1
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Zhuan B, Ma HH, Zhang BC, Li P, Wang X, Yuan Q, Yang Z, Xie J. Identification of non-small cell lung cancer with chronic obstructive pulmonary disease using clinical symptoms and routine examination: a retrospective study. Front Oncol 2023; 13:1158948. [PMID: 37576878 PMCID: PMC10419203 DOI: 10.3389/fonc.2023.1158948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/03/2023] [Indexed: 08/15/2023] Open
Abstract
Background Patients with non-small cell lung cancer (NSCLC) and patients with NSCLC combined with chronic obstructive pulmonary disease (COPD) have similar physiological conditions in early stages, and the latter have shorter survival times and higher mortality rates. The purpose of this study was to develop and compare machine learning models to identify future diagnoses of COPD combined with NSCLC patients based on the patient's disease and routine clinical data. Methods Data were obtained from 237 patients with COPD combined with NSCLC as well as NSCLC admitted to Ningxia Hui Autonomous Region People's Hospital from October 2013 to July 2022. Six machine learning algorithms (K-nearest neighbor, logistic regression, eXtreme gradient boosting, support vector machine, naïve Bayes, and artificial neural network) were used to develop prediction models for NSCLC combined with COPD. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, F1 score, Mathews correlation coefficient (MCC), Kappa, area under the receiver operating characteristic curve (AUROC)and area under the precision-recall curve (AUPRC) were used as performance indicators to evaluate the performance of the models. Results 135 patients with NSCLC combined with COPD, 102 patients with NSCLC were included in the study. The results showed that pulmonary function and emphysema were important risk factors and that the support vector machine-based identification model showed optimal performance with accuracy:0.946, recall:0.940, specificity:0.955, precision:0.972, npv:0.920, F1 score:0.954, MCC:0.893, Kappa:0.888, AUROC:0.975, AUPRC:0.987. Conclusion The use of machine learning tools combining clinical symptoms and routine examination data features is suitable for identifying the risk of concurrent NSCLC in COPD patients.
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Affiliation(s)
- Bing Zhuan
- Department of Respiratory Medicine, Ningxia Hui Autonomous Region People’s Hospital, Yinchuan, Ningxia, China
- Department of Respiratory Medicine, Ningxia Hui Autonomous Region People’s Hospital Affiliated to Ningxia Medical University, Yinchuan, Ningxia, China
| | - Hong-Hong Ma
- Department of Respiratory Medicine, Ningxia Hui Autonomous Region People’s Hospital, Yinchuan, Ningxia, China
- Department of Respiratory Medicine, Ningxia Hui Autonomous Region People’s Hospital Affiliated to Ningxia Medical University, Yinchuan, Ningxia, China
| | - Bo-Chao Zhang
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Suzhou, Jiangsu, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Ping Li
- Department of Respiratory Medicine, Ningxia Hui Autonomous Region People’s Hospital, Yinchuan, Ningxia, China
- Department of Respiratory Medicine, Ningxia Hui Autonomous Region People’s Hospital Affiliated to Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xi Wang
- Department of Respiratory Medicine, Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Qun Yuan
- Department of Respiratory Medicine, Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Zhao Yang
- Department of Respiratory Medicine, Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Jun Xie
- Department of Thoracic Surgery, Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
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2
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Forder A, Zhuang R, Souza VGP, Brockley LJ, Pewarchuk ME, Telkar N, Stewart GL, Benard K, Marshall EA, Reis PP, Lam WL. Mechanisms Contributing to the Comorbidity of COPD and Lung Cancer. Int J Mol Sci 2023; 24:ijms24032859. [PMID: 36769181 PMCID: PMC9918127 DOI: 10.3390/ijms24032859] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 02/05/2023] Open
Abstract
Lung cancer and chronic obstructive pulmonary disease (COPD) often co-occur, and individuals with COPD are at a higher risk of developing lung cancer. While the underlying mechanism for this risk is not well understood, its major contributing factors have been proposed to include genomic, immune, and microenvironment dysregulation. Here, we review the evidence and significant studies that explore the mechanisms underlying the heightened lung cancer risk in people with COPD. Genetic and epigenetic changes, as well as the aberrant expression of non-coding RNAs, predispose the lung epithelium to carcinogenesis by altering the expression of cancer- and immune-related genes. Oxidative stress generated by tobacco smoking plays a role in reducing genomic integrity, promoting epithelial-mesenchymal-transition, and generating a chronic inflammatory environment. This leads to abnormal immune responses that promote cancer development, though not all smokers develop lung cancer. Sex differences in the metabolism of tobacco smoke predispose females to developing COPD and accumulating damage from oxidative stress that poses a risk for the development of lung cancer. Dysregulation of the lung microenvironment and microbiome contributes to chronic inflammation, which is observed in COPD and known to facilitate cancer initiation in various tumor types. Further, there is a need to better characterize and identify the proportion of individuals with COPD who are at a high risk for developing lung cancer. We evaluate possible novel and individualized screening strategies, including biomarkers identified in genetic studies and exhaled breath condensate analysis. We also discuss the use of corticosteroids and statins as chemopreventive agents to prevent lung cancer. It is crucial that we optimize the current methods for the early detection and management of lung cancer and COPD in order to improve the health outcomes for a large affected population.
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Affiliation(s)
- Aisling Forder
- British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Rebecca Zhuang
- British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Vanessa G P Souza
- British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
- Molecular Oncology Laboratory, Experimental Research Unit, School of Medicine, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil
| | - Liam J Brockley
- British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Michelle E Pewarchuk
- British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Nikita Telkar
- British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Greg L Stewart
- British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Katya Benard
- British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
| | - Erin A Marshall
- British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Patricia P Reis
- Molecular Oncology Laboratory, Experimental Research Unit, School of Medicine, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil
| | - Wan L Lam
- British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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3
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Jeganathan V, Knight S, Bricknell M, Ridgers A, Wong R, Brazzale DJ, Ruehland WR, Rahman MA, Leong TL, McDonald CF. Impact of smoking status and chronic obstructive pulmonary disease on pulmonary complications post lung cancer surgery. PLoS One 2022; 17:e0266052. [PMID: 35349598 PMCID: PMC8963579 DOI: 10.1371/journal.pone.0266052] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/11/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Smoking and chronic obstructive pulmonary disease (COPD) are associated with an increased risk of post-operative pulmonary complications (PPCs) following lung cancer resection. It remains unclear whether smoking cessation reduces this risk. Methods Retrospective review of a large, prospectively collected database of over 1000 consecutive resections for lung cancer in a quaternary lung cancer centre over a 23-year period. Results One thousand and thirteen patients underwent curative-intent lobectomy or pneumonectomy between 1995 and 2018. Three hundred and sixty-two patients (36%) were ex-smokers, 314 (31%) were current smokers and 111 (11%) were never smokers. A pre-operative diagnosis of COPD was present in 57% of current smokers, 57% of ex-smokers and 20% of never smokers. Just over 25% of patients experienced a PPC. PPCs were more frequent in current smokers compared to never smokers (27% vs 17%, p = 0.036), however, no difference was seen between current and ex-smokers (p = 0.412) or between never and ex-smokers (p = 0.113). Those with a diagnosis of COPD, independent of smoking status, had a higher frequency of both PPCs (65% vs 35%, p<0.01) and overall complications (60% vs 40%, p<0.01) as well as a longer length of hospital stay (10 vs 9 days, p<0.01). Conclusion Smoking and COPD are both associated with a higher rate of PPCs post lung cancer resection. COPD, independent of smoking status, is also associated with an increased overall post-operative complication rate and length of hospital stay. An emphasis on COPD treatment optimisation, rather than smoking cessation in isolation, may help improve post-operative outcomes.
