Update in Lung Cancer 2005

Multiple independent primary cancers do not adversely affect survival of the lung cancer patient

OBJECTIVE

Diagnosis of multiple independent primary cancers is increasing in many settings. Objectives of this study were to analyze clinical characteristics, organ location, and prognosis associated with the presentation of multiple independent primaries when a lung cancer is involved.

METHODS

We analyzed all patients with a histology-proven diagnosis of lung cancer registered from January 1990 to December 2004 at the Tumor Registry of the Hospital del Mar, Barcelona. We compared 1686 patients presenting a lung cancer as unique primary versus 228 patients presenting a lung cancer and another independent primary. Cofactors included age, sex, smoking habit, lung cancer histology and stage, type and intention of treatment, organ location of the other cancer, and survival from the date of lung cancer diagnosis.

RESULTS

Seventy percent of the other cancers were tobacco-related. Independent risk factors of cancer multiplicity were smoking (OR: 3.99; 95% CI: 1.4-11.2), lung cancer stages I (OR: 1.84; 95% CI: 1.2-2.9) and II (OR: 3.25; 95% CI: 1.7-6.3), and older age (OR: 3.11; 95% CI: 1.9-5.1). Once adjusted by age and sex, the main determinant of survival was lung cancer stage rather than cancer multiplicity. However, patients with multiple cancers presented a slightly better survival than patients with a lung cancer as unique primary. When analyzed by subgroups, survival was higher in patients with the lung cancer first (HR: 0.44; 95% CI: 0.24-0.80), and in patients with the other cancer first (HR: 0.80; 95% CI: 0.65-0.99), but it was not different in the patients with a lung cancer and a synchronous other cancer (HR: 0.80; 95% CI: 0.52-1.15).

CONCLUSIONS

The risk of developing a second independent cancer was strongly associated with tobacco smoking. Cancer multiplicity was not associated with a worse prognosis. As a consequence, when a first primary tobacco-related cancer is treated with curative intention, patients should be closely followed up for an early diagnosis of a possible new independent cancer; and if diagnosed, treatment to cure should be considered as the first option.

CaSm (LSm-1) overexpression in lung cancer and mesothelioma is required for transformed phenotypes

CaSm (cancer-associated Sm-like) was originally identified based on elevated expression in pancreatic cancer and in several cancer-derived cell lines. It encodes a 133-amino acid protein that contains two Sm motifs found in the common snRNP proteins and the LSm (like-Sm) family of proteins. Lung tumors and mesotheliomas express high levels of CaSm mRNA and protein compared with adjacent nontumor and normal lung tissue, measured by immunohistochemistry, qRT-PCR, and Western blot analyses. In addition, several human lung cancer- and mesothelioma-derived cell lines have elevated CaSm expression. Two cell lines, transfected with and expressing antisense CaSm RNA, demonstrate altered transformed phenotypes, reducing their ability to form colonies in soft agar and tumors in SCID mice. Furthermore, RNAi-mediated reduction of CaSm RNA and protein is associated with inhibition of cellular growth. These data support the model that elevated CaSm expression in epithelial tissue contributes to the transformed state. Cell lines expressing exogenous CaSm also exhibit transformed characteristics, including increased anchorage-independent colony formation and tumor growth. Thus, the results of loss of function and gain of function studies presented both indicate that CaSm functions as an oncogene in the promotion of cellular transformation and cancer progression.

Large Adrenal Metastasis in Non-Small Cell Lung Carcinoma. Case Report and Literature Review

Adrenal metastases are frequent in patients with non-small cell lung carcinoma (NSCLC). We present a case of a large adrenal metastasis from NSCLC and we discuss the relevant literature. In such cases, early surgical intervention is recommended to avoid spontaneous rupture of the tumor and improve patient survival.

Neurokinin-1 receptor blockade and murine lung tumorigenesis

RATIONALE

Analogous to the adenoma-carcinoma sequence in the colon, it has been proposed that adenocarcinoma (AC) in the lung arises from adenomatous hyperplasia that progresses through atypical adenomatous hyperplasia to AC. However, the data supporting this sequence are largely circumstantial and the almost impossible task of identifying these lesions before resection rules out any longitudinal study in humans.

OBJECTIVES, METHODS, AND RESULTS

We show in mice that the loss of function of the neurokinin-1 receptor (NK-1R)-due to either a pharmacologic or genetic manipulation-results in a sequence of morphologic changes in response to bleomycin treatment that precede the development of AC. We also demonstrate that a series of alterations in gene expression of proliferation markers (i.e., PCNA and Ki-67) and cell cycle regulators (i.e., FHIT, p53, and p21) characterizes the sequence of the precursor lesions. The loss of function of the NK-1R results in changes of the apoptotic rate and in a delay of DNA break recovery of alveolar epithelial cells following bleomycin treatment. The NK-1R blockade interferes with a caspase-independent pathway of apoptosis by affecting both the translocation of Nur77 into the cytoplasm and the expression of some important Bcl2 family members such as Bcl2 and Bak.

CONCLUSIONS

To our knowledge, this is the first model to demonstrate a role for NK-1R in lung epithelial cell death and tumorigenesis. This animal model may provide new information on the biology of AC and will facilitate designing and testing of new therapeutic interventions.