Microsatellite instability in lung cancer patients 40 years of age or younger

Trends and Characteristics of Young Non-Small Cell Lung Cancer Patients in the United States

BACKGROUND

Although the median age at diagnosis of non-small cell lung cancer (NSCLC) is 70 years, a subset of patients with NSCLC present at a younger age (<40 years). Little is known about the time-trends in incidence of NSCLC in the young, their characteristics and outcomes.

METHODS

The surveillance, epidemiology, and end results database was used to extract NSCLC cases from 1978 to 2010. Yearly incidence rates in various age groups, race, site of disease, histology, treatment patterns, and outcomes were assessed. We modeled Kaplan-Meyer survival curves stratified by age of presentation.

RESULTS

Young patients represented 0.6% of incident NSCLC from 1978 to 2010. The incidence of young NSCLC declined significantly during this time-period. Young NSCLCs had a higher proportion of women (51%), Asians or Pacific Islanders (14%), adenocarcinoma histology (59%) and were more likely to present with distant metastases (68%). The young had better all cause and lung cancer-specific survival than the older patients (median survival for localized, regional, and distant disease: not reached, 28, 9 vs. 46, 17, 5 months; p < 0.001 for all groups). Male sex, non-adenocarcinoma histology, and main bronchial primary were independent negative prognostic factors among the young. In contrast to the overall population, black race was a poor prognostic factor among the young.

CONCLUSION

The incidence of NSCLC in the young decreased from 1978 to 2010. The clinical characteristics of NSCLC in the young, including demographic distribution, treatment, and outcomes are different from those observed in the older patients.

Small-cell lung cancer with lymphadenopathy in an 18-year-old female nonsmoker

BACKGROUND

An asymptomatic 18-year-old female presented in December 2002 with a left pulmonary mass, and an enlarged mediastinum and left hilum, detected on a routine chest X-ray. She had never smoked, and had no history of exposure to known carcinogens, no history of serious illnesses and no family history of malignancy. Superficial lymph nodes were not palpable. A CT scan of the chest disclosed a round tumor in the left lower lobe and marked enlargement of the ipsilateral hilar and mediastinal lymph nodes.

INVESTIGATIONS

CT scan of the chest, routine hematological study, sputum smear and culture for acid-fast bacilli, transbronchial lung biopsy, serum tumor markers, CT scan of the abdomen, MRI scan of the head, bone scintigraphy, lung function tests, blood gas analysis, pathological examination including hematoxylin-eosin staining and immunohistochemistry using chromogranin A, CD56 (neural cell adhesion molecule), and cytokeratin antibodies.

DIAGNOSIS

Limited-stage small-cell lung cancer (T1N2M0, clinical stage IIIA).

MANAGEMENT

Etoposide plus cisplatin chemotherapy with concurrent accelerated hyperfractionated thoracic radiotherapy, left pneumonectomy and lymph-node dissection.

Recent advances in the molecular diagnosis of lung cancer

Despite extensive effort in improvement of diagnosis and treatment of patients with lung cancer in past three decades, the overall survival of patients with the disease remains dismal. Because the development of lung cancer takes a few decades, early diagnosis of the disease or identification of truly high-risk populations may provide us opportunity to successfully cure or prevent the disease. Recent advances in understanding biological basis of lung tumorigenesis provide new tools for detecting malignant cells or the process of malignant transformation and progression. Along with identification of molecular abnormalities in the early lung tumorigenesis, advanced molecular analytic technologies have been emerged, which may facilitate development of rapid and effective methods for early diagnosis and risk assessment. Here, I discuss recent progresses in understanding of early molecular abnormalities in lung cancer, efforts of translating laboratory findings to clinical tests, and prospective of biomarkers in lung cancer diagnosis and risk assessment.

DNA copy number changes in lung adenocarcinoma in younger patients

We performed a comparative genomic hybridization study on 25 lung adenocarcinoma samples from younger patients (<41 y of age) and compared the results with a previous comparative genomic hybridization analysis of lung adenocarcinoma samples from older patients (50-81 y of age). Twenty of the 25 tumor samples from younger patients had DNA copy number changes. Gains, losses, and high-level amplifications were seen more frequently in the specimens from the younger group. The most striking difference between the two groups was the high frequency of gains and/or high-level amplifications in the long arm of chromosome 20 in the samples from the younger patients (14/25, 56%) compared with that in the samples from the older patients (2/24, 8%, P <.001). Gains in the long arm of chromosome 22 and of the chromosomal band 11q13 were also detected significantly more often in the younger group. No correlation was found between DNA copy number changes and clinical parameters. Our results suggest that amplification of genes in the long arm of chromosome 20 may be important in the tumorigenesis of lung adenocarcinoma in young adults. Several candidate genes have already been described in the long arm of chromosome 20, particularly in breast cancer.

