The incidence of lung cancer by histological type: A population-based study in Tianjin, China during 1981-2005

Community-based lung cancer screening by low-dose computed tomography in China: First round results and a meta-analysis

OBJECTIVE

To evaluate the efficiency of low-dose computed tomography (LDCT) screening for lung cancer in China by analyzing the baseline results of a community-based screening study accompanied with a meta-analysis.

METHODS

A first round of community-based lung cancer screening with LDCT was conducted in Tianjin, China, and a systematic literature search was performed to identify LDCT screening and registry-based clinical studies for lung cancer in China. Baseline results in the community-based screening study were described by participant risk level and the lung cancer detection rate was compared with the pooled rate among the screening studies. The percentage of patients per stage was compared between the community-based study and screening and clinical studies.

RESULTS

In the community-based study, 5523 participants (43.6% men) underwent LDCT. The lung cancer detection rate was 0.5% (high-risk, 1.2%; low-risk, 0.4%), with stage I disease present in 70.0% (high-risk, 50.0%; low-risk, 83.3%), and the adenocarcinoma present in 84.4% (high-risk, 61.5%; low-risk, 100%). Among all screen-detected lung cancer, women accounted for 8.3% and 66.7% in the high- and low-risk group, respectively. In the screening studies from mainland China, the lung cancer detection rate 0.6% (95 %CI: 0.3%-0.9%) for high-risk populations. The proportions with carcinoma in situ and stage I disease in the screening and clinical studies were 76.4% (95 %CI: 66.3%-85.3%) and 15.2% (95 %CI: 11.8%-18.9%), respectively.

CONCLUSIONS

The stage shift of lung cancer due to screening suggests a potential effectiveness of LDCT screening in China. Nearly 70% of screen-detected lung cancers in low-risk populations are identified in women.

Effect of aerobic exercise on acquired gefitinib resistance in lung adenocarcinoma

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Long-term gefitinib induction could increase the level of oxidative stress in lung adenocarcinoma cells and reduce the antioxidant capacity.

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Acquired resistance to gefitinib in lung adenocarcinoma was closely related to the high expression of HIF-1 and ALDH1 and the enrichment of CSCs.

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The inhibitory effect of aerobic exercise on oxidative stress can effectively reduce the expression of HIF-1 and ALDH1 and inhibit the enrichment of CSCs, which can enhance the response of drug-resistant cells to gefitinib.

Lung adenocarcinoma patients with epidermal growth factor receptor (EGFR)-activating mutations respond well to tyrosine kinase inhibitors but typically develop resistance. Current therapies mainly target differentiated cells, not cancer stem cells (CSCs), but CSCs affect the occurrence, invasion, metastasis and treatment sensitivity of malignant tumours. Recently, aerobic exercise has emerged as adjuvant therapy for cancer. Aerobic exercise can accelerate blood circulation, improve tissue oxygen supply, reduce the stress level of patients, improve the antioxidant capacity of the body, and facilitate the degradation of hypoxia-inducible factor-1 (HIF-1) in tumour tissues, thus weakening its maintenance effect on CSCs. In this study, we successfully established lung adenocarcinoma cell lines with gefitinib resistance. Long-term gefitinib induction could increase the level of oxidative stress in lung adenocarcinoma cells and reduce the antioxidant capacity, resulting in the high expression of HIF-1 and ALDH1 and leading to the enrichment of CSCs, and a decreased response to gefitinib. This may be one of the important reasons for gefitinib-acquired resistance in lung adenocarcinoma. In the case of drug resistance, effective aerobic exercise could reduce ROS, activate SOD, inhibit HIF-1 and ALDH1, and cause a reduction in CSCs to sensitise cells to gefitinib again and ultimately inhibit the malignant proliferation of tumours. Therefore, in the treatment of lung adenocarcinoma, the inhibitory effect of aerobic exercise on oxidative stress can enhance the response of drug-resistant cells to gefitinib and can be used as an effective adjunct measure in the treatment of lung adenocarcinoma.

