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Powell CL, Saddoughi SA, Wigle DA. Progress in genome-inspired treatment decisions for multifocal lung adenocarcinoma. Expert Rev Respir Med 2023; 17:1009-1021. [PMID: 37982734 DOI: 10.1080/17476348.2023.2286277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/17/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Multifocal lung adenocarcinoma (MFLA) is becoming increasingly recognized as a distinct subset of lung cancer, with unique biology, disease course, and treatment outcomes. While definitions remain controversial, MFLA is characterized by the development and concurrent presence of multiple independent (non-metastatic) lesions on the lung adenocarcinoma spectrum. Disease progression typically follows an indolent course measured in years, with a lower propensity for nodal and distant metastases than other more common forms of non-small cell lung cancer. AREAS COVERED Traditional imaging and histopathological analyses of tumor biopsies are frequently unable to fully characterize the disease, prompting interest in molecular diagnosis. We highlight some of the key questions in the field, including accurate definitions to identify and stage MLFA, molecular tests to stratify patients and treatment decisions, and the lack of clinical trial data to delineate best management for this poorly understood subset of lung cancer patients. We review the existing literature and progress toward a genomic diagnosis for this unique disease entity. EXPERT OPINION Multifocal lung adenocarcinoma behaves differently than other forms of non-small cell lung cancer. Progress in molecular diagnosis may enhance potential for accurate definition, diagnosis, and optimizing treatment approach.
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Affiliation(s)
- Chelsea L Powell
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sahar A Saddoughi
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dennis A Wigle
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Ji H, Liu Q, Chen Y, Gu M, Chen Q, Guo S, Ning S, Zhang J, Li WH. Combined model of radiomics and clinical features for differentiating pneumonic-type mucinous adenocarcinoma from lobar pneumonia: An exploratory study. Front Endocrinol (Lausanne) 2022; 13:997921. [PMID: 36726465 PMCID: PMC9884819 DOI: 10.3389/fendo.2022.997921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/19/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The purpose of this study was to distinguish pneumonic-type mucinous adenocarcinoma (PTMA) from lobar pneumonia (LP) by pre-treatment CT radiological and clinical or radiological parameters. METHODS A total of 199 patients (patients diagnosed with LP = 138, patients diagnosed with PTMA = 61) were retrospectively evaluated and assigned to either the training cohort (n = 140) or the validation cohort (n = 59). Radiomics features were extracted from chest CT plain images. Multivariate logistic regression analysis was conducted to develop a radiomics model and a nomogram model, and their clinical utility was assessed. The performance of the constructed models was assessed with the receiver operating characteristic (ROC) curve and the area under the curve (AUC). The clinical application value of the models was comprehensively evaluated using decision curve analysis (DCA). RESULTS The radiomics signature, consisting of 14 selected radiomics features, showed excellent performance in distinguishing between PTMA and LP, with an AUC of 0.90 (95% CI, 0.83-0.96) in the training cohort and 0.88 (95% CI, 0.79-0.97) in the validation cohort. A nomogram model was developed based on the radiomics signature and clinical features. It had a powerful discriminative ability, with the highest AUC values of 0.94 (95% CI, 0.90-0.98) and 0.91 (95% CI, 0.84-0.99) in the training cohort and validation cohort, respectively, which were significantly superior to the clinical model alone. There were no significant differences in calibration curves from Hosmer-Lemeshow tests between training and validation cohorts (p = 0.183 and p = 0.218), which indicated the good performance of the nomogram model. DCA indicated that the nomogram model exhibited better performance than the clinical model. CONCLUSIONS The nomogram model based on radiomics signatures of CT images and clinical risk factors could help to differentiate PTMA from LP, which can provide appropriate therapy decision support for clinicians, especially in situations where differential diagnosis is difficult.
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Affiliation(s)
- Huijun Ji
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Qianqian Liu
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yingxiu Chen
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Mengyao Gu
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Qi Chen
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Shaolan Guo
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Shangkun Ning
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Juntao Zhang
- GE Healthcare, Precision Health Institution, Shanghai, China
| | - Wan-Hu Li
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
- *Correspondence: Wan-Hu Li,
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Zong Q, Zhu F, Wu S, Peng L, Mou Y, Miao K, Wang Q, Zhao J, Xu Y, Zhou M. Advanced pneumonic type of lung adenocarcinoma: survival predictors and treatment efficacy of the tumor. TUMORI JOURNAL 2020; 107:216-225. [PMID: 32762285 DOI: 10.1177/0300891620947159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To retrospectively explore the survival predictors and treatment efficacy of advanced pneumonic-type lung adenocarcinoma (P-ADC). METHODS Retrospective analysis of clinical data and survival follow-up was undertaken on 41 patients with advanced P-ADC from January 1, 2009, to April 30, 2019. Analysis on tumor biomarkers such as carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and the cytokeratin-19-fragment (Cyfra21-1) were undertaken. The patients in this study were divided into three groups based on usage of tyrosine kinase inhibitor (TKI): TKI therapy group (including combination with chemotherapy), non-TKI therapy group (chemotherapy alone), and palliative care group. RESULTS More than half of the patients had higher levels of tumor biomarkers and the incidence of NSE was highest (81.8%), followed by CEA (74.4%) and Cyfra21-1 (74.1%). All patients had abnormal findings on chest computed tomography and with adenocarcinoma pathology. The overall survival (OS) time was 10.4 months in TKI group, 8.8 months in the non-TKI group, and 2.1 months in the palliative care group. Patients with higher level of serum Cyfra21-1 had insignificantly shorter survival time compared to those with normal Cyfra21-1 (p = 0.067). TKI therapy and non-TKI therapy provided a better prognosis prediction compared to palliative care. TKI therapy improved prognosis compared to non-TKI therapy. The comprehensive based TKI therapy provided improved OS vs the non-TKI therapy. CONCLUSION TKI-based therapy could improve the prognosis and OS for advanced P-ADC. This study recommends the analysis of EGFR mutations for all patients with advanced P-ADC.
