic Surgery, The First Hospital of Jilin University, #71 Xinmin Street, Chaoyang District, Changchun, 130021, Jilin, China
| | - Peng Zhang
- Department of Thoracic Surgery, The First Hospital of Jilin University, #71 Xinmin Street, Chaoyang District, Changchun, 130021, Jilin, China
| | - Yunpeng Liu
- Department of Thoracic Surgery, The First Hospital of Jilin University, #71 Xinmin Street, Chaoyang District, Changchun, 130021, Jilin, China
| | - Zihao Liu
- Department of Thoracic Surgery, The First Hospital of Jilin University, #71 Xinmin Street, Chaoyang District, Changchun, 130021, Jilin, China
| | - Benxin Qian
- Department of Thoracic Surgery, The First Hospital of Jilin University, #71 Xinmin Street, Chaoyang District, Changchun, 130021, Jilin, China
| | - Xing Liu
- Department of Thoracic Surgery, The First Hospital of Jilin University, #71 Xinmin Street, Chaoyang District, Changchun, 130021, Jilin, China
| | - Guoguang Shao
- Department of Thoracic Surgery, The First Hospital of Jilin University, #71 Xinmin Street, Chaoyang District, Changchun, 130021, Jilin, China.
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26
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Japuntich SJ, Kumar P, Pendergast JF, Juarez Caballero GY, Malin JL, Wallace RB, Chrischilles EA, Keating NL, Park ER. Smoking Status and Survival Among a National Cohort of Lung and Colorectal Cancer Patients. Nicotine Tob Res 2020; 21:497-504. [PMID: 29351659 DOI: 10.1093/ntr/nty012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/16/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The purpose of this study was to explore the association of smoking status and clinically relevant duration of smoking cessation with long-term survival after lung cancer (LC) or colorectal cancer (CRC) diagnosis. We compared survival of patients with LC and CRC who were never-smokers, long-term, medium-term, and short-term quitters, and current smokers around diagnosis. METHODS We studied 5575 patients in Cancer Care Outcomes Research and Surveillance (CanCORS), a national, prospective observational cohort study, who provided smoking status information approximately 5 months after LC or CRC diagnosis. Smoking status was categorized as: never-smoker, quit >5 years prior to diagnosis, quit between 1-5 years prior to diagnosis, quit less than 1 year before diagnosis, and current smoker. We examined the relationship between smoking status around diagnosis with mortality using Cox regression models. RESULTS Among participants with LC, never-smokers had lower mortality risk compared with current smokers (HR 0.71, 95% CI 0.57 to 0.89). Among participants with CRC, never-smokers had a lower mortality risk as compared to current smokers (HR 0.79, 95% CI 0.64 to 0.99). CONCLUSIONS Among both LC and CRC patients, current smokers at diagnosis have higher mortality than never-smokers. This effect should be further studied in the context of tumor biology. However, smoking cessation around the time of diagnosis did not affect survival in this sample. IMPLICATIONS The results from our analysis of patients in the CanCORS consortium, a large, geographically diverse cohort, show that both LC and CRC patients who were actively smoking at diagnosis have worse survival as compared to never-smokers. While current smoking is detrimental to survival, cessation upon diagnosis may not mitigate this risk.
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Affiliation(s)
- Sandra J Japuntich
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Department of Psychiatry and Human Behavior, The Alpert Medical School of Brown University, Providence, RI
| | - Pallavi Kumar
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Jane F Pendergast
- Department of Biostatistics, Duke University School of Medicine, Durham, NC
| | | | - Jennifer L Malin
- David Geffen School of Medicine at University of California Los Angeles, California and Veterans Affairs Medical Center, Greater Los Angeles, CA
| | - Robert B Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | | | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Elyse R Park
- Tobacco Research and Treatment Center, and the Mongan Institute for Health Policy Center, Massachusetts General Hospital, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
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27
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Sbrocchi AJ, Denlinger CE. Selecting Appropriate Patients for Sublobar Resection. Semin Thorac Cardiovasc Surg 2019; 32:591-592. [PMID: 31887348 DOI: 10.1053/j.semtcvs.2019.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/15/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Alexander J Sbrocchi
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Chadrick E Denlinger
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.
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28
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Huang YT. Mendelian randomization using semiparametric linear transformation models. Stat Med 2019; 39:890-905. [PMID: 31879996 DOI: 10.1002/sim.8449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 09/03/2019] [Accepted: 11/28/2019] [Indexed: 11/09/2022]
Abstract
Mendelian randomization (MR) uses genetic information as an instrumental variable (IV) to estimate the causal effect of an exposure of interest on an outcome in the presence of unknown confounding. We are interested in the causal effect of cigarette smoking on lung cancer survival, which is subject to confounding by underlying pulmonary functions. Despite the well-developed IV analyses for the continuous and binary outcomes, the scarcity of methodology for the survival outcome limits its utility for the time-to-event data collected in many observational studies. We propose an IV analysis method in the survival context, estimating causal effects on a transformed survival time and survival probabilities using semiparametric linear transformation models. We study the conditions under which hazard ratio and the effect on survival probability can be approximated. For statistical inference, we construct estimating equations to circumvent the difficulty in deriving joint likelihood of the exposure and the outcome, due to the unknown confounding. Asymptotic properties of the proposed estimators are established without parametric assumptions about confounders. We study the finite sample performance in extensive simulation studies. The MR analysis of a lung cancer study suggests a harmful prognostic effect of smoking pack-years that would have been missed by the crude association.
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Affiliation(s)
- Yen-Tsung Huang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
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29
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Cheng TYD, Darke AK, Redman MW, Zirpoli GR, Davis W, Payne Ondracek R, Bshara W, Omilian AR, Kratzke R, Reid ME, Molina JR, Kolesar JM, Chen Y, MacRae RM, Moon J, Mack P, Gandara DR, Kelly K, Santella RM, Albain KS, Ambrosone CB. Smoking, Sex, and Non-Small Cell Lung Cancer: Steroid Hormone Receptors in Tumor Tissue (S0424). J Natl Cancer Inst 2019; 110:734-742. [PMID: 29346580 DOI: 10.1093/jnci/djx260] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/08/2017] [Indexed: 01/07/2023] Open
Abstract
Background To what extent steroid hormones contribute to lung cancer in male and female never smokers and smokers is unclear. We examined expression of hormone receptors in lung tumors by sex and smoking. Methods Patients with primary non-small cell lung cancer were recruited into an Intergroup study in the United States and Canada, led by SWOG (S0424). Tumors from 813 cases (450 women and 363 men) were assayed using immunohistochemistry for estrogen receptor (ER)-α, ER-β, progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Linear regression was used to examine differences in expression by sex and smoking status. Cox proportional hazard models were used to estimate survival associated with the receptors. All statistical tests were two-sided. Results In ever smokers, postmenopause and oral contraceptive use were associated with lower nuclear ER-β (P = .02) and total (nuclear + cytoplasmic) PR expression (P = .02), respectively. Women had lower cytoplasmic ER-α (regression coefficient [β], or differences in H-scores = -15.8, P = .003) and nuclear ER-β (β = -12.8, P = .04) expression than men, adjusting for age, race, and smoking. Ever smokers had both higher cytoplasmic ER-α (β = 45.0, P < .001) and ER-β (β = 25.9, P < .001) but lower total PR (β = -42.1, P < .001) than never smokers. Higher cytoplasmic ER-α and ER-β were associated with worse survival (hazard ratio = 1.73, 95% confidence interval [CI] = 1.15 to 2.58, and HR = 1.59, 95% CI = 1.08 to 2.33, respectively; quartiles 4 vs 1). Conclusions Lower expression of nuclear ER-β in women supports the estrogen hypothesis in lung cancer etiology. Increasing cytoplasmic ER-α and ER-β and decreasing PR protein expression may be mechanisms whereby smoking disrupts hormone pathways.
