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Sheu CC, Wang CC, Hsu JS, Chung WS, Hsu HY, Shi HY. Cost-Effectiveness of Low-Dose Computed Tomography Screenings for Lung Cancer in High-Risk Populations: A Markov Model. World J Oncol 2024; 15:550-561. [PMID: 38993243 PMCID: PMC11236381 DOI: 10.14740/wjon1882] [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: 04/09/2024] [Accepted: 06/10/2024] [Indexed: 07/13/2024] Open
Abstract
Background Domestic and foreign studies on lung cancer have been oriented to the medical efficacy of low-dose computed tomography (LDCT), but there is a lack of studies on the costs, value and cost-effectiveness of the treatment. There is a scarcity of conclusive evidence regarding the cost-effectiveness of LDCT within the specific context of Taiwan. This study is designed to address this gap by conducting a comprehensive analysis of the cost-effectiveness of LDCT and chest X-ray (CXR) as screening methods for lung cancer. Methods Markov decision model simulation was used to estimate the cost-effectiveness of biennial screening with LDCT and CXR based on a health provider perspective. Inputs are based on probabilities, health status utility (quality-adjusted life years (QALYs)), costs of lung cancer screening, diagnosis, and treatment from the literatures, and expert opinion. A total of 1,000 simulations and five cycles of Markov bootstrapping simulations were performed to compare the incremental cost-utility ratio (ICUR) of these two screening strategies. Probability and one-way sensitivity analyses were also performed. Results The ICUR of early lung cancer screening compared LDCT to CXR is $-24,757.65/QALYs, and 100% of the probability agree to adopt it under a willingness-to-pay (WTP) threshold of the Taiwan gross domestic product (GDP) per capita ($35,513). The one-way sensitivity analysis also showed that ICUR depends heavily on recall rate. Based on the prevalence rate of 39.7 lung cancer cases per 100,000 people in 2020, it could be estimated that LDCT screening for high-risk populations could save $17,154,115. Conclusion LDCT can detect more early lung cancers, reduce mortality and is cost-saving than CXR in a long-term simulation of Taiwan's healthcare system. This study provides valuable insights for healthcare decision-makers and suggests analyzing cost-effectiveness for additional variables in future research.
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Affiliation(s)
- Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan, Republic of China
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan, Republic of China
| | - Chun-Chun Wang
- Medical Intensive Care Unit, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan, Republic of China
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan, Republic of China
| | - Jui-Sheng Hsu
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan, Republic of China
- Department of Radiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan, Republic of China
| | - Wei-Shiuan Chung
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan, Republic of China
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan, Republic of China
| | - Hong-Yi Hsu
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan, Republic of China
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan, Republic of China
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan, Republic of China
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan, Republic of China
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan, Republic of China
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2
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Sun Y, Gao Y, Dong M, Li J, Li X, He N, Song H, Zhang M, Ji K, Wang J, Gu Y, Wang Y, Du L, Liu Y, Wang Q, Zhai H, Sun D, Liu Q, Xu C. Kremen2 drives the progression of non-small cell lung cancer by preventing SOCS3-mediated degradation of EGFR. J Exp Clin Cancer Res 2023; 42:140. [PMID: 37270563 DOI: 10.1186/s13046-023-02692-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/28/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND The transmembrane receptor Kremen2 has been reported to participate in the tumorigenesis and metastasis of gastric cancer. However, the role of Kremen2 in non-small cell lung cancer (NSCLC) and the underlying mechanism remain unclear. This study aimed to explore the biological function and regulatory mechanism of Kremen2 in NSCLC. METHODS The correlation between Kremen2 expression and NSCLC was assessed by analyzing the public database and clinical tissue samples. Colony formation and EdU assays were performed to examine cell proliferation. Transwell and wound healing assays were used to observe cell migration ability. Tumor-bearing nude mice and metastatic tumor models were used to detect the in vivo tumorigenic and metastatic abilities of the NSCLC cells. An immunohistochemical assay was used to detect the expression of proliferation-related proteins in tissues. Western blot, immunoprecipitation and immunofluorescence were conducted to elucidate the Kremen2 regulatory mechanisms in NSCLC. RESULTS Kremen2 was highly expressed in tumor tissues from NSCLC patients and was positively correlated with a poor patient prognosis. Knockout or knockdown of Kremen2 inhibited cell proliferation and migration ability of NSCLC cells. In vivo knockdown of Kremen2 inhibited the tumorigenicity and number of metastatic nodules of NSCLC cells in nude mice. Mechanistically, Kremen2 interacted with suppressor of cytokine signaling 3 (SOCS3) to maintain the epidermal growth factor receptor (EGFR) protein levels by preventing SOCS3-mediated ubiquitination and degradation of EGFR, which, in turn, promoted activation of the PI3K-AKT and JAK2-STAT3 signaling pathways. CONCLUSIONS Our study identified Kremen2 as a candidate oncogene in NSCLC and may provide a potential target for NSCLC treatment.
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Affiliation(s)
- Yuxiao Sun
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China
| | - Yu Gao
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China
| | - Mingxin Dong
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China
| | - Jiuzhen Li
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
- Department of Thoracic Surgery, Tianjin Chest Hospital of Tianjin University, Tianjin, 300222, China
| | - Xin Li
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
- Department of Thoracic Surgery, Tianjin Chest Hospital of Tianjin University, Tianjin, 300222, China
| | - Ningning He
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China
| | - Huijuan Song
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China
| | - Manman Zhang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China
| | - Kaihua Ji
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China
| | - Jinhan Wang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China
| | - Yeqing Gu
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China
| | - Yan Wang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China
| | - Liqing Du
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China
| | - Yang Liu
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China
| | - Qin Wang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China
| | - Hezheng Zhai
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China
- School of Precision Instruments and OPTO-Electronics Engineering, Tianjin University, Tianjin, 300072, China
| | - Daqiang Sun
- Graduate School, Tianjin Medical University, Tianjin, 300070, China.
- Department of Thoracic Surgery, Tianjin Chest Hospital of Tianjin University, Tianjin, 300222, China.
| | - Qiang Liu
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China.
| | - Chang Xu
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, 300192, China.
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3
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Shi M, Han W, Loudig O, Shah CD, Dobkin JB, Keller S, Sadoughi A, Zhu C, Siegel RE, Fernandez MK, DeLaRosa L, Patel D, Desai A, Siddiqui T, Gombar S, Suh Y, Wang T, Hosgood HD, Pradhan K, Ye K, Spivack SD. Initial development and testing of an exhaled microRNA detection strategy for lung cancer case-control discrimination. Sci Rep 2023; 13:6620. [PMID: 37095155 PMCID: PMC10126132 DOI: 10.1038/s41598-023-33698-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/18/2023] [Indexed: 04/26/2023] Open
Abstract
For detecting field carcinogenesis non-invasively, early technical development and case-control testing of exhaled breath condensate microRNAs was performed. In design, human lung tissue microRNA-seq discovery was reconciled with TCGA and published tumor-discriminant microRNAs, yielding a panel of 24 upregulated microRNAs. The airway origin of exhaled microRNAs was topographically "fingerprinted", using paired EBC, upper and lower airway donor sample sets. A clinic-based case-control study (166 NSCLC cases, 185 controls) was interrogated with the microRNA panel by qualitative RT-PCR. Data were analyzed by logistic regression (LR), and by random-forest (RF) models. Feasibility testing of exhaled microRNA detection, including optimized whole EBC extraction, and RT and qualitative PCR method evaluation, was performed. For sensitivity in this low template setting, intercalating dye-based URT-PCR was superior to fluorescent probe-based PCR (TaqMan). In application, adjusted logistic regression models identified exhaled miR-21, 33b, 212 as overall case-control discriminant. RF analysis of combined clinical + microRNA models showed modest added discrimination capacity (1.1-2.5%) beyond clinical models alone: all subjects 1.1% (p = 8.7e-04)); former smokers 2.5% (p = 3.6e-05); early stage 1.2% (p = 9.0e-03), yielding combined ROC AUC ranging from 0.74 to 0.83. We conclude that exhaled microRNAs are qualitatively measureable, reflect in part lower airway signatures; and when further refined/quantitated, can potentially help to improve lung cancer risk assessment.
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Affiliation(s)
- Miao Shi
- Pulmonary Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Weiguo Han
- Pharmacology and Toxicology, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | | | - Chirag D Shah
- Pulmonary Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jay B Dobkin
- Pulmonary Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Ali Sadoughi
- Pulmonary Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Changcheng Zhu
- Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Robert E Siegel
- Pulmonary Medicine, Icahn School of Medicine at Mount Sinai, James J. Peters Veterans Affairs Medical Center, New York, USA
| | | | - Lizett DeLaRosa
- Pulmonary Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | - Taha Siddiqui
- Pulmonary Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Saurabh Gombar
- Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yousin Suh
- Reproductive Sciences (in Obstetrics and Gynecology), Columbia University, New York, USA
- Genetics and Development, Columbia University, New York, USA
| | - Tao Wang
- Biostatistics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - H Dean Hosgood
- Epidemiology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kith Pradhan
- Biostatistics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kenny Ye
- Biostatistics, Albert Einstein College of Medicine, Bronx, NY, USA
- Systems and Computational Biology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Simon D Spivack
- Pulmonary Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
- Epidemiology, Albert Einstein College of Medicine, Bronx, NY, USA
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4
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Braithwaite D, Karanth SD, Slatore CG, Zhang D, Bian J, Meza R, Jeon J, Tammemagi M, Schabath M, Wheeler M, Guo Y, Hochhegger B, Kaye FJ, Silvestri GA, Gould MK. Personalised Lung Cancer Screening (PLuS) study to assess the importance of coexisting chronic conditions to clinical practice and policy: protocol for a multicentre observational study. BMJ Open 2022; 12:e064142. [PMID: 35732383 PMCID: PMC9226937 DOI: 10.1136/bmjopen-2022-064142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Lung cancer is the leading cause of cancer death in the USA and worldwide, and lung cancer screening (LCS) with low-dose CT (LDCT) has the potential to improve lung cancer outcomes. A critical question is whether the ratio of potential benefits to harms found in prior LCS trials applies to an older and potentially sicker population. The Personalised Lung Cancer Screening (PLuS) study will help close this knowledge gap by leveraging real-world data to fully characterise LCS recipients. The principal goal of the PLuS study is to characterise the comorbidity burden of individuals undergoing LCS and quantify the benefits and harms of LCS to enable informed decision-making. METHODS AND ANALYSIS PLuS is a multicentre observational study designed to assemble an LCS cohort from the electronic health records of ~40 000 individuals undergoing annual LCS with LDCT from 2016 to 2022. Data will be integrated into a unified repository to (1) examine the burden of multimorbidity by race/ethnicity, socioeconomic status and age; (2) quantify potential benefits and harms; and (3) use the observational data with validated simulation models in the Cancer Intervention and Surveillance Modeling Network (CISNET) to provide LCS outcomes in the real-world US population. We will fit a multivariable logistic regression model to estimate the adjusted ORs of comorbidity, functional limitations and impaired pulmonary function adjusted for relevant covariates. We will also estimate the cumulative risk of LCS outcomes using discrete-time survival models. To our knowledge, this is the first study to combine observational data and simulation models to estimate the long-term impact of LCS with LDCT. ETHICS AND DISSEMINATION The study was approved by the Kaiser Permanente Southern California Institutional Review Board and VA Portland Health Care System. The results will be disseminated through publications and presentations at national and international conferences. Safety considerations include protection of patient confidentiality.