Molecular abnormalities in lung carcinogenesis and their potential clinical implications

Development of lung cancer is multistep and requires accumulation of multiple genetic and epigenetic alterations. Modern molecular technology has facilitated a rapid and effective identification of these genetic alterations as well as epigenetic alterations. The determination of molecular alterations in the early tumorigenic process of the lung will not only extend our understanding of the underlying biology but also provide molecular markers for cancer risk assessment, early detection, and molecular classification. In this article, I will discuss the common molecular abnormalities in lung cancer and how these abnormalities may be used as biomarkers in clinical practice.

Detection of microsatellite alterations in the DNA isolated from tumor cells and from plasma DNA of patients with lung cancer

In this paper, we show that the same panel of three microsatellite markers is useful for the detection of alterations in the DNA of tumor cells and plasma from patients diagnosed with SCLC and NSCLC. In 31% of the SCLC patients, we detected a microsatellite alteration(s) or LOH in at least one locus. In the group of patients diagnosed with NSCLC, a microsatellite alteration or LOH was detected in at least one locus in 33% of the patients. In all but 2 patients, the identical alteration observed in the DNA from tumor cells was also detected in the DNA isolated from blood plasma. This work confirms the results described by other groups and it extends the diagnostic possibilities of finding tumor cell-specific DNA alterations also in the DNA freely circulating in plasma and serum of patients with cancer.

Pathogenesis of non-AIDS-defining cancers: a review

As the AIDS epidemic advances, the number of HIV-infected subjects developing AIDS-related neoplasms is rapidly increasing, and the spectrum of malignancies encountered is expanding. Several non-AIDS-defining cancers are being reported at an increasing incidence in HIV-infected individuals, including anal, skin, oral mucosa, head and neck and lung carcinomas, testicular tumors, and pediatric soft-tissue sarcoma. There appears to be an emerging role for various concurrent viral infections in the HIV-infected host that are likely implicated in the pathogenesis of some nondefining-AIDS neoplasms. Our recent findings in HIV-associated lung cancers and in the precursor lesions of cervical carcinoma suggest that wide-spread genomic instability, as manifested by the development of increased numbers of microsatellite alterations (MAs), may occur frequently in HIV-associated tumors and they may play an important role in the pathogenesis of those neoplasms. Although the mechanism underlying the development of increased MAs is unknown, it may play a crucial role in the development of many HIV-associated tumors. It will be important to track the epidemiological and biological features of non-AIDS-defining cancers in HIV-infected patients, and compare them to those tumors in the general population. It is likely that further clues about malignant transformation and oncogenesis unraveled in the HIV setting will have broad clinical implications.

Young lung cancer patients in Japan: different characteristics between the sexes

BACKGROUND

Lung cancer in younger people is uncommon and has characteristics that distinguish it from cancer in older patients. The percentage of smokers among younger patients ranges from 40% to 50% in Asia to 90% in Western countries. The prognosis for young patients with this disease is controversial.

METHODS

Medical records of 91 young (40 years of age or younger) and 3,221 older (more than 40 years of age) Japanese patients with lung cancer were reviewed to compare smoking habits, distribution of histopathologic types, clinical stage, and survival.

RESULTS

Among female patients, only 39% were smokers in both age groups, whereas smokers were less common among the young male patients (84%) than the older male patients (95%) (p < 0.0001). Adenocarcinomas were diagnosed in 92% of the young and 73% of the older female patients (p = 0.021) versus only 71% and 42% of the corresponding male patients (p < 0.0001). There was no difference in tumor extent or survival between the two groups of female patients. In the male groups, advanced disease (stages IIIB and IV) was more common in the young patients (75%) than in the older patients (54%) (p = 0.0031), but there was no survival difference between the two groups.