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.

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.

Temporal Trends and Geographic Patterns of Lung Cancer Incidence by Histology in Thailand, 1990 to 2014

Purpose

Lung cancer is one of the most common cancers worldwide and in Thailand. We characterize and forecast region-specific patterns of lung cancer incidence by histology and sex.

Methods

We analyzed lung cancer incidence trends in Thailand by histology (adenocarcinoma [AdC]; squamous cell carcinoma [SCC]; and large-cell, small-cell, and other carcinomas) from 1990 to 2014 in four cancer registries in three regions (north, Chiang Mai Province and Lampang Province; northeast: Khon Kaen Province; south: Songkhla Province). Annual percent change (APC) was calculated to quantify the incidence rate trends using joinpoint regression. Age-period-cohort models were used to examine the temporal trends of AdC and SCC by age, calendar year, and birth cohort. We projected the incidence of AdC and SCC up to 2030 using three independent approaches: joinpoint, age-period-cohort, and Nordpred models.

Results

AdC incidence significantly increased from 1990 to 2012 in Chiang Mai males (APC, 1.3%), Songkhla males from 2004 to 2014 (APC, 2.5%), Songkhla females from 1990 to 2014 (APC, 5.9%), and Khon Kaen females from 2005 to 2014 (APC, 3.1%). Conversely, SCC incidence significantly decreased from 1990 to 2012 in Chiang Mai males and females (APC, −1.2% and −4.8%, respectively), Lampang males and females from 1993 to 2014 (APC, −5.4% and −5.2%, respectively), and Songkhla females from 1990 to 2014 (APC, −2.1%). In general, trends of AdC and SCC correlated more with birth cohort than with calendar year. Three projection models suggested that incidence rates of AdC in Songkhla may continue to increase until 2030.

Conclusion

Temporal trends of lung cancer by histology varied among regions in Thailand. Reduction of lung cancer incidence in Thailand likely will require prevention strategies tailored to each specific region.

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.

Primary tumor location is an important predictor of survival in pulmonary adenocarcinoma

Purpose

The prognostic value of tumor location in pulmonary adenocarcinoma (ADC) is controversial. We compared the prognosis and relevant data between central-type ADC (CT-ADC) and peripheral-type ADC (PT-ADC) in order to identify the reasons for the different outcomes between them and to improve the treatment strategy and prognosis of these two types.

Patients and methods

Data of 256 patients with pathologically diagnosed ADC were retrospectively reviewed. The prognostic factors for disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS) were analyzed using univariate and multivariate analyses.

Results

A total of 124 and 132 patients had CT-ADC and PT-ADC, respectively. CT-ADC was associated with an earlier age, poorer Karnofsky Performance Status (KPS), higher rates of advanced stage, bone metastasis, contralateral pulmonary metastasis, and pleural effusion. Besides, CT-ADC showed a trend toward lower rate of EGFR mutation. Patients with CT-ADC had a significantly shorter PFS/DFS and OS than did those with PT-ADC. Multivariate analysis revealed that advanced stage, central-type location, EGFR wild-type, no surgery, presence of COPD, and interstitial lung disease (ILD) were independent poor prognostic factors for OS. The rate of surgery was significantly lower in patients with CT-ADC. Among patients with ILD or COPD, OS is shorter in patients with central- than peripheral-type tumors.

Conclusion

CT-ADC is associated with poorer survival than PT-ADC and the lower rate of surgery in patients with CT-ADC is an important reason for this. Tumor location of pulmonary ADC plays a critical role in predicting prognosis and choosing therapeutic strategies.

Secular trends in incidence of lung cancer by histological type in Beijing, China, 20002016

Objective

The objective of this study was to characterize secular trends in the sex-specific, age-standardized incidence of lung cancer by histological type in Beijing, China, from 2000 to 2016 based on data from a population-based cancer registry.

