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Kuang M, Peng Y, Tao X, Zhou Z, Mao H, Zhuge L, Sun Y, Zhang H. FGB and FGG derived from plasma exosomes as potential biomarkers to distinguish benign from malignant pulmonary nodules. Clin Exp Med 2019; 19:557-564. [PMID: 31576477 DOI: 10.1007/s10238-019-00581-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 09/21/2019] [Indexed: 12/11/2022]
Abstract
Previous proteomic analysis (label-free) of plasma exosomes revealed that the expression of FGG and FGB was significantly higher in the malignant pulmonary nodules group, compared to the benign pulmonary nodules group. The present study was performed to evaluate the role of plasma exosomal proteins FGB and FGG in the diagnosis of benign and malignant pulmonary nodules. We examined the expression levels of FGB and FGG in plasma exosomes from 63 patients before surgery. Postoperative pathological diagnosis confirmed that 43 cases were malignant and 20 cases were benign. The ROC curve was used to describe the sensitivity, specificity, area under the curve (AUC) of the biomarker and the corresponding 95% confidence interval. We confirmed that the expression levels of FGB and FGG were higher in the plasma exosomes of malignant group than in the benign group. The sensitivity and AUC of FGB combined with FGG detection to determine the nature of pulmonary nodules are superior to single FGB or FGG detection. FGB and FGG might represent novel and sensitive biomarker to distinguish benign from malignant pulmonary nodules.
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Affiliation(s)
- Muyu Kuang
- Huadong Hospital, Fudan University, Shanghai, China.,Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yizhou Peng
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaoting Tao
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zilang Zhou
- The First High School, Xintian County, Hunan, China
| | - Hengyu Mao
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Lingdun Zhuge
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yihua Sun
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Huibiao Zhang
- Huadong Hospital, Fudan University, Shanghai, China.
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Risk Prediction in Clinical Practice: A Practical Guide for Cardiothoracic Surgeons. Ann Thorac Surg 2019; 108:1573-1582. [PMID: 31255609 DOI: 10.1016/j.athoracsur.2019.04.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 04/24/2019] [Accepted: 04/27/2019] [Indexed: 01/05/2023]
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Verdial FC, Madtes DK, Hwang B, Mulligan MS, Odem-Davis K, Waworuntu R, Wood DE, Farjah F. Prediction Model for Nodal Disease Among Patients With Non-Small Cell Lung Cancer. Ann Thorac Surg 2019; 107:1600-1606. [PMID: 30710518 DOI: 10.1016/j.athoracsur.2018.12.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 12/12/2018] [Accepted: 12/17/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND We characterized the performance characteristics of guideline-recommended invasive mediastinal staging (IMS) for lung cancer and developed a prediction model for nodal disease as a potential alternative approach to staging. METHODS We conducted a prospective cohort study of adults with suspected/confirmed non-small cell lung cancer without evidence of distant metastatic disease (by computed tomography/positron emission tomography) who underwent nodal evaluation by IMS and/or at the time of resection. The true-positive rate was the proportion of patients with true nodal disease selected to undergo IMS based on guideline recommendations, and the false-positive rate was the proportion of patients without true nodal disease selected to undergo IMS. Logistic regression was used to predict nodal disease using radiographic predictors. RESULTS Among 123 eligible subjects, 31 (25%) had pathologically confirmed nodal disease. A guideline-recommended invasive staging strategy had a true-positive rate and false-positive rate of 100% and 65%, respectively. The prediction model fit the data well (goodness-of-fit test, p = 0.55) and had excellent discrimination (optimism corrected c-statistic, 0.78; 95% confidence interval, 0.72 to 0.89). Exploratory analysis revealed that use of the prediction model could achieve a false-positive rate of 44% and a true-positive rate of 97%. CONCLUSIONS A guideline-recommended strategy for IMS selects all patients with true nodal disease and most patients without nodal disease for IMS. Our prediction model appears to maintain (within a margin of error) the sensitivity of a guideline-recommended invasive staging strategy and has the potential to reduce the use of invasive procedures.
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Affiliation(s)
- Francys C Verdial
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - David K Madtes
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington; Division of Pulmonary and Critical Care Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Billanna Hwang
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington; Center for Lung Biology, University of Washington, Seattle, Washington
| | - Michael S Mulligan
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington; Center for Lung Biology, University of Washington, Seattle, Washington
| | | | - Rachel Waworuntu
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington; Center for Lung Biology, University of Washington, Seattle, Washington
| | - Douglas E Wood
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Farhood Farjah
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington.
