Trends in the incidence rate of lung cancer by histological type and gender in Sichuan, China, 1995-2015: A single-center retrospective study

CT Imaging Patterns in Major Histological Types of Lung Cancer

Lung cancer ranks as the second most prevalent cancer globally and is the primary contributor to neoplastic-related deaths. The approach to its treatment relies on both tumour staging and histological type determination. Data indicate that the prognosis of lung cancer is strongly linked to its clinical stage, underscoring the importance of early diagnosis in enhancing patient outcomes. Consequently, the choice of an appropriate diagnostic method holds significant importance in elevating both the early detection rate and prognosis of lung cancer. This paper aims to assess computer tomography features specific to the most common lung cancer types (adenocarcinoma, squamous cell carcinomas and small cell lung cancer). Data were collected retrospectively from CT scans of 58 patients pathologically diagnosed with lung cancer. The following CT features were evaluated and recorded for each case: location, margins, structure, lymph node involvement, cavitation, vascular bundle-thickening, bronchial obstruction, and pleural involvement. Squamous cell carcinoma (SQCC) and small cell lung cancer (SCLC) showed a higher incidence of central location, while adenocarcinoma (ADC) showed a significant predilection for a peripheral location. Internal cavitation was mostly observed in SQCC, and a solid structure was observed in almost all cases of ADC. These features can provide information about the prognosis of the patient, considering that NSCLCs are more frequent but tend to demonstrate positive results for targetable driver mutations, such as EGFR, thereby increasing the overall survival. In addition, SCLC presents with early distant spreads, which limits the opportunity to investigate the evolution of tumorigenesis and gene alterations at early stages but can have a rapidly positively response to chemotherapy. The location of the lung cancer exhibits distinct forecasts, with several studies suggesting that peripheral lung tumours offer a more favourable prognosis. Cavity formation appears correlate with a poorer prognosis. Histopathological analysis is the gold standard for diagnosing the type of lung cancer; however, using CT scanning for the purpose of a rough, but fast, preliminary diagnosis has the potential to shorten the waiting time for treatment by helping clinicians and patients to know more about the diagnosis and prognosis.

Significance of Gastrokine-1 Polymorphism Rs4254535 as a Prognostic Marker and its Association with Clinical Characteristics in Chinese Lung Cancer Patients

Background: The single nucleotide polymorphism (SNP) of Gastrokine-1 (GKN1) is associated with lung cancer but its association with prognosis is not clear. Methods: Genomic DNA was extracted from the blood samples of 888 patients with lung cancer. The association between GKN1 polymorphism rs4254535 and prognostic was analyzed by the Kaplan-Meier (KM) method, Log-rank test, and Cox proportional hazards model. Results: In females and patients diagnosed with late-stage lung cancer, the CC genotype (CC vs TT, adjusted odds ratio [HR] = 0.57, 95% Confidence Interval [CI]: 0.33-0.99, P = 0.045; HR = 0.66, 95% CI: 0.48-0.92, P = 0.014) and recessive CC genotype (CC vs TT + TC, HR = 0.55, 95% CI: 0.32-0.94, P = 0.028; HR = 0.64, 95% CI: 0.47-0.89, P = 0.006) of rs4254535 conferred a better prognosis, compared with the TT and TT + TC genotype. Rs4254535 dominate TC + CC genotype, recessive CC genotype, and C allele who were adenocarcinoma patients had a significantly better prognosis. The recessive CC genotype of non-smoking patients has a better prognosis, compared to the TT + TC genotype. Additionally, in the dominant TT + TC genotype and C allele, no family history patients had a significantly better prognosis, compared to the TT genotype. Conclusion: For lung cancer patients, GKN1 polymorphism rs4254535 may be a protective genetic marker and predicts the prognosis of lung cancer patients.

Effects of intra-operative fluid management under the guidance of stroke volume variability on short-term prognosis after thoracoscopic lobectomy

AIM

We aimed to explore the influence of intra-operative fluid management under the guidance of stroke volume variability (SVV) on the short-term prognosis after thoracoscopic lobectomy.