CONCLUSIONS

Young male and female lung cancer patients in Japan have different characteristics from each other and from older patients of the same sex. Their survival did not differ from that of older patients.

Frameshift mutations in TGFbetaRII, IGFIIR, BAX, hMSH3 and hMSH6 are absent in lung cancers

A genome-wide instability at simple repeat sequences characterizes gastrointestinal and endometrial cancers of the microsatellite mutator phenotype (MMP). The genes encoding transforming growth factor-beta receptor type II (TGFbetaRII), insulin-like growth factor II receptor (IGFIIR), Bcl-2 associated X protein (BAX), hMSH3 and hMSH6 have simple repeat sequences in their coding regions. Consequently, mutations in the single repeat sequences in these genes provide one major route for carcinogenesis in these cancers. We examined 43 non-small cell lung carcinomas and 16 small cell carcinomas for frameshift mutations in simple repeat sequences of TGFbetaRII, IGFIIR, BAX, hMSH3 and hMSH6. In addition, MMP was assessed using a primer set for BAT-26. None of 59 lung cancers exhibited frameshift mutations or MMP. It is concluded that somatic frameshift mutations in these genes and MMP do not constitute important mechanisms in lung carcinogenesis. The possibility of some sort of genetic instability undetectable as a form of MMP cannot be precluded.

Loss of imprinting in normal tissue of colorectal cancer patients with microsatellite instability

Loss of imprinting (LOI) is an epigenetic alteration of some cancers involving loss of parental origin-specific expression of imprinted genes. We observed LOI of the insulin-like growth factor-II gene in twelve of twenty-seven informative colorectal cancer patients (44%), as well as in the matched normal colonic mucosa of the patients with LOI in their cancers, and in peripheral blood samples of four patients. Ten of eleven cancers (91%) with microsatellite instability showed LOI, compared with only two of sixteen tumors (12%) without microsatellite instability (P < 0.001). Control patients without cancer showed LOI in colonic mucosa of only two of sixteen cases (12%, P < 0.001) and two of fifteen blood samples (13%, P < 0.001). These data suggest that LOI in tumor and normal tissue identifies most colorectal cancer patients with microsatellite instability in their tumors, and that LO! may identify an important subset of the population with cancer or at risk of developing cancer.

Progress in understanding the molecular pathogenesis of human lung cancer

We review the molecular pathogenesis of lung cancer including alterations in dominant oncogenes, recessive oncogenes/tumor suppressor genes, alterations in growth regulatory signaling pathways, abnormalities in other pathways, such as apoptosis, autocrine and paracrine growth stimulatory loops, angiogenesis, and host immune responses, other mechanisms of genetic changes, such as microsatellite and methylation alterations, and the potential for inherited predisposition to lung cancer. These changes are related to multistage carcinogenesis involving preneoplastic lesions, and lung development and differentiation. The translational applications of these findings for developing new ways of early detection, prevention, treatment, and prognosis of lung cancer are discussed.

Deletion of the p16 gene and microsatellite instability in carcinoma arising in pleomorphic adenoma of the parotid gland

Carcinoma arising in pleomorphic adenoma of the salivary gland is a rare tumor, and its molecular aspects are unknown. Recent studies have revealed that malignant transformation of various human cancers may involve two different genetic alterations: inactivation of the p16 gene, which is a putative tumor suppressor gene, and genetic instability represented by microsatellite instability (MSI). However, so far, molecular investigations including p16 gene alteration and MSI have not been performed on carcinoma arising in pleomorphic adenoma. Both inactivation of the p16 gene and MSI were studied using DNA extracted from paraffin-embedded sections of carcinoma arising in pleomorphic adenoma. Samples also were analyzed for cyclin D1 gene amplification, which is thought to have oncogenic effects similar to those with inactivation of the p16 gene. One case showed the homozygous deletion of the p16 gene in the carcinoma, although hypermethylation of the p16 gene and amplification of the cyclin D1 gene were not observed in any cases. In two of four cases, MSI was observed. One case in two showed MSI in both the pleomorphic adenoma and the carcinoma. Results of this study suggest that two different genetic alterations, the inactivation of the p16 gene and genetic instability, play roles in the malignant transformation of carcinoma in pleomorphic adenoma. The MSI observed in the adenoma suggests that genetic alterations occur in pleomorphic adenoma.