Lung Cancer Screening

The effects of different surgical approaches on the psychological status, medical coping mode and quality of life of patients with lung cancer

Objective

This study aimed to compare the effects of robot-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS), and thoracotomy on the psychological status, medical coping mode, and quality of life of patients with lung cancer.

Methods

A total of 158 patients with lung cancer were selected from the thoracic surgery center of a third-grade hospital in Hunan Province, China, from September to November 2020. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Medical Coping Modes Questionnaire (MCMQ), and Medical Outcomes Study (MOS) 36-item Short Form Health Survey (SF-36) were used to assess the effects of the surgical approaches on the study parameters before and 48–96 h after surgery. The t-test and analysis of variance were used to analyze the data.

Results

The results revealed that the patients’ depression increased, their short-term quality of life decreased, and they tended to adopt a positive coping mode after surgery (p < 0.05). The RATS and VATS groups differed in avoidance dimension of medical coping modes (p < 0.05). The VATS and thoracotomy groups differed in the body pain dimension of quality of life (p < 0.05). Different surgical approaches had no effect on the psychological status, medical coping modes except the avoidance dimension, and quality of life except the body pain dimension.

Conclusion

Surgical approaches have little effect on the psychological status, medical coping modes, and quality of life of patients with lung cancer; however, their depression increased and quality of life decreased after the surgery.

Duration of intervals in the care seeking pathway for lung cancer in Bangladesh: A journey from symptoms triggering consultation to receipt of treatment

Timeliness in seeking care is critical for lung cancer patients' survival and better prognosis. The care seeking trajectory of patients with lung cancer in Bangladesh has not been explored, despite the differences in health systems and structures compared to high income countries. This study investigated the symptoms triggering healthcare seeking, preferred healthcare providers (including informal healthcare providers such as pharmacy retailers, village doctors, and "traditional healers"), and the duration of intervals in the lung cancer care pathway of patients in Bangladesh. A cross-sectional study was conducted in three tertiary care hospitals in Bangladesh among diagnosed lung cancer patients through face-to-face interview and medical record review. Time intervals from onset of symptom and care seeking events were calculated and compared between those who sought initial care from different providers using Wilcoxon rank sum tests. Among 418 study participants, the majority (90%) of whom were males, with a mean age of 57 ±9.86 years, cough and chest pain were the most common (23%) combination of symptoms triggering healthcare seeking. About two-thirds of the total respondents (60%) went to informal healthcare providers as their first point of contact. Living in rural areas, lower levels of education and lower income were associated with seeking care from such providers. The median duration between onset of symptom to confirmation of diagnosis was 121 days, between confirmation of diagnosis and initiation of treatment was 22 days, and between onset of symptom and initiation of treatment was 151 days. Pre-diagnosis durations were longer for those who had sought initial care from an informal provider (p<0.05). Time to first contact with a health provider was shorter in this study compared to other developed and developing countries but utilizing informal healthcare providers caused delays in diagnosis and initiation of treatment. Encouraging people to seek care from a formal healthcare provider may reduce the overall duration of the care seeking pathway.

PP7080 expedites the proliferation and migration of lung adenocarcinoma cells via sponging miR-670-3p and regulating UHRF1BP1

BACKGROUND

An increasing body of evidence has revealed that long non-coding RNAs play a significant part in a variety of human cancers, including lung adenocarcinoma (LUAD).

METHODS

The expression of PP7080, miR-670-3p and UHRF1BP1 in LUAD cells and tissues was detected using a quantitative real-time polymerase chain reaction. The role of PP7080 in LUAD cells was validated by CCK-8, flow cytometry, colony formation, transwell and wound healing assays. The binding capacity between PP7080/UHRF1BP1 and miR-670-3p was confirmed by luciferase reporter assays. Moreover, the interactional mechanism among PP7080, miR-670-3p and UHRF1BP1 was determined by means of RNA immunoprecipitation and western blot assays.

RESULTS

The expression level of PP7080 is up-regulated in LUAD cells and tissues compared to their matched controls. Down-regulation of PP7080 restrained the proliferative and migratory abilities of LUAD cells, but induced cell apoptosis. PP7080 up-regulation led to the opposite results. Moreover, the binding ability between miR-670-3p and PP7080/UHRF1BP1 in LUAD cells was confirmed. A rescue assay revealed that PP7080 contributes to LUAD development by modulating the miR-670-3p/UHRF1BP1 signaling pathway.

CONCLUSIONS

PP7080 expedites the proliferation and migration of LUAD cell via sponging miR-670-3p and modulating UHRF1BP1.

Circ-SOX4 drives the tumorigenesis and development of lung adenocarcinoma via sponging miR-1270 and modulating PLAGL2 to activate WNT signaling pathway

Background

Lung adenocarcinoma (LUAD), a widespread histopathological subtype of lung cancer, is deemed as a malignant tumor with a peak risk of mortality. Emerged as RNA with a loop structure that depleted protein coding ability, circular RNA (circRNA) has been identified as a regulator in cancer progression. Circ-SOX4, identified as a novel circRNA, has not been studied in any cancer yet. Thus, the regulatory function that circ-SOX4 exerts on LUAD development remains obscure.