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Affiliation(s)
- Ting-Yuan David Cheng
- Department of Cancer Prevention and Control and Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY.,Department of Epidemiology, University of Florida, Gainesville, FL
| | - Amy K Darke
- SWOG Statistical Center/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mary W Redman
- SWOG Statistical Center/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Gary R Zirpoli
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Warren Davis
- Department of Cancer Prevention and Control and Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | - Rochelle Payne Ondracek
- Department of Cancer Prevention and Control and Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | - Wiam Bshara
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY
| | - Angela R Omilian
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY
| | - Robert Kratzke
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Mary E Reid
- Department of Cancer Prevention and Control and Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | | | - Jill M Kolesar
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI
| | - Yuhchyau Chen
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | | | - James Moon
- SWOG Statistical Center/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Philip Mack
- Department of Internal Medicine, UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - David R Gandara
- Department of Internal Medicine, UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - Karen Kelly
- Department of Internal Medicine, UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - Regina M Santella
- Department of Environmental Health Sciences, Columbia University, New York, NY
| | - Kathy S Albain
- Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control and Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
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30
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Lung cancer survival among never smokers. Cancer Lett 2019; 451:142-149. [PMID: 30851418 DOI: 10.1016/j.canlet.2019.02.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/13/2019] [Accepted: 02/28/2019] [Indexed: 11/22/2022]
Abstract
Lung cancer incidence among never smokers has increased in recent decades with 10-30% of all lung cancers occurring in never smokers, where exposure to residential radon is the leading cause of this disease. Lung cancer survival is low, ranging from 12% to 16% at 5 years of diagnosis. There is scant evidence to date on survival from this disease in never smokers. We aim to evaluate lung cancer survival in never smokers and ascertain whether there might be differences regarding smokers, through a systematic review applying predefined inclusion and exclusion criteria. 17 Studies were included. Never-smoker lung cancer patients seem to experience longer survival times than do smokers or ex-smokers. Lung cancer in never smokers displays distinctive clinical characteristics, is more frequent among women, is diagnosed at more advanced stages, and the predominant histologic type is adenocarcinoma. Further studies are necessary to ascertain lung cancer survival among never smokers.
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Campling BG, Ye Z, Lai Y, Li L, Bar-Ad V, Werner-Wasik M, Lu B, Cowan SW, Evans NR, Chervoneva I, Wang C. Disparity in age at lung cancer diagnosis between current and former smokers. J Cancer Res Clin Oncol 2019; 145:1243-1251. [PMID: 30830294 DOI: 10.1007/s00432-019-02875-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/21/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE In a previous study of smoking cessation in veterans with lung cancer, we noted as an incidental finding that current smokers were much younger than former smokers at diagnosis. To confirm and extend this observation, we analyzed the association of smoking status with age at diagnosis and survival of lung cancer patients. METHODS The Jefferson Cancer Registry collects information on all cancer patients registered at this hospital. Information on smoking status has been recorded since 1995. We determined age at diagnosis and survival of current and former smokers with lung cancer. RESULTS 5111 lung cancer cases were identified in the registry from 1995 to 2011 inclusive. Smoking status was recorded in 4687 cases (91.7%). Of these, 1859 (39.7%) were current, 2423 (51.7%) were former, and 405 (8.6%) were never smokers. There was a 6-year difference in median age at lung cancer diagnosis between the current (63 years) and former smokers (69 years) (P < 0.0001). The median survival was 12.1 months for current versus 14.5 months for former smokers (P < 0.0001). CONCLUSIONS These results confirm and extend our observation that among patients diagnosed with lung cancer, current smokers are younger than former smokers. The possible explanations include higher competing causes of death and increased risk of lung cancer among current smokers as well as increasing proportions of former smokers in older populations. Ongoing exposure to tobacco carcinogens may accelerate the development of lung cancer in continuing smokers. This provides more incentive for smokers to quit at the earliest age possible.
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Affiliation(s)
- Barbara G Campling
- BC Cancer, Sindi Ahluwalia Hawkins Centre for the Southern Interior, 399 Royal Avenue, Kelowna, BC, V1Y 5L3, Canada.
| | - Zhong Ye
- Department of Medical Oncology, Thomas Jefferson University, 1025 Walnut Street, Suite 727, Philadelphia, PA, 19107, USA
| | - Yinzhi Lai
- Department of Medical Oncology, Thomas Jefferson University, 1025 Walnut Street, Suite 727, Philadelphia, PA, 19107, USA
| | - Ling Li
- Department of Medical Oncology, Thomas Jefferson University, 1025 Walnut Street, Suite 727, Philadelphia, PA, 19107, USA
| | - Voichita Bar-Ad
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bo Lu
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott W Cowan
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nathaniel R Evans
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Inna Chervoneva
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Chun Wang
- Department of Medical Oncology, Thomas Jefferson University, 1025 Walnut Street, Suite 727, Philadelphia, PA, 19107, USA.
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32
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Gong J, Xu L, Li Z, Hu X, Liu J, Teng Y, Jin B, Zhao M, Shi J, Guo T, Shi X, Cheng Y, Liu Y, Qu X. A Clinical Prognostic Score to Predict Survival of Advanced or Metastatic Non-Small Cell Lung Cancer (NSCLC) Patients Receiving First-Line Chemotherapy: A Retrospective Analysis. Med Sci Monit 2018; 24:8264-8271. [PMID: 30446633 PMCID: PMC6252050 DOI: 10.12659/msm.911026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although several complicated models have been built to evaluate the prognosis of NSCLC patients receiving chemotherapy, simple economic models are still needed to give a preliminary survival assessment of these patients. MATERIAL AND METHODS This study retrospectively assessed the clinical and biological parameters of 223 patients with advanced NSCLC. Univariate and multivariate analyses of overall survival (OS) and progression-free survival (PFS) for the parameters and the prognostic score were assessed. RESULTS Performance status (PS) score=1, smoking history, fibrinogenemia, thrombocytosis, increased lactate dehydrogenase (LDH) level, and anemia were independent predictors of poor prognosis in the univariate analysis of OS and were assessed in multivariate analysis. There was a significant difference in PS=1 (HR=2.134, p<0.0001), increased LDH level (HR=1.508, p=0.014), thrombocytosis (HR=1.547, p=0.012), and smoking history (HR=1.491, p=0.008), based on which the patients were classified into 3 risk groups: low risk (0-1 points), moderate risk (2 points), and high risk (3-5 points). At p values of <0.0001, the median OS was 565, 340, and 273 days and the median progression-free survival was 250, 209, and 135 days, respectively in these 3 risk groups. CONCLUSIONS We established a new prognostic score model using PS, LDH level, PLT count, and smoking history to predict the survival of patients receiving first-line chemotherapy for advanced NSCLC, which might be useful in clinical practice.
