Lung cancer in lifelong non-smokers. Edinburgh Lung Cancer Group

Expression of miRNA-601 and PD-L1 among Iranian Patients with Lung Cancer and Their Relationship with Smoking and Mycoplasma Infection

OBJECTIVE

microRNAs (miRNAs) are highly conserved noncoding RNA molecules that mainly function to regulate gene expressions, and have a significant role in tumourigenesis. Programmed cell death-ligand 1 (PD-L1) is a major co-inhibitory checkpoint signal that controls T cell activities, maintains peripheral tolerance and is contribute to the development of cancer. The aim of this study is to examine miRNA-601 and PD-L1 gene expression in patients with non-small-cell lung cancer (NSCLC) and its relation with Mycoplasma infection.

MATERIALS AND METHODS

In this case-control study, respiratory secretions and blood samples were collected from 80 healthy people and 80 NSCLC patients. The expression levels of miRNA-601 and PD-L1 were evaluated using real-time polymerase chain reaction (qRT-PCR). The presence of Mycoplasma species in respiratory secretions was detected by biochemical assays and PCR.

RESULTS

There was no significant difference in the expression level of miRNA-601 between control and patients with tumour stage I, but miRNA-601 expression was significantly downregulated in patients with tumour stages II, III, and IV (P<0.05). A significant, negative relationship was found between miRNA-601 expression and tumour stage (P<0.001). Overexpression of PD-L1 was found in all of the disease stages. PCR results showed the presence of Mycoplasma pneumoniae (M. pneumoniae) in respiratory secretions from patients with stages III and IV NSCLC. We observed that 72% of patients with stages III and IV NSCLC had a positive smoking history and 65.3% were positive for Mycoplasma.

CONCLUSION

Serum miRNA-601 may act as a potential noninvasive biomarker for lung cancer and Mycoplasma infection prognosis.

Cancer morbidity trends and regional differences in England-A Bayesian analysis

Reliable modelling of the dynamics of cancer morbidity risk is important, not least due to its significant impact on healthcare and related policies. We identify morbidity trends and regional differences in England for all-cancer and type-specific incidence between 1981 and 2016. We use Bayesian modelling to estimate cancer morbidity incidence at various age, year, gender, and region levels. Our analysis shows increasing trends in most rates and marked regional variations that also appear to intensify through time in most cases. All-cancer rates have increased significantly, with the highest increase in East, North West and North East. The absolute difference between the rates in the highest- and lowest-incidence region, per 100,000 people, has widened from 39 (95% CI 33-45) to 86 (78-94) for females, and from 94 (85-104) to 116 (105-127) for males. Lung cancer incidence for females has shown the highest increase in Yorkshire and the Humber, while for males it has declined in all regions with the highest decrease in London. The gap between the highest- and lowest-incidence region for females has widened from 47 (42-51) to 94 (88-100). Temporal change in in bowel cancer risk is less manifested, with regional heterogeneity also declining. Prostate cancer incidence has increased with the highest increase in London, and the regional gap has expanded from 33 (30-36) to 76 (69-83). For breast cancer incidence the highest increase has occurred in North East, while the regional variation shows a less discernible increase. The analysis reveals that there are important regional differences in the incidence of all-type and type-specific cancers, and that most of these regional differences become more pronounced over time. A significant increase in regional variation has been demonstrated for most types of cancer examined here, except for bowel cancer where differences have narrowed.

[Study KBP-2010-CPHG: inclusion of new cases of primary lung cancer diagnosed in general hospital pneumology departments between 1st January and 31 December 2010]

INTRODUCTION

The College of General Hospital Respiratory Physicians (CPHG) is following up the KBP-2000-CPHG study, performed ten years ago, with a new observational epidemiological study of primary lung cancer.

PATIENTS AND METHODS

The study includes all new cases of primary lung cancer diagnosed on histology or cytology between 1 January and 31 December 2010 and managed by one of the general hospital pneumology departments participating in the study. The primary objective is to estimate five-year mortality and to analyze risk factors. Secondary objectives are to describe the characteristics of this patient population and their management, and to estimate one, four and five-year survival rates. These data will be compared to those of the KBP-2000-CPHG study. The four-year prognosis score developed in 2000 will also be assessed in the new study. Data are collected by standardized questionnaire with exhaustiveness control.

