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Hickey M, Basu P, Sassarini J, Stegmann ME, Weiderpass E, Nakawala Chilowa K, Yip CH, Partridge AH, Brennan DJ. Managing menopause after cancer. Lancet 2024; 403:984-996. [PMID: 38458217 DOI: 10.1016/s0140-6736(23)02802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/18/2023] [Accepted: 12/11/2023] [Indexed: 03/10/2024]
Abstract
Globally, 9 million women are diagnosed with cancer each year. Breast cancer is the most commonly diagnosed cancer worldwide, followed by colorectal cancer in high-income countries and cervical cancer in low-income countries. Survival from cancer is improving and more women are experiencing long-term effects of cancer treatment, such as premature ovarian insufficiency or early menopause. Managing menopausal symptoms after cancer can be challenging, and more severe than at natural menopause. Menopausal symptoms can extend beyond hot flushes and night sweats (vasomotor symptoms). Treatment-induced symptoms might include sexual dysfunction and impairment of sleep, mood, and quality of life. In the long term, premature ovarian insufficiency might increase the risk of chronic conditions such as osteoporosis and cardiovascular disease. Diagnosing menopause after cancer can be challenging as menopausal symptoms can overlap with other common symptoms in patients with cancer, such as fatigue and sexual dysfunction. Menopausal hormone therapy is an effective treatment for vasomotor symptoms and seems to be safe for many patients with cancer. When hormone therapy is contraindicated or avoided, emerging evidence supports the efficacy of non-pharmacological and non-hormonal treatments, although most evidence is based on women older than 50 years with breast cancer. Vaginal oestrogen seems safe for most patients with genitourinary symptoms, but there are few non-hormonal options. Many patients have inadequate centralised care for managing menopausal symptoms after cancer treatment, and more information is needed about cost-effective and patient-focused models of care for this growing population.
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Affiliation(s)
- Martha Hickey
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC, Australia.
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Jenifer Sassarini
- Department of Obstetrics and Gynaecology, School of Gynaecology, University of Glasgow, Glasgow, UK
| | - Mariken E Stegmann
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | | | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Donal J Brennan
- Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland; Systems Biology Ireland, UCD School of Medicine, Dublin, Ireland
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Fiol G, Lete I, Nieto L, Santaballa A, Pla MJ, Baquedano L, Calaf J, Coronado P, de la Viuda E, Llaneza P, Otero B, Sánchez-Méndez S, Ramírez I, Mendoza N. Associations between Menopausal Hormone Therapy and Colorectal, Lung, or Melanoma Cancer Recurrence and Mortality: A Narrative Review. J Clin Med 2023; 12:5263. [PMID: 37629305 PMCID: PMC10455141 DOI: 10.3390/jcm12165263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Objective: to develop eligibility criteria for use in non-gynecological cancer patients. Methods: We searched all the articles published in peer-reviewed journals up to March 2021. We utilized the PICOS standards and the following selection criteria: menopausal women with a history of non-gynecological and non-breast cancer who underwent hormone replacement therapy (HRT) using various preparations (oestrogens alone or in combination with a progestogen, tibolone, or tissue selective oestrogen complex) and different routes of administration (including oral, transdermal, vaginal, or intra-nasal). We focused on randomized controlled trials as well as relevant extension studies or follow-up reports, specifically examining recurrence and mortality outcomes. Results: Women colorectal cancer survivors who use MHT have a lower risk of death from any cause than those survivors who do not use MHT. Women who are skin melanoma survivors using MHT have a longer survival rate than non-MHT survivors. There is no evidence that women lung cancer survivors who use MHT have a different survival rate than those who do not use MHT. Conclusions: MHT is safe for women who have a history of colorectal, lung, or skin melanoma cancers.
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Affiliation(s)
- Gabriel Fiol
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Iñaki Lete
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Laura Nieto
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Ana Santaballa
- Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica), 28001 Madrid, Spain;
| | - María Jesús Pla
- Gynecological Oncology Section of the Spanish Society of Gynecology and Obstetrics (Sección de Oncología Ginecológica de la Sociedad Española de Ginecología y Obstetricia), 28036 Madrid, Spain;
| | - Laura Baquedano
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Joaquín Calaf
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Pluvio Coronado
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Esther de la Viuda
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Plácido Llaneza
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Borja Otero
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Sonia Sánchez-Méndez
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Isabel Ramírez
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Nicolas Mendoza
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
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Zhang J, Tang K, Liu L, Guo C, Zhao K, Li S. Management of pulmonary nodules in women with pregnant intention: A review with perspective. Ann Thorac Med 2023; 18:61-69. [PMID: 37323371 PMCID: PMC10263075 DOI: 10.4103/atm.atm_270_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 06/17/2023] Open
Abstract
The process for the management of pulmonary nodules in women with pregnant intention remains a challenge. There was a certain proportion of targeted female patients with high-risk lung cancer, and anxiety for suspicious lung cancer in early stage also exists. A comprehensive review of hereditary of lung cancer, effects of sexual hormone on lung cancer, natural history of pulmonary nodules, and computed tomography imaging with radiation exposure based on PubMed search was completed. The heredity of lung cancer and effects of sexual hormone on lung cancer are not the decisive factors, and the natural history of pulmonary nodules and the radiation exposure of imaging should be the main concerns. The management of incidental pulmonary nodules in young women with pregnant intention is an intricate and indecisive problem we have to encounter. The balance between the natural history of pulmonary nodules and the radiation exposure of imaging should be weighed.