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Affiliation(s)
- Qiu Zong
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Feng Zhu
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Clinic Center of Human Gene Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shimin Wu
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Peng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yong Mou
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Kang Miao
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qi Wang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jianping Zhao
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yongjian Xu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Min Zhou
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Azzeddine R, Rhorfi IA, Zegmout A, Souhi H, Elouazzani H, Abid A, Chahdi H, Tbouda M. Typical presentation of pulmonary lepidic adenocarcinoma: a rare case report. Pan Afr Med J 2020; 36:11. [PMID: 32550974 PMCID: PMC7282614 DOI: 10.11604/pamj.2020.36.11.22660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/04/2020] [Indexed: 11/15/2022] Open
Abstract
Bronchioloalveolar carcinoma (BAC) is a rare subtype of adenocarcinoma of lung with distinct features and distinctive characteristics. It accounts approximately for 4% of lung cancers. In the following study we report a rare observation of a 50 years old female with a clinical, radiological and histological presentation, which is typical of an invasive mucinous lepidic adenocarcinoma formerly named BAC.
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Affiliation(s)
- Rajae Azzeddine
- Department of Pneumology, Military Hospital Mohamed V, Rabat, Morocco
| | | | - Adil Zegmout
- Department of Pneumology, Military Hospital Mohamed V, Rabat, Morocco
| | - Hicham Souhi
- Department of Pneumology, Military Hospital Mohamed V, Rabat, Morocco
| | - Hanane Elouazzani
- Department of Pneumology, Military Hospital Mohamed V, Rabat, Morocco
| | - Ahmed Abid
- Department of Pneumology, Military Hospital Mohamed V, Rabat, Morocco
| | - Hafsa Chahdi
- Department of Pathology, Military Hospital Mohamed V, Rabat, Morocco
| | - Mohamed Tbouda
- Department of Pathology, Military Hospital Mohamed V, Rabat, Morocco
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Ruppert AM, Baud L, Rabbe N, Perez J, Duruisseaux M, Vieira T, Antoine M, Cadranel J, Wislez M. Calpain 1 in bronchoalveolar lavage fluid is associated with poor prognosis in lepidic predominant pulmonary adenocarcinoma. Bull Cancer 2019; 106:179-188. [PMID: 30683309 DOI: 10.1016/j.bulcan.2018.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/14/2018] [Indexed: 11/17/2022]
Abstract
Calpain 1 is a proinflammatory calcium-activated cysteine protease, which can be partly externalized. Extracellular calpains limit inflammatory processes and promote tissue repair, through cell proliferation and migration. Toll like receptor (TLR) 2 has been identified as a target of extracellular calpains in lymphocytes. The aim was to investigate the externalization of calpain 1 and the release of soluble TLR2 during tumor progression of pulmonary lepidic predominant adenocarcinoma (LPA). Extracellular calpain 1, soluble fragment of TLR2 and cytokines were analyzed by ELISA in bronchoalveolar lavage fluid (BALF) supernatants from patients with LPA (n=68). Source of calpain was analyzed by immunohistochemistry and soluble TLR2 by flow cytometry on polymorphonuclear neutrophils (PMN) and human lung cancer cell lines. Extracellular calpain 1, secreted by tumor cells, was associated to tumor progression, neutrophilic inflammation, with a poor prognostic factor on survival (P=0.003). TLR2 was expressed on PMN and tumor cells and decreased after calpain exposure. Soluble fragment of TLR2 in BALF supernatants was correlated to the extracellular calpain 1 concentration (r=0.624; P<0.001), and its high level was associated with tumor progression and a pro-inflammatory environment. Extracellular calpain 1 secreted by tumor cells, could participate in inflammatory microenvironment and tumor progression through TLR2 in LPA.
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Affiliation(s)
- Anne-Marie Ruppert
- Sorbonne université, GRC n(o) 04, Theranoscan, 75252 Paris, France; Hôpitaux universitaires de l'est parisien, hôpital Tenon (AP-HP), service de pneumologie, 75970 Paris, France
| | - Laurent Baud
- Sorbonne Universités, UMR_S1155 and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), 4, rue de la Chine, 75252 Paris, France; Inserm, UMR_S1155, 75020 Paris, France
| | - Nathalie Rabbe
- Sorbonne université, GRC n(o) 04, Theranoscan, 75252 Paris, France; Hôpitaux universitaires de l'est parisien, hôpital Tenon (AP-HP), service de pneumologie, 75970 Paris, France; Paris Descartes université, équipe « cancer, immune control and escape », centre de recherche des Cordeliers, Inserm UMR_S1138, 75006 Paris, France; AP-HP, hôpitaux universitaires Paris centre, hôpital Cochin, unité d'oncologie thoracique, service de pneumologie, 75014 Paris, France
| | - Joëlle Perez
- Sorbonne Universités, UMR_S1155 and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), 4, rue de la Chine, 75252 Paris, France
| | | | - Thibault Vieira
- Sorbonne université, GRC n(o) 04, Theranoscan, 75252 Paris, France
| | - Martine Antoine
- Sorbonne université, GRC n(o) 04, Theranoscan, 75252 Paris, France; AP-HP, hôpitaux universitaires de l'est parisien, hôpital Tenon, service de cytologie et anatomie pathologique, 75970 Paris, France
| | - Jacques Cadranel
- Sorbonne université, GRC n(o) 04, Theranoscan, 75252 Paris, France; Hôpitaux universitaires de l'est parisien, hôpital Tenon (AP-HP), service de pneumologie, 75970 Paris, France
| | - Marie Wislez
- Sorbonne université, GRC n(o) 04, Theranoscan, 75252 Paris, France; Hôpitaux universitaires de l'est parisien, hôpital Tenon (AP-HP), service de pneumologie, 75970 Paris, France; Paris Descartes université, équipe « cancer, immune control and escape », centre de recherche des Cordeliers, Inserm UMR_S1138, 75006 Paris, France; AP-HP, hôpitaux universitaires Paris centre, hôpital Cochin, unité d'oncologie thoracique, service de pneumologie, 75014 Paris, France.