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Affiliation(s)
- Vishnu Jeganathan
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- * E-mail:
| | - Simon Knight
- Department of Thoracic Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Matthew Bricknell
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Anna Ridgers
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Raymond Wong
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Danny J. Brazzale
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Warren R. Ruehland
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Muhammad Aziz Rahman
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- School of Health, Federation University Australia, Berwick, Victoria, Australia
| | - Tracy L. Leong
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Christine F. McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
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4
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Hackner K, Heim M, Masel EK, Riedl G, Weber M, Strieder M, Danninger S, Pecherstorfer M, Kreye G. Evaluation of diagnostic and treatment approaches to acute dyspnea in a palliative care setting among medical doctors with different educational levels. Support Care Cancer 2022; 30:5759-5768. [PMID: 35338391 PMCID: PMC9135814 DOI: 10.1007/s00520-022-06996-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/17/2022] [Indexed: 11/24/2022]
Abstract
Background Dyspnea is common in patients with advanced cancer. Diagnostic procedures in patients with dyspnea are mandatory but often time-consuming and hamper rapid treatment of the underlying refractory symptoms. Opioids are the first-line drugs for the treatment of refractory dyspnea in palliative care patients with advanced lung cancer. Methods To evaluate the knowledge levels of medical doctors with different educational levels on the diagnosis of and treatment options for dyspnea in patients with advanced lung cancer in a palliative care setting, a case report and survey were distributed to physicians at the University Hospital Krems, describing acute dyspnea in a 64-year-old stage IV lung cancer patient. A total of 18 diagnostic and 22 therapeutic options were included in the survey. The physicians were asked to suggest and rank in order of preference their diagnosis and treatment options. Statistical analyses of the data were performed, including comparison of the responses of the senior doctors and the physicians in training. Results A total of 106 surveys were completed. The respondents were 82 senior physicians and 24 physicians in training (response rates of 86% and 80%, respectively). Regarding diagnostic investigations, inspection and reading the patient’s chart were the most important diagnostic tools chosen by the respondents. The choices of performing blood gas analysis (p = 0.01) and measurement of oxygen saturation (p = 0.048) revealed a significant difference between the groups, both investigations performed more frequently by the physicians in training. As for non-pharmacological treatment options, providing psychological support was one of the most relevant options selected. A significant difference was seen in choosing the option of improving a patient’s position in relation to level of training (65.9% senior physicians vs. 30.4% physicians in training, p = 0.04). Regarding pharmacological treatment options, oxygen application was the most chosen approach. The second most frequent drug chosen was a ß-2 agonist. Only 9.8% of the senior physicians and 8.7% of the physicians in training suggested oral opioids as a treatment option, whereas intravenous opioids were suggested by 43.9% of the senior physicians and 21.7% of the physicians in training (p = 0.089). For subcutaneous application of opioids, the percentage of usage was significantly higher for the physicians in training than for the senior physicians (78.3% vs. 48.8%, p = 0.017, respectively). Conclusion The gold standard treatment for treating refractory dyspnea in patients with advanced lung cancer is opioids. Nevertheless, this pharmacological treatment option was not ranked as the most important. Discussing hypothetical cases of patients with advanced lung cancer and refractory dyspnea with experienced doctors as well as doctors at the beginning of their training may help improve symptom control for these patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-06996-6.
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Affiliation(s)
- Klaus Hackner
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Pneumology, University Hospital Krems, Krems, Austria
| | - Magdalena Heim
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Eva Katharina Masel
- Clinical Division of Palliative Medicine, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria
| | - Gunther Riedl
- Department for Anesthesia and Intensive Care, Landesklinikum Baden-Mödling, Baden, Austria
| | - Michael Weber
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | | | - Sandra Danninger
- Clinical Division of Palliative Medicine, Department of Internal Medicine II, University Hospital Krems, Mitterweg 10, 3500, Krems, Austria
| | - Martin Pecherstorfer
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Clinical Division of Palliative Medicine, Department of Internal Medicine II, University Hospital Krems, Mitterweg 10, 3500, Krems, Austria
| | - Gudrun Kreye
- Karl Landsteiner University of Health Sciences, Krems, Austria. .,Clinical Division of Palliative Medicine, Department of Internal Medicine II, University Hospital Krems, Mitterweg 10, 3500, Krems, Austria.
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5
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Survival impact of treatment for chronic obstructive pulmonary disease in patients with advanced non-small-cell lung cancer. Sci Rep 2021; 11:23677. [PMID: 34880386 PMCID: PMC8654854 DOI: 10.1038/s41598-021-03139-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/23/2021] [Indexed: 02/08/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) may coexist with lung cancer, but the impact on prognosis is uncertain. Moreover, it is unclear whether pharmacological treatment for COPD improves the patient's prognosis. We retrospectively investigated patients with advanced non-small-cell lung cancer (NSCLC) who had received chemotherapy at Kyoto University Hospital. Coexisting COPD was diagnosed by spirometry, and the association between pharmacological treatment for COPD and overall survival (OS) was assessed. Of the 550 patients who underwent chemotherapy for advanced NSCLC between 2007 and 2014, 347 patients who underwent spirometry were analyzed. Coexisting COPD was revealed in 103 patients (COPD group). The median OS was shorter in the COPD group than the non-COPD group (10.6 vs. 16.8 months). Thirty-seven patients had received COPD treatment, and they had a significantly longer median OS than those without treatment (16.7 vs. 8.2 months). Multivariate Cox regression analysis confirmed the positive prognostic impact of COPD treatment. Additional validation analysis revealed similar results in patients treated with immune checkpoint inhibitors (ICIs). Coexisting COPD had a significant association with poor prognosis in advanced NSCLC patients if they did not have pharmacological treatment for COPD. Treatment for coexisting COPD has the potential to salvage the prognosis.
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6
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Miao TW, Xiao W, Du LY, Mao B, Huang W, Chen XM, Li C, Wang Y, Fu JJ. High expression of SPP1 in patients with chronic obstructive pulmonary disease (COPD) is correlated with increased risk of lung cancer. FEBS Open Bio 2021; 11:1237-1249. [PMID: 33626243 PMCID: PMC8016137 DOI: 10.1002/2211-5463.13127] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/07/2021] [Accepted: 02/22/2021] [Indexed: 02/05/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by persistent airway inflammation and fixed airflow obstruction. Patients with COPD have increased risk of lung cancer (LC), and the coexistence of both diseases is associated with poorer survival. However, the mechanisms predisposing patients with COPD to LC development and poor prognosis remain unclear. Gene expression profiles were downloaded from the Gene Expression Omnibus. Twenty‐two data sets were included (n = 876). We identified 133 DEGs and 145 DEGs in patients with COPD and LC compared with healthy controls, respectively. There were 1544 DEGs in patients with LC and coexisting COPD compared with COPD, and these DEGs are mainly involved in the cell cycle, DNA replication, p53 signalling and insulin signalling. The biological processes primarily associated with these DEGs are oxidation reduction and apoptosis. SPP1 was the only overlapping DEG that was up‐regulated in patients with COPD and/or LC, and this was validated by qPCR in an independent cohort. The area under the curve value for SPP1 was 0.893 (0.822–0.963) for the prediction of LC in patients with COPD. High expression of SPP1 in patients with LC was associated with shorter survival time. Up‐regulation of SPP1 may be associated with increased risk of LC in patients with COPD and therefore may have potential as a therapeutic target for LC in patients with COPD.