Methods

Data on the incidence of cancer from 2000 to 2016 were obtained from the Beijing Cancer Registry. We examined trends in the sex-specific, age-standardized incidence of lung cancer by histological type using a Joinpoint regression model.

Results

A total of 117,409 cases of lung cancer were diagnosed from 2000 to 2016. Overall, 73,062 (62.23%) patients were males. The most common histological type among both sexes was adenocarcinoma; however, the proportion of adenocarcinoma differed significantly between males and females (45.36% vs. 77.14%, respectively, P<0.0001). The age-standardized incidence of total lung cancer increased from 2000 to 2010 with an annual percent change (APC) of 2.2% [95% confidence interval (95% CI), 1.5% to 2.9%] and stabilized thereafter. Among males, the incidence of total lung cancer peaked in 2008 and then decreased slightly, with an APC of −1.1% (95% CI, −2.1% to −0.1%). Among females, the incidence increased continuously during the study period, with an APC of 1.4% (95% CI, 0.9% to 1.9%). The incidence of squamous cell carcinoma decreased significantly in recent years among both sexes, with APCs of −2.6% (95% CI, −4.5% to −0.6%) from 2007 to 2016 for males and −5.4% (95% CI, −7.2% to −3.6%) from 2004 to 2016 for females. In contrast, the incidence of adenocarcinoma increased continuously throughout the study period, by APCs of 4.0% (95% CI, 2.6% to 5.4%) for males and 6.2% (95% CI, 4.8% to 7.6%) for females. The incidence of small cell carcinoma peaked in 2007 and stabilized thereafter among males, whereas it peaked in 2012 and then decreased with an APC of −14.7% (95% CI, −25.3% to −2.6%) among females. The incidence of large cell carcinoma and other specified malignant neoplasm did not change much, whereas the incidence of unspecified type decreased among both sexes during the study period.

Conclusions

Although the incidence of squamous cell carcinoma decreased significantly among both sexes in recent years in Beijing, China, adenocarcinoma increased continuously throughout the study period among both sexes. Knowledge of differences in trends is useful for surveillance and control of lung cancer. However, the reason for the increase in adenocarcinoma remains unclear and warrants investigation.

Increased CYFRA 21-1, CEA and NSE are Prognostic of Poor Outcome for Locally Advanced Squamous Cell Carcinoma in Lung: A Nomogram and Recursive Partitioning Risk Stratification Analysis

OBJECTIVES

This study aimed to: (1) assess the prognostic significance of serum tumor markers in locally advanced squamous cell carcinoma in lung (LA-SCCL); (2) generate a nomogram to predict the overall survival (OS) and (3) identify a prognostic stratification to assist the therapeutic decision-making.

METHODS

LA-SCCL patients receiving definitive radiotherapy and baseline tumor marker measurement were eligible for this retrospective study. Cox proportional hazards regression was used to determine independent factors associated with various survival indexes and a nomogram was created to estimate the 5-year OS probability for individual patient. The identified prognostic factors were recruited into a recursive partitioning analysis (RPA) for OS to stratify patients with distinct outcome.

RESULTS

A total of 224 patients were eligible for analysis. Increased cytokeratin-19 fragment (CYFRA 21-1) was independently associated with inferior OS, progression free survival (PFS) and a borderline decreased local-regional progression free survival (LRPFS). Elevated carcino-embryonic antigen (CEA) served as an unfavorable determinant for OS and increased neuron-specific enolase (NSE) was predictive of poor distant metastasis free survival (DMFS). A nomogram integrating KPS, TNM stage, CEA and CYFRA 21-1 was created, resulting in a c-index of 0.62. RPA identified 4 prognostic classifications, with median OS of 27.6, 19.9, 17.3 and 10.9 months for low, intermediate, high and very-high risk groups, respectively.

CONCLUSIONS

Baseline tumor marker panel including CYFRA 21-1, CEA and NSE can be prognostic of outcome for LA-SCCL receiving definitive radiotherapy. The RPA identified four prognostic subgroups, which could assist personalized therapy and clinical trial design in LA-SCCL.