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Affiliation(s)
- Jing Gong
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Ling Xu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Zhi Li
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Xuejun Hu
- Department of Respiratory and Infectious Disease of Geriatrics, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Jing Liu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Yuee Teng
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Bo Jin
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Mingfang Zhao
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Jing Shi
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Tianshu Guo
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Xiaonan Shi
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Yu Cheng
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Yunpeng Liu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Xiujuan Qu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
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Kroeger N, Li H, De Velasco G, Donskov F, Sim HW, Stühler V, Wells JC, Stukalin I, Heide J, Bedke J, Agarwal N, Parekh H, Rini BI, Knox JJ, Pantuck A, Choueiri TK, Chin Heng DY. Active Smoking Is Associated With Worse Prognosis in Metastatic Renal Cell Carcinoma Patients Treated With Targeted Therapies. Clin Genitourin Cancer 2018; 17:65-71. [PMID: 30341028 DOI: 10.1016/j.clgc.2018.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/27/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Smoking increases the risk of developing renal cell carcinoma (RCC) but the effect of tobacco consumption on survival outcome of patients with metastatic RCC (mRCC) treated with targeted therapies has not been well characterized. PATIENTS AND METHODS The primary outcome was overall survival (OS) and secondary outcome was progression-free survival (PFS). Patients with mRCC were categorized as current, former, and nonsmokers at the time of starting targeted therapy. Smoking data from 1980 patients with mRCC treated with targeted therapy were collected through the International mRCC Database Consortium (IMDC) from 12 international cancer centers. RESULTS Although former and nonsmokers had comparable OS times (23.8 vs. 23.4 months; P = .898), current smokers had significantly shorter OS (16.1 months; P < .001) than nonsmokers. Current but not former smoking status was an independent poor prognosis factor (hazard ratio [HR], 1.3; P = .002) when adjusted for the IMDC risk criteria. Each pack-year increased the risk of death by 1% (HR, 1.01; P = .036). The duration of first-line therapy response was not different and was 7.7 months versus 7.5 months versus 6.4 months in never, former (P = .609), and current smokers (P = .839), respectively. CONCLUSION Active smoking is associated with diminished OS in mRCC patients treated with targeted therapy agents. However, patients who quit smoking returned to a similar risk of death from RCC compared with patients who never smoked. Smoking cessation should be a counseling priority among mRCC patients receiving targeted agents and smoking should be considered as a confounding factor in major clinical trials.
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Affiliation(s)
- Nils Kroeger
- Department of Urology, Ernst-Moritz-Arndt University Greifswald, Germany; Tom Baker Cancer Center, University of Calgary, Alberta, Canada
| | - Haoran Li
- Tom Baker Cancer Center, University of Calgary, Alberta, Canada
| | | | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Hao-Wen Sim
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Viktoria Stühler
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - J Connor Wells
- Tom Baker Cancer Center, University of Calgary, Alberta, Canada
| | - Igor Stukalin
- Tom Baker Cancer Center, University of Calgary, Alberta, Canada
| | - Johannes Heide
- Department of Urology, Ernst-Moritz-Arndt University Greifswald, Germany
| | - Jens Bedke
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Neeraj Agarwal
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Hiral Parekh
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Brian I Rini
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Jennifer J Knox
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Allan Pantuck
- UCLA Institute of Urologic Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Irimie AI, Braicu C, Cojocneanu R, Magdo L, Onaciu A, Ciocan C, Mehterov N, Dudea D, Buduru S, Berindan-Neagoe I. Differential Effect of Smoking on Gene Expression in Head and Neck Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071558. [PMID: 30041465 PMCID: PMC6069101 DOI: 10.3390/ijerph15071558] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/11/2018] [Accepted: 07/17/2018] [Indexed: 12/13/2022]
Abstract
Smoking is a well-known behavior that has an important negative impact on human health, and is considered to be a significant factor related to the development and progression of head and neck squamous cell carcinomas (HNSCCs). Use of high-dimensional datasets to discern novel HNSCC driver genes related to smoking represents an important challenge. The Cancer Genome Atlas (TCGA) analysis was performed in three co-existing groups of HNSCC in order to assess whether gene expression landscape is affected by tobacco smoking, having quit, or non-smoking status. We identified a set of differentially expressed genes that discriminate between smokers and non-smokers or based on human papilloma virus (HPV)16 status, or the co-occurrence of these two exposome components in HNSCC. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways classification shows that most of the genes are specific to cellular metabolism, emphasizing metabolic detoxification pathways, metabolism of chemical carcinogenesis, or drug metabolism. In the case of HPV16-positive patients it has been demonstrated that the altered genes are related to cellular adhesion and inflammation. The correlation between smoking and the survival rate was not statistically significant. This emphasizes the importance of the complex environmental exposure and genetic factors in order to establish prevention assays and personalized care system for HNSCC, with the potential for being extended to other cancer types.
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Affiliation(s)
- Alexandra Iulia Irimie
- Department of Prosthetic Dentistry and Dental Materials, Division Dental Propaedeutics, Aesthetic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, 23 Marinescu Street, Cluj-Napoca 40015, Romania.
| | - Cornelia Braicu
- Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, Cluj-Napoca 40015, Romania.
| | - Roxana Cojocneanu
- Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, Cluj-Napoca 40015, Romania.
| | - Lorand Magdo
- Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, Cluj-Napoca 40015, Romania.
| | - Anca Onaciu
- MEDFUTURE-Research Center for Advanced Medicine, University of Medicine and Pharmacy Iuliu Hatieganu, 23 Marinescu Street, Cluj-Napoca 40015, Romania.
| | - Cristina Ciocan
- MEDFUTURE-Research Center for Advanced Medicine, University of Medicine and Pharmacy Iuliu Hatieganu, 23 Marinescu Street, Cluj-Napoca 40015, Romania.
| | - Nikolay Mehterov
- Department of Medical Biology, Faculty of Medicine, Medical University-Plovdiv, 15-А Vassil Aprilov Blvd., Plovdiv 4000, Bulgaria.
- Technological Center for Emergency Medicine, 15-А Vassil Aprilov Blvd., Plovdiv 4000, Bulgaria.
| | - Diana Dudea
- Department of Prosthetic Dentistry and Dental Materials, Division Dental Propaedeutics, Aesthetic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, 23 Marinescu Street, Cluj-Napoca 40015, Romania.
| | - Smaranda Buduru
- Prosthetics and Dental Materials, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, 32 Clinicilor Street, Cluj-Napoca 400006, Romania.
| | - Ioana Berindan-Neagoe
- Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, Cluj-Napoca 40015, Romania.
- Department of Medical Biology, Faculty of Medicine, Medical University-Plovdiv, 15-А Vassil Aprilov Blvd., Plovdiv 4000, Bulgaria.
- Department of Functional Genomics and Experimental Pathology, The Oncology Institute Ion Chiricuta, Republicii 34th Street, Cluj-Napoca 400015, Romania.