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Affiliation(s)
- Dejana Braithwaite
- Department of Surgery, University of Florida, Gainesville, Florida, USA
- Cancer Center, UF Health, Gainesville, Florida, USA
| | - Shama D Karanth
- Cancer Center, UF Health, Gainesville, Florida, USA
- Institute on Aging, University of Florida, Gainesville, Florida, USA
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, Portland VA Medical Center, Portland, Oregon, USA
| | - Dongyu Zhang
- Cancer Center, UF Health, Gainesville, Florida, USA
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Jiang Bian
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Martin Tammemagi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Mattthew Schabath
- Department of Cancer Epidemiology, H Lee Moffitt Cancer Center and Research Center Inc, Tampa, Florida, USA
| | - Meghann Wheeler
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Yi Guo
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Bruno Hochhegger
- Department of Radiology, University of Florida, Gainesville, Florida, USA
| | - Frederic J Kaye
- Division of Hematology and Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Gerard A Silvestri
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael K Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, USA
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Wang G, Qiu M, Xing X, Zhou J, Yao H, Li M, Yin R, Hou Y, Li Y, Pan S, Huang Y, Yang F, Bai F, Nie H, Di S, Guo L, Meng Z, Wang J, Yin Y. Lung cancer scRNA-seq and lipidomics reveal aberrant lipid metabolism for early-stage diagnosis. Sci Transl Med 2022; 14:eabk2756. [PMID: 35108060 DOI: 10.1126/scitranslmed.abk2756] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Lung cancer is the leading cause of cancer mortality, and early detection is key to improving survival. However, there are no reliable blood-based tests currently available for early-stage lung cancer diagnosis. Here, we performed single-cell RNA sequencing of different early-stage lung cancers and found that lipid metabolism was broadly dysregulated in different cell types, with glycerophospholipid metabolism as the most altered lipid metabolism-related pathway. Untargeted lipidomics was carried out in an exploratory cohort of 311 participants. Through support vector machine algorithm-based and mass spectrum-based feature selection, we identified nine lipids (lysophosphatidylcholines 16:0, 18:0, and 20:4; phosphatidylcholines 16:0-18:1, 16:0-18:2, 18:0-18:1, 18:0-18:2, and 16:0-22:6; and triglycerides 16:0-18:1-18:1) as the features most important for early-stage cancer detection. Using these nine features, we developed a liquid chromatography-mass spectrometry (MS)-based targeted assay using multiple reaction monitoring. This target assay achieved 100.00% specificity on an independent validation cohort. In a hospital-based lung cancer screening cohort of 1036 participants examined by low-dose computed tomography and a prospective clinical cohort containing 109 participants, the assay reached more than 90.00% sensitivity and 92.00% specificity. Accordingly, matrix-assisted laser desorption/ionization MS imaging confirmed that the selected lipids were differentially expressed in early-stage lung cancer tissues in situ. This method, designated as Lung Cancer Artificial Intelligence Detector, may be useful for early detection of lung cancer or large-scale screening of high-risk populations for cancer prevention.
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Affiliation(s)
- Guangxi Wang
- Institute of Systems Biomedicine, Department of Pathology, School of Basic Medical Sciences, Peking-Tsinghua Center for Life Sciences, Peking University Health Science Center and Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100191, China
| | - Mantang Qiu
- Institute of Systems Biomedicine, Department of Pathology, School of Basic Medical Sciences, Peking-Tsinghua Center for Life Sciences, Peking University Health Science Center and Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100191, China
| | - Xudong Xing
- Biomedical Pioneering Innovation Center (BIOPIC), School of Life Sciences, Peking University, Beijing 100871, China
| | - Juntuo Zhou
- Institute of Systems Biomedicine, Department of Pathology, School of Basic Medical Sciences, Peking-Tsinghua Center for Life Sciences, Peking University Health Science Center and Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100191, China
| | - Hantao Yao
- Institute of Automation, Chinese Academy of Sciences (CAS), Beijing 100190, China
| | - Mingru Li
- Department of Thoracic Surgery, Aerospace 731 Hospital, Beijing 100074, China
| | - Rong Yin
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Yan Hou
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Yang Li
- Institute of Systems Biomedicine, Department of Pathology, School of Basic Medical Sciences, Peking-Tsinghua Center for Life Sciences, Peking University Health Science Center and Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100191, China
| | - Shuli Pan
- Medical Examination Center, Aerospace 731 Hospital, Beijing 100074, China
| | - Yuqing Huang
- Department of Thoracic Surgery, Beijing Haidian Hospital, Beijing 100080, China
| | - Fan Yang
- Institute of Systems Biomedicine, Department of Pathology, School of Basic Medical Sciences, Peking-Tsinghua Center for Life Sciences, Peking University Health Science Center and Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100191, China
| | - Fan Bai
- Biomedical Pioneering Innovation Center (BIOPIC), School of Life Sciences, Peking University, Beijing 100871, China
| | - Honggang Nie
- Analytical Instrumentation Center, Peking University, Beijing 100871, China
| | - Shuangshuang Di
- Analytical Instrumentation Center, Peking University, Beijing 100871, China
| | - Limei Guo
- Department of Pathology, Peking University Third Hospital, Beijing 100191, China
| | - Zhu Meng
- Beijing University of Posts and Telecommunications, Beijing Key Laboratory of Network System and Network Culture, Beijing 100876, China
| | - Jun Wang
- Institute of Systems Biomedicine, Department of Pathology, School of Basic Medical Sciences, Peking-Tsinghua Center for Life Sciences, Peking University Health Science Center and Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100191, China
| | - Yuxin Yin
- Institute of Systems Biomedicine, Department of Pathology, School of Basic Medical Sciences, Peking-Tsinghua Center for Life Sciences, Peking University Health Science Center and Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100191, China
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6
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Zhu J, Cai T, Zhou J, Du W, Zeng Y, Liu T, Fu Y, Li Y, Qian Q, Yang XH, Li Q, Huang JA, Liu Z. CD151 drives cancer progression depending on integrin α3β1 through EGFR signaling in non-small cell lung cancer. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2021; 40:192. [PMID: 34108040 PMCID: PMC8191020 DOI: 10.1186/s13046-021-01998-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/28/2021] [Indexed: 01/07/2023]
Abstract
Background Tetraspanins CD151, a transmembrane 4 superfamily protein, has been identified participating in the initiation of a variety of cancers. However, the precise function of CD151 in non-small cell lung cancer (NSCLC) remains unclear. Here, we addressed the pro-tumoral role of CD151 in NSCLC by targeting EGFR/ErbB2 which favors tumor proliferation, migration and invasion. Methods First, the mRNA expression levels of CD151 in NSCLC tissues and cell lines were measured by RT-PCR. Meanwhile, CD151 and its associated proteins were analyzed by western blotting. The expression levels of CD151 in NSCLC samples and its paired adjacent lung tissues were then verified by Immunohistochemistry. The protein interactions are evaluated by co-immunoprecipitation. Flow cytometry was applied to cell cycle analysis. CCK-8, EdU Incorporation, and clonogenic assays were used to analyze cell viability. Wound healing, transwell migration, and matrigel invasion assays were utilized to assess the motility of tumor cells. To investigate the role of CD151 in vivo, lung carcinoma xenograft mouse model was applied. Results High CD151 expression was identified in NSCLC tissues and cell lines, and its high expression was significantly associated with poor prognosis of NSCLC patients. Further, knockdown of CD151 in vitro inhibited tumor proliferation, migration, and invasion. Besides, inoculation of nude mice with CD151-overexpressing tumor cells exhibited substantial tumor proliferation compared to that in control mice which inoculated with vector-transfected tumor cells. Noteworthy, we found that overexpression of CD151 conferred cell migration and invasion by interacting with integrins. We next sought to demonstrate that CD151 regulated downstream signaling pathways via activation of EGFR/ErbB2 in NSCLC cells. Therefore, we infer that CD151 probably affects the sensitivity of NSCLC in response to anti-cancer drugs. Conclusions Based on these results, we demonstrated a new mechanism of CD151-mediated tumor progression by targeting EGFR/ErbB2 signaling pathway, by which CD151 promotes NSCLC proliferation, migration, and invasion, which may considered as a potential target of NSCLC treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s13046-021-01998-4.
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Affiliation(s)
- Jianjie Zhu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Respiratory Diseases, Soochow University, 215006, Suzhou, China.,Suzhou Key Laboratory for Respiratory Diseases, 215006, Suzhou, China
| | - Tingting Cai
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Respiratory Diseases, Soochow University, 215006, Suzhou, China
| | - Jieqi Zhou
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Respiratory Diseases, Soochow University, 215006, Suzhou, China
| | - Wenwen Du
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Respiratory Diseases, Soochow University, 215006, Suzhou, China
| | - Yuanyuan Zeng
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Respiratory Diseases, Soochow University, 215006, Suzhou, China.,Suzhou Key Laboratory for Respiratory Diseases, 215006, Suzhou, China
| | - Ting Liu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Respiratory Diseases, Soochow University, 215006, Suzhou, China
| | - Yulong Fu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Respiratory Diseases, Soochow University, 215006, Suzhou, China
| | - Yue Li
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Institute of Respiratory Diseases, Soochow University, 215006, Suzhou, China
| | - Qian Qian
- Department of Medicine, Division of Allergy and Clinical Immunology, National Jewish Health, Denver, 80206, USA
| | - Xiuwei H Yang
- Department of Pharmacology and Nutritional Sciences, Department of Molecular and Cellular Biochemistry, Markey Cancer Center, University of Kentucky, Lexington, KY, 40506, USA
| | - Qinglin Li
- Department of Traditional Chinese Medicine, Cancer Hospital of the University of Chinese Academy of Sciences, 310022, Hangzhou, People's Republic of China.
| | - Jian-An Huang
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China. .,Institute of Respiratory Diseases, Soochow University, 215006, Suzhou, China. .,Suzhou Key Laboratory for Respiratory Diseases, 215006, Suzhou, China.
| | - Zeyi Liu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China. .,Institute of Respiratory Diseases, Soochow University, 215006, Suzhou, China. .,Suzhou Key Laboratory for Respiratory Diseases, 215006, Suzhou, China.
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7
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Comorbidity Profiles and Lung Cancer Screening among Older Adults: U.S. Behavioral Risk Factor Surveillance System 2017 to 2019. Ann Am Thorac Soc 2021; 18:1886-1893. [PMID: 33939595 DOI: 10.1513/annalsats.202010-1276oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Although lung cancer screening (LCS) with low-dose computed tomography (LDCT) is now recommended for those meeting standard risk factor-based eligibility criteria, the role of comorbidity in the uptake of LCS with LDCT in an older real-world U.S. population is not well established. OBJECTIVE To examine the relationships between comorbidity, functional status and LCS utilization in the United States. METHODS Using population-based data from the 2017-2019 Behavioral Risk Factor Surveillance System (BRFSS), we examined the association of comorbid conditions and functional limitations regarding activities of daily living with LCS utilization among participants that met the LCS criteria based on the US Preventive Service Taskforce guidelines. We employed multivariable weighted logistic regression models to evaluate these associations, both overall and within subgroups defined by age (<65 vs. ≥65 years), gender, and smoking history. RESULTS Of 11,214 participants that met the eligibility criteria for LCS, 1731 (16%) underwent LCS with LDCT. The majority were white (90%), male (55%), former smokers (52%) and living with at least one chronic comorbid condition (77%). Over 28% had 3 or more comorbid conditions and approximately 40% of participants reported having some form of functional limitations. In the multivariable models, the likelihood of undergoing LCS with LDCT within the past year was positively associated with higher levels of comorbidity (≥5 vs. 0: aOR=2.34, 95% CI=1.22,4.48) but not with functional limitations (≥3 vs. 0: aOR=1.00, 95% CI=0.66, 1.50). CONCLUSION The presence of comorbid conditions is associated with a higher likelihood of undergoing LCS with LDCT. Because poor health status may diminish the benefits of screening, future research is needed to precisely characterize the health status of LCS-eligible individuals.