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Affiliation(s)
- Jiaqi Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kun Tang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
- Institute of Respiratory Disease of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke Zhao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yang K, Li Z, Chen Y, Yin F, Ji X, Zhou J, Li X, Zeng T, Fei C, Ren C, Wang Y, Fang L, Chen L, Zhang P, Mu L, Qian Y, Chen Y, Yin W. Na, K-ATPase α1 cooperates with its endogenous ligand to reprogram immune microenvironment of lung carcinoma and promotes immune escape. SCIENCE ADVANCES 2023; 9:eade5393. [PMID: 36763655 PMCID: PMC9916986 DOI: 10.1126/sciadv.ade5393] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
Dysregulated endocrine hormones (EHs) contribute to tumorigenesis, but how EHs affect the tumor immune microenvironment (TIM) and the immunotherapy of non-small cell lung cancer (NSCLC) is still unclear. Here, endogenous ouabain (EO), an adrenergic hormone, is elevated in patients with NSCLC and closely related to tumor pathological stage, metastasis, and survival. EO promotes the suppression of TIM in vivo by modulating the expression of immune checkpoint proteins, in which programmed cell death protein ligand 1 (PD-L1) plays a major role. EO increases PD-L1 transcription; however, the EO receptor Na- and K-dependent adenosine triphosphatase (Na, K-ATPase) α1 interacts with PD-L1 to trigger the endocytic degradation of PD-L1. This seemingly contradictory result led us to discover the mechanism whereby EO cooperates with Na, K-ATPase α1 to finely control PD-L1 expression and dampen tumoral immunity. In conclusion, the Na, K-ATPase α1/EO signaling facilitates immune escape in lung cancer, and manipulation of this signaling shows great promise in improving immunotherapy for lung adenocarcinoma.
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Affiliation(s)
- Kaiyong Yang
- State Key Laboratory of Pharmaceutical Biotechnology, College of Life Sciences, Nanjing University, Nanjing 210023, China
- Department of Biochemistry and Molecular Biology, School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Zijian Li
- State Key Laboratory of Pharmaceutical Biotechnology, College of Life Sciences, Nanjing University, Nanjing 210023, China
| | - Yan Chen
- State Key Laboratory of Pharmaceutical Biotechnology, College of Life Sciences, Nanjing University, Nanjing 210023, China
| | - Fangzhou Yin
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Xiaojun Ji
- State Key Laboratory of Pharmaceutical Biotechnology, College of Life Sciences, Nanjing University, Nanjing 210023, China
| | - Jiaqian Zhou
- State Key Laboratory of Pharmaceutical Biotechnology, College of Life Sciences, Nanjing University, Nanjing 210023, China
| | - Xin Li
- State Key Laboratory of Pharmaceutical Biotechnology, College of Life Sciences, Nanjing University, Nanjing 210023, China
| | - Tao Zeng
- State Key Laboratory of Pharmaceutical Biotechnology, College of Life Sciences, Nanjing University, Nanjing 210023, China
| | - Chenghao Fei
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Chenchen Ren
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Yulin Wang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Lei Fang
- Jiangsu Key Laboratory of Molecular Medicine, Chemistry and Biomedicine Innovation Center, Medical School of Nanjing University, Nanjing 210093, China
| | - Lili Chen
- State Key Laboratory of Pharmaceutical Biotechnology, College of Life Sciences, Nanjing University, Nanjing 210023, China
| | - Pei Zhang
- State Key Laboratory of Pharmaceutical Biotechnology, College of Life Sciences, Nanjing University, Nanjing 210023, China
| | - Liyan Mu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Yuxuan Qian
- State Key Laboratory of Pharmaceutical Biotechnology, College of Life Sciences, Nanjing University, Nanjing 210023, China
| | - Yan Chen
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Wu Yin
- State Key Laboratory of Pharmaceutical Biotechnology, College of Life Sciences, Nanjing University, Nanjing 210023, China
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Rao J, Yu Y, Zhang L, Wang X, Wang P, Wang Z. A nomogram for predicting postoperative overall survival of patients with lung squamous cell carcinoma: A SEER-based study. Front Surg 2023; 10:1143035. [PMID: 37091268 PMCID: PMC10118027 DOI: 10.3389/fsurg.2023.1143035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Background Lung squamous cell carcinoma (LSCC) is a common subtype of non-small cell lung cancer. Our study aimed to construct and validate a nomogram for predicting overall survival (OS) for postoperative LSCC patients. Methods A total of 8,078 patients eligible for recruitment between 2010 and 2015 were selected from the Surveillance, Epidemiology, and End Results database. Study outcomes were 1-, 2- and 3-year OS. Analyses performed included univariate and multivariate Cox regression, receiver operating characteristic (ROC) curve construction, calibration plotting, decision curve analysis (DCA) and Kaplan-Meier survival plotting. Results Seven variables were selected to establish our predictive nomogram. Areas under the ROC curves were 0.658, 0.651 and 0.647 for the training cohort and 0.673, 0.667 and 0.658 for the validation cohort at 1-, 2- and 3-year time-points, respectively. Calibration curves confirmed satisfactory consistencies between nomogram-predicted and observed survival probabilities, while DCA confirmed significant clinical usefulness of our model. For risk stratification, patients were divided into three risk groups with significant differences in OS on Kaplan-Meier analysis (P < 0.001). Conclusion Here, we designed and validated a prognostic nomogram for OS in postoperative LSCC patients. Application of our model in the clinical setting may assist clinicians in evaluating patient prognosis and providing highly individualized therapy.
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Affiliation(s)
- Jin Rao
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yue Yu
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Li Zhang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
- Medical College, Guangxi University, Nanning, China
| | - Xuefu Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Pei Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhinong Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
- Correspondence: Zhinong Wang
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Mendoza N, Ramírez I, de la Viuda E, Coronado P, Baquedano L, Llaneza P, Nieto V, Otero B, Sánchez-Méndez S, de Frutos VÁ, Andraca L, Barriga P, Benítez Z, Bombas T, Cancelo MJ, Cano A, Branco CC, Correa M, Doval JL, Fasero M, Fiol G, Garello NC, Genazzani AR, Gómez AI, Gómez MÁ, González S, Goulis DG, Guinot M, Hernández LR, Herrero S, Iglesias E, Jurado AR, Lete I, Lubián D, Martínez M, Nieto A, Nieto L, Palacios S, Pedreira M, Pérez-Campos E, Plá MJ, Presa J, Quereda F, Ribes M, Romero P, Roca B, Sánchez-Capilla A, Sánchez-Borrego R, Santaballa A, Santamaría A, Simoncini T, Tinahones F, Calaf J. Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group. Maturitas 2022; 166:65-85. [PMID: 36081216 DOI: 10.1016/j.maturitas.2022.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/21/2022] [Accepted: 08/17/2022] [Indexed: 11/26/2022]
Abstract
This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.