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

BACKGROUND

In recent years, lung cancer incidence has been increasing; however the impact of different histological types of lung cancer is not yet clear.

METHODS

Trends in the lung cancer incidence rate by histological type were examined based on data of 36 658 primary lung cancer patients from West China Hospital between 1995 and 2015.

RESULTS

The most common histological type of lung cancer in our hospital was adenocarcinoma (ADC) in both genders, followed by squamous cell carcinoma (SQCC), and small cell carcinoma (SCLC), which is consistent with general worldwide trends. The proportion of young patients with SCLC showed a downward trend. In the overall population with lung cancer, the number of elderly patients with lung cancer increased significantly, while the proportion of elderly patients increased gradually. The mean age at diagnosis also increased. The number of women with ADC increased sharply in recent years, especially in young patients, and the incidence rate in women is now greater than in men.

CONCLUSION

Significant increases in the number of patients with ADC and the rate of lung cancer in women over recent years were observed, indicating that research on the pathogenesis of disease in these patients is urgent.

Pathways and cost-effectiveness of routine lung cancer inpatient care in rural Anhui, China: a retrospective cohort study protocol

INTRODUCTION

Routine inpatient care (RIC) for patients with cancer forms various pathways of clinical procedures. Although most individual procedures comprising the pathways have been tested via clinical trials, little is known about the collective cost and effectiveness of the pathways as a whole. This study aims at exploring RIC pathways for patients with lung cancer from rural Anhui, China, and their determinants and economic impacts.

METHODS AND ANALYSIS

The study adopts a retrospective cohort design and proceeds in five steps. Step 1 defines the four main categories of study variables, including clinical procedures, direct cost and effectiveness of procedures, and factors affecting use of these procedures and their cost and effectiveness. Step 2 selects a cohort of 5000 patients with lung cancer diagnosed between 1 July 2015 and 30 June 2016 from rural Anhui by clustered random sampling. Step 3 retrieves the records of all the inpatient care episodes due to lung cancer and extracts data about RIC procedures, proximate variables (eg, Karnofsky Performance Status, Lung Function Score) of patient outcomes and related factors (eg, stage of cancer, age, gender), by two independent clinician researchers using a web-based form. Step 4 estimates the direct cost of each of the RIC procedures using micro-costing and collects data about ultimate patient outcomes (survival and progression-free survival) through a follow-up survey of patients and/or their close relatives. Step 5 analyses the data collected and explores pathways of RIC procedures and their relations with patient outcomes, costs, cost:effect ratios, and a whole range of clinical and sociodemographic factors using multivariate regression and path models.

ETHICS AND DISSEMINATION

The study protocol has been approved by an authorised ethics committee of Anhui Medical University (reference number: 20170312). Findings from the study will be disseminated through conventional academic routes such as peer-reviewed publications and presentations at regional, national and international conferences.

TRIAL REGISTRATION NUMBER

ISRCTN25595562.

Construction of a 26‑feature gene support vector machine classifier for smoking and non‑smoking lung adenocarcinoma sample classification