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Ogawa K, Koh Y, Kaneda H, Izumi M, Matsumoto Y, Sawa K, Fukui M, Taniguchi Y, Yoshimoto N, Tamiya A, Ando M, Kubo A, Isa SI, Saka H, Matsumura A, Kawaguchi T. Can smoking duration alone replace pack-years to predict the risk of smoking-related oncogenic mutations in non-small cell lung cancer? A cross-sectional study in Japan. BMJ Open 2020; 10:e035615. [PMID: 32907893 PMCID: PMC7482473 DOI: 10.1136/bmjopen-2019-035615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To investigate whether smoking duration alone can replace pack-years to predict the risk of oncogenic mutations in non-small cell lung cancer (NSCLC). DESIGN A cross-sectional study using the baseline dataset from the Japan Molecular Epidemiology for Lung Cancer Study. SETTING Forty-three medical institutions nationwide in Japan. PARTICIPANTS From July 2012 to December 2013, 957 patients with newly diagnosed stage I-IIIB NSCLC who underwent surgery were enrolled, and molecular analyses were performed on 876 samples (from 441 ever-smokers and 435 never-smokers). MAIN OUTCOMES MEASURED We calculated the area under the receiver operating characteristic curve (AUC) values using logistic regression to compare between the predictive values of smoking duration and pack-years for mutational frequencies in the v-Ki-ras2 Kirsten rat sarcoma (KRAS), tumour suppressor p53 (TP53), and epidermal growth factor receptor (EGFR) genes and for cytosine-to-adenine base substitution (C>A). RESULTS For predicting KRAS mutations, the AUC values for smoking duration and pack-years were 0.746 (95% CI 0.682 to 0.800) and 0.759 (95% CI 0.700 to 0.810), respectively (p=0.058). For predicting KRAS mutations in smokers, the AUC values for smoking duration and pack-years were 0.772 (95% CI 0.697 to 0.833) and 0.787 (95% CI 0.714 to 0.845), respectively (p=0.036). There were no significant differences between the AUC values for smoking duration and pack-years in terms of predicting TP53 and EGFR mutations and C>A. Pack-years was a significantly better predictor of KRAS mutations than smoking duration. CONCLUSION Smoking duration was not significantly different from pack-years in predicting the likelihood of smoking-related gene mutations. Given the recall bias in obtaining smoking information, smoking duration alone should be considered for further investigation as a simpler alternative to pack-years.
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Affiliation(s)
- Koichi Ogawa
- Respiratory Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Koh
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroyasu Kaneda
- Clinical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Motohiro Izumi
- Respiratory Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yoshiya Matsumoto
- Respiratory Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenji Sawa
- Respiratory Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Mitsuru Fukui
- Laboratory of Statistics, Osaka City University Faculty of Medicine, Osaka, Japan
| | - Yoshihiko Taniguchi
- Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Naoki Yoshimoto
- Clinical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akihiro Tamiya
- Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Masahiko Ando
- Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Akihito Kubo
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Aichi Medical University Graduate School of Medicine, Nagakute, Japan
| | - Shun-Ichi Isa
- Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Hideo Saka
- Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan
| | - Akihide Matsumura
- Surgery, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Tomoya Kawaguchi
- Respiratory Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
- Clinical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
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9
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Pal Choudhury P, Chaturvedi AK, Chatterjee N. Evaluating Discrimination of a Lung Cancer Risk Prediction Model Using Partial Risk-Score in a Two-Phase Study. Cancer Epidemiol Biomarkers Prev 2020; 29:1196-1203. [PMID: 32277002 DOI: 10.1158/1055-9965.epi-19-1574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/28/2020] [Accepted: 04/01/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Independent validation of risk prediction models in prospective cohorts is required for risk-stratified cancer prevention. Such studies often have a two-phase design, where information on expensive biomarkers are ascertained in a nested substudy of the original cohort. METHODS We propose a simple approach for evaluating model discrimination that accounts for incomplete follow-up and gains efficiency by using data from all individuals in the cohort irrespective of whether they were sampled in the substudy. For evaluating the AUC, we estimated probabilities of risk-scores for cases being larger than those in controls conditional on partial risk-scores, computed using partial covariate information. The proposed method was compared with an inverse probability weighted (IPW) approach that used information only from the subjects in the substudy. We evaluated age-stratified AUC of a model including questionnaire-based risk factors and inflammation biomarkers to predict 10-year risk of lung cancer using data from the Prostate, Lung, Colorectal, and Ovarian Cancer (1993-2009) trial (30,297 ever-smokers, 1,253 patients with lung cancer). RESULTS For estimating age-stratified AUC of the combined lung cancer risk model, the proposed method was 3.8 to 5.3 times more efficient compared with the IPW approach across the different age groups. Extensive simulation studies also demonstrated substantial efficiency gain compared with the IPW approach. CONCLUSIONS Incorporating information from all individuals in a two-phase cohort study can substantially improve precision of discrimination measures of lung cancer risk models. IMPACT Novel, simple, and practically useful methods are proposed for evaluating risk models, a critical step toward risk-stratified cancer prevention.
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Affiliation(s)
- Parichoy Pal Choudhury
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Anil K Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Nilanjan Chatterjee
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. .,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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10
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Makinson A, Tron L, Grabar S, Milleron B, Reynes J, Le Moing V, Morquin D, Lert F, Costagliola D, Guiguet M. Potential lung cancer screening outcomes using different age and smoking thresholds in the ANRS-CO4 French Hospital Database on HIV cohort. HIV Med 2019; 21:180-188. [PMID: 31730270 DOI: 10.1111/hiv.12811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES In most lung screening programmes, only subjects ≥ 55 years old and smoking ≥ 30 pack-years are eligible to undergo chest low-dose computed tomography. Whether the same criteria should apply to people living with HIV (PLHIV) is uncertain, given the increased lung cancer risks associated with immunodeficiency and high rates of smoking. We assessed different outcomes obtained from simulating one round of lung cancer screening in PLHIV using different age and smoking thresholds for eligibility. METHODS Data from the French Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS)-CO4 French Hospital Database on HIV (FHDH) cohort of PLHIV and a national representative survey of PLHIV in care in 2011 (the ANRS-VESPA2 [enquête sur les personnes atteintes] study) were used to estimate the maximum proportion of incident lung cancers occurring between 2012 and 2016 that would have potentially been detected by screening in 2011. Secondary outcomes were numbers of eligible subjects in the cohort and numbers of subjects needed to screen (NNS) to detect one lung cancer. RESULTS Among 77819 PLHIV in 2011 (median age 46 years; 66% men), 285 subjects subsequently developed lung cancer. Adoption of the US Preventive Services Task Force (USPSTF) recommendations (55-80 years; ≥ 30 pack-years) would have detected 31% of lung cancers at most. Lowering the minimum age to 50 and 45 years would have detected 49% and 60% of cancers, respectively, but would have greatly increased the number of eligible subjects and the NNS to detect one case of lung cancer. CONCLUSIONS Use of the USPSTF criteria would have detected only a minority of lung cancers in a large French cohort of PLHIV in 2011. Screening PLHIV at younger ages (45 or 50 years) and/or the use of lower smoking thresholds (20 pack-years) may be beneficial, despite the consequently higher numbers of eligible subjects and NNS to detect one case of lung cancer, and should be evaluated in future studies.
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Affiliation(s)
- A Makinson
- Infectious and Tropical Diseases Department, UMI 233/INSERM U1175, Montpellier University Hospital, Montpellier, France
| | - L Tron
- University Hospital of Caen, Caen, France.,ANTICIPE' U1086 INSERM-UCN, François Baclesse Center, Caen, France
| | - S Grabar
- INSERM, Institute of Epidemiology and Public Health Pierre Louis (IPLESP), Sorbonne Université, Paris, France.,Biostatistic and Epidemiology Unit, Cochin Hospital, Paris, France.,Paris-Descartes University, Paris, France
| | - B Milleron
- French Cooperative Thoracic Intergroup (IFCT), Paris, France.,Public Hospitals of Paris (APHP), University Hospitals of Bichat and Tenon, Paris, France
| | - J Reynes
- Infectious and Tropical Diseases Department, UMI 233/INSERM U1175, Montpellier University Hospital, Montpellier, France
| | - V Le Moing
- Infectious and Tropical Diseases Department, UMI 233/INSERM U1175, Montpellier University Hospital, Montpellier, France
| | - D Morquin
- Infectious and Tropical Diseases Department, UMI 233/INSERM U1175, Montpellier University Hospital, Montpellier, France
| | - F Lert
- Department of Epidemiology of Occupational and Social Determinants of Health, Center for Research in Epidemiology and Population Health, INSERM, Villejuif, France
| | - D Costagliola
- INSERM, Institute of Epidemiology and Public Health Pierre Louis (IPLESP), Sorbonne Université, Paris, France
| | - M Guiguet
- INSERM, Institute of Epidemiology and Public Health Pierre Louis (IPLESP), Sorbonne Université, Paris, France
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Cheung LC, Berg CD, Castle PE, Katki HA, Chaturvedi AK. Life-Gained-Based Versus Risk-Based Selection of Smokers for Lung Cancer Screening. Ann Intern Med 2019; 171:623-632. [PMID: 31634914 PMCID: PMC7191755 DOI: 10.7326/m19-1263] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Although risk-based selection of ever-smokers for screening could prevent more lung cancer deaths than screening according to the U.S. Preventive Services Task Force (USPSTF) guidelines, it preferentially selects older ever-smokers with shorter life expectancies due to comorbidities. OBJECTIVE To compare selection of ever-smokers for screening based on gains in life expectancy versus lung cancer risk. DESIGN Cohort analyses and model-based projections. SETTING U.S. population of ever-smokers aged 40 to 84 years. PARTICIPANTS 130 964 National Health Interview Survey participants, representing about 60 million U.S. ever-smokers during 1997 to 2015. INTERVENTION Annual computed tomography (CT) screening for 3 years versus no screening. MEASUREMENTS Estimated number of lung cancer deaths averted and life-years gained after development of a mortality model. RESULTS Using the calibrated and validated mortality model in U.S. ever-smokers aged 40 to 84 years and selecting 8.3 million ever-smokers to match the number selected by the USPSTF criteria in 2013 to 2015, the analysis estimated that life-gained-based selection would increase the total life expectancy from CT screening (633 400 vs. 607 800 years) but prevent fewer lung cancer deaths (52 600 vs. 55 000) compared with risk-based selection. The 1.56 million persons selected by the life-gained-based strategy but not the risk-based strategy were younger (mean age, 59 vs. 75 years) and had fewer comorbidities (mean, 0.75 vs. 3.7). LIMITATION Estimates are model-based and assume implementation of lung cancer screening with short-term effectiveness similar to that from trials. CONCLUSION Life-gained-based selection could maximize the benefits of lung cancer screening in the U.S. population by including ever-smokers who have both high lung cancer risk and long life expectancy. PRIMARY FUNDING SOURCE Intramural Research Program of the National Cancer Institute, National Institutes of Health.