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Krantz SB, Howington JA, Wood DE, Kim KW, Kosinski AS, Cox ML, Kim S, Mulligan MS, Farjah F. Invasive Mediastinal Staging for Lung Cancer by The Society of Thoracic Surgeons Database Participants. Ann Thorac Surg 2018; 106:1055-1062. [DOI: 10.1016/j.athoracsur.2018.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/01/2018] [Accepted: 05/09/2018] [Indexed: 12/25/2022]
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Thornblade LW, Mulligan MS, Odem-Davis K, Hwang B, Waworuntu RL, Wolff EM, Kessler L, Wood DE, Farjah F. Challenges in Predicting Recurrence After Resection of Node-Negative Non-Small Cell Lung Cancer. Ann Thorac Surg 2018; 106:1460-1467. [PMID: 30031845 DOI: 10.1016/j.athoracsur.2018.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND One in 5 patients with completely resected early-stage non-small cell lung cancer will recur within 2 years. Risk stratification may facilitate a personalized approach to the use of adjuvant therapy and surveillance imaging. We developed a prediction model for recurrence based on five clinical variables (tumor size and grade, visceral pleural and lymphovascular invasion, and sublobar resection), and tested the hypothesis that the addition of several new molecular markers of poor long-term outcome (vascular endothelial growth factor C; microRNA precursors 486 and 30d) would enhance prediction. METHODS We performed a retrospective cohort study of patients with completely resected, node-negative non-small cell lung cancer from 2011 to 2014 (follow-up through 2016) using the Lung Cancer Biospecimen Resource Network. Cox regression was used to estimate the 2-year risk of recurrence. Our primary measure of model performance was the optimism-corrected C statistic. RESULTS Among 173 patients (mean tumor size, 3.6 cm; 12% sublobar resection, 32% poorly differentiated, 16% lymphovascular invasion, 26% visceral pleural invasion), the 2-year recurrence rate was 23% (95% confidence interval, 17% to 31%). A prediction model using five known risk factors for recurrence performed only slightly better than chance in predicting recurrence (optimism-corrected C statistic, 0.54; 95% confidence interval, 0.51 to 0.68). The addition of biomarkers did not improve the model's ability to predict recurrence (corrected C statistic, 0.55; 95% confidence interval, 0.52 to 0.71). CONCLUSIONS We were unable to predict lung cancer recurrence using a risk-prediction model based on five well-known clinical risk factors and several biomarkers. Further research should consider novel predictors of recurrence to stratify patients with completely resected early-stage non-small cell lung cancer according to their risk of recurrence.
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Affiliation(s)
| | | | - Katherine Odem-Davis
- Clinical & Translational Research, Seattle Children's Hospital, Seattle, Washington
| | - Billanna Hwang
- Department of Surgery, University of Washington, Seattle, Washington
| | | | - Erika M Wolff
- Department of Surgery, University of Washington, Seattle, Washington
| | - Larry Kessler
- Department of Health Services, University of Washington, Seattle, Washington
| | - Douglas E Wood
- Department of Surgery, University of Washington, Seattle, Washington
| | - Farhood Farjah
- Department of Surgery, University of Washington, Seattle, Washington.
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Thornblade LW, Wood DE, Mulligan MS, Farivar AS, Hubka M, Costas KE, Krishnadasan B, Farjah F. Variability in invasive mediastinal staging for lung cancer: A multicenter regional study. J Thorac Cardiovasc Surg 2018. [PMID: 29534904 DOI: 10.1016/j.jtcvs.2017.12.138] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Prior studies have reported underuse of-but not variability in-invasive mediastinal staging in the pretreatment evaluation of patients with lung cancer. We sought to compare rates of invasive mediastinal staging for lung cancer across hospitals participating in a regional quality improvement and research collaborative. METHODS We conducted a retrospective study (2011-2013) of patients undergoing resected lung cancer from the Surgical Clinical Outcomes and Assessment Program in Washington State. Invasive mediastinal staging included mediastinoscopy and/or endobronchial/esophageal ultrasound-guided nodal aspiration. We used a mixed-effects model to mitigate the influence of small sample sizes at any 1 hospital on rates of invasive staging and to adjust for hospital-level differences in the frequency of clinical stage IA disease. RESULTS A total of 406 patients (mean age, 68 years; 69% clinical stage IA; and 67% lobectomy) underwent resection at 5 hospitals (4 community and 1 academic). Invasive staging occurred in 66% of patients (95% confidence interval [CI], 61%-71%). CI inspection revealed that 2 hospitals performed invasive staging significantly more often than the overall average (94%, [95% CI, 89%-96%] and 84% [95% CI, 78%-88%]), whereas 2 hospitals performed invasive staging significantly less often than overall average (31% [95% CI, 21%-44%] and 17% [95% CI, 7%-36%]). CONCLUSIONS Rates of invasive mediastinal staging varied significantly across hospitals providing surgical care for patients with lung cancer. Future studies that aim to understand the reasons underlying variability in care may inform quality improvement initiatives or lead to the development of novel staging algorithms.
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Affiliation(s)
| | - Douglas E Wood
- Department of Surgery, University of Washington, Seattle, Wash
| | | | | | - Michal Hubka
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, Wash
| | - Kimberly E Costas
- Division of Thoracic Surgery, Providence Regional Medical Center, Everett, Wash
| | | | - Farhood Farjah
- Department of Surgery, University of Washington, Seattle, Wash.
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Singhal S. A new tool in the medical bag shows promise. J Thorac Cardiovasc Surg 2015; 150:804-5. [PMID: 26344684 DOI: 10.1016/j.jtcvs.2015.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/08/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Sunil Singhal
- Division of Thoracic Surgery, University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pa.
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