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Affiliation(s)
- Ti-Wei Miao
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Xiao
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Long-Yi Du
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bing Mao
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Huang
- West China Biobanks, Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Xue-Mei Chen
- Research Core Facility, West China Hospital, Sichuan University, Chengdu, China
| | - Cong Li
- Research Core Facility, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Wang
- Research Core Facility, West China Hospital, Sichuan University, Chengdu, China
| | - Juan-Juan Fu
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
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7
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Nasim F, Moua T. Lung cancer in combined pulmonary fibrosis and emphysema: a large retrospective cohort analysis. ERJ Open Res 2020; 6:00521-2020. [PMID: 33344625 PMCID: PMC7737426 DOI: 10.1183/23120541.00521-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/09/2020] [Indexed: 12/25/2022] Open
Abstract
Background Combined pulmonary fibrosis and emphysema (CPFE) is characterised by upper lobe emphysema and lower lobe fibrosis. Our study aim was to determine the incident risk, presenting characteristics and outcome of lung cancer diagnoses in a cohort of CPFE patients over time. Materials and methods We conducted a retrospective cohort study assessing patients with radiological CPFE followed over a median of 76 months (range 1–237 months). Interval development of lung cancer and clinicopathological characteristics of those with and without lung cancer were compared and survival analysis performed. Results Lung cancer occurred in 26 (11.6%) out of 230 CPFE patients, dominated by nonsmall cell lung cancer (88%, n=23) with squamous cell carcinoma comprising the majority (57%, n=13). There was a predominance of lower lobe (62%) and subpleural (64%) radiological presentation. Survival was reduced for the whole cohort by lung cancer even after adjusting for a priori covariables of age, sex, smoking pack-years, presenting forced vital capacity and radiological honeycombing. Univariable predictors of increased mortality after lung cancer diagnosis included honeycombing (hazard ratio (HR) 3.03, 95% CI 1.16–7.91; p=0.02) and later stage presentation (HR 4.77, 95% CI 1.8–14.94; p=0.001), with those able to undergo surgical resection having better survival (HR 0.29, 95% CI 0.09–0.87; p=0.02). Conclusion Lung cancer occurred in 26 (11.6%) out of 230 CPFE patients and was dominated by squamous cell carcinoma presenting in a lower lobe peripheral distribution. Surgical resection appeared to improve survival in selected patients with earlier stage disease. Further studies are needed to develop a relevant screening programme for CPFE patients. Lung cancer is common in CPFE patients followed over time, with possibly better survival in those diagnosed at earlier stages and successfully resected. Further studies to formulate disease-specific cancer screening protocols are needed.https://bit.ly/3445Bxr
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Affiliation(s)
- Faria Nasim
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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8
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Maritano Furcada J, Castro HM, De Vito EL, Grande Ratti MF, Posadas-Martínez ML, Giunta DH, Vazquez FJ, Ferreyro BL. Diagnosis of pulmonary embolism in patients with acute exacerbations of chronic obstructive pulmonary disease: A cross-sectional study. CLINICAL RESPIRATORY JOURNAL 2020; 14:1176-1181. [PMID: 32780471 DOI: 10.1111/crj.13257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/01/2020] [Accepted: 08/06/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pulmonary embolism (PE) remains a frequent complication in patients with chronic obstructive pulmonary disease (COPD). It is unclear that the extent to which the traditional risk stratifying scores for PE are accurate in this population. METHODS Cross-sectional study of adult patients with COPD and suspected PE included in an Institutional Registry of Thromboembolic Disease at a tertiary teaching hospital in the city of Buenos Aires, Argentina. We estimated the area under the receiver operating characteristic curves (AU-ROC), sensitivity and specificity of the Wells and Geneva scores using a positive computed tomography angiography as the gold standard for PE. We also estimated the sensitivity and specificity for the presence of isolated worsening of dyspnea at presentation, without other cardinal symptoms of acute exacerbation of COPD. RESULTS A total of 168 patients were included, of which 22% had confirmed PE. The AUC was 0.66 (95% CI 0.56-0.76) and 0.56 (95% CI 0.45-0.67) for the Wells and Geneva, respectively. Considering the most widely used cutoff points, the sensitivity and specificity were 24% and 90% for the Wells and 59% and 43% for the Geneva score, respectively. Isolated worsening of dyspnea on presentation had a sensitivity of 92% and specificity of 37%. CONCLUSIONS Both Wells and Geneva scores exhibit poor diagnostic accuracy for the diagnosis of PE in patients with COPD. The presence of isolated worsening of dyspnea on presentation could be an easy to identify criteria for the initial triage in this population. Further validation of our findings remains warranted.
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Affiliation(s)
| | | | - Eduardo Luis De Vito
- Institute of Medical Research Alfredo Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Diego Hernán Giunta
- Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Bruno Leonel Ferreyro
- Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Sinai Health System/University Health Network and Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
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9
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Gentzler ER, Derry H, Ouyang DJ, Lief L, Berlin DA, Xu CJ, Maciejewski PK, Prigerson HG. Underdetection and Undertreatment of Dyspnea in Critically Ill Patients. Am J Respir Crit Care Med 2020; 199:1377-1384. [PMID: 30485121 DOI: 10.1164/rccm.201805-0996oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Rationale: Dyspnea is a common and distressing physical symptom among patients in the ICU and may be underdetected and undertreated. Objectives: To determine the frequency of dyspnea relative to pain, the accuracy of nurses and personal caregiver dyspnea ratings relative to patient-reported dyspnea, and the relationship between nurse-detected dyspnea and treatment. Methods: This was an observational study of patients (n = 138) hospitalized in a medical ICU (MICU). Nurses and patients' personal caregivers at the bedside reported on their perception of patients' symptoms. Measurements and Main Results: Dyspnea was assessed by patients, caregivers, and nurses with a numerical rating scale. Across all three raters, the frequency of moderate to severe dyspnea was similar or greater than that of pain (P < 0.05 for caregiver and nurse ratings). Personal caregivers' ratings of dyspnea had substantial agreement with patient ratings (κ = 0.65, P < 0.001), but nurses' ratings were not significantly related to patient ratings (κ = 0.19, P = 0.39). Nurse detection of moderate to severe pain was significantly associated with opioid treatment (odds ratio, 2.70; 95% confidence interval, 1.10-6.60; P = 0.03); however, nurse detection of moderate to severe dyspnea was not significantly associated with any assessed treatment. Conclusions: Dyspnea was reported at least as frequently as pain among the sampled MICU patients. Personal caregivers had good agreement with patient reports of moderate to severe dyspnea. However, even when detected by nurses, dyspnea appeared to be undertreated. These findings suggest the need for improved detection and treatment of dyspnea in the MICU.
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Affiliation(s)
| | | | | | - Lindsay Lief
- 2 Department of Medicine, Weill Cornell Medicine, New York, New York
| | - David A Berlin
- 2 Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | | | - Holly G Prigerson
- 1 Center for Research on End-Of-Life Care and.,2 Department of Medicine, Weill Cornell Medicine, New York, New York
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10
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Dong W, Zhu Y, Du Y, Wang L, Feng X, Ma S. Impact of severe-to-very severe chronic obstructive pulmonary disease on the prognosis of patients with non-small cell lung cancer who received chemotherapy. CLINICAL RESPIRATORY JOURNAL 2020; 14:345-352. [PMID: 31876095 DOI: 10.1111/crj.13139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/13/2019] [Accepted: 12/18/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is associated with poor prognosis in non-small cell lung cancer (NSCLC) patients. There are limited data about the impact of severe-to-very severe COPD on prognosis in patients with NSCLC receiving first-line chemotherapy. OBJECTIVES To investigate whether severe-to-very severe COPD impacted survival of patients with NSCLC receiving first-line chemotherapy. METHODS A retrospective review was performed on 513 consecutive NSCLC patients receiving first-line chemotherapy between February 2014 and May 2018. Prognostic impact of severe-to-very severe COPD was analysed using regression analyses. RESULTS Totally 258 NSCLC patients (118 non-COPD, 96 mild-to-moderate COPD and 44 severe-to-very severe COPD) were evaluated retrospectively. Kaplan-Meier analysis showed that the median overall survival times in the severe-to-very severe COPD, mild-to-moderate COPD and non-COPD groups were 14.0 months [95% confidence interval (CI): 11.0-17.0], 18 months (95% CI: 14.8-21.2) and 19 months (95% CI: 15.3-22.7), respectively. The difference was significant between patients with severe-to-very severe COPD and those without COPD (χ2 = 6.8, P = 0.009) and between patients with severe-to-very severe COPD and those with mild-to-moderate COPD (χ2 = 4.0, P = 0.045). Multivariate analysis showed that survival time was significantly shorter in the severe-to-very severe COPD group than in the non-COPD group (adjusted hazard ratio: 1.876, 95% CI: 1.161-3.030, P = 0.01) and mild-to-moderate COPD group (adjusted hazard ratio: 1.782, 95% CI: 1.046-3.034, P = 0.033). CONCLUSION Severe-to-very severe COPD may worsen the prognosis of NSCLC patients who received first-line chemotherapy.