EXPECTED RESULTS

One hundred and eight investigating centers have agreed to participate; 4000 to 5000 new cases of primary lung cancer should be collected and analyzed.

CONCLUSION

The study will describe the characteristics of patients presenting with primary lung cancer in the participating pneumology departments during the year 2010, and their diagnostic and therapeutic management, and assess changes over the last ten years.

WWOX gene may contribute to progression of non-small-cell lung cancer (NSCLC)

Lung cancer is the most common cause of cancer-related death worldwide and, like many other cancers, is affected by different genetic, epigenetic, and environmental factors. The WW domain-containing oxidoreductase (WWOX) gene is a tumor-suppressor gene located on chromosome 16q23.3-24.1, and it has been shown that it loses its function due to alterations in genetic and epigenetic mechanisms. The aim of this study is to investigate the relationship between lung cancer and WWOX gene. Tumor tissue samples, corresponding normal tissues, and blood samples obtained from 50 lung cancer patients were involved in the study. We analyzed methylation profile by methylation-specific PCR and mutations and polymorphisms by DNA sequencing. Methylation analysis showed that promoter hypermethylation was present in 38 of 50 (76%) patients. In addition, promoter region of WWOX gene of younger patients was more frequently methylated than older patients. Using DNA sequencing, we found four genetic alterations in WWOX gene. Two of them were germline mutations (Exon 4 and 7), and two of them were polymorphic (Exon 6 and 8). We found a new mutation in exon 7 (Arg-254-->Cys) which has not been described previously. The changes in the short-chain dehydrogenase domain of the protein caused by the genetic alterations may affect the function of the gene. We conclude that hypermethylation of WWOX gene promoter region and mutations in the gene might be related to lung carcinogenesis.

Calibration of disease simulation model using an engineering approach

OBJECTIVES

Calibrating a disease simulation model's outputs to existing clinical data is vital to generate confidence in the model's predictive ability. Calibration involves two challenges: 1) defining a total goodness-of-fit (GOF) score for multiple targets if simultaneous fitting is required, and 2) searching for the optimal parameter set that minimizes the total GOF score (i.e., yields the best fit). To address these two prominent challenges, we have applied an engineering approach to calibrate a microsimulation model, the Lung Cancer Policy Model (LCPM).

METHODS

First, 11 targets derived from clinical and epidemiologic data were combined into a total GOF score by a weighted-sum approach, accounting for the user-defined relative importance of the calibration targets. Second, two automated parameter search algorithms, simulated annealing (SA) and genetic algorithm (GA), were independently applied to a simultaneous search of 28 natural history parameters to minimize the total GOF score. Algorithm performance metrics were defined for speed and model fit.

RESULTS

Both search algorithms obtained total GOF scores below 95 within 1000 search iterations. Our results show that SA outperformed GA in locating a lower GOF. After calibrating our LCPM, the predicted natural history of lung cancer was consistent with other mathematical models of lung cancer development.

CONCLUSION

An engineering-based calibration method was able to simultaneously fit LCPM output to multiple calibration targets, with the benefits of fast computational speed and reduced the need for human input and its potential bias.

Calibration of disease simulation model using an engineering approach

OBJECTIVES

Calibrating a disease simulation model's outputs to existing clinical data is vital to generate confidence in the model's predictive ability. Calibration involves two challenges: 1) defining a total goodness-of-fit (GOF) score for multiple targets if simultaneous fitting is required, and 2) searching for the optimal parameter set that minimizes the total GOF score (i.e., yields the best fit). To address these two prominent challenges, we have applied an engineering approach to calibrate a microsimulation model, the Lung Cancer Policy Model (LCPM).

METHODS

First, 11 targets derived from clinical and epidemiologic data were combined into a total GOF score by a weighted-sum approach, accounting for the user-defined relative importance of the calibration targets. Second, two automated parameter search algorithms, simulated annealing (SA) and genetic algorithm (GA), were independently applied to a simultaneous search of 28 natural history parameters to minimize the total GOF score. Algorithm performance metrics were defined for speed and model fit.