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Kim HJ, Byun HJ, Park MK, Kim EJ, Kang GJ, Lee CH. Novel involvement of RhebL1 in sphingosylphosphorylcholine-induced keratin phosphorylation and reorganization: Binding to and activation of AKT1. Oncotarget 2017; 8:20851-20864. [PMID: 28209923 PMCID: PMC5400551 DOI: 10.18632/oncotarget.15364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/06/2017] [Indexed: 11/25/2022] Open
Abstract
Sphingosylphosphorylcholine induces keratin phosphorylation and reorganization, and increases viscoelasticity of metastatic cancer cells such as PANC-1 cells. However, the mechanism involved in sphingosylphosphorylcholine-induced keratin phosphorylation and reorganization is largely unknown. Sphingosylphosphorylcholine dose- and time-dependently induces the expression of RhebL1. The involvement of RhebL1 in sphingosylphosphorylcholine-induced events including keratin 8 (K8) phosphorylation, reorganization, migration and invasion was examined. Gene silencing of RhebL1 suppressed the sphingosylphosphorylcholine-induced events and overexpression of RhebL1 enhanced those events even without sphingosylphosphorylcholine treatment. We examined whether the G protein function of RhebL1 induces K8 phosphorylation using constitutively active RhebL1Q64L and dominant negative RhebL1D60K. G protein activity of RhebL1 is involved in sphingosylphosphorylcholine-induced K8 phosphorylation. We found that RhebL1 binds and activates AKT1. G protein activity of RhebL1 is involved in the binding and activation of AKT1. MK2206 (AKT inhibitor) and gene silencing of AKT1 inhibited the sphingosylphosphorylcholine-induced events, whereas overexpression of activated-AKT1 induced K8 phosphorylation, reorganization, migration and invasion even without sphingosylphosphorylcholine treatment. The collective results indicate that RhebL1 is involved in sphingosylphosphorylcholine-induced events in A549 lung cancer cells via binding to AKT1 leading to activation of it. These results suggest that suppression of RhebL1 or inhibition of RhebL1′s binding to AKT1 might be a novel way that prevents changes in the physical properties of metastatic cancer cells.
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Affiliation(s)
- Hyun Ji Kim
- College of Pharmacy, Dongguk University, Seoul 100-715, Republic of Korea
| | - Hyun Jung Byun
- College of Pharmacy, Dongguk University, Seoul 100-715, Republic of Korea
| | - Mi Kyung Park
- College of Pharmacy, Dongguk University, Seoul 100-715, Republic of Korea
| | - Eun Ji Kim
- College of Pharmacy, Dongguk University, Seoul 100-715, Republic of Korea
| | - Gyeoung Jin Kang
- College of Pharmacy, Dongguk University, Seoul 100-715, Republic of Korea
| | - Chang Hoon Lee
- College of Pharmacy, Dongguk University, Seoul 100-715, Republic of Korea
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Nemec U, Heidinger BH, Anderson KR, Westmore MS, VanderLaan PA, Bankier AA. Software-based risk stratification of pulmonary adenocarcinomas manifesting as pure ground glass nodules on computed tomography. Eur Radiol 2017; 28:235-242. [PMID: 28710575 PMCID: PMC5717124 DOI: 10.1007/s00330-017-4937-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/08/2017] [Accepted: 06/08/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess the performance of the "Computer-Aided Nodule Assessment and Risk Yield" (CANARY) software in the differentiation and risk assessment of histological subtypes of lung adenocarcinomas manifesting as pure ground glass nodules on computed tomography (CT). METHODS 64 surgically resected and histologically proven adenocarcinomas manifesting as pure ground-glass nodules on CT were assessed using CANARY software, which classifies voxel-densities into three risk components (low, intermediate, and high risk). Differences in risk components between histological adenocarcinoma subtypes were analysed. To determine the optimal threshold reflecting the presence of an invasive focus, sensitivity, specificity, negative predictive value, and positive predictive value were calculated. RESULTS 28/64 (44%) were adenocarcinomas in situ (AIS); 26/64 (41%) were minimally invasive adenocarcinomas (MIA); and 10/64 (16%) were invasive ACs (IAC). The software showed significant differences in risk components between histological subtypes (P<0.001-0.003). A relative volume of 45% or less of low-risk components was associated with histological invasiveness (specificity 100%, positive predictive value 100%). CONCLUSIONS CANARY-based risk assessment of ACs manifesting as pure ground glass nodules on CT allows the differentiation of their histological subtypes. A threshold of 45% of low-risk components reflects invasiveness in these groups. KEY POINTS • CANARY-based risk assessment allows the differentiation of their histological subtypes. • 45% or less of low-risk component reflects histological invasiveness. • CANARY has potential role in suspected adenocarcinomas manifesting as pure ground-glass nodules.
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Affiliation(s)
- Ursula Nemec
- Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.
| | - Benedikt H Heidinger
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kevin R Anderson
- Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Paul A VanderLaan
- Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alexander A Bankier
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Interstitial lung disease pattern turned out to be a predominantly lepidic lung adenocarcinoma. Respir Med Case Rep 2017; 21:56-58. [PMID: 28393007 PMCID: PMC5377009 DOI: 10.1016/j.rmcr.2017.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 11/21/2022] Open
Abstract
We report a case of a 46-year-old woman without any medical history who presented to our Respiratory Department with exertional dyspnoea for the last 6 weeks associated with non-productive cough. Chest radiography showed bilateral diffuse interstitial opacity. Bronchoalveolar lavage and transbronchial biopsies performed during flexible bronchoscopy as a step in the diagnostic workup of idiopathic interstitial pneumonia showed cells of pulmonary adenocarcinoma.