The present study aimed to identify the feature genes associated with smoking in lung adenocarcinoma (LAC) samples and explore the underlying mechanism. Three gene expression datasets of LAC samples were downloaded from the Gene Expression Omnibus database through pre-set criteria and the expression data were processed using meta-analysis. Differentially expressed genes (DEGs) between LAC samples of smokers and non-smokers were identified using limma package in R. The classification accuracy of selected DEGs were visualized using hierarchical clustering analysis in R language. A protein-protein interaction (PPI) network was constructed using gene interaction data from the Human Protein Reference Database for the DEGs. Betweenness centrality was calculated for each node in the network and genes with the greatest BC values were utilized for the construction of the support vector machine (SVM) classifier. The dataset GSE43458 was used as the training dataset for the construction and the other datasets (GSE12667 and GSE10072) were used as the validation datasets. The classification accuracy of the classifier was tested using sensitivity, specificity, positive predictive value, negative predictive value and area under curve parameters with the pROC package in R language. The feature genes in the SVM classifier were subjected to pathway enrichment analysis using Fisher's exact test. A total of 347 genes were identified to be differentially expressed between samples of smokers and non-smokers. The PPI network of DEGs were comprised of 202 nodes and 300 edges. An SVM classifier comprised of 26 feature genes was constructed to distinguish between different LAC samples, with prediction accuracies for the GSE43458, GSE12667 and GSE10072 datasets of 100, 100 and 94.83%, respectively. Furthermore, the 26 feature genes that were significantly enriched in 9 overrepresented biological pathways, including extracellular matrix-receptor interaction, proteoglycans in cancer, cell adhesion molecules, p53 signaling pathway, microRNAs in cancer and apoptosis, were identified to be smoking-related genes in LAC. In conclusion, an SVM classifier with a high prediction accuracy for smoking and non-smoking samples was obtained. The genes in the classifier may likely be the potential feature genes associated with the development of patients with LAC who smoke.

The association between ambient fine particulate matter and incident adenocarcinoma subtype of lung cancer

BACKGROUND

Adenocarcinoma (AC) is the most common lung cancer among non-smokers, but few studies have assessed the effect of PM_2.5 on AC among never smokers. The purpose of this study was to assess the association between ambient PM_2.5 and incident lung AC in the Adventist Health and Smog Study-2 (AHSMOG-2), a cohort of 80,044 non-smokers (81% never smokers) followed for 7.5 years (597,177 person-years) (2002-2011).

METHODS

Incident lung AC was identified through linkage with U.S. state cancer registries. Ambient PM_2.5 levels at subjects' residences were estimated for the years 2000 and 2001, immediately prior to study start.

RESULTS

A total of 164 incident lung AC occurred during follow-up. Each 10 μg/m³ increment in PM_2.5 was associated with an increase in the hazard rate of lung AC [HR = 1.31 (95% confidence interval (CI) 0.87-1.97)] in the single-pollutant model. Excluding those with prevalent non-melanoma skin cancer (NMSC) strengthened the association with lung AC (HR = 1.62 (95% CI, 1.11-2.36) for each 10 μg/m³ PM_2.5 increment. Also, limiting the analyses to subjects who spent more than 1 h/day outdoors, increased the estimate (HR = 1.55, 95% CI: 1.05, 2.30).

CONCLUSIONS

Increased risk of AC was observed for each 10 μg/m³ increment in ambient PM_2.5 concentrations. The risk was higher among those without prevalent NMSC and those who spent more than 1 h/day outdoors.

Evaluating lung cancer screening in China: Implications for eligibility criteria design from a microsimulation modeling approach

More than half of males in China are current smokers and evidence from western countries tells us that an unprecedented number of smoking-attributable deaths will occur as the Chinese population ages. We used the China Lung Cancer Policy Model (LCPM) to simulate effects of computed tomography (CT)-based lung cancer screening in China, comparing the impact of a screening guideline published in 2015 by a Chinese expert group to a version developed for the United States by the U.S. Centers for Medicare & Medicaid Services (CMS). The China LCPM, built using an existing lung cancer microsimulation model, can project population outcomes associated with interventions for smoking-related diseases. After calibrating the model to published Chinese smoking prevalence and lung cancer mortality rates, we simulated screening from 2016 to 2050 based on eligibility criteria from the CMS and Chinese guidelines, which differ by age to begin and end screening, pack-years smoked, and years since quitting. Outcomes included number of screens, mortality reduction, and life-years saved for each strategy. We projected that in the absence of screening, 14.98 million lung cancer deaths would occur between 2016 and 2050. Screening with the CMS guideline would prevent 0.72 million deaths and 5.8 million life-years lost, resulting in 6.58% and 1.97% mortality reduction in males and females, respectively. Screening with the Chinese guideline would prevent 0.74 million deaths and 6.6 million life-years lost, resulting in 6.30% and 2.79% mortality reduction in males and females, respectively. Through 2050, 1.43 billion screens would be required using the Chinese screening strategy, compared to 988 million screens using the CMS guideline. In conclusion, CT-based lung cancer screening implemented in 2016 and based on the Chinese screening guideline would prevent about 20,000 (2.9%) more lung cancer deaths through 2050, but would require about 445 million (44.7%) more screens than the CMS guideline.