RESULTS

Both search algorithms obtained total GOF scores below 95 within 1000 search iterations. Our results show that SA outperformed GA in locating a lower GOF. After calibrating our LCPM, the predicted natural history of lung cancer was consistent with other mathematical models of lung cancer development.

CONCLUSION

An engineering-based calibration method was able to simultaneously fit LCPM output to multiple calibration targets, with the benefits of fast computational speed and reduced the need for human input and its potential bias.

Association of positive family history with survival of patients with lung cancer

BACKGROUND

Risk factors for development of lung cancer include a family history of the disease. The effect of family history on lung cancer outcomes is unknown. A study was conducted to investigate this.

METHODS

The medical records of all patients with lung cancer seen in an academic medical oncology lung cancer clinic between 1999 and 2006 were reviewed for outcomes and family history of lung cancer. chi(2)-test and Wilcoxon test were used for univariate comparisons, while Cox Proportional Hazards regression analysis was used to evaluate the adjusted risk of death. Univariate probability of survival was computed using Kaplan-Meier estimate and compared using the log-rank test.

RESULTS

Of the 560 patients evaluated, 289 (51%) were male and 519 (93%) had a smoking history. Of the 148 patients (26%) with a family history of lung cancer, 115 had an affected first-degree relative. No association between family history and histology or stage at diagnosis was detected. Median survival in patients with a family history of lung cancer was 53 months compared to 58 months in patients without such a history (p=0.06). Patients with a positive family history had an adjusted relative risk of death of 1.65 (95% CI: 1.07-2.56; p=0.02) compared to those without a family history. This risk was especially increased in those with an affected first-degree relative (RR: 1.72; 95% CI: 1.08-2.75, p=0.02).

CONCLUSIONS

Lung cancer patients with a first-degree relative with lung cancer have a poorer outcome than those without such a history.

Estimating long-term effectiveness of lung cancer screening in the Mayo CT screening study

PURPOSE

To use individual-level data provided from the single-arm study of helical computed tomographic (CT) screening at the Mayo Clinic (Rochester, Minn) to estimate the long-term effectiveness of screening in Mayo study participants and to compare estimates from an existing lung cancer simulation model with estimates from a different modeling approach that used the same data.

MATERIALS AND METHODS

The study was approved by institutional review boards and was HIPAA compliant. Deidentified individual-level data from participants (1520 current or former smokers aged 50-85 years) in the Mayo Clinic helical CT screening study were used to populate the Lung Cancer Policy Model, a comprehensive microsimulation model of lung cancer development, screening findings, treatment results, and long-term outcomes. The model predicted diagnosed cases of lung cancer and deaths per simulated study arm (five annual screening examinations vs no screening). Main outcome measures were predicted changes in lung cancer-specific and all-cause mortality as functions of follow-up time after simulated enrollment and randomization.

RESULTS

At 6-year follow-up, the screening arm had an estimated 37% relative increase in lung cancer detection, compared with the control arm. At 15-year follow-up, five annual screening examinations yielded a 9% relative increase in lung cancer detection. The relative reduction in cumulative lung cancer-specific mortality from five annual screening examinations was 28% at 6-year follow-up (15% at 15 years). The relative reduction in cumulative all-cause mortality from five annual screening examinations was 4% at 6-year follow-up (2% at 15 years).

CONCLUSION

Screening may reduce lung cancer-specific mortality but may offer a smaller reduction in overall mortality because of increased competing mortality risks associated with smoking.

Response to treatment and survival of patients with non-small cell lung cancer undergoing somatic EGFR mutation testing

Somatic mutations in the epidermal growth factor receptor (EGFR) gene are associated with clinical response and prolonged survival in patients with non-small cell lung cancer (NSCLC) treated with EGFR tyrosine kinase inhibitors (TKIs). We began screening patients for somatic EGFR mutations by DNA sequencing as part of clinical care in 2004. We performed a retrospective cohort study of 278 patients with NSCLC referred for EGFR testing over a 10-month period. Tumor samples underwent direct DNA sequence analyses of EGFR exons 18 through 24. We determined the clinical characteristics and EGFR mutation status of the patients and analyzed their response to therapy and survival. EGFR somatic mutations were identified in 68 (24%) of patients. A minimal smoking history was the strongest clinical predictor of harboring a mutation. In multivariable analyses, each pack-year of smoking corresponded to a 5% decreased likelihood of having an EGFR mutation. Among 92 patients with unresectable disease undergoing subsequent systemic therapy, EGFR mutations were associated with an increased response rate to EGFR TKIs (p < .0001) but not chemotherapy. Overall survival was significantly prolonged in EGFR mutation-positive patients (p = .001), with a median survival of 3.1 years compared with 1.6 years in mutation-negative patients, after adjusting for age, gender, and stage at diagnosis. Integrating molecular profiling into clinical care is feasible in NSCLC patients and provides useful clinical information.