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Affiliation(s)
- Nicolás Mendoza
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain.
| | - Isabel Ramírez
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | - Pluvio Coronado
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Laura Baquedano
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Plácido Llaneza
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Verónica Nieto
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Borja Otero
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | | | - Leire Andraca
- Sociedad Española de Farmacia Comunitaria (SEFAC), Spain
| | | | - Zully Benítez
- Federación Latino Americana de Sociedades de Climaterio y Menopausia (FLASCYM)
| | - Teresa Bombas
- Red Iberoamericana de Salud Sexual y Reproductiva (REDISSER)
| | | | - Antonio Cano
- European Menopause and Andropause Society (EMAS)
| | | | | | - José Luis Doval
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - María Fasero
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Gabriel Fiol
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Nestor C Garello
- Federación Latino-Americana de Sociedades de Obstetricia y Ginecología (FLASOG)
| | | | - Ana Isabel Gómez
- Sociedad Española de Senología y Patología Mamaria (SESPM), Spain
| | - Mª Ángeles Gómez
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Silvia González
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | | | | | - Sonia Herrero
- Sociedad Española de Trombosis y Hemostasia (SETH), Spain
| | - Eva Iglesias
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Ana Rosa Jurado
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Spain
| | - Iñaki Lete
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Daniel Lubián
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | - Aníbal Nieto
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Laura Nieto
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | | | | | | | - Jesús Presa
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | - Miriam Ribes
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Pablo Romero
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Beatriz Roca
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | | | | | | | | | | | | | - Joaquín Calaf
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
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Bütepage G, Carlqvist P, Jacob J, Toft Hornemann A, Vertuani S. Overall survival of individuals with metastatic cancer in Sweden: a nationwide study. BMC Public Health 2022; 22:1913. [PMID: 36229841 PMCID: PMC9563107 DOI: 10.1186/s12889-022-14255-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022] Open
Abstract
Aims Consistent improvements for overall survival (OS) have been reported for individuals with metastatic cancer. Swedish population-based registers allow national coverage and long follow-up time. The aim of this study was to estimate and explore long-term OS of individuals diagnosed with metastatic cancer using Swedish nationwide health registers. Methods Individuals with metastatic breast (MBC), non-small cell lung (MNSCLC), ovary (MOC) or colorectal cancer (MCRC) or metastatic malignant melanoma (MMM) were identified in the Swedish national cancer register and national patient registers. Survival was estimated and stratified by available variables. Potential cure fractions were estimated using mixture cure models. Results In total, approximately 69,000 individuals were identified. The most common cancers were MCRC (36.2%) and MNSCLC (29.5%). Men were more frequently diagnosed with MNSCLC, MCRC, and MMM compared to women. Except for MOC, about 50% of individuals were 70 years or older at diagnosis. Throughout the study period survival differed across cancers. The longest median OS was observed for individuals with MOC and MBC. At 10 years of follow-up, the survival curves flatten at a survival rate of approximately 10% for all cancers except MNSCLC. The youngest age groups had the longest median OS. Increased survival was also observed for individuals diagnosed in 2015 and 2018 compared to individuals diagnosed during earlier years. The estimated cure fractions were 4% for MBC, 1.5% for MNSCLC, 6.8% for MCRC, 8.6% for MOC and MMM. Conclusions Long-term survival has been assessed across all indications except for NSCLC.. The findings may be relevant for healthcare planning to meet the needs of future patients and potential long-term survivors. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14255-w.
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Abstract
Lung cancer represents the world's leading cause of cancer deaths. Sex differences in the incidence and mortality rates for various types of lung cancers have been identified, but the biological and endocrine mechanisms implicated in these disparities have not yet been determined. While some cancers such as lung adenocarcinoma are more commonly found among women than men, others like squamous cell carcinoma display the opposite pattern or show no sex differences. Associations of tobacco product use rates, susceptibility to carcinogens, occupational exposures, and indoor and outdoor air pollution have also been linked to differential rates of lung cancer occurrence and mortality between sexes. While roles for sex hormones in other types of cancers affecting women or men have been identified and described, little is known about the influence of sex hormones in lung cancer. One potential mechanism identified to date is the synergism between estrogen and some tobacco compounds, and oncogene mutations, in inducing the expression of metabolic enzymes, leading to enhanced formation of reactive oxygen species and DNA adducts, and subsequent lung carcinogenesis. In this review, we present the literature available regarding sex differences in cancer rates, associations of male and female sex hormones with lung cancer, the influence of exogenous hormone therapy in women, and potential mechanisms mediated by male and female sex hormone receptors in lung carcinogenesis. The influence of biological sex on lung disease has recently been established, thus new research incorporating this variable will shed light on the mechanisms behind the observed disparities in lung cancer rates, and potentially lead to the development of new therapeutics to treat this devastating disease.
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Affiliation(s)
- Nathalie Fuentes
- National Institute of Allergy and Infectious Diseases, Bethesda, MD 20852, USA
| | - Miguel Silva Rodriguez
- Department of Environmental and Occupational Health, Indiana University, School of Public Health, Bloomington, IN 47405, USA
| | - Patricia Silveyra
- Department of Environmental and Occupational Health, Indiana University, School of Public Health, Bloomington, IN 47405, USA
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9
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Pilleron S, Maringe C, Charvat H, Atkinson J, Morris E, Sarfati D. Age disparities in lung cancer survival in New Zealand: The role of patient and clinical factors. Lung Cancer 2021; 157:92-99. [PMID: 34006378 DOI: 10.1016/j.lungcan.2021.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Age is an important prognostic factor for lung cancer. However, no studies have investigated the age difference in lung cancer survival per se. We, therefore, described the role of patient-related and clinical factors on the age pattern in lung cancer excess mortality hazard by stage at diagnosis in New Zealand. MATERIALS AND METHODS We extracted 22 487 new lung cancer cases aged 50-99 (median age = 71, 47.1 % females) diagnosed between 1 January 2006 and 31 July 2017 from the New Zealand population-based cancer registry and followed up to December 2019. We modelled the effect of age at diagnosis, sex, ethnicity, deprivation, comorbidity, and emergency presentation on the excess mortality hazard by stage at diagnosis, and we derived corresponding lung cancer net survival. RESULTS The age difference in net survival was particularly marked for localised and regional lung cancers, with a sharp decline in survival from the age of 70. No identified factors influenced age disparities in patients with localised cancer. However, for other stages, females had a greater difference in survival between middle-age and older-age than males. Comorbidity and emergency presentation played a minor role. Ethnicity and deprivation did not influence age disparities in lung cancer survival. CONCLUSION Sex and stage at diagnosis were the most important factors of age disparities in lung cancer survival in New Zealand.