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Affiliation(s)
- Weigang Dong
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Yaqian Zhu
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Yan Du
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Lina Wang
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Xue Feng
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Shuping Ma
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
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Dong W, Du Y, Ma S. Impact of chemotherapy in the prognosis of non-small-cell lung cancer patients with severe to very severe COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:3805-3812. [PMID: 30538442 PMCID: PMC6254538 DOI: 10.2147/copd.s182173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The aim of the study was to investigate if first-line chemotherapy improves total survival time in non-small-cell lung cancer (NSCLC) patients complicated with severe to very severe COPD. MATERIALS AND METHODS This retrospective observational clinical study included 267 consecutive NSCLC patients with COPD complications at the Department of Respiratory and Critical Care Medicine of Tianjin Chest Hospital between January 2009 and January 2018. Sixty-nine evaluable patients were included. The clinical characteristics, toxicity profile, objective response rate, and prognosis were analyzed and compared between patients receiving and those not receiving chemotherapy. RESULTS Forty-five and 24 patients received first-line chemotherapy plus supportive care and supportive care alone, respectively. Kaplan-Meier curves showed that patients receiving chemotherapy had a statistically significant 6-month longer median overall survival (OS) than that of patients receiving supportive care alone (14.0, 95% CI: 8.5-19.5 vs 8.0, 95% CI: 6.4-9.6, respectively) (chi2=8.857, P=0.003). In the multivariate Cox proportional hazard model adjusted for the most relevant variables, the adjusted hazard ratio (HRadj) differed significantly for the receipt of chemotherapy (HRadj=0.4464, 95% CI: 0.2495-0.7988; P=0.0066) but not for gender (HRadj=0.8527, 95% CI: 0.4461-1.6298; P=0.6297), age (HRadj=1.0021, 95% CI: 0.9609-1.0451; P=0.9214), histology (HRadj=1.4422, 95% CI: 0.6959-2.9889; P=0.3247), cancer stage (HRadj=1.9098, 95% CI: 0.8607-4.2375; P=0.1116), performance status score (HRadj=1.5155, 95% CI: 0.7523-3.0529; P=0.2446), lung function (HRadj=1.3856, 95% CI: 0.7149-2.6857; P=0.3341), or respiratory symptoms (HRadj=1.0518, 95% CI: 0.6032-1.8342; P=0.8586). Patients with grade 3/4 adverse reactions accounted for 29% (13/45) of the chemotherapy group. CONCLUSION The results indicated that chemotherapy may improve the OS of NSCLC patients with severe to very severe COPD.
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Affiliation(s)
- Weigang Dong
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China,
| | - Yan Du
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China,
| | - Shuping Ma
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China,
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Stereotactic ablative radiotherapy (SABR) for early-stage central lung tumors: New insights and approaches. Lung Cancer 2018; 123:142-148. [PMID: 30089586 DOI: 10.1016/j.lungcan.2018.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/01/2018] [Indexed: 12/22/2022]
Abstract
The use of stereotactic ablative radiotherapy (SABR) for central lung tumors is increasing. Centrally located lung tumors can be subdivided into two categories, namely the 'moderately central' tumors where the planning target volume is located within 2 cm of the proximal bronchial tree, and the 'ultracentral' tumors where a planning target volume (PTV) overlaps the trachea or main stem bronchi. The toxicity of SABR appears acceptable when 'moderately central' tumors are treated using techniques that comply with organs at risk tolerance doses used for prospective trials and in recent publications. A high toxicity is seen when ultracentral tumors are treated using SABR, and conventional radiotherapy appears more appropriate in such tumors as the true normal organ tolerance doses remain unknown. When ultracentral tumors are treated with non-SABR hypofractionated radiotherapy, a homogenous dose distribution in the planning target volume and limitation of both normal organ maximum point doses and volumes receiving high doses seems to be needed.
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Mouronte-Roibás C, Leiro-Fernández V, Fernández-Villar A, Botana-Rial M, Ramos-Hernández C, Ruano-Ravina A. COPD, emphysema and the onset of lung cancer. A systematic review. Cancer Lett 2016; 382:240-244. [DOI: 10.1016/j.canlet.2016.09.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/25/2016] [Accepted: 09/01/2016] [Indexed: 12/20/2022]
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Mimae T, Suzuki K, Tsuboi M, Ikeda N, Takamochi K, Aokage K, Shimada Y, Miyata Y, Okada M. Severity of lung fibrosis affects early surgical outcomes of lung cancer among patients with combined pulmonary fibrosis and emphysema. Medicine (Baltimore) 2016; 95:e4314. [PMID: 27442681 PMCID: PMC5265798 DOI: 10.1097/md.0000000000004314] [Citation(s) in RCA: 8] [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: 01/12/2023] Open
Abstract
Combined pulmonary fibrosis and emphysema (CPFE) is defined as upper lobe emphysema and lower lobe fibrosis, which are representative lung disorders that increase the prevalence of lung cancer. This unique disorder may affect the morbidity and mortality during the early period after surgery. The present study aimed to identify which clinicopathological features significantly affect early surgical outcomes after lung resection in nonsmall cell lung cancer (NSCLC) patients and in those with CPFE.We retrospectively assessed 2295 patients with NSCLC and found that 151 (6.6%) had CPFE. All were surgically treated between January 2008 and December 2010 at 4 institutions.The postoperative complication rates for patients with and without CPFE were 39% and 17%, respectively. The 90-day mortality rates were higher among patients with than without CPFE (7.9% vs 1%). Acute exacerbation of interstitial pneumonia was the main cause of death among 12 patients with CPFE who died within 90 days after surgery. Multivariate logistic regression analysis selected CPFE, gender, age, and clinical stage as independent predictive factors for postoperative complications, and CPFE, clinical stage, and sex for 90-day mortality. The severity of lung fibrosis on preoperative CT images was an independent predictive factor for 90-day mortality among patients with CPFE.The key predictive factor for postoperative mortality and complications of lung resection for NSCLC was CPFE. The severity of lung fibrosis was the principal predictor of early outcomes after lung surgery among patients with CPFE and NSCLC.
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Affiliation(s)
- Takahiro Mimae
- Department of Surgical Oncology, Hiroshima University, Hiroshima
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo
| | - Masahiro Tsuboi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo
| | - Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa
| | | | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, Hiroshima
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima
- Correspondence: Morihito Okada, Department of Surgical Oncology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (e-mail: )
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Lambert AA, Dransfield MT. COPD Overlap Syndromes: Asthma and Beyond. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2016; 3:459-465. [PMID: 28848867 PMCID: PMC5559127 DOI: 10.15326/jcopdf.3.1.2015.0176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article serves as a CME-available, enduring material summary of the following COPD9USApresentations: "COPD and Asthma" Presenter: Prescott Woodruff, MD, MPH "COPD and Lung Cancer" Presenter: William Bulman, MD "COPD and Bronchiectasis" Presenter: Jeremy Clain, MD "COPD and Interstitial Lung Disease" Presenter GeorgeWashko, MD.