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Kim HC, Jung CY, Cho DG, Jeon JH, Lee JE, Ahn JS, Kim SJ, Kim Y, Kim YC, Kim JE, Lee B, Won YJ, Choi CM. Clinical Characteristics and Prognostic Factors of Lung Cancer in Korea: A Pilot Study of Data from the Korean Nationwide Lung Cancer Registry. Tuberc Respir Dis (Seoul) 2018; 82:118-125. [PMID: 29926550 PMCID: PMC6435924 DOI: 10.4046/trd.2017.0128] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/25/2018] [Accepted: 04/12/2018] [Indexed: 02/02/2023] Open
Abstract
Background Lung cancer is a leading cause of morbidity and mortality worldwide, and the incidence continues to rise. Although many prognostic factors have been identified, the clinical characteristics and outcomes in Korean lung cancer patients are not well defined. Methods Of the 23,254 new lung cancer cases registered at the Korea Central Cancer Registry in 2013, total 489 patients from 19 hospitals were abstracted by the Korean Central Cancer Registry. The clinical data retrospectively analyzed, patients were followed up until December 2015. Results The median age was 69 years (interquartile range, 60–74 years); 65.4% were male and 62.1% were ever-smokers. Cough was the most common initial symptom (33.5%); 13.1% of patients were asymptomatic. While squamous cell carcinoma was the most common subtype in male patients (37.2%), adenocarcinoma was the most frequent histological type in all patients (48.7%) and females (76.3%). The majority of patients received treatment (76.5%), which included surgery, radiation therapy, and chemotherapy. Older age (hazard ratio [HR], 1.037), lower body mass index (HR, 0.904), ever-smoker (HR, 2.003), small cell lung cancer (HR, 1.627), and distant metastasis (HR, 3.990) were independent predictors of mortality. Patients without symptoms (HR, 0.387) and without treatment (HR, 0.364) were associated with a favorable outcome in multivariate Cox analysis. Conclusion Lung cancer in Korea occurs predominantly in elderly patients, with adenocarcinoma being the most frequent subtype. The prognosis was poorer in ever-smokers and older, malnourished, and untreated patients with advanced lung cancer.
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Affiliation(s)
- Ho Cheol Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chi Young Jung
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Deog Gon Cho
- Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jae Hyun Jeon
- Center for Lung Cancer, National Cancer Center, Goyang, Korea
| | - Jeong Eun Lee
- Division of Pulmonology, Department of Internal Medicine, Chungnam National University, Daejeon, Korea
| | - Jin Seok Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Seung Joon Kim
- Division of Pulmonology, Department of Internal Medicine, The Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeongdae Kim
- Department of Cardiothoracic Surgery, Pusan National University Hospital, Busan, Korea
| | - Young Chul Kim
- Department of Pulmonary Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jung Eun Kim
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Boram Lee
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Young Joo Won
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Chang Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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36
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Minnix JA, Karam-Hage M, Blalock JA, Cinciripini PM. The importance of incorporating smoking cessation into lung cancer screening. Transl Lung Cancer Res 2018; 7:272-280. [PMID: 30050765 DOI: 10.21037/tlcr.2018.05.03] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer is the leading cause of cancer-related death in the United States (U.S.) and is the second most common non-skin cancer among men and women, accounting for about 30% of cancer-related deaths. There is clear and accumulating evidence that continued tobacco use has multiple adverse effects on cancer treatment outcomes, including greater probability of recurrence, second primary malignancies, reduced survival, greater symptom burden, and poorer quality of life (QOL). Recent findings suggest an avenue to significantly mitigate the impact of smoking on lung cancer mortality rates through the use of low-dose computed tomography (LDCT) lung cancer screening. Based on the reviewed evidence (type B), the U.S. Preventive Services Task Force (USPSTF) guidelines of 2015 recommend screening combined with smoking cessation interventions for high-risk heavy smokers and recent quitters. These practice changes offer opportunities to develop novel smoking cessation strategies tailored to highly specific settings that aim to amplify the survivorship gains expected from screening alone. However, there is a paucity of research and data that speaks to the feasibility and efficacy of providing smoking cessation treatment specifically within the context of the LDCT lung cancer screening environment. While some studies have attempted to characterize the parameters within which smoking cessation interventions should be implemented in this context, further research is needed to explore relevant factors such as the format, components, and timing of interventions, as well as the influence of risk perceptions and results of the screening itself on motivation and ability to quit smoking.
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Affiliation(s)
- Jennifer Anne Minnix
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maher Karam-Hage
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janice A Blalock
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul M Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lin L, Zhao J, Hu J, Zou G, Huang F, Han J, He Y, Cao X. Current Smoking has a Detrimental Effect on Survival for Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK) negative Advanced non-squamous Non-small Cell Lung Cancer (NSCLC) Patients Treated with Pemetrexed Continuation Maintenance. J Cancer 2018; 9:2140-2146. [PMID: 29937933 PMCID: PMC6010680 DOI: 10.7150/jca.24872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/13/2018] [Indexed: 12/20/2022] Open
Abstract
Objectives: The aim of this study is to investigate the predictive value of smoking history on treatment outcomes of pemetrexed continuation maintenance therapy in advanced non-squamous NSCLC patients without EGFR mutations and ALK rearrangements. Methods: 71 consecutive EGFR and ALK negative advanced non-squamous NSCLC patients who had received pemetrexed continuation maintenance therapy at least two cycles were retrospectively analyzed in our single center. The enrolled patients were categorized into two groups as never-/former light smokers and current smokers according to their smoking history. Results: In the 71 non-squamous NSCLC patients, 30 (42.3%) were never-/former light smokers and 41 (57.7%) were current smokers. The objective response rate (ORR) of never-/former light smokers was significantly higher than that of current smokers (26.7% vs. 7.3%, p = 0.026). Never-/former light smokers showed significantly longer progression free survival (PFS) (6.6 [95% CI 5.3-7.9] months vs. 5.1 [95% CI 3.5-6.7] months; HR: 0.557, 95% CI 0.339-0.915, p = 0.021) and overall survival (OS) (17.3 [95% CI 14.4-20.2] months vs. 15.7 [95% CI 12.0-19.4] months; HR: 0.578, 95% CI 0.338-0.986, p = 0.044) than current smokers. Multivariate analysis identified smoking history was an independent predictive factor for PFS and OS. Conclusions: Current smoking is an independent negative predictive factor of outcomes for pemetrexed continuation maintenance therapy in advanced non-squamous NSCLC patients without EGFR mutations and ALK rearrangements.