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Affiliation(s)
- Sophie Pilleron
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand; Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Camille Maringe
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Hadrien Charvat
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
| | - June Atkinson
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand.
| | - Eva Morris
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK. https://www.twitter.com/EJAMorris
| | - Diana Sarfati
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand. https://www.twitter.com/DiSarfati
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10
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Pilleron S, Gower H, Janssen-Heijnen M, Signal VC, Gurney JK, Morris EJ, Cunningham R, Sarfati D. Patterns of age disparities in colon and lung cancer survival: a systematic narrative literature review. BMJ Open 2021; 11:e044239. [PMID: 33692182 PMCID: PMC7949400 DOI: 10.1136/bmjopen-2020-044239] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To identify patterns of age disparities in cancer survival, using colon and lung cancer as exemplars. DESIGN Systematic review of the literature. DATA SOURCES We searched Embase, MEDLINE, Scopus and Web of Science through 18 December 2020. ELIGIBILITY CRITERIA We retained all original articles published in English including patients with colon or lung cancer. Eligible studies were required to be population-based, report survival across several age groups (of which at least one was over the age of 65) and at least one other characteristic (eg, sex, treatment). DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed the quality of included studies against selected evaluation domains from the QUIPS tool, and items concerning statistical reporting. We evaluated age disparities using the absolute difference in survival or mortality rates between the middle-aged group and the oldest age group, or by describing survival curves. RESULTS Out of 3047 references, we retained 59 studies (20 for colon, 34 for lung and 5 for both sites). Regardless of the cancer site, the included studies were highly heterogeneous and often of poor quality. The magnitude of age disparities in survival varied greatly by sex, ethnicity, socioeconomic status, stage at diagnosis, cancer site, and morphology, the number of nodes examined and treatment strategy. Although results were inconsistent for most characteristics, we consistently observed greater age disparities for women with lung cancer compared with men. Also, age disparities increased with more advanced stages for colon cancer and decreased with more advanced stages for lung cancer. CONCLUSIONS Although age is one of the most important prognostic factors in cancer survival, age disparities in colon and lung cancer survival have so far been understudied in population-based research. Further studies are needed to better understand age disparities in colon and lung cancer survival. PROSPERO REGISTRATION NUMBER CRD42020151402.
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Affiliation(s)
- Sophie Pilleron
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Helen Gower
- Department of Surgery and Anaesthesia, Surgical Cancer Research Group, University of Otago, Wellington, New Zealand
| | - Maryska Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Epidemiology, Maastricht University Medical Centre+, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Virginia Claire Signal
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Jason K Gurney
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Eva Ja Morris
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Oxford, UK
| | - Ruth Cunningham
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Diana Sarfati
- New Zealand Cancer Control Agency, Wellington, New Zealand
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11
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Elkbuli A, Byrne MM, Zhao W, Sutherland M, McKenney M, Godinez Y, Dave DJ, Bouzoubaa L, Koru-Sengul T. Gender disparities in lung cancer survival from an enriched Florida population-based cancer registry. Ann Med Surg (Lond) 2020; 60:680-685. [PMID: 33318793 PMCID: PMC7723764 DOI: 10.1016/j.amsu.2020.11.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 12/24/2022] Open
Abstract
Background Previous studies have revealed gender disparities in lung cancer survivorship, but comprehensive inclusion of clinical/individual variables which affect outcomes is underreported. We utilized the Florida Data Cancer System (FCDS) to examine associations between gender and lung cancer survivorship while controlling for prognostic variables on a large population-based scale. Methods A retrospective cohort analysis utilizing the FCDS, linked to Florida Agency for Health Care Administration and US Census Bureau tracts for patients diagnosed with primary lung cancer (n = 165,465) from 1996 to 2007. Primary outcome measures included median survival time and mortality. Multivariable Cox regression models, independent sample T-tests, and descriptive statistics were utilized with significance defined as p < 0.05. Results 165,465 cases were analyzed revealing 44.3% females and 55.7% males. The majority of patients were white/Caucasian, males, middle-high socioeconomic status, lived in urban areas, and geriatric age. Females had longer median survival compared to males (9.6 vs 7.1 months). Multivariable analyses showed that women had better survival after controlling for sociodemographic, clinical, and comorbidity covariates. Males had higher risk of mortality than females (aHR = 1.17, 95%CI 1.14-1.19, p < 0.01). Conclusions Individuals of higher socioeconomic status experienced greater survivorship compared to those of lower socioeconomic status. Women experienced significantly better survival for lung cancer at multiple time frames after controlling for covariates compared to men. Interventions aimed at public education and access to high-quality healthcare are needed to ameliorate socioeconomic and gender-based disparities in lung cancer survivorship. Future studies should investigate gender differences in lung cancer while incorporating individual socioeconomic status and treatment received.