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Affiliation(s)
- Allison A Lambert
- Department of Internal Medicine Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care and Lung Health Center, University of Alabama at Birmingham and the Birmingham Veterans Administration Medical Center, University of Alabama, Birmingham
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Células mieloides supresoras: potencial vínculo entre la enfermedad pulmonar obstructiva crónica y el cáncer de pulmón. Arch Bronconeumol 2016; 52:29-35. [DOI: 10.1016/j.arbres.2015.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 12/22/2022]
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Gao YH, Guan WJ, Liu Q, Wang HQ, Zhu YN, Chen RC, Zhang GJ. Impact of COPD and emphysema on survival of patients with lung cancer: A meta-analysis of observational studies. Respirology 2015; 21:269-79. [PMID: 26567533 DOI: 10.1111/resp.12661] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/20/2015] [Accepted: 07/30/2015] [Indexed: 12/20/2022]
Abstract
Both COPD and emphysema are associated with an increased incidence of lung cancer, but the impacts of these comorbidities on lung cancer prognosis are still unclear. Herein, we conducted a meta-analysis to clarify whether the presence of these comorbidities indicates poor survival in patients with lung cancer. A comprehensive search was conducted using PubMed, Embase, Web of Science, ASCO Abstracts and Cochrane library for articles published before 1 June 2015. Papers referenced by the obtained articles were also reviewed. Main outcomes were overall survival (OS) and disease-free survival (DFS) in patients with lung cancer. Pooled hazard ratio (HR) and 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup and sensitivity analyses were also conducted. Of 58 full texts reviewed, 26 met our inclusion criteria that were derived from 21 and seven studies examining the impacts of COPD and emphysema on survival of lung cancer, respectively. Meta-analyses revealed that concomitant COPD was associated with poorer OS (HR, 1.17; 95% CI: 1.10-1.25, n = 20), which was independent of tumour staging, diagnostic criteria of COPD or location, and DFS (HR, 1.52; 95% CI: 1.04-2.23, n = 6) with high heterogeneity (I(2) = 78%). The presence of emphysema in patients with lung cancer predicted worse OS (HR, 1.66; 95% CI: 1.25-2.22, n = 7), but not poorer DFS. The presence of COPD and emphysema are robust predictors of poor survival in patients with lung cancer. Early detection of these diseases should be taken into account for lung cancer surveillance and management.
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Affiliation(s)
- Yong-Hua Gao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qi Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hua-Qi Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ya-Nan Zhu
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Rong-Chang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guo-Jun Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Mimae T, Suzuki K, Tsuboi M, Nagai K, Ikeda N, Mitsudomi T, Saji H, Okumura S, Okumura M, Yoshimura K, Okada M. Surgical Outcomes of Lung Cancer in Patients with Combined Pulmonary Fibrosis and Emphysema. Ann Surg Oncol 2015; 22 Suppl 3:S1371-9. [DOI: 10.1245/s10434-015-4577-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Indexed: 11/18/2022]
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Impact of chronic obstructive pulmonary disease on the mortality of patients with non-small-cell lung cancer. J Thorac Oncol 2015; 9:812-7. [PMID: 24807154 DOI: 10.1097/jto.0000000000000158] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The impact of chronic obstructive pulmonary disease (COPD) on the mortality of patients with lung cancer has not been studied extensively. The objective of this study is to compare the mortality and clinical characteristics of patients with non-small-cell lung cancer (NSCLC) according to the presence of COPD. METHODS The medical records of 221 smokers diagnosed with NSCLC were reviewed. Eligible patients were dichotomized into the COPD group (n = 111) and the non-COPD group (n = 110). The overall survival and clinical characteristics were compared, and predictors of worse survival were analyzed using Cox proportional hazards regression. RESULTS COPD was present in 50.2% of all patients with NSCLC, and most of the patients (92.8%) with COPD were unaware of the disease before the diagnosis of lung cancer. Patients in the COPD group were older and had a lower body mass index, higher pack-years smoking history, higher frequency of dyspnea, and higher incidence of previous malignancy. The overall survival of enrolled patients and propensity score-matched subjects was comparable between the two groups (log-rank test, p = 0.2 and 0.396, respectively). Old age, low body mass index, advanced disease stage (stages III and IV), non-squamous histology, Eastern Cooperative Oncology Group performance status of greater than or equal to 2, weight loss, and coexistence of interstitial lung disease were independent risk factors for shorter survival. CONCLUSION COPD frequently and subliminally coexists with NSCLC. Although differences in clinical characteristic did exist, there was no impact of COPD on the mortality of patients with NSCLC with a positive smoking history in this study.
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Izquierdo JL, Resano P, El Hachem A, Graziani D, Almonacid C, Sánchez IM. Impact of COPD in patients with lung cancer and advanced disease treated with chemotherapy and/or tyrosine kinase inhibitors. Int J Chron Obstruct Pulmon Dis 2014; 9:1053-8. [PMID: 25336937 PMCID: PMC4200171 DOI: 10.2147/copd.s68766] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
While it is relatively well known that the prognosis of patients with lung cancer (LC) treated with surgery is worse in the presence of chronic obstructive pulmonary disease (COPD), it is unknown if this assessment can be extrapolated to patients with advanced disease treated with chemotherapy and/or tyrosine kinase inhibitors. The aim of our study is to analyze the clinical characteristics and survival rates in patients with LC and COPD, and to compare these to the patients without airflow obstruction. From 471 evaluable patients, 324 (69%) were not treated with surgery due to disseminated disease (stages 3B and 4). Of them, 47.7% also had COPD. All patients were treated at the moment of diagnosis according to National Comprehensive Cancer Network guidelines with platinum-based chemotherapy or tyrosine kinase inhibitors. Kaplan–Meier curves showed no significant differences in overall survival between COPD and non-COPD patients (log–rank P=0.65). In the multivariate Cox proportional hazard model adjusting for the most relevant variables, the adjusted hazard ratio (HRadj) was statistically significant for performance status (HRadj =1.33, 95% confidence interval [CI]: 1.11–1.59; P=0.002) and clinical stage (HRadj =0.67, 95% CI: 0.50–0.89; P=0.006), but not for COPD status (HRadj =1.20, 95% CI: 0.83–1.50; P=0.46). Our conclusion is that at present, when using standard care in advanced LC (stages 3B and 4), COPD does not have a significant deleterious impact on overall survival.
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Affiliation(s)
| | - Pilar Resano
- Pulmonology Department, Guadalajara University Hospital, Guadalajara, Spain
| | | | - Desiré Graziani
- Pulmonology Department, Guadalajara University Hospital, Guadalajara, Spain
| | - Carlos Almonacid
- Pulmonology Department, Guadalajara University Hospital, Guadalajara, Spain
| | - Ignacio M Sánchez
- Pulmonology Department, Guadalajara University Hospital, Guadalajara, Spain
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Sekine Y, Hata A, Koh E, Hiroshima K. Lung carcinogenesis from chronic obstructive pulmonary disease: characteristics of lung cancer from COPD and contribution of signal transducers and lung stem cells in the inflammatory microenvironment. Gen Thorac Cardiovasc Surg 2014; 62:415-21. [PMID: 24627306 DOI: 10.1007/s11748-014-0386-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Indexed: 10/25/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) and lung cancer are closely related. The annual incidence of lung cancer arising from COPD has been reported to be 0.8-1.7 %. Treatment of lung cancer from COPD is very difficult due to low cardiopulmonary function, rapid tumor growth, and resistance to molecularly targeted therapies. Chronic inflammation caused by toxic gases can induce COPD and lung cancer. Carcinogenesis in the inflammatory microenvironment occurs during cycles of tissue injury and repair. Cellular damage can induce induction of necrotic cell death and loss of tissue integrity. Quiescent normal stem cells or differentiated progenitor cells are introduced to repair injured tissues. However, inflammatory mediators may promote the growth of bronchioalveolar stem cells, and activation of NF-κB and signal transducer and activator of transcription 3 (STAT3) play crucial roles in the development of lung cancer from COPD. Many of the protumorgenic effects of NF-κB and STAT3 activation in immune cells are mediated through paracrine signaling. NF-κB and STAT3 also contribute to epithelial-mesenchymal transition. To improve lung cancer treatment outcomes, lung cancer from COPD must be overcome. In this article, we review the characteristics of lung cancer from COPD and the mechanisms of carcinogenesis in the inflammatory microenvironment. We also propose the necessity of identifying the mechanisms underlying progression of COPD to lung cancer, and comment on the clinical implications with respect to lung cancer prevention, screening, and therapy.