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Affiliation(s)
- Li C Cheung
- National Cancer Institute, Bethesda, Maryland (L.C.C., C.D.B., H.A.K., A.K.C.)
| | - Christine D Berg
- National Cancer Institute, Bethesda, Maryland (L.C.C., C.D.B., H.A.K., A.K.C.)
| | - Philip E Castle
- Albert Einstein School of Medicine, Bronx, New York (P.E.C.)
| | - Hormuzd A Katki
- National Cancer Institute, Bethesda, Maryland (L.C.C., C.D.B., H.A.K., A.K.C.)
| | - Anil K Chaturvedi
- National Cancer Institute, Bethesda, Maryland (L.C.C., C.D.B., H.A.K., A.K.C.)
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12
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Okereke IC, Nishi S, Zhou J, Goodwin JS. Trends in lung cancer screening in the United States, 2016-2017. J Thorac Dis 2019; 11:873-881. [PMID: 31019776 DOI: 10.21037/jtd.2019.01.105] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- Ikenna C Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Shawn Nishi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA.,Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Jie Zhou
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - James S Goodwin
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.,Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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13
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Monitoring Lung Cancer Screening Use and Outcomes at Four Cancer Research Network Sites. Ann Am Thorac Soc 2018; 14:1827-1835. [PMID: 28683215 DOI: 10.1513/annalsats.201703-237oc] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Lung cancer screening registries can monitor screening outcomes and improve quality of care. OBJECTIVES To describe nascent lung cancer screening programs and share efficient data collection approaches for mandatory registry reporting in four integrated health care systems of the National Cancer Institute-funded Cancer Research Network. METHODS We documented the distinctive characteristics of lung cancer screening programs, and we provide examples of strategies to facilitate data collection and describe early challenges and possible solutions. In addition, we report preliminary data on use and outcomes of screening with low-dose computed tomography at each of the participating sites. RESULTS Programs varied in approaches to confirming patient eligibility, ordering screening low-dose computed tomographic scans, and coordinating follow-up care. Most data elements were collected from structured fields in electronic health records, but sites also made use of standardized order templates, local procedure codes, identifiable hashtags in radiology reports, and natural language processing algorithms. Common challenges included incomplete documentation of tobacco smoking history, difficulty distinguishing between scans performed for screening versus diagnosis or surveillance, and variable adherence with use of standardized templates. Adherence with eligibility criteria as well as the accuracy and completeness of data collection appeared to depend at least partly on availability of personnel and other resources to support the successful implementation of screening. CONCLUSIONS To maximize the effectiveness of lung cancer screening, minimize the burden of data collection, and facilitate research and quality improvement, clinical workflow and information technology should be purposefully designed to ensure that patients meet eligibility criteria and receive appropriate follow-up testing.
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14
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Gould MK. Precision Screening for Lung Cancer: Risk-Based but Not Always Preference-Sensitive? Ann Intern Med 2018; 169:52-53. [PMID: 29809245 DOI: 10.7326/m18-1350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Michael K Gould
- Kaiser Permanente Southern California, Pasadena, California (M.K.G.)
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15
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Katki HA, Kovalchik SA, Petito LC, Cheung LC, Jacobs E, Jemal A, Berg CD, Chaturvedi AK. Implications of Nine Risk Prediction Models for Selecting Ever-Smokers for Computed Tomography Lung Cancer Screening. Ann Intern Med 2018; 169:10-19. [PMID: 29800127 PMCID: PMC6557386 DOI: 10.7326/m17-2701] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Lung cancer screening guidelines recommend using individualized risk models to refer ever-smokers for screening. However, different models select different screening populations. The performance of each model in selecting ever-smokers for screening is unknown. OBJECTIVE To compare the U.S. screening populations selected by 9 lung cancer risk models (the Bach model; the Spitz model; the Liverpool Lung Project [LLP] model; the LLP Incidence Risk Model [LLPi]; the Hoggart model; the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Model 2012 [PLCOM2012]; the Pittsburgh Predictor; the Lung Cancer Risk Assessment Tool [LCRAT]; and the Lung Cancer Death Risk Assessment Tool [LCDRAT]) and to examine their predictive performance in 2 cohorts. DESIGN Population-based prospective studies. SETTING United States. PARTICIPANTS Models selected U.S. screening populations by using data from the National Health Interview Survey from 2010 to 2012. Model performance was evaluated using data from 337 388 ever-smokers in the National Institutes of Health-AARP Diet and Health Study and 72 338 ever-smokers in the CPS-II (Cancer Prevention Study II) Nutrition Survey cohort. MEASUREMENTS Model calibration (ratio of model-predicted to observed cases [expected-observed ratio]) and discrimination (area under the curve [AUC]). RESULTS At a 5-year risk threshold of 2.0%, the models chose U.S. screening populations ranging from 7.6 million to 26 million ever-smokers. These disagreements occurred because, in both validation cohorts, 4 models (the Bach model, PLCOM2012, LCRAT, and LCDRAT) were well-calibrated (expected-observed ratio range, 0.92 to 1.12) and had higher AUCs (range, 0.75 to 0.79) than 5 models that generally overestimated risk (expected-observed ratio range, 0.83 to 3.69) and had lower AUCs (range, 0.62 to 0.75). The 4 best-performing models also had the highest sensitivity at a fixed specificity (and vice versa) and similar discrimination at a fixed risk threshold. These models showed better agreement on size of the screening population (7.6 million to 10.9 million) and achieved consensus on 73% of persons chosen. LIMITATION No consensus on risk thresholds for screening. CONCLUSION The 9 lung cancer risk models chose widely differing U.S. screening populations. However, 4 models (the Bach model, PLCOM2012, LCRAT, and LCDRAT) most accurately predicted risk and performed best in selecting ever-smokers for screening. PRIMARY FUNDING SOURCE Intramural Research Program of the National Institutes of Health/National Cancer Institute.
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Affiliation(s)
- Hormuzd A Katki
- National Cancer Institute, Bethesda, Maryland (H.A.K., S.A.K., L.C.P., L.C.C., C.D.B., A.K.C.)
| | - Stephanie A Kovalchik
- National Cancer Institute, Bethesda, Maryland (H.A.K., S.A.K., L.C.P., L.C.C., C.D.B., A.K.C.)
| | - Lucia C Petito
- National Cancer Institute, Bethesda, Maryland (H.A.K., S.A.K., L.C.P., L.C.C., C.D.B., A.K.C.)
| | - Li C Cheung
- National Cancer Institute, Bethesda, Maryland (H.A.K., S.A.K., L.C.P., L.C.C., C.D.B., A.K.C.)
| | - Eric Jacobs
- American Cancer Society, Atlanta, Georgia (E.J., A.J.)
| | - Ahmedin Jemal
- American Cancer Society, Atlanta, Georgia (E.J., A.J.)
| | - Christine D Berg
- National Cancer Institute, Bethesda, Maryland (H.A.K., S.A.K., L.C.P., L.C.C., C.D.B., A.K.C.)
| | - Anil K Chaturvedi
- National Cancer Institute, Bethesda, Maryland (H.A.K., S.A.K., L.C.P., L.C.C., C.D.B., A.K.C.)
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16
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Meaney CL, Zingone A, Brown D, Yu Y, Cao L, Ryan BM. Identification of serum inflammatory markers as classifiers of lung cancer mortality for stage I adenocarcinoma. Oncotarget 2018; 8:40946-40957. [PMID: 28402963 PMCID: PMC5522266 DOI: 10.18632/oncotarget.16784] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 02/20/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related mortality worldwide. Low-dose CT (LDCT) imaging is now recommended to screen high-risk lung cancer individuals in the USA. LDCT has resulted in increased detection of stage I lung cancer for which the current standard of care is surgery alone. However, approximately 30% of these patients develop recurrence and therefore are in need of further treatment upon diagnosis. This study aims to explore blood-based inflammatory biomarkers to identify patients at high-risk of mortality for which additional treatment modalities can be offered at time of diagnosis. PATIENTS AND METHODS Recent work on a small panel of circulating cytokines identified elevated levels of IL-6, a pro-inflammatory cytokine, as an indicator of poor survival for lung cancer patients. To reflect the broader role of inflammation in lung cancer, we examined a large panel of 33 inflammatory proteins in the sera of 129 lung cancer patients selected from the National Cancer Institute-Maryland case-control study. To reduce heterogeneity, we specifically focused our study on stage I lung adenocarcinoma patients. RESULTS We replicated the previous observations that IL-6 is associated with prognosis of lung cancer and extended its utility to prognosis in this highly-selected population of stage I lung adenocarcinoma patients. In addition, we developed a multi-marker, combined prognostic classifier that includes the pro-inflammatory Th-17 cell effector cytokine, IL-17. Patients with high levels of IL-6 and IL-17A had a significantly adverse survival compared with patients with low levels (P for trend <0.0001). Patients in the high risk group, with high levels of both proteins had a 5-year survival rate of 46% in comparison to 93% for those with low levels of both markers. Furthermore, we validated the same trends for the IL-6 and IL-17A prognostic signature in an independent data set. CONCLUSIONS The results identified here justify further investigation of this novel, combined cytokine prognostic classifier for the identification of high-risk stage I lung adenocarcinoma patients. This classifier has the much-needed potential to identify patients at high risk of recurrence and thus prospectively identify the subset of patients requiring more aggressive treatment regimens at the time of diagnosis.
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Affiliation(s)
- Claire L Meaney
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Adriana Zingone
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Derek Brown
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Yunkai Yu
- Genetics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Liang Cao
- Genetics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Bríd M Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
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17
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Dai J, Yang P, Cox A, Jiang G. Lung cancer and chronic obstructive pulmonary disease: From a clinical perspective. Oncotarget 2017; 8:18513-18524. [PMID: 28061470 PMCID: PMC5392346 DOI: 10.18632/oncotarget.14505] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/27/2016] [Indexed: 12/18/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and lung cancer are devastating pulmonary diseases that commonly coexist and present a number of clinical challenges. COPD confers a higher risk for lung cancer development, but available chemopreventive measures remain rudimentary. Current studies have shown a marked benefit of cancer screening in the COPD population, although challenges remain, including the common underdiagnosis of COPD. COPD-associated lung cancer presents distinct clinical features. Treatment for lung cancer coexisting with COPD is challenging as COPD may increase postoperative morbidities and decrease survival. In this review, we outline current progress in the understanding of the clinical association between COPD and lung cancer, and suggest possible cancer prevention strategies in this patient population.
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Affiliation(s)
- Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ping Yang
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Minnesota, United States of America
| | - Angela Cox
- Department of Oncology, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Hocker JR, Deb SJ, Li M, Lerner MR, Lightfoot SA, Quillet AA, Hanas RJ, Reinersman M, Thompson JL, Vu NT, Kupiec TC, Brackett DJ, Peyton MD, Dubinett SM, Burkhart HM, Postier RG, Hanas JS. Serum Monitoring and Phenotype Identification of Stage I Non-Small Cell Lung Cancer Patients. Cancer Invest 2017; 35:573-585. [PMID: 28949774 DOI: 10.1080/07357907.2017.1373120] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A stage I non-small cell lung cancer (NSCLC) serum profiling platform is presented which is highly efficient and accurate. Test sensitivity (0.95) for stage I NSCLC is the highest reported so far. Test metrics are reported for discriminating stage I adenocarcinoma vs squamous cell carcinoma subtypes. Blinded analysis identified 23 out of 24 stage I NSCLC and control serum samples. Group-discriminating mass peaks were targeted for tandem mass spectrometry peptide/protein identification, and yielded a lung cancer phenotype. Bioinformatic analysis revealed a novel lymphocyte adhesion pathway involved with early-stage lung cancer.