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Affiliation(s)
- Adel Elkbuli
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120, NW 14Street, Don Soffer Clinical Research Center, Miami, FL, 33136, USA.,Department of Surgery, Kendall Regional Medical Center, 11750 SW 40th St, Miami, FL, 33175, USA
| | - Margaret M Byrne
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120, NW 14Street, Don Soffer Clinical Research Center, Miami, FL, 33136, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Mason Sutherland
- Department of Surgery, Kendall Regional Medical Center, 11750 SW 40th St, Miami, FL, 33175, USA
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, 11750 SW 40th St, Miami, FL, 33175, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Yeissen Godinez
- Department of Internal Medicine, Kendall Regional Medical Center, 11750 SW 40th St, Miami, FL, 33175, USA
| | - Devina J Dave
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120, NW 14Street, Don Soffer Clinical Research Center, Miami, FL, 33136, USA
| | - Layla Bouzoubaa
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120, NW 14Street, Don Soffer Clinical Research Center, Miami, FL, 33136, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120, NW 14Street, Don Soffer Clinical Research Center, Miami, FL, 33136, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, 33136, USA
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12
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Costa GJ, Silva GTD, Ferreira CG, Mello MJGD, Bergmann A, Thuler LCS. Brazilian Women With Lung Cancer Have a Higher Overall Survival Than Their Male Equivalents: A Cohort Study. Clin Lung Cancer 2020; 22:e313-e319. [PMID: 32665167 DOI: 10.1016/j.cllc.2020.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 04/18/2020] [Accepted: 05/14/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lung cancer is the principal cause of cancer-related deaths worldwide; however, there has been controversy as to whether there is a difference in survival rate according to gender in Brazil. The aim of the present study, therefore, was to compare the epidemiologic and clinical profile and the overall survival of patients with lung cancer according to gender. PATIENTS AND METHODS A retrospective cohort study was performed involving 1283 patients diagnosed with lung cancer between 2006 and 2014 at a single cancer center. Survival analysis was conducted using Kaplan-Meier statistics. A log-rank test was used to assess differences between survival curves, and Cox proportional hazards regression analysis was performed to quantitate the relationship between gender and overall survival. RESULTS Compared with men, women were more frequently younger (P < .001), nonsmokers (P = .007), diagnosed with adenocarcinoma (P < .001), had early stage disease (P < .001), received surgery or surgery in combination with chemotherapy (P < .001), and had a better survival rate (P < .001). The median overall survival rate was higher in women (14.2 vs. 10.5 months in men; P < .001). Cox regression-adjusted analysis shows that women were 16% less likely to die than men (hazard ratio, 0.84; 95% confidence interval, 0.72-0.98; P = .03). CONCLUSIONS A higher overall survival rate was found in women with lung cancer as compared with men with lung cancer in Brazil.
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Affiliation(s)
- Guilherme Jorge Costa
- Department of Oncology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil; Department of Research and Education, Hospital de Câncer de Pernambuco, Recife, Pernambuco, Brazil.
| | - Gustavo Telles da Silva
- Department of Physiotherapy, National Cancer Institute, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Anke Bergmann
- Research Centre, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
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13
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Li Y, Huang C, Kavlashvili T, Fronk A, Zhang Y, Wei Y, Dai D, Devor EJ, Meng X, Thiel KW, Leslie KK, Yang S. Loss of progesterone receptor through epigenetic regulation is associated with poor prognosis in solid tumors. Am J Cancer Res 2020; 10:1827-1843. [PMID: 32642294 PMCID: PMC7339273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/30/2020] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Hormonal therapy using progestins, acting through the progesterone receptor (PR), is a well-established method to treat uterine endometrial hyperplasia and carcinoma. Recent population studies indicate that progestin exposure significantly reduces the incidence of ovarian, pancreatic and lung cancers in addition to endometrial cancer in women. This unexpected differentiating function of progestin in organs outside of the reproductive system led us to hypothesize that progestins/PR are protective against cancer development and progression in many tumor types. METHODS The Cancer Genome Atlas, Oncomine and Prognostic Databases were searched to determine the relative expression of PR in tumors from multiple sites, and clinical outcomes linked to PR expression were determined. In addition, mRNA and protein expression were evaluated using real-time PCR and Western blotting. Chromatin immunoprecipitation (ChIP) assay was performed to understand the PR downregulation mechanisms in tumor cells and patient samples. Methylation-specific PCR was conducted to survey the PR methylation status. The Student's t-test were performed to determine significance. Flow cytometry was used to quantify apoptotic cells. RESULTS Low PR expression levels were consistently linked to less favorable clinical outcomes in endometrial, pancreatic, ovarian and non-small cell lung cancers. Clinical specimens and cell lines from these cancers demonstrate low levels of PR, and we now report that the mechanism for loss of PR is mediated through epigenetic repression. However, PR silencing can be overcome with epigenetic modulators. Histone deacetylase inhibitor (LBH589) and hypomethylating agent (5-aza-decitabine) restored functional PR expression at both the mRNA and protein levels and promoted marked cell death through induction of apoptosis in the presence of progesterone. CONCLUSIONS Our studies support the possibility that progestin therapy in combination with epigenetic modulators, a concept we term "molecularly enhanced progestin therapy", is an approach worthy of study for malignancies originating from tissues outside of the reproductive tract.
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Affiliation(s)
- Yiyang Li
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of IowaIA 52242, USA
- Department of Gynecology, First Hospital of Jilin UniversityChangchun 130021, Jilin, China
| | - Cheng Huang
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of IowaIA 52242, USA
- Jiangsu Vocational College of MedicineYancheng 224000, Jiangsu, China
| | - Tamar Kavlashvili
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of IowaIA 52242, USA
- Univesity of VanderbiltNashville, TN 37240, USA
| | - Abby Fronk
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of IowaIA 52242, USA
| | - Yuping Zhang
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of IowaIA 52242, USA
| | - Yang Wei
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of IowaIA 52242, USA
| | - Donghai Dai
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of IowaIA 52242, USA
- Carver College of Medicine and Holden Comprehensive Cancer Center, University of IowaIA 52242, USA
| | - Eric J Devor
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of IowaIA 52242, USA
- Carver College of Medicine and Holden Comprehensive Cancer Center, University of IowaIA 52242, USA
| | - Xiangbing Meng
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of IowaIA 52242, USA
- Department of Pathology, Carver College of Medicine, University of IowaIA 52242, USA
- Carver College of Medicine and Holden Comprehensive Cancer Center, University of IowaIA 52242, USA
| | - Kristina W Thiel
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of IowaIA 52242, USA
| | - Kimberly K Leslie
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of IowaIA 52242, USA
- Department of Pathology, Carver College of Medicine, University of IowaIA 52242, USA
| | - Shujie Yang
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of IowaIA 52242, USA
- Department of Pathology, Carver College of Medicine, University of IowaIA 52242, USA
- Carver College of Medicine and Holden Comprehensive Cancer Center, University of IowaIA 52242, USA
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14
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Molinier O, Goupil F, Debieuvre D, Auliac JB, Jeandeau S, Lacroix S, Martin F, Grivaux M. Five-year survival and prognostic factors according to histology in 6101 non-small-cell lung cancer patients. Respir Med Res 2019; 77:46-54. [PMID: 32036284 DOI: 10.1016/j.resmer.2019.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 10/14/2019] [Accepted: 10/20/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To estimate five-year survival in non-small-cell lung cancer (NSCLC) patients according to histology and to identify independent prognostic factors by histology. METHODS Data were obtained during the KBP-2010-CPHG study, which included all new cases of primary lung cancer diagnosed in 2010 in 104 non-academic hospitals. RESULTS In all, 3199 patients had adenocarcinoma (ADC), 1852 squamous cell carcinoma (SCC), 754 large cell carcinoma (LCC). Five-year survival was 13.3% [12.1%-14.5%] for ADC, 14.3% [12.7%-16.0%] for SCC, 9.6% [7.6%-11.9%] for LCC (P<0.001). Performance status, weight loss prior to diagnosis and tumour stage were consistently significant independent prognostic factors. Age (>70 years; P=0.004), male gender (P<0.001), and smoking (P<0.001) were independent negative prognostic factors for ADC. Epidermal Growth Factor Receptor (EGFR)-mutation tests, performed in 1638 ADC patients, were positive for 186. Five-year survival was 14.7% [10.3%-21%] and 10.9% [9.4%-12.6%] for mutated and wild-type EGFR, respectively (P<0.001). EFGR mutation was an independent positive prognostic factor (HR=0.5 [0.4-0.6], P<0.001); however, the proportional hazards assumption was not fulfilled and hazards were inverted after 35 months. CONCLUSIONS Five-year survival in patients managed in French non-academic hospitals for primary NSCLC in 2010 remained poor (<15%), whatever the histologic type. The independent negative prognostic factors for five-year survival were: weight, particularly weight loss prior to diagnosis; smoking (active or former) at diagnosis in ADC and LCC and smoking level at diagnosis in smoker patients with SCC. The independent positive prognostic factors were young age and female gender for ADC.