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Feng ZM, Zhuang ZJ, He WB, Ding JP, Yang WJ, Chen XY. Lung Cancer with Diffuse Ground-glass Shadow in Two Lungs and Respiratory Failure. Chin Med J (Engl) 2016; 129:1873-6. [PMID: 27453241 PMCID: PMC4976580 DOI: 10.4103/0366-6999.186632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Zhe-Min Feng
- Department of Respiratory Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China
| | - Zhen-Jie Zhuang
- Translational Medicine Center, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China
| | - Wen-Bo He
- Department of Respiratory Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China
| | - Jian-Ping Ding
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China
| | - Wen-Jun Yang
- Department of Pathology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China
| | - Xue-Yuan Chen
- Department of Respiratory Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China
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Koike T, Kitahara A, Sato S, Hashimoto T, Aoki T, Koike T, Yoshiya K, Toyabe SI, Tsuchida M. Lobectomy Versus Segmentectomy in Radiologically Pure Solid Small-Sized Non-Small Cell Lung Cancer. Ann Thorac Surg 2016; 101:1354-60. [DOI: 10.1016/j.athoracsur.2015.10.048] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 09/28/2015] [Accepted: 10/14/2015] [Indexed: 01/15/2023]
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Detterbeck FC, Marom EM, Arenberg DA, Franklin WA, Nicholson AG, Travis WD, Girard N, Mazzone PJ, Donington JS, Tanoue LT, Rusch VW, Asamura H, Rami-Porta R. The IASLC Lung Cancer Staging Project: Background Data and Proposals for the Application of TNM Staging Rules to Lung Cancer Presenting as Multiple Nodules with Ground Glass or Lepidic Features or a Pneumonic Type of Involvement in the Forthcoming Eighth Edition of the TNM Classification. J Thorac Oncol 2016; 11:666-680. [PMID: 26940527 DOI: 10.1016/j.jtho.2015.12.113] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/01/2015] [Accepted: 12/23/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Application of tumor, node, and metastasis (TNM) classification is difficult in patients with lung cancer presenting as multiple ground glass nodules or with diffuse pneumonic-type involvement. Clarification of how to do this is needed for the forthcoming eighth edition of TNM classification. METHODS A subcommittee of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee conducted a systematic literature review to build an evidence base regarding such tumors. An iterative process that included an extended workgroup was used to develop proposals for TNM classification. RESULTS Patients with multiple tumors with a prominent ground glass component on imaging or lepidic component on microscopy are being seen with increasing frequency. These tumors are associated with good survival after resection and a decreased propensity for nodal and extrathoracic metastases. Diffuse pneumonic-type involvement in the lung is associated with a worse prognosis, but also with a decreased propensity for nodal and distant metastases. CONCLUSION For multifocal ground glass/lepidic tumors, we propose that the T category be determined by the highest T lesion, with either the number of tumors or m in parentheses to denote the multifocal nature, and that a single N and M category be used for all the lesions collectively-for example, T1a(3)N0M0 or T1b(m)N0M0. For diffuse pneumonic-type lung cancer we propose that the T category be designated by size (or T3) if in one lobe, as T4 if involving an ipsilateral different lobe, or as M1a if contralateral and that a single N and M category be used for all pulmonary areas of involvement.
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Affiliation(s)
| | - Edith M Marom
- Department of Diagnostic Imaging, Tel-Aviv University, Ramat Gan, Israel
| | - Douglas A Arenberg
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, United Kingdom
| | - William D Travis
- Department of Pathology, Sloan-Kettering Cancer Center, New York, New York
| | - Nicolas Girard
- Respiratory Medicine Service, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Peter J Mazzone
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Lynn T Tanoue
- Department of Internal Medicine, Yale University, New Haven, Connecticut
| | - Valerie W Rusch
- Thoracic Surgery Service, Sloan-Kettering Cancer Center, New York, New York
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University, School of Medicine, Tokyo, Japan
| | - Ramón Rami-Porta
- Thoracic Surgery Service, Hospital Universitari Mutua Terrassa; Centros de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
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Lee EJ, Park MK, Kim HJ, Kim EJ, Kang GJ, Byun HJ, Lee CH. Epithelial membrane protein 2 regulates sphingosylphosphorylcholine-induced keratin 8 phosphorylation and reorganization: Changes of PP2A expression by interaction with alpha4 and caveolin-1 in lung cancer cells. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2016; 1863:1157-69. [PMID: 26876307 DOI: 10.1016/j.bbamcr.2016.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 12/13/2022]
Abstract
Sphingosylphosphorylcholine (SPC) is found at increased in the malignant ascites of tumor patients and induces perinuclear reorganization of keratin 8 (K8) filaments that contribute to the viscoelasticity of metastatic cancer cells. However, the detailed mechanism of SPC-induced K8 phosphorylation and reorganization is not clear. We observed that SPC dose-dependently reduced the expression of epithelial membrane protein 2 (EMP2) in lung cancer cells. Then, we examined the role of EMP2 in SPC-induced phosphorylation and reorganization of K8 in lung cancer cells. We found that SPC concentration-dependently reduced EMP2 in A549, H1299, and other lung cancer cells. This was verified at the mRNA level by RT-PCR and real-time PCR (qPCR), and intracellular variation through confocal microscopy. EMP2 gene silencing and stable lung cancer cell lines established using EMP2 lentiviral shRNA induced K8 phosphorylation and reorganization. EMP2 overexpression reduced K8 phosphorylation and reorganization. We also observed that SPC-induced loss of EMP2 induces phosphorylation of JNK and ERK via reduced expression of protein phosphatase 2A (PP2A). Loss of EMP2 induces ubiquitination of protein phosphatase 2A (PP2A). SPC induced caveolin-1 (cav-1) expression and EEA1 endosome marker protein but not cav-2. SPC treatment enhanced the binding of cav-1 and PP2A and lowered binding of PP2A and alpha4. Gene silencing of EMP2 increased and gene silencing of cav-1 reduced migration of A549 lung cancer cells. Overall, these results suggest that SPC induces EMP2 down-regulation which reduces the PP2A via ubiquitination induced by cav-1, which sequestered alpha4, leading to the activation of ERK and JNK.
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Affiliation(s)
- Eun Ji Lee
- BK21PLUS R-FIND team, College of Pharmacy, Dongguk University, Seoul 100-715, Republic of Korea
| | - Mi Kyung Park
- BK21PLUS R-FIND team, College of Pharmacy, Dongguk University, Seoul 100-715, Republic of Korea
| | - Hyun Ji Kim
- BK21PLUS R-FIND team, College of Pharmacy, Dongguk University, Seoul 100-715, Republic of Korea
| | - Eun Ji Kim
- BK21PLUS R-FIND team, College of Pharmacy, Dongguk University, Seoul 100-715, Republic of Korea
| | - Gyeoung-Jin Kang
- BK21PLUS R-FIND team, College of Pharmacy, Dongguk University, Seoul 100-715, Republic of Korea
| | - Hyun Jung Byun
- BK21PLUS R-FIND team, College of Pharmacy, Dongguk University, Seoul 100-715, Republic of Korea
| | - Chang Hoon Lee
- BK21PLUS R-FIND team, College of Pharmacy, Dongguk University, Seoul 100-715, Republic of Korea.