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Affiliation(s)
- James R Hocker
- a Department of Biochemistry and Molecular biology, Stephenson Cancer Center , University of Oklahoma Health Sciences Center , 940 Stanton L. Young Blvd., BMSB 853, Oklahoma City , OK , USA
| | - Subrato J Deb
- b Department of Surgery, Stephenson Cancer Center , University of Oklahoma Health Sciences Center , P.O. Box Williams Pavilion Room 2140. Oklahoma City , OK , USA
| | - Min Li
- b Department of Surgery, Stephenson Cancer Center , University of Oklahoma Health Sciences Center , P.O. Box Williams Pavilion Room 2140. Oklahoma City , OK , USA
| | - Megan R Lerner
- b Department of Surgery, Stephenson Cancer Center , University of Oklahoma Health Sciences Center , P.O. Box Williams Pavilion Room 2140. Oklahoma City , OK , USA.,c Department of Veterans Affairs , Veterans Affairs Medical Center , 921 NE 13th Street, Oklahoma City , OK , USA
| | - Stan A Lightfoot
- c Department of Veterans Affairs , Veterans Affairs Medical Center , 921 NE 13th Street, Oklahoma City , OK , USA
| | - Aurelien A Quillet
- a Department of Biochemistry and Molecular biology, Stephenson Cancer Center , University of Oklahoma Health Sciences Center , 940 Stanton L. Young Blvd., BMSB 853, Oklahoma City , OK , USA
| | - R Jane Hanas
- a Department of Biochemistry and Molecular biology, Stephenson Cancer Center , University of Oklahoma Health Sciences Center , 940 Stanton L. Young Blvd., BMSB 853, Oklahoma City , OK , USA
| | - Matthew Reinersman
- b Department of Surgery, Stephenson Cancer Center , University of Oklahoma Health Sciences Center , P.O. Box Williams Pavilion Room 2140. Oklahoma City , OK , USA
| | - Jess L Thompson
- b Department of Surgery, Stephenson Cancer Center , University of Oklahoma Health Sciences Center , P.O. Box Williams Pavilion Room 2140. Oklahoma City , OK , USA
| | - Nicole T Vu
- d Analytical Research Laboratories BioPharma , 840 Research Parkway, Ste. 546, Oklahoma City , OK , USA
| | - Thomas C Kupiec
- d Analytical Research Laboratories BioPharma , 840 Research Parkway, Ste. 546, Oklahoma City , OK , USA
| | - Daniel J Brackett
- c Department of Veterans Affairs , Veterans Affairs Medical Center , 921 NE 13th Street, Oklahoma City , OK , USA
| | - Marvin D Peyton
- b Department of Surgery, Stephenson Cancer Center , University of Oklahoma Health Sciences Center , P.O. Box Williams Pavilion Room 2140. Oklahoma City , OK , USA
| | - Stephen M Dubinett
- e David Geffen School of Medicine , University of California , 10833 Le Conte Ave. CHS 37-131, Los Angeles , CA , USA
| | - Harold M Burkhart
- b Department of Surgery, Stephenson Cancer Center , University of Oklahoma Health Sciences Center , P.O. Box Williams Pavilion Room 2140. Oklahoma City , OK , USA
| | - Russell G Postier
- b Department of Surgery, Stephenson Cancer Center , University of Oklahoma Health Sciences Center , P.O. Box Williams Pavilion Room 2140. Oklahoma City , OK , USA
| | - Jay S Hanas
- a Department of Biochemistry and Molecular biology, Stephenson Cancer Center , University of Oklahoma Health Sciences Center , 940 Stanton L. Young Blvd., BMSB 853, Oklahoma City , OK , USA.,b Department of Surgery, Stephenson Cancer Center , University of Oklahoma Health Sciences Center , P.O. Box Williams Pavilion Room 2140. Oklahoma City , OK , USA.,c Department of Veterans Affairs , Veterans Affairs Medical Center , 921 NE 13th Street, Oklahoma City , OK , USA
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Pack-Year Cigarette Smoking History for Determination of Lung Cancer Screening Eligibility. Comparison of the Electronic Medical Record versus a Shared Decision-making Conversation. Ann Am Thorac Soc 2017; 14:1320-1325. [DOI: 10.1513/annalsats.201612-984oc] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Presentation at computed tomography (CT) scan of the thorax and first year diagnostic and treatment utilization among patients diagnosed with lung cancer. PLoS One 2017; 12:e0181319. [PMID: 28708876 PMCID: PMC5510847 DOI: 10.1371/journal.pone.0181319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 06/20/2017] [Indexed: 11/19/2022] Open
Abstract
Background As Medicare expands the use of computed tomography (CT) for diagnosing lung cancer, there is increased opportunity to diagnose lung cancer in asymptomatic patients. This descriptive study characterizes the disease-specific diagnostic and treatment services that patients with a positive diagnosis following CT received, stratified by presentation at CT. Methods Patients who were diagnosed with lung cancer following CT in 2013, had no history of lung cancer, survived at least 1 year, were aged 55–80 years, and had Medicare Advantage insurance were included. Patients were grouped based upon presentation at CT: morbidities unrelated to lung cancer, classic lung cancer symptoms, and cancer syndromes. Patients with none of these factors were categorized into a no diagnoses/symptoms group. The type and intensity of services used in the year following the CT was reported for each group. Results 1,261 patients were included. Early treatment services were most common in the group with morbidities unrelated to lung cancer (13.7%) and least common in the cancer syndromes group (6.6%). Advanced treatment services were used by 47.3% of the cancer syndromes group versus 23.5% of the no diagnoses/symptoms group. Conclusions The intensity of disease-specific diagnostic and treatment services varied by presentation at CT. Patients with no symptoms or morbidities at the time of CT less frequently received advanced interventions. Learning about the utilization patterns of others with a similar presentation at CT may help patients with positive lung cancer diagnoses engage in shared decision making and in norming their experiences against those of other similarly-situated patients.
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Quantitative computer-aided diagnostic algorithm for automated detection of peak lesion attenuation in differentiating clear cell from papillary and chromophobe renal cell carcinoma, oncocytoma, and fat-poor angiomyolipoma on multiphasic multidetector computed tomography. Abdom Radiol (NY) 2017; 42:1919-1928. [PMID: 28280876 DOI: 10.1007/s00261-017-1095-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the performance of a novel, quantitative computer-aided diagnostic (CAD) algorithm on four-phase multidetector computed tomography (MDCT) to detect peak lesion attenuation to enable differentiation of clear cell renal cell carcinoma (ccRCC) from chromophobe RCC (chRCC), papillary RCC (pRCC), oncocytoma, and fat-poor angiomyolipoma (fp-AML). MATERIALS AND METHODS We queried our clinical databases to obtain a cohort of histologically proven renal masses with preoperative MDCT with four phases [unenhanced (U), corticomedullary (CM), nephrographic (NP), and excretory (E)]. A whole lesion 3D contour was obtained in all four phases. The CAD algorithm determined a region of interest (ROI) of peak lesion attenuation within the 3D lesion contour. For comparison, a manual ROI was separately placed in the most enhancing portion of the lesion by visual inspection for a reference standard, and in uninvolved renal cortex. Relative lesion attenuation for both CAD and manual methods was obtained by normalizing the CAD peak lesion attenuation ROI (and the reference standard manually placed ROI) to uninvolved renal cortex with the formula [(peak lesion attenuation ROI - cortex ROI)/cortex ROI] × 100%. ROC analysis and area under the curve (AUC) were used to assess diagnostic performance. Bland-Altman analysis was used to compare peak ROI between CAD and manual method. RESULTS The study cohort comprised 200 patients with 200 unique renal masses: 106 (53%) ccRCC, 32 (16%) oncocytomas, 18 (9%) chRCCs, 34 (17%) pRCCs, and 10 (5%) fp-AMLs. In the CM phase, CAD-derived ROI enabled characterization of ccRCC from chRCC, pRCC, oncocytoma, and fp-AML with AUCs of 0.850 (95% CI 0.732-0.968), 0.959 (95% CI 0.930-0.989), 0.792 (95% CI 0.716-0.869), and 0.825 (95% CI 0.703-0.948), respectively. On Bland-Altman analysis, there was excellent agreement of CAD and manual methods with mean differences between 14 and 26 HU in each phase. CONCLUSION A novel, quantitative CAD algorithm enabled robust peak HU lesion detection and discrimination of ccRCC from other renal lesions with similar performance compared to the manual method.
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Shieh Y, Bohnenkamp M. Low-Dose CT Scan for Lung Cancer Screening. Chest 2017; 152:204-209. [DOI: 10.1016/j.chest.2017.03.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 12/17/2022] Open
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Federman DG, Baldassarri RJ, Cain HC. A rare 'incidentaloma' found on low-dose CT screening for lung cancer: 'scanner beware'. Postgrad Med 2017; 129:653-656. [PMID: 28562187 DOI: 10.1080/00325481.2017.1334506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Screening for lung cancer with low-dose computed tomography (LDCT) has been shown to reduce mortality and has been recommended by the U.S. Preventive Services Task Force for adults 55 to 80 years of age with a 30 pack-year smoking history who are either current smokers or those that quit within 15 years. However, the overwhelming majority of abnormalities detected are not from malignancy. We report a case of pulmonary Langerhans' cell histiocytosis, here-to-fore thought of as extremely uncommon, and make readers aware that this may be increasingly found as LDCT is more widely adopted.