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Affiliation(s)
- O Molinier
- Respiratory medicine department, hospital, avenue Rubillard, 72037 Le Mans, France.
| | - F Goupil
- Respiratory medicine department, hospital, avenue Rubillard, 72037 Le Mans, France.
| | - D Debieuvre
- Pneumology department, Regional Hospital Group Mulhouse-Sud Alsace, Emile Muller hospital, 20 Avenue du Docteur René Laennec, 68070 Mulhouse, France.
| | - J-B Auliac
- Respiratory medicine department, François Quesnay hospital, 2, boulevard Sully, 78200 Mantes-la-Jolie, France.
| | - S Jeandeau
- Respiratory medicine department, National Medical Center MGEN, 4, Les Bains, 23006 Sainte-Feyre, France.
| | - S Lacroix
- Respiratory medicine department, Périgueux hospital, 80, avenue Georges-Pompidou, 24000 Périgueux, France.
| | - F Martin
- Pneumology and sleep disorders department, Compiègne-Noyon, Intercommunal Hospital, 8, avenue Henri Adnot, BP 50029, 60321 Compiègne cedex, France.
| | - M Grivaux
- Respiratory medicine department, hospital, 6-8, rue Saint Fiacre, BP 218, 77104 Meaux cedex, France.
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15
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Klugman M, Xue X, Hosgood HD. Race/ethnicity and lung cancer survival in the United States: a meta-analysis. Cancer Causes Control 2019; 30:1231-1241. [DOI: 10.1007/s10552-019-01229-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/04/2019] [Indexed: 12/11/2022]
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16
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Koh YW, Lee D, Lee SJ. Intratumoral heterogeneity as measured using the tumor-stroma ratio and PET texture analyses in females with lung adenocarcinomas differs from that of males with lung adenocarcinomas or squamous cell carcinomas. Medicine (Baltimore) 2019; 98:e14876. [PMID: 30882693 PMCID: PMC6426613 DOI: 10.1097/md.0000000000014876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We compared intratumoral stromal proportions and positron emission tomography (PET) textural features between females and males with lung adenocarcinoma (ADC) or squamous cell carcinoma (SCC).We retrospectively evaluated 167 consecutive patients (male 122, female 45) who underwent pretreatment fluorodeoxyglucose PET/CT and surgical resection. The tumor-stroma ratios (TSRs) of primary tumors were estimated on hematoxylin-and-eosin-stained histological sections, and higher-order textural features were extracted on PET. We compared the histological and PET features between the sexes.More females than males had ADC. Age and pathological tumor size did not significantly differ between females and males. Females with ADC had more stroma-rich tumors than males with ADC (P = .016) or SCC (P = .047). In addition, some PET textural features significantly differed between females with ADC and males with ADC and SCC; short run emphasis, long run emphasis, coarseness, strength, short-zone emphasis, zone percentage and high-intensity large-zone percentage were the commonly differed textural features. However, the TSRs and PET textural features did not significantly differ between males with ADC or SCC.Intratumoral heterogeneity in females with lung ADC differs from that in males with lung ADC or SCC.
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Affiliation(s)
| | | | - Su Jin Lee
- Department of Nuclear Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
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17
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Dubois C, Rocks N, Blacher S, Primac I, Gallez A, García-Caballero M, Gérard C, Brouchet L, Noël A, Lenfant F, Cataldo D, Pequeux C. Lymph/angiogenesis contributes to sex differences in lung cancer through oestrogen receptor alpha signalling. Endocr Relat Cancer 2019; 26:201-216. [PMID: 30444717 DOI: 10.1530/erc-18-0328] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/14/2018] [Indexed: 12/23/2022]
Abstract
Oestrogen signalling pathways are emerging targets for lung cancer therapy. Unravelling the contribution of oestrogens in lung cancer development is a pre-requisite to support the development of sex-based treatments and identify patients who could potentially benefit from anti-oestrogen treatments. In this study, we highlight the contribution of lymphatic and blood endothelia in the sex-dependent modulation of lung cancer. The orthotopic graft of syngeneic lung cancer cells into immunocompetent mice showed that lung tumours grow faster in female mice than in males. Moreover, oestradiol (E2) promoted tumour development, increased lymph/angiogenesis and VEGFA and bFGF levels in lung tumours of females through an oestrogen receptor (ER) alpha-dependent pathway. Furthermore, while treatment with ERb antagonist was inefficient, ERa antagonist (MPP) and tamoxifen decreased lung tumour volumes, altered blood and lymphatic vasculature and reduced VEGFA and bFGF levels in females, but not in males. Finally, the quantification of lymphatic and blood vasculature of lung adenocarcinoma biopsies from patients aged between 35 and 55 years revealed more extensive lymphangiogenesis and angiogenesis in tumour samples issued from women than from men. In conclusion, our findings highlight an E2/ERa-dependent modulation of lymphatic and blood vascular components of lung tumour microenvironment. Our study has potential clinical implication in a personalised medicine perspective by pointing to the importance of oestrogen status or supplementation on lung cancer development that should be considered to adapt therapeutic strategies.