METHODS

A total of 171 eligible patients from April 2017 to April 2019 were selected. All patients received intra-operative fluid management under the guidance of SVV, and were divided into low-, middle- and high-level groups (n = 57) using a random-numbers table. The general data, respiratory function indices at different time points, haemodynamic indices at different time points, use of vasoactive drugs, short-term prognosis indices and incidence of complications were compared.

RESULTS

There were no significant differences in age, gender, operation time, one-lung ventilation time, amount of bleeding, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, lung compliance and peak airway pressure at different time points, usage amount of anisodamine and incidence rate of complications among the three groups. In the low-level group, the fluid infusion amount and urine volume were significantly larger, the forced expiratory volume in one second (FEV1), percentage of FEV1 in the predicted value (FEV1%pred) and FEV1/forced vital capacity (FEV1/FVC) seven days after operation were higher, and the six-minute walk test (6MWT) distance was longer than those in the other two groups. The usage amount of dopamine, norepinephrine and esmolol was smaller, and the postoperative exhaust time was shorter than those in the other two groups. The low-level group had a smaller usage amount of isosorbide dinitrate injection and shorter length of postoperative hospital stay than the high-level group. Stroke volume had a significant difference at T2 and T3 in the low-level group, central venous pressure (CVP) and stroke volume had significant differences at T2 and T3 in the middle-level group, and heart rate (HR), mean arterial pressure and CVP were significantly different at T2 and T3 in the high-level group.

CONCLUSIONS

Fluid management under the guidance of low-level SVV (8% ≤ SVV ≤ 9%) was conducive to the maintenance of stable haemodynamics in patients during thoracoscopic lobectomy, thereby improving short-term prognosis.

EML4‑ALK fusion gene in non‑small cell lung cancer (Review)

Non-small cell lung cancer (NSCLC) is a malignant tumor with a high morbidity and mortality rate that is a threat to human health. With the development of molecular targeted research, breakthroughs have been made on the molecular mechanism of lung cancer. The echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) fusion gene is one of the most important pathogenic driver genes of NSCLC discovered thus far. Four generations of targeted drugs for EML4-ALK have been developed, with patients benefiting significantly from these drugs. Therefore, EML4-ALK has become a research hotspot in NSCLC. The aim of the present study is to introduce the current research progress of EML4-ALK and its association with NSCLC.

Analysis of Hazard Factors Affecting the Quality of Life for Lung Cancer Patients after Chemotherapy

Objective

To explore the hazard factors affecting the quality of life for patients with lung cancer after chemotherapy, so as to provide evidence-based clinical proof to improve their quality of life.

Methods

The clinic data of lung cancer patients treated with chemotherapy from November 2020 to November 2021 in our hospital were selected for retrospective analysis. A questionnaire survey was administered to 74 patients who met the inclusion criteria. The general condition questionnaire made by the department was used to analyzed the patients' demographic characteristics and disease status. The quality of life questionnaire for Chinese cancer patients receiving chemobiotherapy (QLQ-CCC) was used to evaluate the patients' quality of life.

Results

The research objects selected for this study scored an average of (94.53 ± 22.65) points in the quality of life. It was found by logistic regression analysis that age, education level, marital status, pathological types, monthly family income, and metastasis were the independent influencing factors that lowered the quality of life of lung cancer patients after chemotherapy (P < 0.001).

Conclusion

Chemotherapy can lead to a decline in the quality of life of lung cancer patients, and there are many factors at play. Therefore, medical and nursing staff should focus on the overall condition of patients when carrying out clinical treatment.

Clinical efficacy and safety of crizotinib and alectinib in ALK-positive non-small cell lung cancer treatment and predictive value of CEA and CA125 for treatment efficacy

BACKGROUND

To investigate the clinical efficacy and safety of crizotinib and alectinib in anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) treatment and the predictive value of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 125 (CA125) for treatment efficacy.