Aim of the study

This study aimed to investigate the biological function and molecular mechanism of circ-SOX4 in LUAD.

Methods

The expression of circ-SOX4 was detected by qRT-PCR. CCK-8, colony formation, transwell and wound healing assays were performed to explore the biological function of circ-SOX4 in LUAD. The interaction between miR-1270 and circ-SOX41 (or PLAGL2) was confirmed by RNA pull down, luciferase reporter and RIP assays.

Results

Circ-SOX4 was found to be obviously upregulated in LUAD tissues and cells, and knockdown of it inhibited cell proliferation, invasion and migration in LUAD. Furthermore, silenced circ-SOX4 also inhibited LUAD tumor growth. Molecular mechanism assays revealed that circ-SOX4 interacted with miR-1270 in LUAD. Besides, PLAGL2 was confirmed as a downstream gene of miR-1270. Rescue assays validated that miR-1270 suppression or PLAGL2 overexpression countervailed circ-SOX4 depletion-mediated inhibition on cell proliferation, invasion and migration in LUAD. Additionally, it was discovered that circ-SOX4/miR-1270/PLAGL2 axis activated WNT signaling pathway in LUAD.

Conclusions

Circ-SOX4 boosted the development of LUAD and activate WNT signaling pathway through sponging miR-1270 and modulating PLAGL2, which provided a valuable theoretical basis for exploring underlying therapeutic target in LUAD.

Trends in lung cancer screening in the United States, 2016-2017

Background

Lung cancer is the most common cancer killer annually, yet the overall rate of eligible patients who undergo screening with low-dose computed tomography (LDCT) is low. Our goal was to determine factors which were associated with the probability of obtaining lung cancer screening.

Methods

The Clinformatics Data Mart (CDM) database, a national commercial health insurance database with over 18,000,000 enrollees, was queried to determine the rate of LDCT screening and factors which influenced receiving LDCT screening. All enrollees between the ages of 55 and 77 from 2016 to 2017 were included. Demographics, history of tobacco exposure and state smoking statistics were recorded.

Results

All 8,350,197 enrollees aged 55-77 were included in the study. Among enrollees, the rate of screening increased throughout 2016 and early 2017 and then appeared to stabilize. In the second half of 2017 the LDCT rate was approximately 6 per 1,000 enrollees per year, and was increasing at a slope of 0.1 additional LDCT per 1,000 enrollees per year. There was marked geographic variation, with 5-fold differences in LDCT rates between different regions. There was no correlation between smoking rate and LDCT rate at the state level (r=0.02; P=0.87). Enrollees aged 65-69 were most likely to be screened (OR =1.53; 1.45-1.61) compared to enrollees aged 55-59.

Conclusions

The rate of LDCT screening is increasing very slowly with time, and most eligible patients are not screened. Further studies are needed to determine the reasons for low screening rates, and the marked geographic variation.

A P53-Deficiency Gene Signature Predicts Recurrence Risk of Patients with Early-Stage Lung Adenocarcinoma

Background: Lung cancer is associated with the highest mortality rate of all cancer types, and the most common histologic subtype of lung cancer is adenocarcinoma. To apply more effective therapeutic treatment, molecular markers that are able to predict the recurrence risk of patients with adenocarcinoma are critically needed. Mutations in TP53 tumor suppressor gene have been found in approximately 50% of lung adenocarcinoma cases, but the presence of a TP53 mutation does not always associate with increased mortality.Methods: The Cancer Genome Atlas RNA sequencing data of lung adenocarcinoma were used to define a novel gene signature for P53 deficiency. This signature was then used to calculate a sample-specific P53 deficiency score based on a patient's transcriptomic profile and tested in four independent lung adenocarcinoma microarray datasets.Results: In all datasets, P53 deficiency score was a significant predictor for recurrence-free survival where high P53 deficiency score was associated with poor survival. The score was prognostic even after adjusting for several key clinical variables including age, tumor stage, smoking status, and P53 mutation status. Furthermore, the score was able to predict recurrence-free survival in patients with stage I adenocarcinoma and was also associated with smoking status.Conclusions: The P53 deficiency score was a better predictor of recurrence-free survival compared with P53 mutation status and provided additional prognostic values to established clinical factors.Impact: The P53 deficiency score can be used to stratify early-stage patients into subgroups based on their risk of recurrence for aiding physicians to decide personalized therapeutic treatment. Cancer Epidemiol Biomarkers Prev; 27(1); 86-95. ©2017 AACR.