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Affiliation(s)
- Liping Lin
- Department of Oncology, Panyu Central Hospital, Guangzhou, China, 511400.,Cancer Institute of Panyu, Guangzhou, China, 511400
| | - Juanjuan Zhao
- School of Nursing, Sun Yat-sen University, Guangzhou, China, 510000
| | - Jiazhu Hu
- Department of Oncology, Panyu Central Hospital, Guangzhou, China, 511400.,Cancer Institute of Panyu, Guangzhou, China, 511400
| | - Guorong Zou
- Department of Oncology, Panyu Central Hospital, Guangzhou, China, 511400.,Cancer Institute of Panyu, Guangzhou, China, 511400
| | - Fuxi Huang
- Department of Oncology, Panyu Central Hospital, Guangzhou, China, 511400.,Cancer Institute of Panyu, Guangzhou, China, 511400
| | - Jianjun Han
- Department of Oncology, Panyu Central Hospital, Guangzhou, China, 511400.,Cancer Institute of Panyu, Guangzhou, China, 511400
| | - Yan He
- Department of Oncology, Panyu Central Hospital, Guangzhou, China, 511400.,Cancer Institute of Panyu, Guangzhou, China, 511400
| | - Xiaolong Cao
- Department of Oncology, Panyu Central Hospital, Guangzhou, China, 511400.,Cancer Institute of Panyu, Guangzhou, China, 511400
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Siegel DA, Henley SJ, Wike JM, Ryerson AB, Johnson CJ, Rees JR, Pollack LA. Capture of tobacco use among population-based registries: Findings from 10 National Program of Cancer Registries states. Cancer 2018; 124:2381-2389. [PMID: 29579317 DOI: 10.1002/cncr.31326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/23/2018] [Accepted: 02/10/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Tobacco use data are important when the epidemiology and prognosis of tobacco-associated cancers are being defined. Central cancer registries in 10 National Program of Cancer Registries states pilot-tested the collection of standardized tobacco use variables. This study evaluated the capture of tobacco use data and examined smoking prevalence among cancer patients. METHODS Participating registries collected data about the use of tobacco-cigarettes, other smoked tobacco, and smokeless tobacco-for cases diagnosed during 2011-2013. The percentage of cases with known tobacco variable values was calculated, and the prevalence of tobacco use was analyzed by the primary cancer site and state. RESULTS Among 1,646,505 incident cancer cases, 51% had known cigarette use data: 18% were current users, 31% were former users, and 51% reported never using. The percentage of cases with a known status for both other smoked tobacco and smokeless tobacco was 43%, with 97% and 98% coded as never users, respectively. The percent known for cigarette use ranged from 27% to 81% by state and improved from 47% in 2011 to 59% in 2013 for all 10 states combined. The percent known for cigarette use and the prevalence of ever smoking cigarettes were highest for laryngeal cancer and tracheal, lung, and bronchus cancer. CONCLUSIONS Cancer registrars ascertained cigarette use for slightly more than half of all new cancer cases, but other tobacco-related fields were less complete. Studies to evaluate the validity of specific tobacco-related variables and the ability of cancer registries to capture this information from the medical record are needed to gauge the usefulness of collecting these variables through cancer surveillance systems. Cancer 2018;124:2381-9. © 2018 American Cancer Society.
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Affiliation(s)
- David A Siegel
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - S Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer M Wike
- DB Consulting Group, Inc, CDC-NPCR Contractor, Atlanta, Georgia
| | - A Blythe Ryerson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Judy R Rees
- New Hampshire State Cancer Registry, Lebanon, New Hampshire.,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Lori A Pollack
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Zhang P, Nie X, Bie Z, Li L. Impact of heavy smoking on the benefits from first-line EGFR-TKI therapy in patients with advanced lung adenocarcinoma. Medicine (Baltimore) 2018; 97:e0006. [PMID: 29489642 PMCID: PMC5851738 DOI: 10.1097/md.0000000000010006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Smoking is a risk factor for nonsmall cell lung carcinoma (NSCLC) and is associated with a lower response to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI). The purpose of this study is to examine the impact of the smoking status on the benefits from first-line EGFR-TKI in NSCLC patients with EGFR mutation.This was a retrospective study of 159 patients with advanced NSCLC treated at the Beijing Hospital between January 2011 and December 2016. The follow-up was censored on December 2017. EGFR mutation status, smoking (nonsmoker vs <30 packs/year (light smoker) vs ≥30 packs/year (heavy smoker)), treatment, treatment response, and progression-free survival (PFS) were collected from the charts.Median follow-up was 10.0 (1.0-36.6) months. Response rate was lower in heavy smokers compared with nonheavy smokers (19.0% vs 71.7%, P < .001). There was no difference in PFS between nonsmokers (median, 10.5 months) and light smoker (median, 11.0 months), and these 2 groups were pooled together. PFS was longer in nonheavy smokers compared with heavy-smokers (median, 10.7 vs 6.0 months, P < .001). Smoking ≥ 30 packs/year (HR = 2.48, 95% CI: 1.55-3.98, P < .001) was associated with PFS.In patients with advanced NSCLC, the benefits and PFS of EGFR-TKI were better for nonheavy smokers than for heavy smokers.
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Affiliation(s)
| | | | - Zhixin Bie
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Beijing, China
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40
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EGFR mutation, smoking, and gender in advanced lung adenocarcinoma. Oncotarget 2017; 8:98384-98393. [PMID: 29228697 PMCID: PMC5716737 DOI: 10.18632/oncotarget.21842] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/24/2017] [Indexed: 01/21/2023] Open
Abstract
Purpose In the current targeted therapy era, information on the effect of smoking in epidermal growth factor receptor (EGFR)-mutant lung cancer patients is scarce. Results In total, 11,678 adenocarcinoma patients were enrolled. Of these, 33.3% and 91.8% of male and female patients were non-smokers, respectively. An increased amount of smoking (P < 0.001 for trend), fewer smoke-free years (P < 0.001 for trend), and younger age of smoking initiation (P = 0.034 for trend) were all associated with significantly lower EGFR mutation rates. Smokers had a shorter median overall survival (OS) among both EGFR-mutant and EGFR-wild type patients (17.8 vs. 21.1 months, and 7.9 vs. 11.4 months respectively; both P < 0.001). Among patients with EGFR-mutant adenocarcinoma, younger smokers were associated with shorter OS (P = 0.047). In multivariate analysis, female gender was an independent prognostic factor for OS (hazard ratio: 0.86 [95% confidence interval {CI}: 0.80-0.93]; P < 0.001 in the EGFR-mutant group and 0.88 [95% CI: 0.81-0.96]; P = 0.004 in the EGFR-wild type group). Materials and Methods We reviewed the National Lung Cancer database (Taiwan) to assess the impact of smoking on the EGFR mutation rate and survival in advanced lung adenocarcinoma patients during 2011 and 2014 retrospectively. Conclusions Smoking was associated with lower incidence of EGFR mutation rate and reduced OS of advanced lung adenocarcinoma patients in a dose-dependent manner. In addition to EGFR mutation and smoking, gender also plays an important role in survival among these patients.