Lung Cancer Screening

Advances in imaging technology have ushered in a new era for lung cancer screening in high-risk individuals using computed tomographic (CT) scans. Although most published studies are nonrandomized observational cohorts of volunteers, the ability of CT scans to detect early stage lung cancer is undisputable. What is unresolved is the ability of spiral CT screening to affect lung cancer-related mortality. A large randomized trial sponsored by the National Cancer Institute to address this question is currently under way. Genomic and proteomic approaches promise to complement the ability of spiral CT to detect early lung cancer in the next few years. Currently, the decision to screen for lung cancer should involve a careful discussion with the individuals involved about the potential advantages, costs, and drawbacks of the approach.

Improved survival in never-smokers vs current smokers with primary adenocarcinoma of the lung

STUDY OBJECTIVES

Adenocarcinoma of the lung is now the most common histologic subtype of lung cancer in the United States. To determine if there are survival differences in never-smokers and current smokers with adenocarcinoma, we conducted an analysis of lung adenocarcinomas seen at the H. Lee Moffitt Cancer Center, and looked for demographic and survival differences in the two groups.

DESIGN

Data were gathered through the tumor registry at the H. Lee Moffitt Cancer Center and confirmed by chart review. A total of 132 documented never-smokers and 522 current smokers with lung adenocarcinoma were included. Detailed demographic survival information were gathered and tabulated. Former smokers were not included in the study. Multivariate analyses were performed using the Cox regression method to identify variables with independent prognostic significance. Life table actuarial analyses were performed to determine survival. Differences between survival curves were estimated using the log-rank test.

RESULTS

The mean age at diagnosis for never-smokers was higher as compared to current smokers: 63.5 years vs 59.4 years (p = 0.0005). In addition, there was an increased percentage of female subjects in the never-smoker category: 78% vs 54% (p < 0.0001). There was a statistically significant difference in survival between current smokers and never-smokers (p = 0.004). The Kaplan-Meier estimates at 5 years were 16% for current smokers and 23% for never-smokers. On multivariate analyses, smoking was identified as an independent negative prognostic factor.

CONCLUSION

Our data show that never-smokers with adenocarcinoma are predominantly female, present at a higher mean age, and have improved survival when compared to current smokers. By multivariate analyses, the never-smoking status was found to be an independent predictor of improved survival. The survival difference may be partly influenced by less comorbidity among never-smokers. Nevertheless, owing to differences in the mechanism of carcinogenesis (in smokers vs nonsmokers), demographic factors, tumor behavior and survival, adenocarcinomas occurring in never-smokers may display a distinct natural history and may warrant further investigation as a separate entity with epidemiologic studies and clinical trials designed specifically for this category of non-small cell lung cancer.

Women and small cell lung cancer: social characteristics, medical history, management and survival

The literature make it clear that lung cancer in women differs from that in men in several specific aspects. We conducted a retrospective study of the 967 consecutive recorded patients (696 men and 91 women after exclusions) diagnosed with small cell lung cancers (SCLC) between 1981 and 1994 in the Bas-Rhin population-based cancer registry to determine if such particularities could be observed in SCLC. Data included demographic and social characteristics, medical and smoking history, management (diagnosis and treatment), hospitalisation and survival. The end point for survival was 31 December 1998. Women were more frequently single, divorced, or widowed (P=0.007) and lived more often in urban areas (places with more than 10,000 inhabitants) (P=0.017). They differed significantly from men in their tobacco exposure (P=0.0001) and non-smoking rates (P=0.0003) but not in clinical presentation, except for more frequently elevated LDH levels (P=0.02). Bone marrow biopsies were more often performed in men (P=0.004), but management was otherwise comparable. The mean number of hospitalisations (for any reason) was comparable in both sexes but women tended to remain hospitalised longer (P=0.057). Overall survival did not differ, but women older than 70 years died sooner than their male counterparts (P=0.026). Our study confirms that some of gender differences reported in the lung cancer literature exist in SCLC. Sex-related differences in LDH levels have not previously been reported, to our knowledge. North American and European data concerning survival among women and men are discordant. Whether these gender differences are related to a real difference between the sexes or simply to differential exposure to carcinogens remains to be determined.