Slowing the Titanic: China's Epic Struggle with Tobacco

China is home to a third of the world's smokers and, correspondingly, to a third of the world's cases of lung cancer. Beginning in the mid-1990s, a generation or so later than in many Western countries, the Chinese government commenced measures to control tobacco, limiting advertising, banning smoking in many public venues, and increasing taxation. At the time of this review, there are signs that these policies are having some effect, but hundreds of millions of Chinese continue to smoke and rates of diagnosis of lung cancer continue to rise. There is much work to be done and much premature death to be suffered before the epidemic is slowed to the levels reached in Australia or the United States. This article aims to provide, particularly for practicing lung cancer clinicians, a description of patterns of smoking in China, the lung cancer epidemic there, and the stimuli for and barriers to tobacco control imposed by the highly complex and unique regulatory setting of the Chinese tobacco industry. A particular challenge in developing this description has come from the variability of studies published about a huge nation that has enormous diversity in wealth, education, urbanization, and tradition. The studies vary because the data vary. Much information on lung cancer and smoking rates in China comes, for example, from studies of cohorts that may number in the millions yet represent only a small percentage of the population and sometimes only a tiny geographic area of such a vast nation. National registry data on lung cancer in China do not yet cover even a fifth of the national population. Even so, we argue that several major trends can be identified: (1) more than 50% of men smoke regularly; (2) there are more than 300 million smokers in China; (3) almost half a million new cases of lung cancer are diagnosed in China each year; (4) secondhand smoking is a significant problem in China (as elsewhere), accounting for a high proportion of lung cancer cases among women, most of whom do not smoke; (5) corrected for age and sex, lung cancer rates in the Chinese population are as least as high as in Western countries and arguably higher; and (6) a shift over time from squamous cell carcinoma (SCC) to adenocarcinoma is occurring in parallel with that noted in Western populations. Looking to the future, measures to control tobacco in China are strengthening but remain relatively weak. The reinforcement of control is hampered by the circumstance that the tobacco industry remains a powerful state-owned monopoly that participates, through its membership of key government bodies, in the processes that oversee the implementation of tobacco control. The conflict between the government's dual responsibilities for both the production and distribution of tobacco and for the implementation of tobacco control carries inherent contradictions and bias. How long the Chinese government chooses to live with these contradictions will determine how quickly the smoking of tobacco will be reduced and how soon the burden of disease that tobacco inflicts on individuals and society as a whole will be eased.

Histologic Distribution of Pulmonary Tumors in Lebanon: A 5-Year Single Institution Experience

BACKGROUND

To compare the current histologic distribution of lung cancer in Lebanon to the worldwide trends, according to the 2004 WHO Classification.

MATERIALS AND METHODS

1,760 patients with a pulmonary pathology examination at Hotel-Dieu de France University Hospital between July 2009 and July 2014 were included.

RESULTS

Some 676 out of the total investigated patients (38.4%) had a lung tumor. In 665 (98.4%) the tumors were malignant, with a mean age at diagnosis of 63.8 years and a male/female (M/F) sex ratio of 1.7:1. Among the malignant tumors, 86.2% were epithelial tumors with a mean age at diagnosis of 64.8 years and an M/F sex ratio of 1.9. Other malignant tumors consisted of metastatic tumors (10.2%), lymphoproliferative tumors (2.1%) and mesenchymal tumors (1.5%). Most common carcinoma subtypes were adenocarcinoma (48.0%), squamous cell carcinoma (23.0%) and small cell carcinoma (13.3%). Carcinoid tumors were the only carcinoma subtype with an M/F sex ratio below 1 (0.7). Salivary gland tumors were the carcinoma with lowest mean age at diagnosis (45.5 years).