METHODS

A total of 120 patients with ALK-positive NSCLC were enrolled and randomly assigned to receive crizotinib treatment (54 patients, the control group) or alectinib treatment (66 patients, the research group). Treatment efficacy, adverse reactions, survival, and quality of life of patients were compared between the two groups. Enzyme-linked immunosorbent assay was used to determine the serum CEA and CA125 concentrations and these levels were compared between patients with certain treatment responses or no responses. Receiver operating characteristic curve was used to assess the predictive value of CEA and CA125 for treatment efficacy.

RESULTS

The overall disease control rate, overall response rate, and number of 1-year survival patients were substantially higher in the research group compared with the control group. Moreover, the incidence of adverse reactions was significantly lower and progression-free survival and overall survival rates were higher in the research group compared with those in the control group. The area under the curve (AUC) for predicting treatment efficacy was 0.889 for CEA and 0.866 for CA125.

CONCLUSION

Alectinib was clinically more efficacious and safer than crizotinib for ALK-positive NSCLC treatment. Both CEA and CA125 demonstrated excellent predictive value for treatment efficacy.

Diagnostic potential of extracellular vesicle-associated microRNA-10b and tumor markers for lung adenocarcinoma

MicroRNAs (miRNAs/miRs) in extracellular vesicles (EVs) are potential diagnostic markers. The purpose of the present study was to investigate potential EV miRNA biomarkers for lung adenocarcinoma (LUAD). Potential miRNAs were identified by searching public databases and verified by examining clinical samples. The diagnostic value of EV-associated miR-10b, plasma miR-10b and tumor markers (TMs), including α-fetoprotein (AFP), neuron-specific enolase, carcinoembryonic antigen (CEA), cytokeratin 19 fragment 21-1 (CYFRA211), pro-gastrin-releasing-peptide, carbohydrate antigen (CA)125, CA153, CA199 and CA724, was evaluated via receiver operating characteristic curve analysis. By searching the Gene Expression Omnibus and The Cancer Genome Atlas databases, miR-10b was identified as a potential biomarker. The analysis of clinical samples suggested that EV-associated miR-10b from plasma was significantly differentially expressed between LUAD and control samples. EV-associated miR-10b could function as a diagnostic marker for LUAD, with an AUC of 0.998, which was higher than the AUCs for TMs such as AFP, CEA, CYFRA211, CA125, CA153, CA199, CA724, pro-gastrin-releasing-peptide and neuron-specific enolase. In conclusion, EV-associated miR-10b may be a potential diagnostic biomarker for LUAD that is superior to plasma miR-10b and TMs.

Epidemiology and histopathological classification of lung cancer: A study from Jordan, retrospective observational study

Background

Lung cancer is a major health burden in Jordan. With the failure of tobacco control policies and the evolution of new smoking methods like water pipes and e-cigarettes, lung cancer is projected to further increase. This study investigates the epidemiology and the different histopathological subtypes of lung cancer in correlation with age, sex and smoking.

Material and methods

434 tumors diagnosed in the main tertiary hospital in Northern Jordan throughout the period of 2004–2017 were included. Specimens were tested by H&E and immunohistochemical stains. Clinical data were collected from patients' medical files. IRB approval number 310/2016 was granted by Jordan University of Science and Technology review board.

Results

86.9% of cases were males compared to 13.1% in females obtaining a male:female ratio of 6.6:1. The mean age was 63.8 years with a range of 28–103 years. Prevalence of cases increased with increasing age and smoking. Histopathologically, adenocarcinoma accounted for over half of the cases followed by Squamous cell carcinoma (SCC) and neuroendocrine tumors (NET) in both sexes. Adenocarcinoma had the lowest mean age; 62.74 years, while SCC had the highest mean age with 65.42 years. All subtypes increased with age but in different degrees. The increase was more pronounced in SCC and NET and less with adenocarcinoma. Adenocarcinoma was more common in both smokers and non-smokers. However, smokers to non-smokers ratio differed; where it was the highest in NET (6:1) compared to 4:1 in SCC and 2:1 in adenocarcinoma.