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41
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Zhang L, Li J, Hu J, Li D, Wang X, Zhang R, Zhang H, Shi M, Chen H. Cigarette smoke extract induces EGFR-TKI resistance via promoting EGFR signaling pathway and ROS generation in NSCLC cell lines. Lung Cancer 2017; 109:109-116. [PMID: 28577939 DOI: 10.1016/j.lungcan.2017.05.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/10/2017] [Accepted: 05/10/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Epithelial growth factor receptor (EGFR) somatic-mutated non-small cell lung cancer (NSCLC) patients with smoking history always show a poor response to EGFR tyrosine kinase inhibitors (EGFR-TKIs). The aim of the study is to explore the molecular mechanism of EGFR-TKI resistance induced by cigarette smoke extract and investigate the novel anti-resistance strategies. METHODS The effect of cigarette smoke extract (CSE) on gefitinib sensitivity, EGFR signaling, apoptosis and reactive oxygen species (ROS) levels were detected in vitro by MTT assays, western blot, flow cytometry and laser scanning confocal microscope, respectively. RESULTS MTT assays presented that CSE claimed antagonistic effect on gefitinib sensitivity via the up-regulated half maximal inhibitory concentration (IC50) values, western blot showed that CSE instigated EGFR, AKT phosphorylation, while N-Acetyl-l-Cysteine (NAC) could alleviate gefitinib resistance and abort the aberrant phosphorylation in both PC-9 and A549 cells. Confocal microscope and flow cytometry displayed that ROS generation increased after CSE exposure in NSCLC cells and this change could be inhibited by NAC. CONCLUSION Cigarette smoke extract induces EGFR-TKI resistance via promoting EGFR signaling and ROS generation in NSCLC cell lines which could be suppressed by NAC. Alternatively, combined NAC with EGFR-TKIs to treat EGFR mutated NSCLC patients with smoking history may be a potential choice in clinical setting.
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Affiliation(s)
- Lu Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jun Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jing Hu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Dandan Li
- Department of Respiratory Medicine, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Xiaohui Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Rui Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Hui Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Meng Shi
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Hong Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
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Erdogan B, Kodaz H, Karabulut S, Cinkaya A, Tozkir H, Tanriverdi O, Cabuk D, Hacioglu MB, Turkmen E, Hacibekiroglu I, Uzunoglu S, Cicin I. Impact of active smoking on survival of patients with metastatic lung adenocarcinoma harboring an epidermal growth factor receptor (EGFR) mutation. Bosn J Basic Med Sci 2016; 16:280-285. [PMID: 27371767 DOI: 10.17305/bjbms.2016.1380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 11/16/2022] Open
Abstract
Lung cancer in smokers and non-smokers demonstrates distinct genetic profiles, and cigarette smoking affects epidermal growth factor receptor (EGFR) function and causes secondary EGFR tyrosine kinase resistance. We evaluated the effect of active smoking in patients with metastatic lung adenocarcinoma. A total of 132 metastatic lung adenocarcinoma patients, diagnosed between 2008 and 2013, with known EGFR mutation status, were evaluated retrospectively. Among these patients, 40 had an activating EGFR mutation. Patients who continued smoking during the treatment were defined as active smokers. Former smokers and never smokers were together defined as non-smokers. The outcomes of the treatment in relation to the EGFR mutation and smoking status were evaluated. The median follow-up time was 10.5 months. The overall response rate for the first-line therapy was significantly higher among the EGFR-mutant patients (p = 0.01), however, smoking status had no impact on the response rate (p = 0.1). The EGFR-mutant active smokers progressed earlier than the non-smokers (p < 0.01). The overall survival (OS) of the non-smokers and patients treated with erlotinib was significantly longer (p = 0.02 and p = 0.01, respectively). Smoking status did not affect the OS in EGFR wild type tumors (p = 0.49) but EGFR-mutant non-smokers had a longer OS than the active smokers (p = 0.01).The active smokers treated with erlotinib had poorer survival than the non-smokers (p = 0.03). Multivariate analysis of EGFR-mutant patients showed that erlotinib treatment at any line and non-smoking were independent prognostic factors for the OS (p = 0.04 and p = 0.01, respectively). Smoking during treatment is a negative prognostic factor in metastatic lung adenocarcinoma with an EGFR mutation.
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Affiliation(s)
- Bulent Erdogan
- Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey.
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Li HM, Azhati B, Rexiati M, Wang WG, Li XD, Liu Q, Wang YJ. Impact of smoking status and cumulative smoking exposure on tumor recurrence of non-muscle-invasive bladder cancer. Int Urol Nephrol 2016; 49:69-76. [PMID: 27766490 DOI: 10.1007/s11255-016-1441-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/15/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the effect of smoking status, cumulative smoking exposure and smoking cessation on the outcomes of patient with non-muscle-invasive bladder cancer (NMIBC). METHODS We collected smoking data from 484 patients with NMIBC who were treated with transurethral resection (TUR); smoking status was categorized as (never smokers vs current smokers vs former smokers). Cumulative smoking exposure was categorized as high smoking exposure (cigarette index ≥400) versus low smoking exposure (cigarette index <400). Association with outcomes was examined by multivariable analyses after adjusting for the effects of standard clinicopathologic factors, and the Kaplan-Meier method was used to estimate the effect of smoking status and cumulative smoking exposure on RFS. RESULTS A total of 168 (34.7 %) patients were never smoker, 121 (25 %) patients were current smokers, and 195 (40.3 %) patients were former smokers. The median follow-up was 25 months. By multivariate analysis, pathological grade (p = 0.013), history of recurrence (p < 0.001), number of tumors (p < 0.001) and size of tumors (p = 0.013) were significantly associated with tumor recurrence; nevertheless, smoking status did not influence tumor recurrence (p = 0.063). Among current and former smokers, cumulative smoking exposure was significantly associated with tumor recurrence (p < 0.001), compared to current smokers, patients with smoking cessation ≥10 years had a lower risk of tumor recurrence [hazard ratio (HR) 0.456, p = 0.007]. CONCLUSIONS Smoking affects the prognosis of patient with NMIBC, which is still controversial; however, among ever smokers, a high cumulative exposure smoking can significantly increase the risk of tumor recurrence. Quitting smoking might be associated with a lower recurrence rate for patients with NMIBC.
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Affiliation(s)
- Hao Min Li
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, Xinjiang, 830054, People's Republic of China
| | - Baihetiya Azhati
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, Xinjiang, 830054, People's Republic of China
| | - Mulati Rexiati
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, Xinjiang, 830054, People's Republic of China
| | - Wen Guang Wang
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, Xinjiang, 830054, People's Republic of China
| | - Xiao Dong Li
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, Xinjiang, 830054, People's Republic of China
| | - Qiang Liu
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, Xinjiang, 830054, People's Republic of China
| | - Yu-Jie Wang
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, Xinjiang, 830054, People's Republic of China.
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Chen J, Hao X, Cheng F, Zhang T, Xing P, Li J. [Clinicopathologic Characteristics of the Patients in the Elderly Lung Carcinoma]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:675-678. [PMID: 27760597 PMCID: PMC5973418 DOI: 10.3779/j.issn.1009-3419.2016.10.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND As the prevalence of tobacco and the aging of the population, the incidence of lung cancer in the elderly rises. However, few elderly patients (older than 70 years old) with lung squamous cell carcinoma were involved into the clinical trials, which offered insufficient clinical evidence for these patients. Lung squamous cell carcinoma patients older than 80 years old were included in our study to analyze the clinical characteristics, treatment and prognostic factors, and to explore the optimal treatment choices for these patients. METHODS We retrospectively analyzed the clinical features of 38 elderly patients with lung squamous carcinoma and summarized the treatment under the clear diagnosis and clinical staging. RESULTS Elderly patients with squamous cell carcinoma can choose surgery, radiotherapy and chemotherapy based on diagnosis and clinical staging when their physical condition is permitted. CONCLUSIONS Because of the short life expectancy of patients more than 80 years old, fewer of them could receive completed and effective treatment, comparing with patients between 70 and 80 years old.