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Affiliation(s)
- Yasuo Sekine
- Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owada-Shinden, Yachiyo, Chiba, 276-8524, Japan,
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Ayabe T, Tomita M, Chosa E, Kawagoe K, Nakamura K. Effect of Inhaled Tiotropium as the Perioperative Management of Patients Undergoing Pulmonary Resection for Primary Lung Cancer. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/jct.2014.59093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jeba J, George R, Pease N. Nebulised furosemide in the palliation of dyspnoea in cancer: a systematic review. BMJ Support Palliat Care 2013; 4:132-139. [DOI: 10.1136/bmjspcare-2013-000492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 10/14/2013] [Accepted: 11/05/2013] [Indexed: 11/04/2022]
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Fujiwara A, Tsushima K, Sugiyama S, Yamaguchi K, Soeda S, Togashi Y, Kono Y, Kasagi S, Setoguchi Y. Histological types and localizations of lung cancers in patients with combined pulmonary fibrosis and emphysema. Thorac Cancer 2013; 4:354-360. [PMID: 28920226 DOI: 10.1111/1759-7714.12023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 12/13/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Most patients with combined pulmonary fibrosis and emphysema (CPFE) are males, and heavy smokers. CPFE is more prevalent than fibrosis in patients with lung cancer, and patients with CPFE usually have a poor prognosis. This study reviewed the differences in the prevalence of lung cancer among patients with normal, fibrosis, emphysema and CPFE via chest computed tomography (CT), and the relationship between histopathology and the localizations of lung cancer. METHODS Patients that were diagnosed with lung cancer confirmed by pathological examinations between 2003 and 2011 were retrospectively reviewed to obtain clinical, pathological, and radiological data. These patients were categorized into four groups based on chest CT findings: normal, fibrosis, emphysema and CPFE. RESULTS Two hundred and seventy-four patients with lung cancer were classified into 146 normal, 14 fibrosis, 78 emphysema, and 36 CPFE groups. Combined centriacinar and paraseptal emphysema was common in the CPFE group. The prevalence of squamous cell carcinoma in the CPFE group was significantly higher in comparison to the normal group. The rate of peripheral localization of lung cancer in the CPFE group was significantly higher in comparison to the normal, fibrosis, and emphysema groups. The prevalence of squamous cell carcinoma of peripheral areas in the CPFE group was significantly higher in the normal and emphysema groups. CONCLUSIONS CPFE patients demonstrated histopathological and radiological differences concerning the histological types and localization of lung cancers.
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Affiliation(s)
- Akahito Fujiwara
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Kenji Tsushima
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shinya Sugiyama
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Koichi Yamaguchi
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Seiko Soeda
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yuki Togashi
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yuta Kono
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Satoshi Kasagi
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yasuhiro Setoguchi
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
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Biomarkers in Exhaled Breath Condensate and Serum of Chronic Obstructive Pulmonary Disease and Non-Small-Cell Lung Cancer. Int J Chronic Dis 2013; 2013:578613. [PMID: 26464846 PMCID: PMC4590922 DOI: 10.1155/2013/578613] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/08/2013] [Indexed: 01/17/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and lung cancer are leading causes of deaths worldwide which are associated with chronic inflammation and oxidative stress. Lung cancer, in particular, has a very high mortality rate due to the characteristically late diagnosis. As such, identification of novel biomarkers which allow for early diagnosis of these diseases could improve outcome and survival rate. Markers of oxidative stress in exhaled breath condensate (EBC) are examples of potential diagnostic markers for both COPD and non-small-cell lung cancer (NSCLC). They may even be useful in monitoring treatment response. In the serum, S100A8, S100A9, and S100A12 of the S100 proteins are proinflammatory markers. They have been indicated in several inflammatory diseases and cancers including secondary metastasis into the lung. It is highly likely that they not only have the potential to be diagnostic biomarkers for NSCLC but also prognostic indicators and therapeutic targets.
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Nimako K, Gunapala R, Popat S, O'Brien MER. Patient factors, health care factors and survival from lung cancer according to ethnic group in the south of London, UK. Eur J Cancer Care (Engl) 2012; 22:79-87. [PMID: 22738286 DOI: 10.1111/j.1365-2354.2012.01373.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
International and UK data suggest that there are ethnic differences in survival for some malignancies. The aim of the present study was to identify any health inequalities related to lung cancer and ethnicity. Data on 423 patients with a diagnosis of lung cancer treated at a large specialist cancer hospital in London UK were analysed. Data on stage of disease at diagnosis, co-morbidities, socio-economic status, treatments received and survival were collected and examined for differences by ethnic group. There was a significant difference between black and minority ethnic (BME) patients and White-European patients in socio-economic status (Chi-square test P-value < 0.001). BME patients were over-represented in the most deprived socio-economic groups and under-represented in the most affluent. There were no significant differences in histology, stage of disease, co-morbidities and performance status or treatments received between the different ethnic groups. Ethnicity was not associated with survival. Significant prognostic factors for overall survival were performance status (P < 0.001), stage of disease (P = 0.001) and gender (P = 0.003). Our findings suggest that patients from BME groups are over-represented in more deprived socio-economic groups; however, this did not impact on significant prognostic factors or the treatments that they received. Importantly ethnicity did not influence survival.
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Affiliation(s)
- K Nimako
- Lung Unit, The Royal Marsden Hospital, NHS Foundation Trust, Sutton, Surrey, UK.
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Gnadt M, Trammer B, Kardziev B, Bayliss MK, Edwards CD, Schmidt M, Högger P. Comparison of the bronchodilating effects of inhaled β₂-agonists after methacholine challenge in a human lung reperfusion model. Eur J Pharm Biopharm 2012; 81:617-26. [PMID: 22561952 DOI: 10.1016/j.ejpb.2012.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 04/07/2012] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
Abstract
The aim of the present investigation was to compare the onset of action and intrinsic activity of the long-acting β(2)-agonist GW597901 with the fast- and short-acting salbutamol as model compounds using an isolated human lung reperfusion model. Twelve resected human lung lobes were challenged with methacholine (MCh) and subsequently nebulised with either GW597901 or salbutamol. Prostaglandin E(2) (PGE(2)) concentrations in the perfusion fluid were compared with the dose of MCh that was required to induce a bronchoconstriction. After successful MCh provocation, nebulisation of GW597901 and salbutamol fully reversed any observed bronchoconstriction. The bronchodilating effect was more pronounced for GW597901. Salbutamol revealed an immediate onset of action while the effect of GW597901 was observed with an approximate delay of 6 min. Higher doses of MCh were required for a successful bronchial challenge in the presence of elevated PGE(2) levels (r=0.8171, p ≤ 0.05). For the first time, an isolated perfused human lung model has been established for comparing the onset of action and potency of a short- and long-acting β(2)-agonist. We therefore conclude that it is an alternative for determination of drug effect characteristics and suitable for supplementing or predicting clinical data.