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Affiliation(s)
- Charline Dubois
- Laboratory of Tumour and Development Biology, GIGA-Cancer, University of Liège, CHU-B23, Liège, Belgium
| | - Natacha Rocks
- Laboratory of Tumour and Development Biology, GIGA-Cancer, University of Liège, CHU-B23, Liège, Belgium
| | - Silvia Blacher
- Laboratory of Tumour and Development Biology, GIGA-Cancer, University of Liège, CHU-B23, Liège, Belgium
| | - Irina Primac
- Laboratory of Tumour and Development Biology, GIGA-Cancer, University of Liège, CHU-B23, Liège, Belgium
| | - Anne Gallez
- Laboratory of Tumour and Development Biology, GIGA-Cancer, University of Liège, CHU-B23, Liège, Belgium
| | - Melissa García-Caballero
- Laboratory of Tumour and Development Biology, GIGA-Cancer, University of Liège, CHU-B23, Liège, Belgium
| | - Céline Gérard
- Laboratory of Tumour and Development Biology, GIGA-Cancer, University of Liège, CHU-B23, Liège, Belgium
| | - Laurent Brouchet
- Thoracic Surgery Department, University Hospital CHU Toulouse, Toulouse, France
| | - Agnès Noël
- Laboratory of Tumour and Development Biology, GIGA-Cancer, University of Liège, CHU-B23, Liège, Belgium
| | - Françoise Lenfant
- INSERM UMR1048, Institut des Maladies Métaboliques et Cardiovasculaires - I2MC, University of Toulouse III Paul Sabatier, UPS, Toulouse, France
| | - Didier Cataldo
- Laboratory of Tumour and Development Biology, GIGA-Cancer, University of Liège, CHU-B23, Liège, Belgium
| | - Christel Pequeux
- Laboratory of Tumour and Development Biology, GIGA-Cancer, University of Liège, CHU-B23, Liège, Belgium
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Heilbroner SP, Xanthopoulos EP, Buono D, Huang Y, Carrier D, Shah A, Kim J, Corradetti M, Wright JD, Neugut AI, Hershman DL, Cheng SK. Impact of estrogen monotherapy on survival in women with stage III-IV non-small cell lung cancer. Lung Cancer 2018; 129:8-15. [PMID: 30797496 DOI: 10.1016/j.lungcan.2018.12.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/13/2018] [Accepted: 12/23/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Women with lung cancer have better survival than men. The reasons are unknown, but estrogen is hypothesized to improve survival. Our objective was to examine the association between estrogen monotherapy and cancer-specific and overall survival in elderly women with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS We used the SEER-Medicare database to identify women ≥65 years old who were diagnosed with stage III or IV NSCLC. Estrogen monotherapy (EM) was defined as at least one estrogen claim without any progesterone claims 6 months prior to diagnosis. To assess cancer-specific survival and overall survival, we used Kaplan-Meier and multivariate Cox modeling with propensity score adjustments. As an exploratory analysis, we also examined the effect of combined estrogen and progesterone hormonal therapy on survival using Cox modeling. RESULTS We identified 6958 women in our initial cohort: 283 used EM (4%) and 6675 (96%) did not. The median follow-up time was 46.5 months in the EM patients and 49.5 months in the non-EM patients. In a Kaplan-Meier analysis, median overall survival was 8.2 months in patients who receive EM and 6.2 months in those who did not (p = 0.004). In our 1:4 propensity-matched cohort, median follow-up was 46.5 in the EM group and 50.6 in the non-EM group; median overall survival was 8.0 months in the EM group and 6.4 months in the non-EM group (p = 0.02). In a multivariate Cox regression of the matched cohort, EM was significantly associated with overall survival (HR 0.84; 95% CI 0.73 - 0.97). All results were similar for cancer-specific survival. In our exploratory analysis, combined Estrogen-Progesterone did significantly impact overall survival (HR 0.84; 95% CI 0.71-0.99, p = 0.04) but did not appear to effect cancer-specific survival (HR 0.91; 95% CI 0.77-1.09, p = 0.30). CONCLUSION EM was associated with a significant improvement in cancer-specific survival and overall survival in women with late stage NSCLC.
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Affiliation(s)
- Samuel P Heilbroner
- Columbia University College of Physicians & Surgeons, 630 W 168th St, New York, NY, 10032, United States
| | - Eric P Xanthopoulos
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, United States
| | - Donna Buono
- Herbert Irving Comprehensive Cancer Center, 1130 St Nicholas Ave, New York, NY, 10032, United States
| | - Yongmei Huang
- Herbert Irving Comprehensive Cancer Center, 1130 St Nicholas Ave, New York, NY, 10032, United States
| | - Daniel Carrier
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, United States
| | - Anand Shah
- Food and Drug Administration, 10 Exchange Pl #804, Jersey City, NJ, 07302, United States
| | - Jerry Kim
- Columbia Business School, Uris Hall 719, 3022 Broadway, New York, NY, 10027, United States
| | - Michael Corradetti
- Duke Cancer Center, 3404 Wake Forest Rd, Raleigh, NC, 27609, United States
| | - Jason D Wright
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital, 161 Fort Washington Avenue, 4th Floor, New York, NY, 10032, United States
| | - Alfred I Neugut
- Herbert Irving Comprehensive Cancer Center, 1130 St Nicholas Ave, New York, NY, 10032, United States
| | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, 1130 St Nicholas Ave, New York, NY, 10032, United States
| | - Simon K Cheng
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, United States; Herbert Irving Comprehensive Cancer Center, 1130 St Nicholas Ave, New York, NY, 10032, United States.