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Affiliation(s)
- Daniel G Federman
- a VA Connecticut Healthcare System , West Haven , CT , USA.,b Yale University School of Medicine , New Haven , CT , USA
| | - Rebecca J Baldassarri
- a VA Connecticut Healthcare System , West Haven , CT , USA.,b Yale University School of Medicine , New Haven , CT , USA
| | - Hilary C Cain
- a VA Connecticut Healthcare System , West Haven , CT , USA.,b Yale University School of Medicine , New Haven , CT , USA
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Weber M, Yap S, Goldsbury D, Manners D, Tammemagi M, Marshall H, Brims F, McWilliams A, Fong K, Kang YJ, Caruana M, Banks E, Canfell K. Identifying high risk individuals for targeted lung cancer screening: Independent validation of the PLCOm2012
risk prediction tool. Int J Cancer 2017; 141:242-253. [DOI: 10.1002/ijc.30673] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/31/2017] [Accepted: 02/08/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Marianne Weber
- Cancer Research Division; Cancer Council NSW; New South Wales Australia
- School of Public Health; Sydney Medical School, University of Sydney; New South Wales Australia
| | - Sarsha Yap
- Cancer Research Division; Cancer Council NSW; New South Wales Australia
| | - David Goldsbury
- Cancer Research Division; Cancer Council NSW; New South Wales Australia
| | - David Manners
- Midland Physician Service; St John of God Public and Private Hospitals Midland; Western Australia Australia
| | | | - Henry Marshall
- Department of Thoracic Medicine; The Prince Charles Hospital; Queensland Australia
| | - Fraser Brims
- Curtin Medical School, Faculty of Health Sciences, Curtin University; Western Australia Australia
| | - Annette McWilliams
- Fiona Stanley Hospital; Respiratory Medicine Department, University of Western Australia; Western Australia Australia
| | - Kwun Fong
- Department of Thoracic Medicine; The Prince Charles Hospital; Queensland Australia
| | - Yoon Jung Kang
- Cancer Research Division; Cancer Council NSW; New South Wales Australia
| | - Michael Caruana
- Cancer Research Division; Cancer Council NSW; New South Wales Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health; Australian National University; Australian Capital Territory Australia
| | - Karen Canfell
- Cancer Research Division; Cancer Council NSW; New South Wales Australia
- School of Public Health; Sydney Medical School, University of Sydney; New South Wales Australia
- Prince of Wales Clinical School, UNSW; New South Wales Australia
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Agustí A. Predicting the future from the past. Eur Respir J 2017; 49:49/1/1601854. [DOI: 10.1183/13993003.01854-2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 09/25/2016] [Indexed: 12/20/2022]
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Stang A, Schuler M, Kowall B, Darwiche K, Kühl H, Jöckel KH. Lung Cancer Screening Using Low Dose CT Scanning in Germany. Extrapolation of results from the National Lung Screening Trial. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:637-44. [PMID: 26429636 DOI: 10.3238/arztebl.2015.0637] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/08/2015] [Accepted: 07/08/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND It is now debated whether the screening of heavy smokers for lung cancer with low dose computed tomography (low dose CT) might lower their mortality due to lung cancer. We use data from the National Lung Screening Trial (NLST) in the USA to predict the likely effects of such screening in Germany. METHODS The number of heavy smokers aged 55-74 in Germany was extrapolated from survey data obtained by the Robert Koch Institute. Published data from the NLST were then used to estimate the likely effects of low dose CT screening of heavy smokers in Germany. RESULTS If low dose CT screening were performed on 50% of the heavy smokers in Germany aged 55-74, an estimated 1 329 506 persons would undergo such screening. If the screening were repeated annually, then, over three years, 916 918 screening CTs would reveal suspect lesions, and the diagnosis of lung cancer would be confirmed thereafter in 32 826 persons. At least one positive test result in three years would be obtained in 39.1% of the participants (519 837 persons). 4155 deaths from lung cancer would be prevented over 6.5 years, and the number of persons aged 55-74 who die of lung cancer in Germany would fall by 2.6%. 12 449 persons would have at least one complication, and 1074 persons would die in the 60 days following screening. CONCLUSION The screening of heavy smokers for lung cancer can lower their risk of dying of lung cancer by 20% in relative terms, corresponding to an absolute risk reduction of 0.3 percentage points. These figures can provide the background for a critical discussion of the putative utility of this type of screening in Germany.
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Affiliation(s)
- Andreas Stang
- Center for Clinical Epidemiology; Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, School of Public Health, Department of Epidemiology, Boston University, USA, German Cancer Consortium (DKTK), Heidelberg, West German Cancer Center, Clinic for Internal Medicine (Tumor Research), University Hospital Essen, Department of Thoracic Oncology, Ruhrlandklinik, University Hospital Essen, Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen
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Barreiro E, Bustamante V, Curull V, Gea J, López-Campos JL, Muñoz X. Relationships between chronic obstructive pulmonary disease and lung cancer: biological insights. J Thorac Dis 2016; 8:E1122-E1135. [PMID: 27867578 DOI: 10.21037/jtd.2016.09.54] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lung cancer (LC) has become one of the leading causes of preventable death in the last few decades. Cigarette smoking (CS) stays as the main etiologic factor of LC despite that many other causes such as occupational exposures, air pollution, asbestos, or radiation have also been implicated. Patients with chronic obstructive pulmonary disease (COPD), which also represents a major cause of morbidity and mortality in developed countries, exhibit a significantly greater risk of LC. The study of the underlying biological mechanisms that may predispose patients with chronic respiratory diseases to a higher incidence of LC has also gained much attention in the last few years. The present review has been divided into three major sections in which different aspects have been addressed: (I) relevant etiologic agents of LC; (II) studies confirming the hypothesis that COPD patients are exposed to a greater risk of developing LC; and (III) evidence on the most relevant underlying biological mechanisms that support the links between COPD and LC. Several carcinogenic agents have been described in the last decades but CS remains to be the leading etiologic agent in most geographical regions in which the incidence of LC is very high. Growing evidence has put the line forward the implications of COPD and especially of emphysema in LC development. Hence, COPD represents a major risk factor of LC in patients. Different avenues of research have demonstrated the presence of relevant biological mechanisms that may predispose COPD patients to develop LC. Importantly, the so far identified biological mechanisms offer targets for the design of specific therapeutic strategies that will further the current treatment options for patients with LC. Prospective screening studies, in which patients with COPD should be followed up for several years will help identify biomarkers that may predict the risk of LC among these patients.
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Affiliation(s)
- Esther Barreiro
- Pulmonology Department-Lung Cancer and Muscle Research Group, IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Pompeu Fabra University (UPF), Barcelona Autonomous University (UAB), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain; ; Network of Excellence in Lung Diseases (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Víctor Bustamante
- Pneumology Department, Basurto University Hospital, Osakidetza, Department of Medicine, EHU-University of the Basque Country, Bilbao, Bizkaia, Spain
| | - Víctor Curull
- Pulmonology Department-Lung Cancer and Muscle Research Group, IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Pompeu Fabra University (UPF), Barcelona Autonomous University (UAB), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain; ; Network of Excellence in Lung Diseases (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Joaquim Gea
- Pulmonology Department-Lung Cancer and Muscle Research Group, IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Pompeu Fabra University (UPF), Barcelona Autonomous University (UAB), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain; ; Network of Excellence in Lung Diseases (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - José Luis López-Campos
- Network of Excellence in Lung Diseases (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain; ; Medical-Surgery Unit of Respiratory Disease, Sevilla Biomedicine Institute (IBIS), Virgen del Rocío University Hospital, University of Seville, Seville, Spain
| | - Xavier Muñoz
- Network of Excellence in Lung Diseases (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain; ; Pulmonology Service, Medicine Department, Vall d'Hebron University Hospital, Barcelona Autonomous University (UAB), Barcelona, Spain
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Makinson A, Le Moing V, Reynes J, Ferry T, Lavole A, Poizot-Martin I, Pujol JL, Spano JP, Milleron B. Lung Cancer Screening with Chest Computed Tomography in People Living with HIV: A Review by the Multidisciplinary CANCERVIH Working Group. J Thorac Oncol 2016; 11:1644-52. [PMID: 27449803 DOI: 10.1016/j.jtho.2016.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/16/2016] [Accepted: 06/27/2016] [Indexed: 01/16/2023]
Abstract
A shift in mortality and morbidity has been observed in people living with human immunodeficiency virus (PLWHIV) from acquired immunodeficiency syndrome (AIDS) to non-AIDS diseases. Lung cancer has the highest incidence rates among all the non-AIDS-defining malignancies and is associated with mortality rates that exceed those of other cancers. Strategies to increase lung cancer survival in PLWHIV are needed. Lung cancer screening with chest LDCT has been shown to be efficient in the general population at risk. The objective of this review is to discuss lung cancer screening with chest computed tomography in PLWHIV. Lung cancer screening in PLWHIV is feasible. Whether PLWHIV could benefit from an age threshold for screening that is earlier than the minimum age of 55 years usually required in the general population still needs further investigation. Studies evaluating smoking cessation programs and how they could be articulated with lung cancer screening programs are also needed in PLWHIV.
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Affiliation(s)
- Alain Makinson
- Department of Infectious and Tropical Diseases, U1175-National Institute of Health and Medical Research/Mixt International Department 233, Development Research Institute, University Montpellier, Montpellier, France.
| | - Vincent Le Moing
- Department of Infectious and Tropical Diseases, U1175-National Institute of Health and Medical Research/Mixt International Department 233, Development Research Institute, University Montpellier, Montpellier, France
| | - Jacques Reynes
- Department of Infectious and Tropical Diseases, U1175-National Institute of Health and Medical Research/Mixt International Department 233, Development Research Institute, University Montpellier, Montpellier, France
| | - Tristan Ferry
- Infectious and Tropical Disease Unit, University Hospital de la Croix Rousse, Lyon, France
| | - Armelle Lavole
- Department of Pneumology and Reanimation, Hôpital Tenon, Public Assistance-Parisian Hospitals, and Faculté de Médecine Pierre and Marie Curie, University Paris VI, Paris, France
| | - Isabelle Poizot-Martin
- Clinical Immunohaematology Service, University Aix-Marseille, Public Assistance-Hospitals of Marseille Sainte-Marguerite, National Institute of Health and Medical Research, U912 (Economical and Social Sciences of Health and Treatment of Medical Information), Marseille, France
| | - Jean-Louis Pujol
- Thoracic Oncology Unit, University Hospital Montpellier, Montpellier, French Cooperative Thoracic Intergroup, Paris, France
| | - Jean-Philippe Spano
- Department of Medical Oncology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Public Assistance-Parisian Hospitals, National Institute of Health and Medical Research, Mixt Research Department_S 1136, Institute Pierre Louis Epidemiology and of Public Health, Sorbonne University, University Pierre Marie Curie University Paris 06, Paris, France
| | - Bernard Milleron
- Respiratory Disease Department, Tenon Hospital APHP, Paris VI University, French Cooperative Thoracic Intergroup, Paris, France
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Katki HA, Kovalchik SA, Berg CD, Cheung LC, Chaturvedi AK. Development and Validation of Risk Models to Select Ever-Smokers for CT Lung Cancer Screening. JAMA 2016; 315:2300-11. [PMID: 27179989 PMCID: PMC4899131 DOI: 10.1001/jama.2016.6255] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The US Preventive Services Task Force (USPSTF) recommends computed tomography (CT) lung cancer screening for ever-smokers aged 55 to 80 years who have smoked at least 30 pack-years with no more than 15 years since quitting. However, selecting ever-smokers for screening using individualized lung cancer risk calculations may be more effective and efficient than current USPSTF recommendations. OBJECTIVE Comparison of modeled outcomes from risk-based CT lung-screening strategies vs USPSTF recommendations. DESIGN, SETTING, AND PARTICIPANTS Empirical risk models for lung cancer incidence and death in the absence of CT screening using data on ever-smokers from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO; 1993-2009) control group. Covariates included age; education; sex; race; smoking intensity, duration, and quit-years; body mass index; family history of lung cancer; and self-reported emphysema. Model validation in the chest radiography groups of the PLCO and the National Lung Screening Trial (NLST; 2002-2009), with additional validation of the death model in the National Health Interview Survey (NHIS; 1997-2001), a representative sample of the United States. Models were applied to US ever-smokers aged 50 to 80 years (NHIS 2010-2012) to estimate outcomes of risk-based selection for CT lung screening, assuming screening for all ever-smokers, yield the percent changes in lung cancer detection and death observed in the NLST. EXPOSURES Annual CT lung screening for 3 years beginning at age 50 years. MAIN OUTCOMES AND MEASURES For model validity: calibration (number of model-predicted cases divided by number of observed cases [estimated/observed]) and discrimination (area under curve [AUC]). For modeled screening outcomes: estimated number of screen-avertable lung cancer deaths and estimated screening effectiveness (number needed to screen [NNS] to prevent 1 lung cancer death). RESULTS Lung cancer incidence and death risk models were well calibrated in PLCO and NLST. The lung cancer death model calibrated and discriminated well for US ever-smokers aged 50 to 80 years (NHIS 1997-2001: estimated/observed = 0.94 [95%CI, 0.84-1.05]; AUC, 0.78 [95%CI, 0.76-0.80]). Under USPSTF recommendations, the models estimated 9.0 million US ever-smokers would qualify for lung cancer screening and 46,488 (95% CI, 43,924-49,053) lung cancer deaths were estimated as screen-avertable over 5 years (estimated NNS, 194 [95% CI, 187-201]). In contrast, risk-based selection screening of the same number of ever-smokers (9.0 million) at highest 5-year lung cancer risk (≥1.9%) was estimated to avert 20% more deaths (55,717 [95% CI, 53,033-58,400]) and was estimated to reduce the estimated NNS by 17% (NNS, 162 [95% CI, 157-166]). CONCLUSIONS AND RELEVANCE Among a cohort of US ever-smokers aged 50 to 80 years, application of a risk-based model for CT screening for lung cancer compared with a model based on USPSTF recommendations was estimated to be associated with a greater number of lung cancer deaths prevented over 5 years, along with a lower NNS to prevent 1 lung cancer death.