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Affiliation(s)
- Mirjam Gnadt
- Institut für Pharmazie und Lebensmittelchemie, Universität Würzburg, Würzburg, Germany
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Comprehensive Management of Respiratory Symptoms in Patients with Advanced Lung Cancer. ACTA ACUST UNITED AC 2012; 10:1-9. [DOI: 10.1016/j.suponc.2011.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/26/2011] [Accepted: 07/11/2011] [Indexed: 11/23/2022]
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Pohl G, Marosi C, Dieckmann K, Goldner G, Elandt K, Hassler M, Schemper M, Strasser-Weippl K, Nauck F, Gaertner J, Watzke H. Evaluation of diagnostic and treatment approaches towards acute dyspnea in a palliative care setting among medical students at the University of Vienna. Wien Med Wochenschr 2012; 162:18-28. [DOI: 10.1007/s10354-011-0046-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 12/16/2011] [Indexed: 12/01/2022]
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USUI K, TANAI C, TANAKA Y, NODA H, ISHIHARA T. The prevalence of pulmonary fibrosis combined with emphysema in patients with lung cancer. Respirology 2011; 16:326-31. [DOI: 10.1111/j.1440-1843.2010.01907.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bölükbas S, Eberlein M, Eckhoff J, Schirren J. Short-term effects of inhalative tiotropium/formoterol/budenoside versus tiotropium/formoterol in patients with newly diagnosed chronic obstructive pulmonary disease requiring surgery for lung cancer: a prospective randomized trial. Eur J Cardiothorac Surg 2010; 39:995-1000. [PMID: 20970351 DOI: 10.1016/j.ejcts.2010.09.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 09/14/2010] [Accepted: 09/19/2010] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE A new diagnosis of chronic obstructive pulmonary disease (COPD) is often made during the evaluation of patients requiring a surgical intervention for lung cancer. Based on initial impaired lung function, these untreated patients are often considered not fit for lung surgery. There is limited information on the short-term effectiveness of preoperative pharmacologic treatment strategies in patients with newly diagnosed COPD before lung surgery. METHODS A prospective randomized study was conducted comparing 1-week-treatment periods of tiotropium/formoterol/budenoside (GR1) with tiotropium/formoterol (GR2) in conjunction with smoking cessation and chest physiotherapy. No patients had been previously treated for COPD. The primary end point was body plethysmography (forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), and airway resistance (RAW)) at the end of each treatment period. Secondary end points were improvement of ≥ 10% in FEV1 (% predicted) and improvement of the severity of COPD after the 1-week treatment, as well as the rate of pulmonary complications after surgery. RESULTS A total of 46 patients were randomized in GR1 (n=24) and GR2 (n=22). Both groups were comparable with regard to age, height, weight, smoking history, baseline body plethysmography (FVC, FEV1, and RAW), and the severity of COPD according to the Global Initiative for Obstructive Lung Disease (GOLD) staging, respectively. However, the short-term effects of the treatment with regard to FEV1 (2.0 l vs 1.7 l; p=0.031) and increase of FEV1 (0.31 l vs 0.10 l; p=0.02) were better in GR1. More patients in GR1 had an improvement of ≥ 10% in FEV1 (p=0.004) and improvement of the severity of COPD (p=0.012) after the 1-week treatment. Fewer pulmonary complications (11.1% vs 42.9%, p=0.04) were observed in GR1 after surgery. CONCLUSIONS Both therapies resulted in an improvement of lung function. There is benefit from adding inhalative budenoside to tiotropium and formoterol in terms of an improvement in FEV1 and the severity of COPD. These beneficial results might lead to less pulmonary complications in the postoperative period.
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Affiliation(s)
- Servet Bölükbas
- Department of Thoracic Surgery, Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany.
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Dorman S, Jolley C, Abernethy A, Currow D, Johnson M, Farquhar M, Griffiths G, Peel T, Moosavi S, Byrne A, Wilcock A, Alloway L, Bausewein C, Higginson I, Booth S. Researching breathlessness in palliative care: consensus statement of the National Cancer Research Institute Palliative Care Breathlessness Subgroup. Palliat Med 2009; 23:213-27. [PMID: 19251835 DOI: 10.1177/0269216309102520] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breathlessness is common in advanced disease and can have a devastating impact on patients and carers. Research on the management of breathlessness is challenging. There are relatively few studies, and many studies are limited by inadequate power or design. This paper represents a consensus statement of the National Cancer Research Institute Palliative Care Breathlessness Subgroup. The aims of this paper are to facilitate the design of adequately powered multi-centre interventional studies in breathlessness, to suggest a standardised, rational approach to breathlessness research and to aid future 'between study' comparisons. Discussion of the physiology of breathlessness is included.
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Affiliation(s)
- S Dorman
- Poole Hospital NHS Foundation Trust, Longfleet Road, Poole.
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Bozinovski S, Vlahos R, Hansen M, Liu K, Anderson GP. Akt in the pathogenesis of COPD. Int J Chron Obstruct Pulmon Dis 2007; 1:31-8. [PMID: 18046900 PMCID: PMC2706607 DOI: 10.2147/copd.2006.1.1.31] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
In this review we consider the therapeutic potential of targeting Akt for the treatment of COPD. Akt is a serine/threonine protein kinase that functions as a signaling intermediate linked to multiple signaling programs involved in survival, inflammation, and growth. Akt is closely associated with key membrane-bound receptors and represents a convergent integration point for multiple stimuli implicated in COPD pathogenesis. Persistent activation of Akt secondary to somatic mutations in regulatory oncogenes, such as PTEN, may explain why inflammation in COPD does not resolve when smoking is ceased. Akt is also implicated in the systemic manifestations of COPD such as skeletal muscle wasting and metabolic disturbances. Furthermore, targeting Akt may provide a useful means of limiting the severity and duration of disease exacerbations in COPD. As such, Akt represents a particularly attractive therapeutic target for the treatment of COPD. Interestingly, current knowledge suggests that both inhibitors and activators of Akt may be useful for treating different clinical subpopulations of COPD patients.
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Affiliation(s)
- Steven Bozinovski
- The Lung Disease Research Laboratories, Cooperative Research Centre for Chronic Inflammatory Diseases, Department of Pharmacology, The University of Melbourne, VIC, Australia.
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Del Fabbro E, Dalal S, Bruera E. Symptom control in palliative care--Part III: dyspnea and delirium. J Palliat Med 2006; 9:422-36. [PMID: 16629572 DOI: 10.1089/jpm.2006.9.422] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Egidio Del Fabbro
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, 77030, USA
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Abstract
Dyspnea, defined as uncomfortable or labored breathing, is a common and often devastating cause of distress for patients and their caregivers with advanced cancer and other life-threatening illnesses. The mechanism by which dyspnea develops is not fully understood, but it involves integration of the central respiratory complex with the sensory (perceptual) cortex. The gold standard of diagnosis is patient self-report. Careful assessment should be undertaken to identify reversible existing causes. Systemic opioids are the first-line therapy for symptomatic management, along with other general comfort measures (positioning, cool air, calming environment). Medical or surgical management can be directed toward underlying causes. Advanced care planning should include discussions concerning the burdens and benefits of medical/surgical management of underlying causes of dyspnea to more effectively direct goals of care. This article reviews current literature on dyspnea, with a focus on items published since 2000.
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Loganathan RS, Stover DE, Shi W, Venkatraman E. Prevalence of COPD in Women Compared to Men Around the Time of Diagnosis of Primary Lung Cancer. Chest 2006; 129:1305-12. [PMID: 16685023 DOI: 10.1378/chest.129.5.1305] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
PURPOSES COPD is a well-known independent risk factor that is associated with primary lung cancer. There is, however, a striking paucity of women in studies demonstrating this association. The purpose of this study was to compare the prevalence of COPD as determined by pulmonary function tests (PFTs) between women and men at around the time of lung cancer diagnosis. METHODS We retrospectively reviewed patients with newly diagnosed primary lung cancer who had undergone PFTs prior to their treatment. The diagnosis of airflow obstruction was made according to American Thoracic Society guidelines. Comparisons of the prevalence of COPD between men and women were performed using univariate and multivariate logistic regression analysis. RESULTS Of the 294 patients in the study, 151 patients (51.4%) were men and 143 patient (48.6%) were women. Of the men, 110 patients (72.8%) had COPD compared with 75 patients (52.5%) among the women. This represented a significantly lower prevalence of COPD in women than in men (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.25 to 0.67; p = 0.0003). When adjusted for age and smoking status, a sustained lower prevalence of COPD was noted in women compared to men (OR, 0.44; 95% CI, 0.26 to 0.74; p = 0.002). In a subset of 256 smokers, there remained a lower prevalence of COPD in women compared to men (OR, 0.45; 95% CI, 0.27 to 0.77; p = 0.003). Adjusted analysis to control for age and number of pack-years of smoking in this subset again showed a sustained reduction in the OR for women presenting with COPD (OR, 0.48; 95% CI, 0.28 to 0.83; p = 0.009). CONCLUSIONS When COPD was examined as an end point among patients who had newly diagnosed lung cancer, a significantly higher proportion of women had normal PFT results. Gender-based differences on PFT results should be considered during the screening of lung cancer, because the stratification of high-risk patients based on the presence of COPD may miss a significant proportion of women with lung cancer.
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Affiliation(s)
- Raghu S Loganathan
- Lincoln Medical and Mental Health Center, Department of Medicine, 234 E 149th St, Bronx, NY 10451, USA.