Smoking status, occupational asbestos exposure and bronchial location of lung cancer

The objective of this study was to determine the factors associated with central airway versus peripheral bronchial location of lung cancer. All patients diagnosed with lung cancer from 1997 through 2000 in the Respiratory Disease Department of Rouen University Hospital were prospectively interviewed about their smoking and occupational history using a standardized questionnaire. All patients underwent white-light bronchial endoscopy using a 4.5 mm flexible endoscope. Tumors were classified as central when they were accessible and visible using this technique. Out of 217 cases of lung cancer included in this study, 155 (71%) were central. Histological type of lung cancer was strongly associated with bronchial location as central location was observed in 48, 82 and 92% of Adenocarcinoma (AC), Squamous Cell (SqC), and Small Cell Carcinoma (SCC), respectively (P<0.0001). Among non asbestos-exposed patients, location varied little with smoking status, with central location frequency ranging from 74 to 80%. In contrast, lung cancer was recorded central in 41% of long-term (> or =10 years) ex-smokers, 67% of short-term (<10 years) ex-smokers and 75% of current smokers (P=0.04) among patients exposed to asbestos, suggesting an interaction between duration of smoking cessation and occupational asbestos exposure with respect to lung cancer location. These findings were confirmed after adjustment for sex, age and histologic type in multivariate analysis. These results suggest that individually-tailored multimodality screening strategies relying on various combinations of low-dose CT scan, sputum analysis and fluorescence endoscopy according to each patient's profile may be more effective than standard strategies based on a single approach for all patients.

Lung cancer: the oncologist's role in smoking cessation

Cigarette smoking is by far the most common preventable cause of lung cancer in our society, and is therefore responsible for the leading cause of cancer death in both men and women. Physicians are uniquely positioned to impact smoking rates, but frequently fail to address the issue in practice because of competing concerns and a sense of frustration. Oncologists, though not typically thought of as preventive care providers, can be empowered to advocate for more effective smoking cessation strategies, and to implement treatment guidelines in their practice in an effort to improve cancer outcomes in their community. Pharmacologic and behavioral interventions for smokers, including the role of nicotine replacement therapies and bupropion, and their relevance to oncologic practice are reviewed.

Epidemiology, etiology, and prevention of lung cancer

Over the past century, lung cancer has gone from an obscure disease to the leading cause of cancer death worldwide. Initially an epidemic disease among men in industrialized nations, lung cancer now has become the leading cancer killer in both sexes in the United States and an increasingly common disease of both sexes in developing countries. Lung cancer incidence largely mirrors smoking prevalence, with a latency period of several decades. Other important risk factors for the development of lung cancer include environmental exposure to tobacco smoke, radon, occupational carcinogens, and pre-existing nonmalignant lung disease. Studies in molecular biology have elucidated the role that genetic factors play in modifying an individual's risk for lung cancer. Although chemopreventive agents may be developed to prevent lung cancer, prevention of smoking initiation and promotion of smoking cessation are currently the best weapons to fight lung cancer. No other malignancy has been shown to have such a strong epidemiologic relation between a preventable behavior and incidence of disease. Despite this knowledge, more than 20% of all Americans smoke, and tobacco use is exploding in developing countries. Based on current and projected smoking patterns, it is anticipated that lung cancer will remain the leading cause of cancer death in the world for decades to come.

Age does not influence early and late tumor-related outcome for bronchogenic carcinoma

BACKGROUND

The influence of age on early and late outcome after surgical resection of bronchogenic carcinoma is unknown. In an attempt to clarify this issue, we reviewed the outcome of 212 consecutive patients with primary lung cancer who had surgical treatment for bronchogenic carcinoma.

