Lung Cancer in Women

Distributions and trends in the global burden of young-onset tracheal, bronchus, and lung cancer by region, age, and sex from 1990 to 2021: An age-period-cohort analysis

BACKGROUND

The young onset Tracheal, Bronchus, and Lung Cancer (TBLC) exhibits distinct gene mutations and clinical characteristics. With worsening air pollution, the incidence of young onset TBLC is increasing, resulting in significant economic burdens. The specific epidemiology of the disease burden remains elusive.

METHODS

The updated Global Burden of Disease (GBD) 2021 study was employed. This study reports on the disease burden trends of young TBLC (≤54 years) and its risk factors. Data is presented as counts and age-standardized rates (ASRs) per 100,000 people across different age groups, years, sexes, sociodemographic levels (SDI), and geographic locations (global, regional, and national). An age-period-cohort (APC) model was used to analyze longitudinal curves on age, period, and cohort effects for young TBLC. Decomposition analysis broke down temporal changes into three factors: population aging, population growth, and epidemiological change, to quantify the changes and identify their causes. An inequality index was applied to examine the inequality of disease burden of young TBLC by sex across different SDI levels between 1990 and 2021.

RESULTS

From 1990-2021, the global number of individuals under 55 diagnosed with TBLC increased from 320,715 to 489,080, representing a 52 % rise. However, the age-standardized rates of prevalence (Average annual percentage changes (AAPC) -0.05 %), incidence (AAPC -0.59 %), mortality (AAPC -0.88 %), and disability-adjusted life-years (DALYs) (AAPC -0.92 %) all showed a notable decline tendency. In 2021, there were 258,360 new diagnoses and 207,000 deaths from young TBLC, with ASRs of incidence and mortality at 6.43 and 5.49 per 100,000, respectively. Regionally, East Asia bore the highest burden, with about 117,730 new young TBLC cases and an ASR of 12.01 per 100,000 people. Decomposition analysis indicated that population growth was the primary driver for the increased prevalence of young TBLC. While tobacco-related DALYs for young TBLC decreased globally, tobacco remains the leading risk factor. In contrast, air pollution-related DALYs have significantly increased in middle and lower SDI regions. Over the past two decades, the burden of young TBLC among females has grown substantially, with increased inequality observed in 2021. Tobacco was the largest contributor to the PAF of young female DALYs in high SDI regions, whereas air pollution was the leading contributor in other SDI regions.

CONCLUSION

While the total number of young TBLC cases has been on the rise trend, primarily due to population changes, the ASRs of young TBLC burdens have decreased over the past two decades. In 2021, East Asia recorded the highest ASRs for young TBLC in terms of prevalence, incidence, and mortality. Tobacco remains the primary risk factor for young TBLC, and the DALYs burden from tobacco use has significantly decreased. However, the incidence of TBLC among non-smoking young females has grown rapidly over the past two decades, mainly due to air pollution, leading to increased inequality.

Comprehensive Analysis of circRNA-Related mRNAs as Prognostic Factors in Non-Smoking Women with Lung Adenocarcinoma

Background

Non-smoking women with lung adenocarcinoma(NSWLA) is a significant health problem globally; the carcinogenesis and prognostic signature remain poorly understood. Circular RNAs (circRNAs) are gradually implicated in cancer formation through sponging miRNAs to regulate mRNAs.

Methods

Tumor and paracancerous specimens from non-smoking women after lung adenocarcinoma surgery were collected for high-throughput sequencing of circRNA. miRNA and mRNA datasets were downloaded from TCGA. A circRNA-miRNA-mRNA network was built using differentially expressed circRNAs (DEcircRNAs), miRNAs (DEmiRNAs), and mRNAs (DEmRNAs). Following that, GSEA was applied to analyze the biological function of mRNAs in the ceRNA network. Utilizing the mRNAs associated with prognosis, we created an original prognostic risk score model. The expression of DEmRNA in the ceRNA network was verified by mRNA-seq and scRNA-seq data (GSE131907). The expression of BTBD3 and EIF4EBP2 was then verified by immunohistochemistry.