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Liu J, Shen J, Yang C, He P, Guan Y, Liang W, He J. High incidence of EGFR mutations in pneumonic-type non-small cell lung cancer. Medicine (Baltimore) 2015; 94:e540. [PMID: 25715252 PMCID: PMC4554154 DOI: 10.1097/md.0000000000000540] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
To retrospectively identify computed tomography (CT) features that correlate with epidermal growth factor receptor (EGFR) mutation in surgically resected pneumonic-type lung cancer (P-LC). A total of 953 consecutive patients with surgically resected lung cancer in the First Affiliated Hospital of Guangzhou Medical University from August 2011 to August 2013 were studied. The CT manifestations were reevaluated independently by 2 radiologists. The presence of pneumonic-type consolidation with pathological confirmed non-small lung cancer (NSCLC) was defined as P-LC. EGFR mutation was determined by direct DNA sequencing or amplification refractory mutation system-PCR. EGFR mutation rates as well as clinical and pathological manifestations between P-LC and control lung cancer patients were compared. P-LC was diagnosed in 85 patients. Among these patients, 82 were adenocarcinoma (including 78 cases of invasive adenocarcinoma and 4 cases of microinvasive adenocarcinoma), 2 were squamous carcinoma and 1 was other type. P-LC occurred more frequently in female (58.8% vs 37.1%, P < 0.01), nonsmoking (76.5% vs 56.5%, P = 0.001) and adenocarcinoma (58.8% vs 37.1%, P < 0.01) patients. Moreover, EGFR mutations were found in 39 of 52 P-LC patients (75%) and 263 of 542 non-P-LC NSCLC patients (48.5%). However, no difference was found on the mutation sites of EGFR. Histological type, sex, and radiological manifestations (P-LC vs non-P-LC) but not smoking or sequencing method can be served as the independent predictor of EGFR mutations. P-LC patients showed a significant higher incidence of EGFR mutations, which was independent of sex, histological type, and smoking history. The patients with imaging manifestation of pneumonic-type consolidation are highly suggested to perform EGFR mutation analysis to guide the sequential treatment.
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Affiliation(s)
- Jun Liu
- From the Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University (JL, JS, CY, PH, YG, WL, JH); Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease (JL, JS, CY, PH, YG, WL, JH); Department of Pathology (PH); and Department of Radiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China (YG)
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Jordá Aragón C, Peñalver Cuesta JC, Mancheño Franch N, de Aguiar Quevedo K, Vera Sempere F, Padilla Alarcón J. [Mortality in early-stage, surgically resected non-small cell lung cancer less than 3 cm of size: Competing risk analysis]. Med Clin (Barc) 2014; 145:185-91. [PMID: 25433784 DOI: 10.1016/j.medcli.2014.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/09/2014] [Accepted: 07/21/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Survival studies of non-small cell lung cancer (NSCLC) are usually based on the Kaplan-Meier method. However, other factors not covered by this method may modify the observation of the event of interest. There are models of cumulative incidence (CI), that take into account these competing risks, enabling more accurate survival estimates and evaluation of the risk of death from other causes. We aimed to evaluate these models in resected early-stage NSCLC patients. PATIENTS AND METHOD This study included 263 patients with resected NSCLC whose diameter was ≤ 3 cm without node involvement (N0). Demographic, clinical, morphopathological and surgical variables, TNM classification and long-term evolution were analysed. To analyse CI, death by another cause was considered to be competitive event. For the univariate analysis, Gray's method was used, while Fine and Gray's method was employed for the multivariate analysis. RESULTS Mortality by NSCLC was 19.4% at 5 years and 14.3% by another cause. Both curves crossed at 6.3 years, and probability of death by another cause became greater from this point. In multivariate analysis, cancer mortality was conditioned by visceral pleural invasion (VPI) (P=.001) and vascular invasion (P=.020), with age>50 years (P=.034), smoking (P=.009) and the Charlson index ≥ 2 (P=.000) being by no cancer. CONCLUSIONS By the method of CI, VPI and vascular invasion conditioned cancer death in NSCLC >3 cm, while non-tumor causes of long-term death were determined.
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Affiliation(s)
- Carlos Jordá Aragón
- Servicio de Cirugía Torácica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - Nuria Mancheño Franch
- Servicio de Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Departamento de Patología, Universidad de Valencia, Valencia, España
| | | | - Francisco Vera Sempere
- Servicio de Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Departamento de Patología, Universidad de Valencia, Valencia, España
| | - José Padilla Alarcón
- Servicio de Cirugía Torácica, Instituto Valenciano de Oncología, Valencia, España.
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Calvayrac O, Pradines A, Raymond-Letron I, Rouquette I, Bousquet E, Lauwers-Cances V, Filleron T, Cadranel J, Beau-Faller M, Casanova A, Milia J, Favre G, Mazières J. RhoB determines tumor aggressiveness in a murine EGFRL858R-induced adenocarcinoma model and is a potential prognostic biomarker for Lepidic lung cancer. Clin Cancer Res 2014; 20:6541-50. [PMID: 25320360 DOI: 10.1158/1078-0432.ccr-14-0506] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE A crucial event in lung adenocarcinoma progression is the switch from an aerogenous spread toward an infiltrating tumor. Loss of RhoB expression has been suggested to be critical for lung cancer invasion. Here, we tested RhoB expression as a prognostic biomarker in non-small cell lung cancer (NSCLC) with a special focus on lepidic pattern. EXPERIMENTAL DESIGN We analyzed RhoB expression using both IHC and RT-qPCR in two series of operated patients (n = 100 and 48, respectively) and in a series of advanced lepidic adenocarcinoma (n = 31) from different hospitals. Next, we examined the role of RhoB in lung cancer progression in transgenic mice that express inducible EGFR(L858R) crossed with Rhob null mice. RESULTS We identified that loss of RhoB expression was strongly associated with worse survival (P = 0.0001) and progression-free survival (P < 0.001) in the first series. We then confirmed these results after multivariate analyses of the second series. In the series of adenocarcinoma with lepidic features issued from a clinical trial (IFCT-0401), we showed that loss of RhoB expression was associated with higher aggressiveness of stage IV. Finally, we showed that EGFR(L858R)/Rhob(+/+) mice developed mainly diffuse lung tumors with a lepidic pattern, whereas EGFR(L858R)/Rhob(+/-) and EGFR(L858R)/Rhob(-/-) developed a greater number of tumors, and aggressive adenocarcinomas with invasive properties. CONCLUSIONS We showed that RhoB is not only a strong prognostic factor in NSCLC but it is also critical for the acquisition of an aggressive phenotype of adenocarcinoma.