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Affiliation(s)
- Hormuzd A. Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
- Corresponding authors:HAK: Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Room 7E606, Bethesda, MD 20892, Phone: 240-276-7423, Fax: 240-276-7838, ; AKC: Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Room 6E238, Bethesda, MD 20892, Phone: 240-276-7193,
| | - Stephanie A. Kovalchik
- Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia
| | - Christine D. Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Li C. Cheung
- Information Management Services Inc., Calverton, MD, USA
| | - Anil K. Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
- Corresponding authors:HAK: Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Room 7E606, Bethesda, MD 20892, Phone: 240-276-7423, Fax: 240-276-7838, ; AKC: Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Room 6E238, Bethesda, MD 20892, Phone: 240-276-7193,
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Gonzalez J, Marín M, Sánchez-Salcedo P, Zulueta JJ. Lung cancer screening in patients with chronic obstructive pulmonary disease. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:160. [PMID: 27195278 DOI: 10.21037/atm.2016.03.57] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer and chronic obstructive pulmonary disease (COPD) are two intimately related diseases, with great impact on public health. Annual screening using low-dose computed tomography (LDCT) of the chest significantly reduces mortality due to lung cancer, and several scientific societies now recommend this technique. COPD, defined by the presence of airflow obstruction [forced expiratory volume and forced vital capacity (FVC) ratio less than 0.70], and their clinical phenotypes, namely emphysema and chronic bronchitis, have been associated with increased lung cancer risk. Several epidemiological studies, including lung cancer screening trials, have found a 2- to 4-fold increase in lung cancer risk in patients with COPD when compared to individuals without airflow obstruction. Part of the risk attributed to airflow obstruction appears to be derived from the presence of radiographic emphysema. The latter has proven to be an important lung cancer risk factor in smokers without airflow obstruction and even in never smokers. This evidence supports the idea of including patients with COPD and/or emphysema in lung cancer screening programs. There is evidence that lung cancer screening in this population is effective and can potentially reduce mortality. Specific lung cancer risk scores have been developed for patients with COPD [COPD lung cancer screening score (LUCSS) and COPD-LUCSS-diffusing capacity for carbon monoxide (DLCO)] to identify those at high risk. A multidisciplinary approach for an adequate patient selection, especially of patients with severe disease, is key to maximize benefits and reduce harms from lung cancer screening in this population. Patients with COPD included in lung cancer screening programs could also benefit from other interventions, such as smoking cessation and adequate treatment.
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Affiliation(s)
- Jessica Gonzalez
- 1 Respiratory Medicine Service, Clinica Universidad de Navarra, Pamplona, Spain ; 2 Respiratory Medicine Service, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Marta Marín
- 1 Respiratory Medicine Service, Clinica Universidad de Navarra, Pamplona, Spain ; 2 Respiratory Medicine Service, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Pablo Sánchez-Salcedo
- 1 Respiratory Medicine Service, Clinica Universidad de Navarra, Pamplona, Spain ; 2 Respiratory Medicine Service, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Javier J Zulueta
- 1 Respiratory Medicine Service, Clinica Universidad de Navarra, Pamplona, Spain ; 2 Respiratory Medicine Service, Complejo Hospitalario de Navarra, Pamplona, Spain
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Gould MK. Lung Cancer Screening in Individuals with Chronic Obstructive Pulmonary Disease. Finding the Sweet Spot. Am J Respir Crit Care Med 2016; 192:1027-8. [PMID: 26517412 DOI: 10.1164/rccm.201508-1594ed] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Michael K Gould
- 1 Department of Research and Evaluation Kaiser Permanente Southern California Pasadena, California
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Schiffman JD, Fisher PG, Gibbs P. Early detection of cancer: past, present, and future. Am Soc Clin Oncol Educ Book 2016:57-65. [PMID: 25993143 DOI: 10.14694/edbook_am.2015.35.57] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Screening in both healthy and high-risk populations offers the opportunity to detect cancer early and with an increased opportunity for treatment and curative intent. Currently, a defined role for screening exists in some cancer types, but each screening test has limitations, and improved screening methods are urgently needed. Unfortunately, many cancers still lack effective screening recommendations, or in some cases, the benefits from screening are marginal when weighed against the potential for harm. Here we review the current status of cancer screening: we examine the role of traditional tumor biomarkers, describe recommended imaging for early tumor surveillance, and explore the potential of promising novel cancer markers such as circulating tumor cells (CTC) and circulating tumor DNA. Consistent challenges for all of these screening tests include limited sensitivity and specificity. The risk for overdiagnosis remains a particular concern in screening, whereby lesions of no clinical consequence may be detected and thus create difficult management decisions for the clinician and patient. If treatment is pursued following overdiagnosis, patients may be exposed to morbidity from a treatment that may not provide any true benefit. The cost-effectiveness of screening tests also needs to be an ongoing focus. The improvement of genomic and surveillance technologies, which leads to more precise imaging and the ability to characterize blood-based tumor markers of greater specificity, offers opportunities for major progress in cancer screening.
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Affiliation(s)
- Joshua D Schiffman
- From the Department of Pediatrics and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Stanford Cancer Center, Stanford University, Palo Alto, CA; Walter and Eliza Hall Institute, Ludwig Cancer Research, Royal Melbourne and Western Hospital, Melbourne, Australia
| | - Paul G Fisher
- From the Department of Pediatrics and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Stanford Cancer Center, Stanford University, Palo Alto, CA; Walter and Eliza Hall Institute, Ludwig Cancer Research, Royal Melbourne and Western Hospital, Melbourne, Australia
| | - Peter Gibbs
- From the Department of Pediatrics and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Stanford Cancer Center, Stanford University, Palo Alto, CA; Walter and Eliza Hall Institute, Ludwig Cancer Research, Royal Melbourne and Western Hospital, Melbourne, Australia
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Abstract
Cancer screening is an important tool for reducing morbidity and mortality in the elderly. In this article, performance characteristics of commonly used screening tests for colorectal, lung, prostate, breast, and cervical cancers are discussed. Guidelines are emphasized and key issues to consider in screening older adults are highlighted.
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Affiliation(s)
- Sarah A Wingfield
- Geriatric Medicine, Duke University Medical Center, Box 3003, Durham, NC 27710, USA
| | - Mitchell T Heflin
- Department of Medicine, Division of Geriatrics, Center for the Study of Aging and Human Development, Duke University Medical Center, Duke University, Box 3003, Durham, NC 27710, USA.
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Inamoto Y, Shah NN, Savani BN, Shaw BE, Abraham AA, Ahmed IA, Akpek G, Atsuta Y, Baker KS, Basak GW, Bitan M, DeFilipp Z, Gregory TK, Greinix HT, Hamadani M, Hamilton BK, Hayashi RJ, Jacobsohn DA, Kamble RT, Kasow KA, Khera N, Lazarus HM, Malone AK, Lupo-Stanghellini MT, Margossian SP, Muffly LS, Norkin M, Ramanathan M, Salooja N, Schoemans H, Wingard JR, Wirk B, Wood WA, Yong A, Duncan CN, Flowers MED, Majhail NS. Secondary solid cancer screening following hematopoietic cell transplantation. Bone Marrow Transplant 2015; 50:1013-23. [PMID: 25822223 PMCID: PMC4989866 DOI: 10.1038/bmt.2015.63] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 12/30/2014] [Accepted: 12/31/2014] [Indexed: 11/10/2022]
Abstract
Hematopoietic stem cell transplant (HCT) recipients have a substantial risk of developing secondary solid cancers, particularly beyond 5 years after HCT and without reaching a plateau overtime. A working group was established through the Center for International Blood and Marrow Transplant Research and the European Group for Blood and Marrow Transplantation with the goal to facilitate implementation of cancer screening appropriate to HCT recipients. The working group reviewed guidelines and methods for cancer screening applicable to the general population and reviewed the incidence and risk factors for secondary cancers after HCT. A consensus approach was used to establish recommendations for individual secondary cancers. The most common sites include oral cavity, skin, breast and thyroid. Risks of cancers are increased after HCT compared with the general population in skin, thyroid, oral cavity, esophagus, liver, nervous system, bone and connective tissues. Myeloablative TBI, young age at HCT, chronic GVHD and prolonged immunosuppressive treatment beyond 24 months were well-documented risk factors for many types of secondary cancers. All HCT recipients should be advised of the risks of secondary cancers annually and encouraged to undergo recommended screening based on their predisposition. Here we propose guidelines to help clinicians in providing screening and preventive care for secondary cancers among HCT recipients.
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Affiliation(s)
- Y Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - N N Shah
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institute of Health (NIH), Bethesda, MD, USA
| | - B N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - B E Shaw
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - A A Abraham
- Division of Blood and Marrow Transplantation, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA
| | - I A Ahmed
- Department of Hematology Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - G Akpek
- Section of Hematology Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Y Atsuta
- 1] Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan [2] Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K S Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - G W Basak
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - M Bitan
- Department of Pediatric Hematology/Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Z DeFilipp
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - T K Gregory
- Colorado Blood Cancer Institute at Presbyterian/St Luke's Medical Center, Denver, CO, USA
| | - H T Greinix
- Bone Marrow Transplantation Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - M Hamadani
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B K Hamilton
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - R J Hayashi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - D A Jacobsohn
- Division of Blood and Marrow Transplantation, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA
| | - R T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - K A Kasow
- Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - N Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - H M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - A K Malone
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M T Lupo-Stanghellini
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - S P Margossian
- Department of Pediatric Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - L S Muffly
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA, USA
| | - M Norkin
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - M Ramanathan
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worchester, MA, USA
| | | | - H Schoemans
- University Hospital of Leuven, Leuven, Belgium
| | - J R Wingard
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - B Wirk
- Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - W A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - A Yong
- Royal Adelaide Hospital/SA Pathology and School of Medicine, University of Adelaide, Adelaide, Australia
| | - C N Duncan
- Department of Pediatric Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - M E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - N S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
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Sanchez-Salcedo P, Wilson DO, de-Torres JP, Weissfeld JL, Berto J, Campo A, Alcaide AB, Pueyo J, Bastarrika G, Seijo LM, Pajares MJ, Pio R, Montuenga LM, Zulueta JJ. Improving selection criteria for lung cancer screening. The potential role of emphysema. Am J Respir Crit Care Med 2015; 191:924-31. [PMID: 25668622 DOI: 10.1164/rccm.201410-1848oc] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Lung cancer (LC) screening using low-dose chest computed tomography is now recommended in several guidelines using the National Lung Screening Trial (NLST) entry criteria (age, 55-74; ≥30 pack-years; tobacco cessation within the previous 15 yr for former smokers). Concerns exist about their lack of sensitivity. OBJECTIVES To evaluate the performance of NLST criteria in two different LC screening studies from Europe and the United States, and to explore the effect of using emphysema as a complementary criterion. METHODS Participants from the Pamplona International Early Lung Action Detection Program (P-IELCAP; n = 3,061) and the Pittsburgh Lung Screening Study (PLuSS; n = 3,638) were considered. LC cumulative frequencies, incidence densities, and annual detection rates were calculated in three hypothetical cohorts, including subjects who met NLST criteria alone, those with computed tomography-detected emphysema, and those who met NLST criteria and/or had emphysema. MEASUREMENTS AND MAIN RESULTS Thirty-six percent and 59% of P-IELCAP and PLuSS participants, respectively, met NLST criteria. Among these, higher LC incidence densities and detection rates were observed. However, applying NLST criteria to our original cohorts would miss as many as 39% of all LC. Annual screening of subjects meeting either NLST criteria or having emphysema detected most cancers (88% and 95% of incident LC of P-IELCAP and PLuSS, respectively) despite reducing the number of screened participants by as much as 52%. CONCLUSIONS LC screening based solely on NLST criteria could miss a significant number of LC cases. Combining NLST criteria and emphysema to select screening candidates results in higher LC detection rates and a lower number of cancers missed.