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19
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Li W, Lin X, Wang R, Wang F, Xie S, Tse LA. Hormone therapy and lung cancer mortality in women: Systematic review and meta-analysis. Steroids 2017; 118:47-54. [PMID: 27964943 DOI: 10.1016/j.steroids.2016.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 12/15/2022]
Abstract
The mortality of lung cancer presents a significant difference between the sexes. A role of hormone therapy (HT) in lung cancer mortality has been suggested, but the evidence is inconclusive. We sought to elucidate this issue with a meta-analysis. We conducted a systematic literature search in both Pubmed and Embase. Studies that reported the association of HT and mortality of lung cancer cases were included. Pooled hazard ratio (HR) was computed as the effect size to reflect the association between HT and lung cancer mortality. In total, 11 studies were included in the meta-analysis. The pooled HR of HT in relation to lung cancer mortality was 0.97 (95% CI 0.83-1.12, I2=59.2%, p=0.006) in all studies disregarding study design, and it was 0.80 (95% CI: 0.69-0.92, I2=21.4%, p=0.278) in prospective cohort studies. Results of this meta-analysis were robust, and there was no indication of significant differences in association in small and large studies. We observed a protective role of HT use in lung cancer mortality in pooled prospective cohorts, but not in pooled retrospective cohorts and post hoc analyses of randomized controlled trials. Future studies that address smoking, type and time of HT, menopausal status, and histology are warranted.
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Affiliation(s)
- Wentao Li
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiaona Lin
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Rui Wang
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Feng Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Shaohua Xie
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Lap Ah Tse
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
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20
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Kuhle CL, Kapoor E, Sood R, Thielen JM, Jatoi A, Faubion SS. Menopausal hormone therapy in cancer survivors: A narrative review of the literature. Maturitas 2016; 92:86-96. [PMID: 27621244 DOI: 10.1016/j.maturitas.2016.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 12/25/2022]
Abstract
Decision making regarding the use of menopausal hormone therapy (MHT) for the treatment of bothersome menopausal symptoms in a cancer survivor can be complex, and includes assessment of its impact on disease-free or overall survival. Estrogen receptors are present in several cancer types, but this does not always result in estrogen-mediated tumor proliferation and adverse cancer-related outcomes. Estrogen may even be protective against certain cancers. Menopausal hormone therapy is associated with an increased risk of recurrence and mortality after diagnosis of some cancer types, but not others. We provide a narrative review of the medical literature regarding the risk of cancer recurrence and associated mortality with initiation of MHT after the diagnosis of breast, gynecologic, lung, colorectal, hematologic cancers, and melanoma. Menopausal hormone therapy may be considered for management of bothersome menopausal symptoms in women with some cancer types (e.g., colorectal and hematologic cancer, localized melanoma, and most cervical, vulvar and vaginal cancers), while nonhormonal treatment options may be preferred for others (e.g., breast cancer). In women with other cancer types, recommendations are less straightforward, and the use of MHT must be individualized.
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Affiliation(s)
- Carol L Kuhle
- Women's Health Clinic, Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Ekta Kapoor
- Women's Health Clinic, Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States; Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Richa Sood
- Women's Health Clinic, Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jacqueline M Thielen
- Women's Health Clinic, Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Aminah Jatoi
- Division of Medical Oncology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Stephanie S Faubion
- Women's Health Clinic, Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
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21
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Chlebowski RT, Wakelee H, Pettinger M, Rohan T, Liu J, Simon M, Tindle H, Messina C, Johnson K, Schwartz A, Gass M, Wactawski-Wende J. Estrogen Plus Progestin and Lung Cancer: Follow-up of the Women's Health Initiative Randomized Trial. Clin Lung Cancer 2016; 17:10-7.e1. [PMID: 26577506 PMCID: PMC6855180 DOI: 10.1016/j.cllc.2015.09.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 09/13/2015] [Accepted: 09/22/2015] [Indexed: 12/22/2022]
Abstract
INTRODUCTION In the Women's Health Initiative (WHI) estrogen plus progestin trial, after 5.6 years' intervention and 8 years' median follow-up, more women died from lung cancer in the hormone therapy group (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.16-2.52; P = .01). Now after 14 years' median follow-up, we reexamined combined hormone therapy effects on lung cancer mortality. PATIENTS AND METHODS In the WHI placebo-controlled trial, 16,608 postmenopausal women aged 50 to 79 years and with an intact uterus were randomly assigned to once-daily 0.625 mg conjugated equine estrogen plus 2.5 mg medroxyprogesterone acetate (n = 8506) or placebo (n = 8102). Incidence and mortality rates for lung cancer were assessed from multivariant proportional hazard models. RESULTS After 14 years' cumulative follow-up, there were 219 lung cancers (0.19% per year) in the estrogen plus progestin group and 184 (0.17%) in the placebo group (HR, 1.12; 95% CI, 0.92-1.37; P = .24). While there were more deaths from lung cancer with combined hormone therapy (153 [0.13%] vs. 132 [0.12%], respectively), the difference was not statistically significant (HR, 1.09; 95% CI, 0.87-1.38; P = .45). The statistically significant increase in deaths from lung cancer observed during intervention in women assigned to estrogen plus progestin was attenuated after discontinuation of study pills (linear trend over time, P = .042). CONCLUSION The increased risk of death from lung cancer observed during estrogen plus progestin use was attenuated after discontinuation of combined hormone therapy.
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Affiliation(s)
- Rowan T Chlebowski
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.
| | | | - Mary Pettinger
- Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, WA
| | - Thomas Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Jingmin Liu
- Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, WA
| | - Michael Simon
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | | | | | - Karen Johnson
- The University of Tennessee Health Science Center, Memphis, TN
| | - Ann Schwartz
- The University of California San Francisco, San Francisco, CA
| | - Margery Gass
- The North American Menopause Society, Maryland Heights, OH
| | - Jean Wactawski-Wende
- University of Buffalo, School of Public Health and Health Professions, Buffalo, NY
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22
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Sandler BJ, Wang Z, Hancock JG, Boffa DJ, Detterbeck FC, Kim AW. Gender, Age, and Comorbidity Status Predict Improved Survival with Adjuvant Chemotherapy Following Lobectomy for Non-small Cell Lung Cancers Larger than 4 cm. Ann Surg Oncol 2015; 23:638-45. [DOI: 10.1245/s10434-015-4902-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Indexed: 11/18/2022]
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