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Affiliation(s)
- Olivier Calvayrac
- Inserm, UMR 1037-CRCT, Toulouse, France. Université Paul Sabatier, Toulouse, France. Institut Claudius Regaud, Toulouse, France
| | - Anne Pradines
- Inserm, UMR 1037-CRCT, Toulouse, France. Université Paul Sabatier, Toulouse, France. Institut Claudius Regaud, Toulouse, France
| | - Isabelle Raymond-Letron
- Université de Toulouse, UPS-INP-ENVT, UMS006, Laboratoire d'histopathologie, Toulouse, France
| | - Isabelle Rouquette
- Université Paul Sabatier, Toulouse, France. Hôpital Rangueil, Departement d'Anatomo-Cytopathologie, CHU Toulouse, Toulouse, France
| | - Emilie Bousquet
- Inserm, UMR 1037-CRCT, Toulouse, France. Université Paul Sabatier, Toulouse, France. Institut Claudius Regaud, Toulouse, France
| | | | | | - Jacques Cadranel
- Hôpital Tenon, Service de Pneumologie, AP-HP; GRC-UPMC 04 Theranoscan Paris 6 University, France
| | - Michèle Beau-Faller
- Hôpital de Hautepierre, Pôle de Biologie, Laboratoire de Biochimie et Biologie Moléculaire, CHU Strasbourg, Strasbourg cedex, France
| | - Anne Casanova
- Inserm, UMR 1037-CRCT, Toulouse, France. Université Paul Sabatier, Toulouse, France. Institut Claudius Regaud, Toulouse, France
| | - Julie Milia
- Université Paul Sabatier, Toulouse, France. Hôpital Larrey, Département de Pneumologie, CHU Toulouse, Toulouse, France
| | - Gilles Favre
- Inserm, UMR 1037-CRCT, Toulouse, France. Université Paul Sabatier, Toulouse, France. Institut Claudius Regaud, Toulouse, France.
| | - Julien Mazières
- Inserm, UMR 1037-CRCT, Toulouse, France. Université Paul Sabatier, Toulouse, France. Hôpital Larrey, Département de Pneumologie, CHU Toulouse, Toulouse, France.
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Detterbeck FC, Postmus PE, Tanoue LT. The stage classification of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e191S-e210S. [PMID: 23649438 DOI: 10.1378/chest.12-2354] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The current Lung Cancer Stage Classification system is the seventh edition, which took effect in January 2010. This article reviews the definitions for the TNM descriptors and the stage grouping in this system.
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Affiliation(s)
| | - Pieter E Postmus
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Lynn T Tanoue
- Section of Pulmonary and Critical Care Medicine, Yale School of Medicine, New Haven, CT
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Kozower BD, Larner JM, Detterbeck FC, Jones DR. Special treatment issues in non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e369S-e399S. [PMID: 23649447 DOI: 10.1378/chest.12-2362] [Citation(s) in RCA: 240] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This guideline updates the second edition and addresses patients with particular forms of non-small cell lung cancer that require special considerations, including Pancoast tumors, T4 N0,1 M0 tumors, additional nodules in the same lobe (T3), ipsilateral different lobe (T4) or contralateral lung (M1a), synchronous and metachronous second primary lung cancers, solitary brain and adrenal metastases, and chest wall involvement. METHODS The nature of these special clinical cases is such that in most cases, meta-analyses or large prospective studies of patients are not available. To ensure that these guidelines were supported by the most current data available, publications appropriate to the topics covered in this article were obtained by performing a literature search of the MEDLINE computerized database. Where possible, we also reference other consensus opinion statements. Recommendations were developed by the writing committee, graded by a standardized method, and reviewed by all members of the Lung Cancer Guidelines panel prior to approval by the Thoracic Oncology NetWork, Guidelines Oversight Committee, and the Board of Regents of the American College of Chest Physicians. RESULTS In patients with a Pancoast tumor, a multimodality approach appears to be optimal, involving chemoradiotherapy and surgical resection, provided that appropriate staging has been carried out. Carefully selected patients with central T4 tumors that do not have mediastinal node involvement are uncommon, but surgical resection appears to be beneficial as part of their treatment rather than definitive chemoradiotherapy alone. Patients with lung cancer and an additional malignant nodule are difficult to categorize, and the current stage classification rules are ambiguous. Such patients should be evaluated by an experienced multidisciplinary team to determine whether the additional lesion represents a second primary lung cancer or an additional tumor nodule corresponding to the dominant cancer. Highly selected patients with a solitary focus of metastatic disease in the brain or adrenal gland appear to benefit from resection or stereotactic radiosurgery. This is particularly true in patients with a long disease-free interval. Finally, in patients with chest wall involvement, provided that the tumor can be completely resected and N2 nodal disease is absent, primary surgical resection should be considered. CONCLUSIONS Carefully selected patients with more uncommon presentations of lung cancer may benefit from an aggressive surgical approach.
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Affiliation(s)
- Benjamin D Kozower
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA
| | - James M Larner
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - Frank C Detterbeck
- Division of Thoracic Surgery, Yale University School of Medicine, New Haven, CT
| | - David R Jones
- Department of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA.
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Chemotherapy effectiveness after first-line gefitinib treatment for advanced lepidic predominant adenocarcinoma (formerly advanced bronchioloalveolar carcinoma): exploratory analysis of the IFCT-0401 trial. J Thorac Oncol 2013; 7:1423-31. [PMID: 22767177 DOI: 10.1097/jto.0b013e31825ab897] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
HYPOTHESIS This study explored whether chemotherapy after first-line gefitinib was effective in patients with advanced lepidic predominant adenocarcinoma (LPA), formerly advanced bronchioloalveolar carcinoma, who were enrolled in the Intergroupe Francophone de Cancérologie Thoracique (IFCT)-0401 trial. METHODS Overall, 88 patients presenting advanced LPA were enrolled in the IFCT-0401 trial, receiving gefitinib as first-line therapy. No predefined second-line treatment was mandatory in the case of progression or limiting toxicity under gefitinib. However, the carboplatin plus paclitaxel regimen was recommended for patients with a performance status (PS) 0 or 1 and gemcitabine monotherapy for those with a PS 2. For these patients, data concerning treatment efficacy was collected from the IFCT-0401 trial database. RESULTS In total, 47 patients (53%) received second-line treatment after the failure of gefitinib, with 43 having PS 0 or 1. Regarding treatment, 43 were treated with chemotherapy, with 38 receiving a platinum-doublet regimen (taxane-based, n = 29; gemcitabine-based, n = 9) and five receiving monotherapy (gemcitabine, n = 3; pemetrexed, n = 2). The overall response rate (ORR) to chemotherapy was 21% (95% confidence interval [CI]: 10-36), disease control rate 56% (95% CI: 40-71), and median progression-free survival (PFS) 3.0 months (95% CI: 2.4-4.9). For patients receiving a platinum doublet (n = 38), ORR was 21% (95% CI: 10-37), with disease control rate being 55% (95% CI: 38-71), and median PFS 2.9 months (95% CI: 2.4-4.4). For patients receiving taxane-based regimen (n = 29) and gemcitabine-based regimen (n = 12), ORR was 28% and 0%, respectively, with a median PFS of 3.3 and 2.0 months, respectively, (p = 0.0243). The two patients receiving pemetrexed experienced a prolonged response. Multivariate Cox model analysis revealed that only the use of taxane-based chemotherapy or pemetrexed was related to PFS. CONCLUSION Platinum-doublet chemotherapy showed some effectiveness in treating advanced LPA patients after first-line gefitinib. Our findings also suggest that taxane-based chemotherapy and pemetrexed should be investigated further in future clinical trials.