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Affiliation(s)
- Jie Chen
- Beijing Chaoyang Sanhuan Cancer Hospital, Beijing 100122, China
| | - Xuezhi Hao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fang Cheng
- Beijing Chaoyang Sanhuan Cancer Hospital, Beijing 100122, China;National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Tongtong Zhang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Puyuan Xing
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Junling Li
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Smit EF, Wu YL, Gervais R, Zhou C, Felip E, Feng J, Guclu SZ, Hoiczyk M, Dorokhova E, Freudensprung U, Grange S, Perez-Moreno PD, Mitchell L, Reck M. A randomized, double-blind, phase III study comparing two doses of erlotinib for second-line treatment of current smokers with advanced non-small-cell lung cancer (CurrentS). Lung Cancer 2016; 99:94-101. [PMID: 27565921 DOI: 10.1016/j.lungcan.2016.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/23/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Active smokers with non-small-cell lung cancer (NSCLC) have increased erlotinib metabolism versus non-smoking patients, which reduces exposure. Therefore, an increased erlotinib dose may be beneficial. The CurrentS study (NCT01183858) assessed efficacy and safety of 300mg erlotinib (E300) as second-line therapy in current smokers with locally advanced or metastatic NSCLC versus the standard 150mg dose (E150). MATERIALS AND METHODS Patients with stage IIIB/IV NSCLC (current smokers who failed first-line platinum-based chemotherapy) were randomized to receive E150 or E300 until progression/death/unacceptable toxicity. PRIMARY ENDPOINT progression-free survival (PFS). Secondary endpoints: overall survival (OS), disease control rate and safety. RESULTS A total of 342 patients were screened; the intent-to-treat population comprised 159 E300 patients and 154 E150 patients. Median PFS was 7.0 versus 6.9 weeks with E300 versus E150, respectively (unstratified hazard ratio [HR]=1.05, 95% confidence interval [CI]: 0.83-1.33; unstratified log-rank P=0.671). Median OS was 6.8 months in both arms (unstratified HR=1.03, 95% CI: 0.80-1.32; unstratified log-rank P=0.846). Overall, 89.2% (E300 arm) and 84.4% (E150 arm) experienced ≥1 adverse event (AE) of any grade (44.3% and 37%, respectively, experienced grade ≥3 AEs); AEs of special interest were reported in 67.7% and 47.4% of patients, respectively. E300 resulted in higher mean plasma concentrations versus E150, however, this did not improve efficacy. CONCLUSIONS Despite the difference in erlotinib exposure, there was no evidence of an incremental efficacy benefit of a higher erlotinib dose versus the standard dose in this population of highly active smokers.
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Affiliation(s)
- Egbert F Smit
- Netherlands Cancer Institute, Thoracic Oncology, Amsterdam, The Netherlands.
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | | | - Caicun Zhou
- Shanghai Pulmonary Hospital, Shanghai, China
| | | | - Jifeng Feng
- Jiangsu Province Cancer Hospital, Nanjing, China
| | - Salih Zeki Guclu
- Dr Suat Seren Chest Diseases and Surgery Hospital, Izmir, Turkey
| | - Mathias Hoiczyk
- Innere Klinik and Poliklinik Tumorforschung, West German Cancer Centre, Essen, Germany
| | | | | | | | | | | | - Martin Reck
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
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Li D, Du XL, Ren Y, Liu P, Li S, Yang J, Lv M, Chen L, Wang X, Li E, Yang J, Yi M. Comparative Analysis of Clinicopathologic Features of, Treatment in, and Survival of Americans with Lung or Bronchial Cancer. PLoS One 2016; 11:e0156617. [PMID: 27244238 PMCID: PMC4886968 DOI: 10.1371/journal.pone.0156617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/17/2016] [Indexed: 01/12/2023] Open
Abstract
Ethnic disparities in lung and bronchial cancer diagnoses and disease-specific survival (DSS) rates in the United States are well known. However, few studies have specifically assessed these differences in Asian subgroups. The primary objectives of the retrospective analysis described herein were to identify any significant differences in clinicopathologic features, treatment, and survival rate between Asian lung cancer patients and lung cancer patients in other broad ethnic groups in the United States and to determine the reasons for these differences among subgroups of Asian patients with lung or bronchial cancer. We searched the Surveillance, Epidemiology, and End Results Program database to identify patients diagnosed with lung or bronchial cancer from 1990 to 2012. Differences in clinicopathologic features, treatment, and DSS rate in four broad ethnic groups and eight Asian subgroups were compared. The study population consisted of 849,088 patients, 5.2% of whom were of Asian descent. Female Asian patients had the lowest lung and bronchial cancer incidence rates, whereas male black patients had the highest rates. Asian patients had the best 5-year DSS rate. In our Asian subgroup analysis, Indian/Pakistani patients had the best 5-year DSS rate, whereas Hawaiian/Pacific Islander patients had the worst 5-year DSS rates. We found the differences in DSS rate among the four broad ethnic groups and eight Asian subgroups when we grouped patients by age and disease stage, as well. Asian patients had better DSS rates than those in the other three broad ethnic groups in almost every age and disease-stage group, especially in older patients and those with advanced-stage disease. In conclusion, we found that clinicopathologic features and treatment of lung and bronchial cancer differ by ethnicity in the United States, and the differences impact survival in each ethnic group.
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Affiliation(s)
- Dan Li
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xianglin L. Du
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, United States of America
| | - Yinghong Ren
- Department of Internal Medicine, Shangluo Central Hospital, Shangluo, Shaanxi, China
| | - Peijun Liu
- Department of Translational Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Shuting Li
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Jiao Yang
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Meng Lv
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Ling Chen
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xin Wang
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Enxiao Li
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Jin Yang
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- * E-mail: (MY); (Jin Yang)
| | - Min Yi
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail: (MY); (Jin Yang)
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47
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Zheng S, Wang R, Zhang Y, Pan Y, Cheng C, Zheng D, Sun Y, Chen H. Former smokers with non-small-cell lung cancers: a comprehensive investigation of clinicopathologic characteristics, oncogenic drivers, and prognosis. Cancer Med 2016; 5:2117-25. [PMID: 27227356 PMCID: PMC4884640 DOI: 10.1002/cam4.764] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 04/05/2016] [Accepted: 04/15/2016] [Indexed: 12/03/2022] Open
Abstract
The aim of this present investigation was to evaluate the clinicopathologic characteristics, oncogenic drivers, and prognosis of former smokers with non‐small‐cell lung cancer (NSCLC), and to compare them with those of the current and never smokers. This investigation was a single‐institution retrospective study of 2289 NSCLC patients, who were classified as former, current, or never smokers. A collection was made of the clinicopathological characteristics, spectra of well‐identified driver genes and survival rates. The survival rates were compared using log‐rank test, and independent prognostic factors, identified using Cox regression analysis. Of 2289 NSCLC patients, 257 (11.2%) were former smokers; 868 (37.9%), current smokers; and 1164 (50.9%), never smokers. Compared with the current, the former were characterized by older age at diagnosis (64.3y vs. 59.9y; P < 0.001), earlier TNM stage (stage I, 47.9% vs. 39.5%; P = 0.017), fewer solid predominance in adenocarcinomas (16.2% vs. 29.5%; P = 0.005), and more EGFR mutation (33.2% vs. 20.7%; P < 0.001) but less KRAS mutation (6.7% vs. 11.9%, P = 0.041). No statistically significant survival differences were observed between the former and current. However, the light former smokers presented favorable overall survival when compared with the light current and heavy former or current (the light former vs. the heavy former, P = 0.028; the light former vs. the light current, P = 0.048; and the light former vs. the heavy current, P = 0.048). Our findings suggest that the former smokers with NSCLCs can have distinctive clinicopathologic characteristics, oncogenic drivers, and prognosis, and they, especially the light former, can benefit from smoking cessation.