CONCLUSIONS

The histologic distribution of lung tumors in Lebanon is similar to that in developed countries. We believe this resemblance is due to common smoking habits, known to be responsible for the increase of lung adenocarcinoma at the expense of other subtypes.

Trends in Lung Cancer Incidence Rates by Histological Type in 1975-2008: A Population-Based Study in Osaka, Japan

Background

Monitoring trends in lung cancer incidence and mortality is important for the evaluation of cancer control activities. We investigated recent trends in age-standardized incidence rates by histological type of lung cancer in Osaka, Japan.

Methods

Cancer incidence data for 1975–2008 were obtained from the Osaka Cancer Registry. Lung cancer mortality data with population data in Osaka during 1975–2012 were obtained from vital statistics. We examined trends in age-standardized incidence and mortality rates for all histological types and age-standardized incidence rates by histological type and age group using a joinpoint regression model.

Results

The age-standardized incidence rate of lung cancer levelled off or slightly increased from 1975–2008, with an annual percentage change of 0.3% (95% confidence interval [CI], 0.1%–0.4%) for males and 1.1% (95% CI, 0.9%–1.3%) for females, and the mortality rate decreased by 0.9% (95% CI, 1.2%–0.7%) for males and 0.5% (95% CI, 0.8%–0.3%) for females. The incidence rates of squamous cell carcinoma (SQC) and small cell carcinoma (SMC) significantly decreased for both genders, whereas that of adenocarcinoma (ADC) significantly increased among almost all age groups in both genders.

Conclusions

The incidence rates of SQC and SMC decreased with the decline in smoking prevalence, which probably explains the change in trends in the incidence rates of lung cancer from the mid-1980s. However, the reason for the increase in ADC remains unclear. Therefore, trends in incidence rates of lung cancer should be carefully monitored, especially for ADC, and the associations between ADC and its possible risk factors should be studied.

Advanced Lung Cancer Inflammation Index, a New Prognostic Score, Predicts Outcome in Patients With Small-Cell Lung Cancer

This report is the first to use the value of the Advanced Lung Cancer Inflammation Index (ALI) to predict the overall survival in patients with small-cell lung cancer. We enrolled 365 patients who were eligible for analysis and found that lower ALI was significantly associated with worse overall survival in small-cell lung cancer patients. The results showed that evaluation using ALI could authenticate the patients with poor prognosis and be a useful prognostic marker in clinical practice.

BACKGROUND

A recent study indicated that the Advanced Lung Cancer Inflammation Index (ALI) could predict overall survival (OS) in patients with non-small-cell lung cancer. However, the prognostic value in small-cell lung cancer (SCLC) has not been studied. Therefore, the aim of this study was to explore the relationship between ALI and the prognosis of SCLC.

PATIENTS AND METHODS

We screened 460 patients who were diagnosed with SCLC from June 2006 to December 2011 in Sun Yat-Sen University Cancer Center. Data acquisition was through patients' medical information, and blood results recorded at the time of diagnosis. ALI was calculated as the formula: body mass index × serum albumin/neutrophil-lymphocyte ratio.

RESULTS

In total, 365 patients were enrolled in this study. Patients were allocated to 2 groups: ALI < 19.5 (n = 60) and ALI ≥ 19.5 (n = 305). For patients with ALI < 19.5 and ≥ 19.5, the median OS was 10.97 and 20.14 months, respectively (P < .001). On multivariate analysis, clinical stage (P < .001), performance status (P = .001), lactate dehydrogenase (P < .001), and ALI (P = .005) were all independent prognostic factors for OS.

CONCLUSION

The results of this study demonstrated that lower ALI was significantly associated with worse OS in SCLC patients. The evaluation of ALI could authenticate the patients with poor prognosis and be a useful prognostic marker in clinical practice.