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36
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Recurrent Syncope Associated with Lung Cancer. Case Rep Med 2015; 2015:309784. [PMID: 26064126 PMCID: PMC4443876 DOI: 10.1155/2015/309784] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 04/29/2015] [Accepted: 05/01/2015] [Indexed: 12/02/2022] Open
Abstract
Syncope is an important problem in clinical practice with many possible causes that might be misdiagnosed. We present an unusual case of syncope, which has a normal chest X-ray. Exercise EKG and coronary angioplasty results confirmed the existence of serious coronary heart disease. The patient was treated with coronary stent transplantation. However, scope occurred again and the elevated tumor makers cytokeratin-19-fragment and neuron-specific enolase revealed the bronchogenic carcinoma, which was confirmed by enhanced CT examination. The treatment of carcinoma by chemotherapy was indeed sufficient for prompt elimination of the syncope symptoms.
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38
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Montani F, Marzi MJ, Dezi F, Dama E, Carletti RM, Bonizzi G, Bertolotti R, Bellomi M, Rampinelli C, Maisonneuve P, Spaggiari L, Veronesi G, Nicassio F, Di Fiore PP, Bianchi F. miR-Test: a blood test for lung cancer early detection. J Natl Cancer Inst 2015; 107:djv063. [PMID: 25794889 DOI: 10.1093/jnci/djv063] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Lung cancer is the leading cause of cancer death worldwide. Low-dose computed tomography screening (LDCT) was recently shown to anticipate the time of diagnosis, thus reducing lung cancer mortality. However, concerns persist about the feasibility and costs of large-scale LDCT programs. Such concerns may be addressed by clearly defining the target "high-risk" population that needs to be screened by LDCT. We recently identified a serum microRNA signature (the miR-Test) that could identify the optimal target population. Here, we performed a large-scale validation study of the miR-Test in high-risk individuals (n = 1115) enrolled in the Continuous Observation of Smoking Subjects (COSMOS) lung cancer screening program. The overall accuracy, sensitivity, and specificity of the miR-Test are 74.9% (95% confidence interval [CI] = 72.2% to 77.6%), 77.8% (95% CI = 64.2% to 91.4%), and 74.8% (95% CI = 72.1% to 77.5%), respectively; the area under the curve is 0.85 (95% CI = 0.78 to 0.92). These results argue that the miR-Test might represent a useful tool for lung cancer screening in high-risk individuals.
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Affiliation(s)
- Francesca Montani
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy (FM, FD, ED, RMC, GB, PPDF, FB); Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, 20139 Milan, Italy (MJM, FN); Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (ED, PM); IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy (RMC, PPDF); Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy (RB, LS, GV); Division of Radiology, European Institute of Oncology, Milan, Italy (MB, CR); Department of Scienze della Salute, University of Milan, Milan, Italy (MB, LS, PPDF)
| | - Matteo Jacopo Marzi
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy (FM, FD, ED, RMC, GB, PPDF, FB); Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, 20139 Milan, Italy (MJM, FN); Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (ED, PM); IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy (RMC, PPDF); Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy (RB, LS, GV); Division of Radiology, European Institute of Oncology, Milan, Italy (MB, CR); Department of Scienze della Salute, University of Milan, Milan, Italy (MB, LS, PPDF)
| | - Fabio Dezi
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy (FM, FD, ED, RMC, GB, PPDF, FB); Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, 20139 Milan, Italy (MJM, FN); Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (ED, PM); IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy (RMC, PPDF); Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy (RB, LS, GV); Division of Radiology, European Institute of Oncology, Milan, Italy (MB, CR); Department of Scienze della Salute, University of Milan, Milan, Italy (MB, LS, PPDF)
| | - Elisa Dama
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy (FM, FD, ED, RMC, GB, PPDF, FB); Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, 20139 Milan, Italy (MJM, FN); Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (ED, PM); IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy (RMC, PPDF); Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy (RB, LS, GV); Division of Radiology, European Institute of Oncology, Milan, Italy (MB, CR); Department of Scienze della Salute, University of Milan, Milan, Italy (MB, LS, PPDF)
| | - Rose Mary Carletti
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy (FM, FD, ED, RMC, GB, PPDF, FB); Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, 20139 Milan, Italy (MJM, FN); Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (ED, PM); IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy (RMC, PPDF); Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy (RB, LS, GV); Division of Radiology, European Institute of Oncology, Milan, Italy (MB, CR); Department of Scienze della Salute, University of Milan, Milan, Italy (MB, LS, PPDF)
| | - Giuseppina Bonizzi
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy (FM, FD, ED, RMC, GB, PPDF, FB); Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, 20139 Milan, Italy (MJM, FN); Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (ED, PM); IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy (RMC, PPDF); Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy (RB, LS, GV); Division of Radiology, European Institute of Oncology, Milan, Italy (MB, CR); Department of Scienze della Salute, University of Milan, Milan, Italy (MB, LS, PPDF)
| | - Raffaella Bertolotti
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy (FM, FD, ED, RMC, GB, PPDF, FB); Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, 20139 Milan, Italy (MJM, FN); Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (ED, PM); IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy (RMC, PPDF); Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy (RB, LS, GV); Division of Radiology, European Institute of Oncology, Milan, Italy (MB, CR); Department of Scienze della Salute, University of Milan, Milan, Italy (MB, LS, PPDF)
| | - Massimo Bellomi
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy (FM, FD, ED, RMC, GB, PPDF, FB); Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, 20139 Milan, Italy (MJM, FN); Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (ED, PM); IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy (RMC, PPDF); Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy (RB, LS, GV); Division of Radiology, European Institute of Oncology, Milan, Italy (MB, CR); Department of Scienze della Salute, University of Milan, Milan, Italy (MB, LS, PPDF)
| | - Cristiano Rampinelli
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy (FM, FD, ED, RMC, GB, PPDF, FB); Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, 20139 Milan, Italy (MJM, FN); Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (ED, PM); IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy (RMC, PPDF); Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy (RB, LS, GV); Division of Radiology, European Institute of Oncology, Milan, Italy (MB, CR); Department of Scienze della Salute, University of Milan, Milan, Italy (MB, LS, PPDF)
| | - Patrick Maisonneuve
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy (FM, FD, ED, RMC, GB, PPDF, FB); Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, 20139 Milan, Italy (MJM, FN); Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (ED, PM); IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy (RMC, PPDF); Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy (RB, LS, GV); Division of Radiology, European Institute of Oncology, Milan, Italy (MB, CR); Department of Scienze della Salute, University of Milan, Milan, Italy (MB, LS, PPDF)
| | - Lorenzo Spaggiari
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy (FM, FD, ED, RMC, GB, PPDF, FB); Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, 20139 Milan, Italy (MJM, FN); Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (ED, PM); IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy (RMC, PPDF); Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy (RB, LS, GV); Division of Radiology, European Institute of Oncology, Milan, Italy (MB, CR); Department of Scienze della Salute, University of Milan, Milan, Italy (MB, LS, PPDF)
| | - Giulia Veronesi
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy (FM, FD, ED, RMC, GB, PPDF, FB); Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, 20139 Milan, Italy (MJM, FN); Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (ED, PM); IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy (RMC, PPDF); Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy (RB, LS, GV); Division of Radiology, European Institute of Oncology, Milan, Italy (MB, CR); Department of Scienze della Salute, University of Milan, Milan, Italy (MB, LS, PPDF)
| | - Francesco Nicassio
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy (FM, FD, ED, RMC, GB, PPDF, FB); Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, 20139 Milan, Italy (MJM, FN); Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (ED, PM); IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy (RMC, PPDF); Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy (RB, LS, GV); Division of Radiology, European Institute of Oncology, Milan, Italy (MB, CR); Department of Scienze della Salute, University of Milan, Milan, Italy (MB, LS, PPDF)
| | - Pier Paolo Di Fiore
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy (FM, FD, ED, RMC, GB, PPDF, FB); Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, 20139 Milan, Italy (MJM, FN); Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (ED, PM); IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy (RMC, PPDF); Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy (RB, LS, GV); Division of Radiology, European Institute of Oncology, Milan, Italy (MB, CR); Department of Scienze della Salute, University of Milan, Milan, Italy (MB, LS, PPDF)
| | - Fabrizio Bianchi
- Molecular Medicine Program, Department of Experimental Oncology, European Institute of Oncology, Milan, Italy (FM, FD, ED, RMC, GB, PPDF, FB); Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, 20139 Milan, Italy (MJM, FN); Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (ED, PM); IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy (RMC, PPDF); Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy (RB, LS, GV); Division of Radiology, European Institute of Oncology, Milan, Italy (MB, CR); Department of Scienze della Salute, University of Milan, Milan, Italy (MB, LS, PPDF)
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Bunn PA, Kim ES. Improving the Care of Patients With Stage IB Non-Small-Cell Lung Cancer: Role of Prognostic Signatures and Use of Cell Cycle Progression Biomarkers. Clin Lung Cancer 2015; 16:245-51. [PMID: 25887065 DOI: 10.1016/j.cllc.2015.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/23/2015] [Accepted: 02/26/2015] [Indexed: 01/01/2023]
Abstract
Patients with non-small-cell lung cancer have relatively poor survival outcomes after surgery (overall 5-year survival rate < 50%). Adjuvant chemotherapy adds only a small incremental survival benefit (hazard ratio, 0.89) with a 5% improvement in 5-year survival. There is no proven benefit to adjuvant chemotherapy in stage 1A or 1B disease. However, for patients with stage IB disease, outcomes after chemotherapy have been mixed; therefore, additional risk stratification measures are needed to guide decision-making in this patient population. Several significant prognostic indicators have been identified, including the presence of poorly differentiated tumors, tumors > 4 cm, blood vessel invasion, visceral pleural invasion, and incomplete lymph node dissection. A new risk stratification tool based on the expression of cell cycle genes recently has become available. Assessment of cell cycle gene expression may provide useful prognostic and predictive data when considered along with existing prognostic indicators to help identify patients with a poor prognosis and highly proliferative disease who would benefit the most from adjuvant chemotherapy.
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Affiliation(s)
- Paul A Bunn
- University of Colorado Cancer Center, Aurora, CO.
| | - Edward S Kim
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
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