Conclusion

Median age of our patients was slightly lower than that previously reported in Jordan. This study also showed an increase in the relative incidence of adenocarcinoma compared to SCC.

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Lung cancer was more common among males increasing with age and cigarette smoking.

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Adenocarcinoma was the most frequent histological subtype of lung cancer.

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Adenocarcinoma had higher frequency in younger age groups.

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Frequency of squamous cell carcinoma was higher in older age groups.

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Jordan is in urgent need to implement stricter tobacco control regulations.

Spatial and Temporal Analysis of Lung Cancer in Shenzhen, 2008-2018

Lung cancer is the most commonly diagnosed cancer in China. The incidence trend and geographical distribution of lung cancer in southern China have not been reported. The present study explored the temporal trend and spatial distribution of lung cancer incidence in Shenzhen from 2008 to 2018. The lung cancer incidence data were obtained from the registered population in the Shenzhen Cancer Registry System between 2008 and 2018. The standardized incidence rates of lung cancer were analyzed by using the joinpoint regression model. The Moran's I method was used for spatial autocorrelation analysis and to further draw a spatial cluster map in Shenzhen. From 2008 to 2018, the average crude incidence rate of lung cancer was 27.1 (1/100,000), with an annual percentage change of 2.7% (p < 0.05). The largest average proportion of histological type of lung cancer was determined as adenocarcinoma (69.1%), and an increasing trend was observed in females, with an average annual percentage change of 14.7%. The spatial autocorrelation analysis indicated some sites in Shenzhen as a high incidence rate spatial clustering area. Understanding the incidence patterns of lung cancer is useful for monitoring and prevention.

Role of CT in differentiation between subtypes of lung cancer; is it possible?

Background

Context and purpose: lung cancer is the second in the incidence rate and the first in death rate in the United States of America in 2017. Its treatment depends upon the tumor staging as well as the histological subtype of lung cancer. CT has been the modality of choice for screening as well as diagnosis of lung cancer; however, few studies tried to correlate different CT features of lung cancer to certain pathological subtypes. Our study aims to assess the CT characteristics of the subtypes of bronchogenic carcinoma.

Results

SQCC shows a higher incidence of central location compared with the rest of the lung cancers (significance level of 50%, p value of 0.5), internal cavitations (significance level of 94.9%, p value of less than 0.05) as well as more frequency of higher stage within the study population, ADC shows significant predilection to peripheral location compared with the rest of the lung cancers (significance level of 94.9%, p value of less than 0.05).

Conclusion

There is an evident correlation between the MDCT diagnosis of bronchogenic carcinoma and that of histopathology/cytology. The most common types are SQCC and ADC subtypes. The SQCC type of bronchial carcinoma tends to be central with the internal cavitations are common while ADC tends to be peripheral and solid.

Lung Cancer: A Nationwide Study to Characterize Sex Differences, Incidence, and Spatial Patterns in Portugal

BACKGROUND/AIM

This study characterized lung cancer (LC) in Portugal, to capture sex differences, regional variation, and spatial distribution.

PATIENTS AND METHODS

Variables: age, sex, vital status, region of residence, degree of urbanization, histologic types and stage at diagnosis. Spatial analyses conducted to identify high (HIC) and low incidence (LIC) clusters.

RESULTS

In total, 11,642 cases were diagnosed (76.6% male, 23.4% female), with a similar mean age at diagnosis. There were 23,6% locally advanced and 58.4% metastatic disease cases, with 13.4% alive five years after diagnosis. Non-small-cell LC accounted for 77.3% of which 40.8% was adenocarcinoma and 22.7% was squamous cell carcinoma. Standardized incident rate (IR) was 37.5/10⁵, 65.2/10⁵ in males, and 15.7/10⁵ in females, with four HIC (urban) clusters and four LIC (non-urban).