METHODS

Ninety-two patients were younger than 50 years (group 1), and 120 patients were older than 70 years of age (group 2). Squamous cell carcinoma and adenocarcinoma were the most common histologic types in both groups. According to the new international staging classification, a similar proportion of stage I, II, and III were observed in both groups.

RESULTS

Only the rate of pneumonectomy was significantly higher in younger patients (41% versus 22%, p = 0.002). The overall operative mortality rate in group 1 was 2.2% and 2.6% after pneumonectomy. In group 2 the overall mortality rate was 2.5% and 3.8% after pneumonectomy. Advanced age did not affect operative mortality. The adjusted (tumor-related) survival rate at 5 years was 56% in group 1 and 53% in group 2 (p = 0.93). The adjusted survival rate for patients with stage I was 61% in group 1 and 65% in group 2 (p = 0.21), and for stage IIIa 39% in group 1 and 48% in group 2 (p = 0.43). The adjusted 5-year survival rate was 56% in group 1 and 59% in group 2 for squamous cell carcinoma (p = 0.53) and 49% in group 1 and 42% in group 2 for adenocarcinoma (p = 0.76).

CONCLUSIONS

Perioperative risk and midterm survival were similar in younger and older patients after surgical resection of bronchogenic carcinoma. We believe that this result is because surgical candidates constitute already a highly selected group of patients. From these data it is not possible to conclude that biologic behavior of lung cancer is more aggressive in younger patients.

Adenocarcinoma of the lung--clinical features and survival

Four thousand patients were registered by the Edinburgh Lung Cancer Group in 1981-1987; 9.5% had adenocarcinoma. Of these, 102 patients with pathological confirmation of the diagnosis, presenting to one hospital group in Edinburgh, were reviewed. Two cases were excluded after case note review. Of the remaining 100, 64 were male and 36 were female, with a mean age of 73 years. The majority (89%) were smokers or ex-smokers, and 52% had a poor performance status (Karnofsky Index 10-70). Significantly, more adenocarcinoma patients underwent surgery compared to other cell types (39 vs. 19%, P < 0.01), and less were treated with radiotherapy (19 vs. 31%). The 5-yr survival rate for the adenocarcinoma patients was 19 vs. 7% in the remainder of patients. Of 39 patients referred for surgery, 37 had lung resections and their 5-yr survival rate was 42%. Post-operative staging showed 48% in Stage I, 27% in Stage II and 24% in Stage III. The majority of the long-term survivors had Stage I disease (64%). Forty-two percent of the patients received palliative therapy alone (all died within 10 months). Ten percent of patients receiving radiotherapy survived for 5 yr. Review of these cases suggested two patterns of presentations: (1) patients with poor performance status, extensive disease and often pleural involvement (16%); and (2) patients with more localized disease (39%), many of whom were suitable for surgical resection with surprisingly good prognosis.

Clinico-pathological features and survival of lung cancer patients in Paris, France

We studied the clinico-pathological features of 750 lung cancers identified in Paris, France, during 1988. An internal comparison was performed between adenocarcinomas and other subtypes. Survival of 502 patients was studied. 85% of patients were males; 93% were smokers or ex-smokers. Squamous cell carcinomas, adenocarcinomas, small cell carcinomas and large cell cancers accounted for 51, 22, 15 and 12% of all cases, respectively. Differences were found for the distribution of histological subtyping according to sex (P = 0.001) and smoking status (P = 0.0001) with a greater proportion of adenocarcinomas for women and non-smokers. Median overall survival was less than one year. In multiple regression analysis, small cell lung cancer patients appeared to have a worse prognosis than other histological subtypes. This study describes patients who were treated in community practice and might be more representative of the real clinico-pathological profile of this disease in France.

Objective malignancy grading of squamous cell carcinoma of the lung. Stereologic estimates of mean nuclear size are of prognostic value, independent of clinical stage of disease

BACKGROUND

The prognostic value of quantitative histopathologic parameters was evaluated in 55 consecutively treated patients with operable lung carcinoma of squamous (N = 39) and mixed, adenosquamous (N = 16) cell type. Patients alive were followed for at least 12 years.