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Abstract
The key points of this article are anorexia and cachexia are: A major cause of cancer deaths. Several drugs are available to treat anorexia and cachexia. Dyspnea in cancer usually is caused by several factors. Treatment consists of reversing underlying causes, empiric bronchodilators, cortico-steroids--and in the terminally ill patients-opioids, benzodiazepines,and chlorpromazine. Delirium is associated with advanced cancer. Empiric treatment with neuroleptics while evaluating for reversible causes is a reasonable approach to management. Nausea and vomiting are caused by extra-abdominal factors (drugs,electrolyte abnormalities, central nervous system metastases) or intra-abdominal factors (gastroparesis, ileus, gastric outlet obstruction, bowel obstruction). The pattern of nausea and vomiting differs depending upon whether the cause is extra- or intra-abdominal. Reversible causes should be sought and empiric metoclopramide or haloperidol should be initiated. Fatigue may be caused by anemia, depression, endocrine abnormalities,or electrolyte disturbances that should be treated before using empiric methylphenidate. Constipation should be treated with laxatives and stool softeners. Both should start with the first opioid dose.
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Affiliation(s)
- Ruth L Lagman
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, The Cleveland Clinic Foundation, 9500 Euclid Avenue, M76 Cleveland, OH 44195, USA.
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Papi A, Casoni G, Caramori G, Guzzinati I, Boschetto P, Ravenna F, Calia N, Petruzzelli S, Corbetta L, Cavallesco G, Forini E, Saetta M, Ciaccia A, Fabbri LM. COPD increases the risk of squamous histological subtype in smokers who develop non-small cell lung carcinoma. Thorax 2004; 59:679-81. [PMID: 15282388 PMCID: PMC1747095 DOI: 10.1136/thx.2003.018291] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Squamous cell carcinoma has a stronger association with tobacco smoking than other non-small cell lung cancers (NSCLC). A study was undertaken to determine whether chronic obstructive pulmonary disease (COPD) is a risk factor for the squamous cell carcinoma histological subtype in smokers with surgically resectable NSCLC. METHODS Using a case-control design, subjects with a surgically confirmed diagnosis of squamous cell carcinoma were enrolled from smokers undergoing lung resection for NSCLC in the District Hospital of Ferrara, Italy. Control subjects were smokers who underwent lung resection for NSCLC in the same hospital and had a surgically confirmed diagnosis of NSCLC of any histological type other than squamous cell. RESULTS Eighty six cases and 54 controls (mainly adenocarcinoma, n = 50) were enrolled. The presence of COPD was found to increase the risk for the squamous cell histological subtype by more than four times. Conversely, the presence of chronic bronchitis was found to decrease the risk for this histological subtype by more than four times. Among patients with chronic bronchitis (n = 77), those with COPD had a 3.5 times higher risk of having the squamous cell histological subtype. CONCLUSIONS These data suggest that, among smokers with surgically resectable NSCLC, COPD is a risk factor for the squamous cell histological subtype and chronic bronchitis, particularly when not associated with COPD, is a risk factor for the adenocarcinoma histological subtype.
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Affiliation(s)
- A Papi
- Research Centre on Asthma and COPD, University of Ferrara, Via Savonarola 9, 44100 Ferrara, Italy.
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Stephenson D, McHugh A. CPD: The non-pharmacological nursing management of dyspnoea in end-stage respiratory disease and palliative care populations. Collegian 2004. [DOI: 10.1016/s1322-7696(08)60454-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Sputum cytology is an important step in the early diagnosis of roentgenographically occult lung cancer. It identifies primarily intraepithelial lesions, which are the most common squamous carcinomas not detected by helical CT. Patients at highest risk for lung cancer (eg, heavy smokers with airflow obstruction) should undergo sputum cytology. Patients with premalignant lesions (eg, moderate or severe dysplasia) and of course patients with carcinoma in situ or invasive carcinoma should receive fiberoptic bronchoscopy. The diagnosis and treatment of early-stage lung cancer usually has a favorable outcome. Today we have the knowledge and technology that can change the outcome of lung cancer through early identification, particularly in high-risk patients.
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Affiliation(s)
- Thomas L Petty
- University of Colorado Health Sciences Center, Denver 80203-3154, USA
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Fraser J. Dyspnoea worsened by salmeterol. J R Soc Med 2002. [PMID: 12411626 PMCID: PMC1279258 DOI: 10.1258/jrsm.95.11.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- John Fraser
- Discipline of General Practice, University of Newcastle, Newcastle N9W, Australia.
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Fraser J. Dyspnoea worsened by salmeterol. J R Soc Med 2002; 95:558-9. [PMID: 12411626 PMCID: PMC1279258 DOI: 10.1177/014107680209501113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- John Fraser
- Discipline of General Practice, University of Newcastle, Newcastle N9W, Australia.
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Abstract
The management of dyspnea is a challenge even for the most experienced palliative medicine teams. In the absence of effective treatment for the underlying disease, therapeutic options are limited to the supplementation of oxygen, the use of opioids, and multidisciplinary nonpharmacologic interventions. There is increased research into both the physiology of dyspnea and the correlates of the symptom in advanced disease. Hopefully, this research will lead to improved therapy in the future. This article reviews current literature on dyspnea with a focus on publications in 2001.
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Affiliation(s)
- Susan B LeGrand
- Palliative Medicine Fellowship, Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Petty TL, Tockman MS, Palcic B. Diagnosis of roentgenographically occult lung cancer by sputum cytology. Clin Chest Med 2002; 23:59-64. [PMID: 11901920 DOI: 10.1016/s0272-5231(03)00060-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The specialty has the knowledge and technology to change the outcome of lung cancer. Lung cancer, diagnosed in early stages, is as curable as all other cancers. Sputum cytology is the initial step in diagnosing roentgenographically occult lung cancer. Sputum cytology is complementary to CT scanning. Sputum cytology identifies small central lesions, and CT scanning discovers peripheral tiny adenocarcinomas.
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Affiliation(s)
- Thomas L Petty
- University of Colorado Health Sciences Center, Denver, Colorado, USA.
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López-Encuentra A. Comorbidity in operable lung cancer: a multicenter descriptive study on 2992 patients. Lung Cancer 2002; 35:263-9. [PMID: 11844600 DOI: 10.1016/s0169-5002(01)00422-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
STUDY OBJECTIVES To ascertain the frequency of diseases associated (comorbidity) with operable lung cancer (LC) globally, in relation to the presence of neoplastic clinical symptoms and age. DESIGN Prospective; multi-institutional of 19 Spanish hospitals. PATIENTS Two thousand nine hundred and ninety two consecutive cases of LC, treated surgically by the Bronchogenic Carcinoma Co-operative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S) between 1993 and 1997, are analysed. METHODS At time of treatment, data on the presence or absence of different specific comorbidities in all consecutive patients operated on for LC were entered on identical forms at all hospitals of the GCCB-S. RESULTS In 2189 patients (73%) there was one or several comorbidities (chronic obstructive pulmonary disease [COPD], systemic arterial hypertension, previous tumour, cardiac disease, peripheral vascular disease or diabetes). Fifty percent of the LC was associated to COPD; in 32% of these patients with COPD, preoperative measurement of FEV1 was 70% below the theoretical value. In comparing the cases with symptoms ascribable to LC, it was found that in asymptomatic patients the presence of a previous tumour, arterial hypertension or cardiac disease was significantly more frequent. Conversely, in symptomatic patients, COPD was significantly more frequent. The frequency of all evaluated comorbidities is significantly higher in the older age groups. CONCLUSIONS In this multicenter study encompassing 2992 patients with operable LC, a high frequency of comorbidity has been found, COPD occurring most frequently. Certain diseases are more prevalent in asymptomatic patients, probably due to a screening bias. In older patients, there was a significant increase of all comorbidities.
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Affiliation(s)
- Angel López-Encuentra
- Pneumology Service, Hospital Universitario 12 de Octubre, Ctta. Andalucía 5.4, 28041 Madrid, Spain.
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Affiliation(s)
- S K Reddy
- M.D. Anderson Cancer Center, Houston, Texas 77030, USA
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