CONCLUSION

This study highlighted the sex differences in incidence, mortality, histology, and geographic distribution of LC in Portugal. Considering the advanced stages and the poor overall survival, understanding sex and geographic differences is important for public health interventions.

Effects of hospice care on quality of life and negative emotions in patients with advanced tumor: A protocol for systematic review and meta-analysis

BACKGROUND

To evaluate the effect of hospice care on the quality of life and negative emotion of advanced tumor patients systematically, which compared with routine nursing mode, improving the quality of life of advanced tumor patients, reducing the negative emotion of advanced tumor patients, and providing evidence-based medicine for better implementation of targeted service of hospice care.

METHODS

Computer retrieval network electronic database: Retrieval CNKI, Chinese clinical trial registry, WANFANG database, China Biology Medicine disc, CQVIP database, PubMed, Embase, The Cochrane Library, and Web of Science database on the clinical research of hospice care on the quality of life and negative emotions of advanced tumor patients. While dating from the references included in the study, manually retrieving relevant tabloids, papers, and related journals without electronic version. The retrieval strategy adopts the combination of subject words and free words. The range of searching time was from the beginning of each database to April 1, 2020. According to the inclusion and exclusion criteria, the 2 researchers selected the literature and extracted the data independently, and used the Cochrane system evaluator manual 5.1.0 to conduct a bias risk assessment of the literature, which was finally included in the study. If two researchers disagree in the process of literature selection, a third researcher is invited to join in, discuss the issues that have differences, and then make a decision. RevMan 5.3.3 software and Stata 14.0 software were used to conduct the meta-analysis of the included research.

RESULTS

According to the process of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), this study will be carried out strictly, and the results of research will be published publicly in high-quality international academic journals with peer review.

CONCLUSION

Through the study, we will arrive at whether hospice care has advantages in improving the quality of life and negative emotion of advanced tumor patients, which compared with routine nursing mode, and the formulation of individualized hospice care strategy to provide the basis for the application of hospice care in the treatment of end stage tumor patients.

REGISTRATION

OSF platform, registration number: 47enh.

Small cell lung cancer (SCLC) incidence and trends vary by gender, geography, age, and subcategory based on population and hospital cancer registries in Hebei, China (2008-2017)

BACKGROUND

Lung cancer is the leading cause of morbidity and mortality worldwide. Small cell lung cancer (SCLC) has been determined to be the most lethal lung malignancy. Few studies have previously analyzed the epidemiological characteristics of SCLC in China. This study analyzed the epidemiological characteristics of SCLC aiming to provide a reference for the prevention of SCLC in Hebei Province.

METHODS

The epidemiological characteristics of SCLC using lung cancer data based on population and hospital cancer registries in Hebei Province between 2008 and 2017 were analyzed.

RESULTS

The proportion of both population- and hospital-based SCLC cases displayed a significant increasing trend. Moreover, the proportion of males was higher than that for female based on population- and hospital-based cases. The proportion of hospital-based SCLC cases in counties was higher than that in cities, whereas there were no significant regional differences between cities and counties based on population. The proportion of both population- and hospital-based SCLC cases decreased consistently with increasing age. There was a difference between population- and hospital-based distribution of subcategories of SCLC.

CONCLUSIONS

Significant increases in the proportion of both population- and hospital-based SCLC cases over recent years, particularly in males and in patients aged over 55 years, were observed. Research on the pathogenesis of SCLC in these patients and prevention is urgently required.

A Phase III, randomized, double-blind, placebo-controlled, multicenter study of fruquintinib in Chinese patients with advanced nonsquamous non-small-cell lung cancer - The FALUCA study

OBJECTIVES

Fruquintinib is an orally active kinase inhibitor that selectively targets the vascular endothelial growth factor (VEGF) receptor. A Phase II trial has demonstrated a significant benefit in progression-free survival (PFS) for fruquintinib-treated patients with locally advanced/metastatic nonsquamous non-small-cell lung cancer (NSCLC) who have progressed after second-line chemotherapy. This Phase III trial is a randomized, double-blind, multicenter trial to confirm fruquintinib's efficacy in the same patient population.