Results

16 pairs of adenocarcinoma tissues and their corresponding para-tumor samples were collected from thoracic surgery. We created a circRNA related ceRNA in NSWLA. The hsa_circ_0002346 regulation of the cancer cell proliferation may through the hsa_circ_0002346/miR-96-5p/EIF4EBP2 axis. Hsa_circ_0072309 may affect proliferation of lung adenocarcinoma and activate Nature Killer cells by targeting miR-32-5p to regulate PCMTD1 expression. Based upon mRNA (BTBD3, CFL2, EIF4EBP2, EVI5, PCMTD1, SYDE2) related to overall survival, we also created a predictive signature. According to mRNA-seq, scRNA-seq, and immunohistochemical data, the expression of BTBD3 and EIF4EBP2 was lower in tumor samples than in normal tissues nearby.

Conclusion

The circRNA related mRNAs played an important role in predicting the overall survival of NSWLA. The circRNA in the ceRNA network might unravel the pathogenesis and be potential novel targets for NSWLA.

Interpretable machine learning model for digital lung cancer prescreening in Chinese populations with missing data

We developed an interpretable model, BOUND (Bayesian netwOrk for large-scale lUng caNcer Digital prescreening), using a comprehensive EHR dataset from the China to improve lung cancer detection rates. BOUND employs Bayesian network uncertainty inference, allowing it to predict lung cancer risk even with missing data and identify high-risk factors. Developed using data from 905,194 individuals, BOUND achieved an AUC of 0.866 in internal validation, with time- and geography-based external validations yielding AUCs of 0.848 and 0.841, respectively. In datasets with 10%-70% missing data, AUC ranged from 0.827 - 0.746. The model demonstrates strong calibration, clinical utility, and robust performance in both balanced and imbalanced datasets. A risk scorecard was also created, improving detection rates up to 6.8 times, available free online ( https://drzhang1.aiself.net/ ). BOUND enables non-radiative, cost-effective lung cancer prescreening, excels with missing data, and addresses treatment inequities in resource-limited primary healthcare settings.

Sex-specificity in Surgical Stages of Lung Cancer in Young Adults

Background

Young Patients with lung cancer represent a distinct subset of patients with this neoplasm. Young International studies show increased lung cancer rates in females, while the incidence in males continues to decline. There is evidence to suggest that this trend recurs in younger patients. We studied the effects of gender differences on the incidence of surgical stages of lung cancer in young adults and its mortality rate.

Methods

This study is a retrospective review (2010-2020) of young adults (aged under 45 years) with surgical-stage of lung cancer. We calculated female-to-male differences in incidence rate ratios, tumor characteristics, surgical management, and survival. Cumulative survival curves were generated by the Kaplan-Meier method.

Results

We examined 46 men and 24 women, under 45 years. Female patients were diagnosed at earlier stages. The proportion of stage IA disease was significantly higher in women than in men (46% versus 13%, respectively) (p=0.03). Women were more likely never smokers (42% versus 83%, p=0.02). A histologic subtype, females were more likely to have typical carcinoid tumors (13.54% versus 10.21% for males) (p>0.05). The largest histological type in men was adenocarcinoma (25.53% versus 4.16%, p>0.05). All the patients were operated. Three men had neoadjuvant chemotherapy and one was operated on for cerebral oligometastatic before his chest surgery. Adjuvant chemotherapy was given to 7 women and 21 men. Despite the small number of postoperative complications in our study (n= 8, 11.2%), the male sex was significant in predicting this complication (p<0.05). The mortality rate was 1.4%. The 5-year overall survival rates were 84% in men and 87% in women.

Conclusion

Our study identified sex differences in the incidence and mortality rates for surgical lung cancers in young adults, but the biological and endocrine mechanisms implicated in these disparities have not yet been determined.