Lung Cancer Screening and Its Impact on Surgical Volume

Lung cancer screening has demonstrated a reduction in lung cancer mortality by 20%. Annual low-dose computed tomography examination in high-risk individuals is now recommended by multiple national health care organizations and is covered under Medicare and Medicaid services. The impact of this public health intervention is projected to increase the case load for the thoracic surgery workforce.

hsa_circ_0013958: a circular RNA and potential novel biomarker for lung adenocarcinoma

Circular RNAs (circRNAs) are associated with cancer progression and metastasis, although little is known about their role in lung adenocarcinoma (LAC). In the present study, microarrays were first used to screen for tumour-specific circRNA candidates in LAC tissue. Thirty-nine circRNAs were found to be up-regulated and 20 were down-regulated (fold change > 2.0). Among them, hsa_circ_0013958 was further confirmed to be up-regulated in all of the LAC tissues, cells and plasma. In addition, hsa_circ_0013958 levels were associated with TNM stage (P = 0.009) and lymphatic metastasis (P = 0.006). The area under the receiver operating characteristic curve was 0.815 (95% confidence interval = 0.727-0.903; P < 0.001). In addition, to further illustrate the bioactivities of hsa_circ_0013958 in LAC, siRNA-mediated inhibition of hsa_circ_0013958 was performed in vitro. The results showed that hsa_circ_0013958 promoted cell proliferation and invasion and inhibited cell apoptosis in LAC. Moreover, hsa_circ_0013958 was identified as a sponge of miR-134, and thus it up-regulated oncogenic cyclin D1, which plays a pivotal role in the development of non-small cell lung cancer. In conclusion, our results suggested that hsa_circ_0013958 could be used as a potential non-invasive biomarker for the early detection and screening of LAC.

Integration of multiple "OMIC" biomarkers: A precision medicine strategy for lung cancer

More than half of all new lung cancer diagnoses are made in patients with locally advanced or metastatic disease, at which point therapeutic options are scarce. It is anticipated, however, that the widespread use of Low-Dose Computed Tomography (LDCT) screening, will lead to a greater proportion of lung cancers being diagnosed at an early, operable, stage. Still, the overall rate of recurrence for surgically treated Stage I lung cancer patients is up to 30% within 5 years of diagnosis. Thus, the identification and clinical application of biomarkers of early stage lung cancer are a pressing medical need. The integrative analysis of "omic," clinical and epidemiological data for single patients is a core principle of precision medicine. Through rigorous bioinformatics and statistical analyses we have identified biomarkers of early-stage lung cancer based on DNA methylation, expression of mRNA and miRNA, inflammatory cytokines, and urinary metabolites. Beyond a more comprehensive understanding of the molecular taxonomy of lung cancer, these biomarkers can have very practical implications in the context of unmet clinical needs of early stage lung cancer patients: First, current guidelines for LDCT screening broadly include individuals based on age and history of heavy smoking. Tumor-derived circulating biomarkers in the blood and urine associated with lung cancer risk could narrow and prioritize individuals for LDCT screening. Second, a high number of nodules are identified by LDCT, of which fewer than 5% are finally diagnosed as lung cancer. Biomarkers may help discriminate malignant nodules from benign or indolent lesions. Third, the expected rise in the numbers of lung cancer patients diagnosed at an early stage will necessitate new treatment options. Circulating, urinary and tissue-based biomarkers that molecularly categorize Stage I patients after tumor resection can help identify high-risk patients who may benefit from adjuvant chemotherapy or innovative immunotherapy regimens.

Clinical investigation into the initial diagnosis and treatment of 539 patients with stage IV lung cancer

Objective

The aim of the study was to analyze clinical data, including the types of pathologic classification, metastatic organs, treatment strategy, and prognosis of patients with stage IV lung cancer.

Methods

A retrospective analysis of the clinical features of 539 patients with stage IV lung cancer who were initially diagnosed and treated in 2009 was conducted. There were 146 cases of single organ metastases and 393 cases of multiple organ metastases. The Kaplan-Meier method and multivariate Cox regression analysis were performed to analyze the influence of age, pathological classification, metastatic organs, and treatment strategy on overall survival.

Results

The 1-, 2-, and 3-year survival rates were 64.2% (n=346), 19.7% (n=106), and 1.5% (n=8), respectively. Metastases to the liver and pleura predicted poor prognosis, although bone metastases predicted relatively good prognosis. The prognosis of single brain metastasis was relatively better than that of multiple brain metastases. Multi-factor analysis showed that the patient’s age, different metastatic organs, the numbers of metastatic organs, and different treatment were independent risk factors for survival.

Conclusion

The prognosis for patients with stage IV lung cancer is poor. Patient’s age, the type and number of metastatic organs, and method of treatment are the main factors affecting survival.

Rare occurrence of metastasis from lung cancer to the anus: case report and review of the literature

Background

Anal metastases from lung cancer are infrequent, and there are only 10 published cases. Life expectancy is no longer than 1 year after diagnosis because of the typically advanced stage of disease. Treatment, which is typically inefficient, is administered with the intent to cure or avoid local complications.

Case presentation

We report a case of a patient with non-small cell lung cancer presenting with perianal metastasis mimicking an abscess.

Conclusions

Because perianal masses may be misdiagnosed, patients with lung and other cancers should be evaluated for metastatic disease.