MATERIALS AND METHODS

From December 2015 to February 2018, 730 patients were screened, of whom 527 were enrolled into the study. Participants were randomized 2:1 to receive fruquintinib (n = 354) or placebo (n = 173) once daily for 3 weeks on-treatment, and 1 week off-treatment. Patients were stratified according to epidermal growth factor receptor mutation status and prior use of VEGF inhibitors. Primary endpoint was overall survival (OS).

RESULTS

Median OS was 8.9 months for the fruquintinib group and 10.4 months for placebo group (hazard ratio [HR] 1.02; 95 % confidence interval [CI], 0.82-1.28; P = 0.841), with median PFS of 3.7 months and 1.0 months, respectively (HR 0.34; 95 % CI, 0.28-0.43; P < 0.001). Objective response rate and disease control rate were 13.8 % and 66.7 % for fruquintinib, and 0.6 % and 24.9 % for placebo, respectively (P < 0.001). Hypertension was the most frequent treatment-emergent adverse event (≥grade 3) observed in fruquintinib-treated patients (21.0 %). Post hoc analysis revealed that fruquintinib prolonged the median OS for patients who did not receive subsequent antitumor therapy: 7.0 months versus 5.1 months for placebo (HR 0.65; 95 % CI, 0.46-0.91; P = 0.012). Patients receiving fruquintinib also reported improvements in quality of life for most functional scales measured by EORTC QLQ-C30 and LC13 questionnaires.

CONCLUSION

Although the study did not meet its primary endpoint, fruquintinib could be effective in combination with other agents for the treatment of patients with NSCLC who have failed second-line chemotherapy.

Economic burden of patients with advanced non-small-cell lung cancer receiving nivolumab versus chemotherapy in China

Aim: As new treatment patterns are gradually being used in patients with non-small-cell lung cancer, it is necessary to have a better understanding of real-world data on clinical practices and their potential impact on healthcare resource utilization (HCRU). Patients & methods: A retrospective observational study was conducted with electronic medical records from Shanghai Chest Hospital. Hospitalized patients treated with nivolumab or second-line chemotherapy were included. Results: A total of 296 patients were included in this study, of whom 187 were treated with nivolumab. About 74.33% received nivolumab monotherapy at different doses. The mean cost of nivolumab was $3334.14 (±86.69). Nivolumab decreased inpatient days to 1.9545 days with a more stable cost and HCRU per cycle. Conclusion: Nivolumab is expensive but it reduces other HCRU.

Prognostic Value of the Advanced Lung Cancer Inflammation Index in Patients with Lung Cancer: A Meta-Analysis

Background

The advanced lung cancer inflammation index (ALI) has been related to tumor survival in lung cancer (LC) patients. However, these findings regarding the prognostic relevance of ALI in LC were inconsistent. Our study is aimed at characterizing the prognostic significance of low pretreatment ALI in LC cases. Methods. Relevant published studies were systematically searched in several online databases. The combined hazard ratios (HRs) were applied to assess the correlation between ALI and overall/recurrence-free/progression-free survival (OS/PFS/RFS) in LC.

Results

A total of 1587 LC patients from eight articles were recruited. Pooled results indicated that pretreatment ALI was significantly associated with prognosis in cases with LC. Compared to those with high-ALI, LC cases in the low-ALI group had a poorer OS (HR: 1.64, 95% CI: 1.34-1.93, p < 0.001). Subgroup analyses further revealed the negative significant prognostic value of low ALI in LC. In addition, low ALI had obvious connection with inferior PFS/RFS (HR: 1.71, 95% CI: 1.35-2.07, p < 0.001) in LC patients.

Conclusions

Low ALI before treatments indicates poor prognosis in LC patients. Serum ALI may serve as a promising predictive tumor marker of survival in LC sufferers.