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Abstract
It has been proved that lobectomy for lung cancer of less than 3 cm is superior to sublobar resection (segmentectomy and wedge resection) in the Lung Cancer Study Group trial published in 1995. Lobectomy is therefore recommended, with lymph node resection. Nevertheless, some publications have shown identical or close results after segmentectomy for tumors of less than 2 cm, and after wedge resection for tumors of less than 1 cm. It is likely that local recurrences are avoided by respecting a macroscopic margin of more than 2 cm around the tumor. A new trial comparing lobectomy and sublobar resection has been ongoing since 2007 for tumors of less than 2 cm. Persistent ground glass opacities are now often discovered after screening, either pure or with a small solid component, and correspond to an in situ or a micro-invasive adenocarcinoma, that can be removed with sublobar resection without recurrence.
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Lutringer-Magnin D, Girard N, Cadranel J, Leroux C, Quoix E, Cottin V, Signore CD, Lebitasy MP, Cordier G, Vanhems P, Mornex JF. Professional exposure to goats increases the risk of pneumonic-type lung adenocarcinoma: results of the IFCT-0504-Epidemio study. PLoS One 2012; 7:e37889. [PMID: 22655078 PMCID: PMC3360000 DOI: 10.1371/journal.pone.0037889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 04/30/2012] [Indexed: 12/14/2022] Open
Abstract
Pneumonic-type lung adenocarcinoma (P-ADC) represents a distinct subset of lung cancer with specific clinical, radiological, and pathological features. Given the weak association with tobacco-smoking and the striking similarities with jaagsiekte sheep retrovirus (JSRV)-induced ovine pulmonary adenocarcinoma, it has been suggested that a zoonotic viral agent infecting pulmonary cells may predispose to P-ADC in humans. Our objective was to explore whether exposure to domestic small ruminants may represent a risk factor for P-ADC. We performed a multicenter case-control study recruiting patients with P-ADC as cases and patients with non-P-ADC non-small cell lung cancer as controls. A dedicated 356-item questionnaire was built to evaluate exposure to livestock. A total of 44 cases and 132 controls were included. At multivariate analysis, P-ADC was significantly more associated with female gender (Odds-ratio (OR) = 3.23, 95% confidence interval (CI): 1.32–7.87, p = 0.010), never- smoker status (OR = 3.57, 95% CI: 1.27–10.00, p = 0.015), personal history of extra-thoracic cancer before P-ADC diagnosis (OR = 3.43, 95% CI: 1.10–10.72, p = 0.034), and professional exposure to goats (OR = 5.09, 95% CI: 1.05–24.69, p = 0.043), as compared to other subtypes of lung cancer. This case-control suggests a link between professional exposure to goats and P-ADC, and prompts for further epidemiological evaluation of potential environmental risk factors for P-ADC.
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Affiliation(s)
- Delphine Lutringer-Magnin
- Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- UMR 5558 CNRS, Laboratoire de biométrie et biologie évolutive, Lyon, France
| | - Nicolas Girard
- Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- UMR754 INRA, Rétrovirus et pathologie comparée, Lyon, France
| | | | - Caroline Leroux
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- UMR754 INRA, Rétrovirus et pathologie comparée, Lyon, France
| | - Elisabeth Quoix
- Service de pneumologie, Hôpital Hautepierre, Strasbourg, France
| | - Vincent Cottin
- Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- UMR754 INRA, Rétrovirus et pathologie comparée, Lyon, France
| | - Corinne Del Signore
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- UMR 5558 CNRS, Laboratoire de biométrie et biologie évolutive, Lyon, France
| | | | - Geneviève Cordier
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- UMR754 INRA, Rétrovirus et pathologie comparée, Lyon, France
| | - Philippe Vanhems
- Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- UMR 5558 CNRS, Laboratoire de biométrie et biologie évolutive, Lyon, France
| | - Jean-François Mornex
- Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- UMR754 INRA, Rétrovirus et pathologie comparée, Lyon, France
- * E-mail:
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Whitson BA, Groth SS, Andrade RS, Mitiek MO, Maddaus MA, D’Cunha J. Invasive adenocarcinoma with bronchoalveolar features: A population-based evaluation of the extent of resection in bronchoalveolar cell carcinoma. J Thorac Cardiovasc Surg 2012; 143:591-600.e1. [DOI: 10.1016/j.jtcvs.2011.10.088] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 09/24/2011] [Accepted: 10/05/2011] [Indexed: 11/30/2022]
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Sigua NL, Cummings O, Lahm T. A 42-year-old woman with diffuse pulmonary infiltrates and bilateral pneumothoraces. Chest 2011; 140:550-553. [PMID: 21813536 DOI: 10.1378/chest.10-3116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Ninotchka L Sigua
- Division of Pulmonary, Critical Care, Allergy and Occupational Medicine, Indiana University, Indianapolis, IN.