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Affiliation(s)
- Shanbo Zheng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Rui Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yunjian Pan
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chao Cheng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Difan Zheng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yihua Sun
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Jing X, Meng X, Sun X, Yu J. Delineation of clinical target volume for postoperative radiotherapy in stage IIIA-pN2 non-small-cell lung cancer. Onco Targets Ther 2016; 9:823-31. [PMID: 26929651 PMCID: PMC4767117 DOI: 10.2147/ott.s98765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
With the high locoregional relapse rate and the improvement of radiation technology, postoperative radiotherapy (PORT) has been widely used in the treatment of completely resected stage IIIA-pN2 non-small-cell lung cancer (NSCLC). However, there is still no definitive consensus on clinical target volume for the pN2 subgroup. This review will discuss how to delineate the clinical target volume (CTV) for pN2 subgroups of IIIA-N2 NSCLC based on the published literature and to investigate the optimal PORT CTV in this cohort of patients. Besides overall survival (OS), locoregional recurrence (LR), and radiotherapy-related toxicity of this subset of the population in the modern PORT era, selection of proper patients will also be considered in this review. In summary, it is appropriate to include involved lymph node stations and uninvolved stations at high risk in PORT CTV for patients with pN2 disease when PORT is administered. PORT can reduce LR and has the potential to improve OS. In the current era of modern radiation technology, PORT can be administered safely with well-tolerated toxicity. Clinicopathological characteristics may be helpful in selecting proper candidates for PORT.
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Affiliation(s)
- Xuquan Jing
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, People's Republic of China; Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, People's Republic of China
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, People's Republic of China
| | - Xindong Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, People's Republic of China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, People's Republic of China
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49
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Wu GX, Goldstein L, Kim JY, Raz DJ. Proportion of Non-Small-Cell Lung Cancer Patients that Would Have Been Eligible for Lung Cancer Screening. Clin Lung Cancer 2016; 17:e131-e139. [PMID: 26872765 DOI: 10.1016/j.cllc.2016.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lung cancer screening is recommended for current smokers (CS) and former smokers (FS) who meet specific age and smoking criteria. We used existing criteria to estimate the proportion of non-small-cell lung cancer (NSCLC) patients that would have been screening-eligible. METHODS We identified 2030 NSCLC patients at our institution from 1994 to 2014 and recorded their cigarette smoking status and history. Using criteria from the United States Preventative Services Task Force (USPSTF) and from other organizations, we ascertained the proportions of screening-eligible patients. Associations among smoking status, gender, race/ethnicity, and insurance type were assessed using Chi-Square test. RESULTS In our cohort, 31.0% (n = 630) were CS, 43.0% (n = 873) were FS, and 26.0% (n = 527) were never smokers. There were 698 patients (34.4%) who met all USPSTF screening criteria. Among 1503 CS and FS, 77.5% (n = 1165) were between age 55 and 80 years, and 67.9% (n = 1021) had smoked ≥ 30 pack-years. Among FS, 50.4% (n = 440) had quit within 15 years of diagnosis. Median pack-years smoked was 40 (interquartile range, 20-55 pack-years). CS were more likely to meet screening criteria than FS (67.5% vs. 31.3%; P < .0001). Significant differences were found among individuals meeting criteria by gender, race/ethnicity, and insurance type. CONCLUSION Only a third of patients diagnosed with NSCLC were eligible for lung cancer screening based on USPSTF criteria. FS were less likely to meet all screening criteria due to only half meeting the quit-time criterion. Additional evidence is needed to evaluate the utility of restricting screening among FS to those who quit within 15 years.
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Affiliation(s)
- Geena X Wu
- Division of Thoracic Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA.
| | - Leanne Goldstein
- Division of Biostatistics, City of Hope National Medical Center, Duarte, CA
| | - Jae Y Kim
- Division of Thoracic Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Dan J Raz
- Division of Thoracic Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA
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50
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Wu XY, Huang XE. Screening for patients with non-small cell lung cancer who could survive long term chemotherapy. Asian Pac J Cancer Prev 2015; 16:647-52. [PMID: 25684501 DOI: 10.7314/apjcp.2015.16.2.647] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lung cancer was one of the most common cancers in both men and women all over the world. In this study, we aimed to clarify who could survive after long term chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). METHODS We enrolled 186 patients with stage IV NSCLC after long term chemotherapy from Jun 2006 to Nov 2014 diagnosed in Jiangsu Cancer Hospital. Multiple variables like age, gender, smoking, histology of adenocarcinoma and squamous-cell cancer, number of metastatic sites, metastatic sites (e.g. lung, brain, bone, liver and pleura), hemoglobin, lymphocyte rate (LYR), Change of LYR during multiple therapies, hypertension, diabetes, chronic bronchitis, treatments (e.g.radiotherapy and targeted therapy) were selected. For consideration of factors influencing survival and response for patients with advanced NSCLC, logistic regression analysis and Cox regression analysis were used in an attempt to develop a screening module for patients with elevated survival after long term chemotherapy become possible. RESULTS Of the total of 186 patients enrolled, 69 survived less than 1 year (short-term group), 45 one to two years, and 72 longer than 3 years (long-term group). For logistic regression analysis, the short-term group was taken as control group and the long-term group as the case group. We found that age, histology of adenocarcinoma, metastatic site (e.g. lung and liver), treatments (e.g. targeted therapy and radiotherapy), LYR, a decreasing tendency of LYR and chronic bronchitis were individually associated with overall survival by Cox regression analysis. A multivariable Cox regression model showed that metastatic site (e.g. lung and liver), histology of adenocarcinoma, treatments (e.g. targeted therapy and radiotherapy) and chronic bronchitis were associated with overall survival. Thus metastatic site (e.g. lung and liver) and chronic bronchitis may be important risk factors for patients with advanced NSCLC. Gender, metastatic site (e.g. lung and liver), LYR and the decreasing tendency of LYR were significantly associated with long-term survival in the individual-variable logistic regression model (P<0.05). On multivariate logistic regression analysis, gender, metastatic site (e.g. lung and liver) and the decreasing tendency of LYR associated with long-term survival. CONCLUSIONS In conclusion, female patients with stage IV adenocarcinoma of NSCLC who had decreasing tendency of LYR during the course therapy and had accepted multiple therapies e.g. more than third-line chemotherapy, radiotherapy and/or targeted therapy might be expected to live longer.
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Affiliation(s)
- Xue-Yan Wu
- Department of Chemotherapy, the Affiliated Jiangsu Cancer Hospital of Nanjing Medical University and Jiangsu Institute of Cancer Research, Nanjing, China E-mail :
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