Methylenetetrahydrofolate Reductase (MTHFR) Gene rs1801133 C>T Polymorphisms and Lung Cancer Susceptibility: An Updated Meta-analysis

Objective: The aim of this study was to investigate the methylenetetrahydrofolate reductase (MTHFR) gene rs1801133 C>T polymorphisms and lung cancer susceptibility by pooling openly published data.

Methods: Electronic databases of Medline, Web of Science, Embase, Google scholar, CBM and CNKI were systematic searched to find the relevant studies related to MTHFR gene rs1801133 C>T polymorphisms and lung cancer susceptibility. The odds of TT, CT and CC alleles in lung cancer patients compared with healthy controls was pooled by the effect size of odds ratio (OR) and corresponding 95% confidence interval (95%CI) under random or fixed effect model. Publication bias was analyzed by Begg’s funnel plot and Egger’s line regression test.

Results: Overall, twenty-one studies relevant to MTHFR gene rs1801133 C>T polymorphisms and lung cancer susceptibility were included. The pooled data showed subject with T allele had significant increased risk of developing lung cancer in dominant (OR=1.14, 95%CI: 1.01-1.28, p<0.05), recessive (OR=1.26, 95%CI:1.08-1.48, p<0.01) and homologous (OR=1.36, 95%CI:1.12-1.65, p<0.01) genetic model. Begg’s funnel plot and Egger’s line regression test showed significant publication bias in all genetic models.

Conclusion: Based on present data, subjects with TT or CT alleles may have increased susceptibility to lung cancer. However, due to significant publication bias, the conclusion should be drawn with caution and should be proved by further well-designed case-control or cohort studies relevant to MTHFR gene rs1801133 C>T polymorphisms and lung cancer risk.

Are comorbidities associated with long-term survival of lung cancer? A population-based cohort study from French cancer registries

Background

Survival rates of lung cancer remains poor and the impact of comorbidities on the prognosis is discussed. The objective of this study was to assess if the Charlson Comorbidity Index (CCI) was associated with 8-year survival rates by histological type.

Methods

A cohort study was conducted using randomly selected cases from 10 French cancer registries. Net survival rates were computed using the Pohar-Perme estimator of the net cumulative rate. Three Cox models were independently built for adenocarcinomas, squamous cell and small cell cancers to estimate prognostic factors including CCI grade.

Results

A total of 646 adenocarcinomas, 524 squamous cell and 233 small cell cancers were included in the analysis. The net 8-year survival rate ranged from 12.6% (95% CI: 9.8–15.4%) for adenocarcinomas and 13.4% (95% CI: 10.1–16.7%) for squamous cell carcinomas, to 3.7% (95% CI: 1.1–6.3%) for small cell cancers. Observed and net survival rates decreased for CCI grades ≥3 for all histological group considered.

After adjustment for sex, age group, stage and diagnostic mode, CCI grades 1 (HR = 1.6 [95% CI: 1.1–2.3]), 2 (HR = 1.7 [95% CI: 1.1–2.7]) and ≥ 3 (HR = 2.7 [95% CI: 1.7–4.4]) were associated with lower survival rates only for small cell cancers.

Conclusion

After adjustment for age, sex, stage and diagnostic mode, the presence of comorbidity based on CCI grades 1–2 and ≥ 3 was associated with lower survival rates for small cell cancers whereas no differences were observed for adenocarcinomas and squamous cell cancers.

Body surface area as a novel risk factor for chylothorax complicating video-assisted thoracoscopic surgery lobectomy for non-small cell lung cancer

Background

The study was conducted to demonstrate the predictive value of body surface area (BSA) for chylothorax complicating video‐assisted thoracoscopic surgery (VATS) lobectomy for non‐small cell lung cancer (NSCLC).

Methods

Large‐scale retrospective analysis was conducted on the data of 1379 patients who underwent VATS lobectomy between January 2014 and October 2017 at our institution. Receiver operating characteristic analysis was conducted to determine a threshold BSA value for the prediction of chylothorax. This optimal BSA cutoff, other clinicopathological variables, and P < 0.15 were included into a multivariable logistic regression model to determine the risk factors for chylothorax.