METHODS

Using a projection microscope and a simple test system in fields of vision systematically selected from the whole tumor area of one routine section, five quantitative histopathologic variables were estimated: the mean nuclear volume, the mean nuclear profile area, the density of nuclear profiles, the volume fraction of nuclei to tissue, and the number of mitotic profiles per 10(3) nuclear profiles. For each patient, information was recorded regarding sex, age at diagnosis, and clinical stage of disease.

RESULTS

Single-factor analyses showed that a favorable prognosis was associated with early clinical stages (Stages I and II) and young age (P < or = 0.03), and that females tended to do better than males (P = 0.09). Estimates of the mean nuclear volume were of prognostic significance (P = 0.02), small nuclei being associated with the worst prognosis. In a multivariate Cox analysis, clinical stage, age, and mean nuclear volume were found to be parameters of significant, independent prognostic value.

CONCLUSIONS

The present feasibility study indicates that estimates of the mean nuclear volume are of prognostic value, independent of the clinical stage of disease. This quantitative histopathologic variable is highly reproducible and easily obtained using an unbiased stereologic method. Thus, the mean nuclear volume may be a parameter of future importance in the clinical management of patients with carcinoma of the lung.

Bronchogenic cancer in patients under 40 years old. The experience of a Latin American country

Lung cancer in young patients is increasing in frequency, as documented by data from the United States, Canada, Japan, and European countries. However, to date and to our knowledge, there have not been any reports from Latin America on this topic. The published reports show that lung cancer in young patients is associated with smoking habit and family history of lung cancer. Its clinical course seems to be more aggressive than in older patients and the histologic type is less often squamous type. We describe 48 patients, aged 40 years or younger, who were diagnosed as having lung cancer in the Instituto Nacional de Cancerología from 1980 to 1990. The patients were equally divided between men and women. Smoking was documented for only 46 percent of the cases. The histologic type most frequently diagnosed was adenocarcinoma (N = 26) followed by squamous cell carcinoma (N = 12). Almost all the cases (46 cases) were staged IV according to the TNM classification. A group of 33 patients older than 40 years (56 to 82 years) were used for comparison. The differences in sex ratio that were higher for men in the elder (m/f, 2.7:1) were family history for cancer in six patients elder; positive smoking habit in all the aged patients (100 percent) compared with only 43.7 percent in the younger group; histologic type (26 adenocarcinomas and 4 squamous in the younger compared with 14 and 12, respectively, in the elder).

Tumor-associated antigen 43-9F is of prognostic value in squamous cell carcinoma of the lung. A retrospective immunohistochemical study

BACKGROUND

Squamous cell lung carcinoma (SLC), the most frequent type of lung cancer, generally is treated surgically and its prognosis is poor. The only current clinically useful prognostic criterion is lymph node staging (TNM classification). Expression of a novel tumor-associated carbohydrate epitope Gal beta 1-3[Fuc alpha 1-4]GlcNAc beta 1-4[Fuc alpha 1-3]GlcNAc beta 1-3 Gal beta 1-4Glc identified by the 43-9F monoclonal antibody (MoAb) is associated with the growth pattern of SLC cell lines in athymic mice and in vitro. This implies that the 43-9F epitope may be related to tumor progression in patients with SLC and that, as such, it could be of prognostic value.

METHODS

Primary tumor specimens from 231 patients with lung carcinoma (130 with SLC, 64 with adenocarcinoma, 10 with small cell carcinoma, 16 with large cell carcinoma, and 11 with adenosquamous carcinoma) were examined by immunohistochemical studies on formalin-fixed, paraffin-embedded tissue samples for immunoreactivity with an MoAb to the 43-9F antigen. Univariate and step-wise Cox regression analyses were used to compare survival time by histopathologic diagnosis, smoker status, TNM classification, and type of surgical treatment.

RESULTS AND CONCLUSIONS

Patients with 43-9F epitope-positive SLC tumors had a significantly (P less than 0.01) better prognosis than patients with epitope-negative tumors. In contrast, no association was seen between 43-9F epitope expression and survival time for patients with lung adenocarcinomas. Further, the prognostic value of 43-9F expression in SLC was found to be superior to the N-classification with the added advantage that it requires access only to primary tumor tissue and thus is available before therapy.