| | - Oscar Cummings
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN
| | - Tim Lahm
- Division of Pulmonary, Critical Care, Allergy and Occupational Medicine, Indiana University, Indianapolis, IN; Richard L. Roudebush VA Medical Center, Indianapolis, IN
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Pelosi G, Sonzogni A, Viale G. The Classification of Lung Carcinoma: Time to Change the Morphology-Based Approach? Int J Surg Pathol 2010; 18:161-72. [DOI: 10.1177/1066896910361736] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Morphology still remains the cornerstone in lung cancer classification and always has been accompanying pathologists in their daily activity, even though several ancillary techniques have been incorporated over time to improve diagnostic, prognostic, and predictive capabilities in lung cancer. Currently, we are also faced with a global rethinking of lung cancer care, especially once novel therapy strategies have been made available on the basis of the diverse characteristics of tumors. Although morphology still remains a not easily replaceable tool for lung cancer classification, we are now challenged by the need of offering clinicians more detailed subtyping of non-small-cell lung cancer especially in event of limited diagnostic material, poorly differentiated tumors, or unresectable lesions. Close integration of improved morphology, immunohistochemistry, and molecular tests will be able to not only sharpen our diagnostic algorithms and prognostic and predictive potentialities but also get insights into several lung cancer biology issues, such as histogenesis and new classification schemes.
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Affiliation(s)
- Giuseppe Pelosi
- European Institute of Oncology, Milan, Italy, , University of Milan School of Medicine, Milan, Italy
| | | | - Giuseppe Viale
- European Institute of Oncology, Milan, Italy, University of Milan School of Medicine, Milan, Italy
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Detterbeck FC, Boffa DJ, Tanoue LT, Wilson LD. Details and Difficulties Regarding the New Lung Cancer Staging System. Chest 2010; 137:1172-80. [DOI: 10.1378/chest.09-2626] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Detterbeck FC, Terrien CM. Coping with the unexpected at surgery. Expert Rev Respir Med 2010; 4:115-22. [PMID: 20387297 DOI: 10.1586/ers.09.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In lung cancer surgery, it is best to avoid surprises; this requires knowledge of the reliability of preoperative assessment and careful planning. If this has been done, most of the more common situations should be manageable. If there is limited chest wall, mediastinal or N2 node involvement, one should proceed with resection. Unanticipated T4 tumors or bulky pN2 disease should not come as a surprise, and such patients should be sent to a more experienced center. One has to be careful to practice within the scope of one's knowledge and abilities as well as the sophistication of the institution. It only makes a mistake worse if an intraoperative surprise prompts one to embark on an operation that is beyond the means at hand. Collaborative organization via multidisciplinary tumor boards or inter-institutional interaction allows collective wisdom to promote better outcomes for all.
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Affiliation(s)
- Frank C Detterbeck
- Yale University School of Medicine, Thoracic Surgery, 330 Cedar Street, BB 205, New Haven, CT 06520-8062, USA.
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IFCT-0401 Trial: A Phase II Study of Gefitinib Administered as First-Line Treatment in Advanced Adenocarcinoma with Bronchioloalveolar Carcinoma Subtype. J Thorac Oncol 2009; 4:1126-35. [DOI: 10.1097/jto.0b013e3181abeb5d] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Evidence for disease control with erlotinib after gefitinib failure in typical gefitinib-sensitive Asian patients with non-small cell lung cancer. J Thorac Oncol 2008; 3:400-4. [PMID: 18379359 DOI: 10.1097/jto.0b013e318168c801] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) gefitinib and erlotinib are gaining an increasing role in the management of advanced non-small cell lung cancer (NSCLC). There is mounting interest in the benefit of administering a second TKI after failure of the first TKI, especially in Asian patients, in whom they are expected to be more efficacious. METHODS We did a retrospective analysis of patients receiving both gefitinib and erlotinib in our institution during a 2-year period. Patients were to have received the second TKI after progressive disease on the first TKI. EGFR gene mutation analysis was done on patient tumor samples. RESULTS Fourteen patients were included in the analysis, all of whom received erlotinib after progression on gefitinib. Chinese race, females, never-smokers, and adenocarcinoma subtype were predominant in their respective categories. Disease control rate was 64.3% (9 of 14) for gefitinib. Disease control rate for erlotinib administered after progression on gefitinib was 35.7% (5 of 14). All patients who achieved disease control with erlotinib after progression on gefitinib were never-smokers with adenocarcinoma subtype, who had prior disease control on gefitinib. Presence of EGFR mutations predicted for disease control with gefitinib, and for disease control with erlotinib after gefitinib failure. CONCLUSION A significant proportion of typical gefitinib-sensitive Asian NSCLC patients can have disease control with erlotinib after gefitinib failure. The role of subsequent administration of a second EGFR TKI after failure of the first TKI in advanced NSCLC should be further pursued.
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Arenberg D. Bronchioloalveolar lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132:306S-13S. [PMID: 17873176 DOI: 10.1378/chest.07-1383] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To review the current evidence on special issues relating to the diagnosis, imaging, prognosis, and treatment of bronchioloalveolar carcinoma (BAC). METHODS This guideline focuses on aspects of BAC that are unique and ways in which BAC differs importantly from other forms of non-small cell lung cancer (NSCLC). The author reviewed published literature reporting on BAC using key words "histology," "CT scans," "fluorodeoxyglucose positron emission tomography scan," "sensitivity," "specificity," "surgical resection," "sublobar resection," and "epidermal growth factor receptor tyrosine kinase inhibitor" and selected references from published review articles. Also included was a review of the 1999 World Health Organization (WHO) revised classification system for lung tumors, which established a more restrictive definition of BAC to tumors with a pure lepidic spreading pattern and no evidence of stromal, vascular, or pleural invasion. RESULTS With the notable exception of a lower likelihood of a positive positron emission tomography finding in the presence of BAC, staging, diagnosis, and treatment are the same as for other histologic subtypes of NSCLC, but additional treatment options that may prove to be equivalent, if not more effective, for more patients exist (eg, epidermal growth factor receptor tyrosine kinase inhibitor therapy, sublobar resection). CONCLUSIONS BAC is a form of adenocarcinoma with unique clinical, radiologic, and epidemiologic features. The diagnosis of BAC should be reserved for tumors that meet the WHO criteria. Additional clinical trials are needed on this population of patients, using strict definitions and enrollment criteria to allow the results to be applied to appropriate patient populations.
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Affiliation(s)
- Douglas Arenberg
- University of Michigan, Pulmonary and Critical Care Medicine, 6301 MSRB III, 1150 West Medical Center Dr, Ann Arbor, MI 48109, USA.
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