Results

Twenty‐six patients (1.9%) developed postoperative chylothorax. The mean BSA in patients with chylothorax was significantly higher than in patients without (1.84 ± 0.14 vs. 1.73 ± 0.16 m²; P = 0.001). A BSA of 1.69 m² was identified as the threshold value with maximum joint sensitivity (96.2%) and specificity (43.8%). Patients with BSA > 1.69 m² had a significantly higher incidence of chylothorax (3.0% vs. 0.3%; P < 0.001) and a longer hospital stay (log rank P < 0.001) than patients with BSA ≤ 1.69 m². Multivariable logistic regression analysis suggested that BSA > 1.69 m² (odds ratio 7.35, 95% confidence interval 1.54–35.71; P = 0.013) was predictive of postoperative chylothorax.

Conclusions

BSA can serve as a novel categorical predictor for chylothorax complicating VATS lobectomy for NSCLC. It may be more helpful to incorporate a BSA cutoff into routine risk stratification tools for lung cancer surgery.

Multiple Organ Lesions in a Case of Contamination With Multiple Radionuclides After 38 Years

The patient was contaminated with multiple radionuclides 38 years ago due to an accident. To investigate the effects of radionuclide contamination on humans, he has been followed up by examinations for many years. Long-term effects gradually emerge in these years. Lung cancer was diagnosed by medical examinations. Besides, chronic gastritis with intestinal metaplasia was indicated by gastroscopic biopsies, while colorectal polyps found by colonoscopy. All 13 colorectal polyps were removed, and radical surgery for lung cancer was performed. Fortunately, pathological examinations indicated that it was early lung cancer. The ground glass nodule (GGN) in left lung identified during the follow-up will be resected when needed. It is speculated that multiple manifestations of the patient may be related to radiation, and different lesions in the organs may be related to systemic adaptive response. However, longer follow-up is needed due to a lack of effective and direct evidence. This work is expected to provide experiences for similar patients' treatment and follow-up.

Incidence and mortality of lung cancer in China, 20082012

Objective

To analyze the incidence and mortality rates of lung cancer in China from 2008 to 2012.

Methods

Incident and death cases of lung cancer were retrieved from the National Central Cancer Registry (NCCR) database collecting from 135 cancer registries in China during 2008−2012. The crude incidence and mortality rates of lung cancer were calculated by area (urban/rural), region (eastern, middle, western), gender and age group (0, 1−4, 5−9, …, 85+). China census in 2000 and Segi’s world population were applied for age-standardized rates. JoinPoint (Version 4.5.0.1) model was used for time trend analysis.

Results

The crude incidence rate of lung cancer was 54.66/100,000 which ranked the first in overall cancers. The age-standardized incidence rates by China population (ASIRC) and by World population (ASIRW) were 35.13/100,000 and 34.86/100,000, respectively. The crude mortality of lung cancer in China was 45.60/100,000 and it was the first cause of cancer-related death in overall cancers. The age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 28.57/100,000 and 28.22/100,000, respectively. Incidence and mortality rates of lung cancer were higher in males than in females and higher in urban areas than in rural areas. Eastern areas had the highest incidence and mortality rates followed by middle and western areas. Incidence and mortality rates of lung cancer retained low level in age groups before 40 years old but increased greatly after and peaked in age group of 80−84. During 2003−2012, the temporal trend of the incidence rate of lung cancer in both sexes in China was general stable (P<0.05). The lung cancer incidence rate increased by 0.71% per year in females (P<0.05) and 2.26% per year in rural areas (P<0.05). The mortality rate of lung cancer decreased slightly annually during 2003−2012 in China (P>0.05). In urban areas, it declined by 0.76% per year (P<0.05), but rose by 2.09% per year (P<0.05) in rural areas.

Conclusions

Appropriate targeted prevention, early detection and treatment programs should be carried out to control the local burden of lung cancer.