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Zhang M, Yan L, Lippi G, Hu ZD. Pleural biomarkers in diagnostics of malignant pleural effusion: a narrative review. Transl Lung Cancer Res 2021; 10:1557-1570. [PMID: 33889529 PMCID: PMC8044497 DOI: 10.21037/tlcr-20-1111] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although cytology and pleural biopsy of pleural effusion (PE) are the gold standards for diagnosing malignant pleural effusion (MPE), these tools’ diagnostic accuracy is plagued by some limitations such as low sensitivity, considerable inter-observer variation and invasiveness. The assessment of PE biomarkers may hence be seen as an objective and non-invasive diagnostic alternative in MPE diagnostics. In this review, we summarize the characteristics and diagnostic accuracy of available PE biomarkers, including carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), carbohydrate antigens 125 (CA125), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 15-3 (CA15-3), a fragment of cytokeratin 19 (CYFRA 21-1), chitinase-like proteins (CLPs), vascular endothelial growth factor (VEGF) and its soluble receptor, endostatin, calprotectin, cancer ratio, homocysteine, apolipoprotein E (Apo-E), B7 family members, matrix metalloproteinase (MMPs) and tissue-specific inhibitors of metalloproteinases (TIMPs), reactive oxygen species modulator 1 (Romo1), tumor-associated macrophages (TAMs) and monocytes, epigenetic markers (e.g., cell-free microRNA and mRNA). We summarized the evidence from systematic review and meta-analysis for traditional tumor markers’ diagnostic accuracy. According to the currently available evidence, we conclude that the traditional tumor markers have high specificity (around 0.90) but low sensitivity (around 0.50). The diagnostic accuracy of novel tumor markers needs to be validated by further studies. None of these tumor biomarkers would have sufficient diagnostic accuracy to confirm or exclude MPE when used alone. A multi-biomarker strategy, also encompassing the use of artificial intelligence algorithms, may be a valuable perspective for improving the diagnostic accuracy of MPE.
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Affiliation(s)
- Man Zhang
- Department of Thoracic Surgery, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Li Yan
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Zhi-De Hu
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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Wang WW, Zhou XL, Song YJ, Yu CH, Zhu WG, Tong YS. Combination of long noncoding RNA MALAT1 and carcinoembryonic antigen for the diagnosis of malignant pleural effusion caused by lung cancer. Onco Targets Ther 2018; 11:2333-2344. [PMID: 29731641 PMCID: PMC5923246 DOI: 10.2147/ott.s157551] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose Long noncoding RNAs (lncRNAs) are present in body fluids, but their potential as tumor biomarkers has never been investigated in malignant pleural effusion (MPE) caused by lung cancer. The aim of this study was to assess the clinical significance of lncRNAs in pleural effusion, which could potentially serve as diagnostic and predictive markers for lung cancer-associated MPE (LC-MPE). Patients and methods RNAs from pleural effusion were extracted in 217 cases of LC-MPE and 132 cases of benign pleural effusion (BPE). Thirty-one lung cancer-associated lncRNAs were measured using quantitative real-time polymerase chain reaction (qRT-PCR). The level of carcinoembryonic antigen (CEA) was also determined. The receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) were established to evaluate the sensitivity and specificity of the identified lncRNAs and other biomarkers. The correlations between baseline pleural effusion lncRNAs expression and response to chemotherapy were also analyzed. Results Three lncRNAs (MALAT1, H19, and CUDR) were found to have potential as diagnostic markers in LC-MPE. The AUCs for MALAT1, H19, CUDR, and CEA were 0.891, 0.783, 0.824, and 0.826, respectively. Using a logistic model, the combination of MALAT1 and CEA (AUC, 0.924) provided higher sensitivity and accuracy in predicting LC-MPE than CEA (AUC, 0.826) alone. Moreover, baseline MALAT1 expression in pleural fluid was inversely correlated with chemotherapy response in patients with LC-MPE. Conclusion Pleural effusion lncRNAs were effective in differentiating LC-MPE from BPE. The combination of MALAT1 and CEA was more effective for LC-MPE diagnosis.
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Affiliation(s)
- Wan-Wei Wang
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China
| | - Xi-Lei Zhou
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China
| | - Ying-Jian Song
- Department of Respiratory Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China
| | - Chang-Hua Yu
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China
| | - Wei-Guo Zhu
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China
| | - Yu-Suo Tong
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China
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Franks SE, Briah R, Jones RA, Moorehead RA. Unique roles of Akt1 and Akt2 in IGF-IR mediated lung tumorigenesis. Oncotarget 2016; 7:3297-316. [PMID: 26654940 PMCID: PMC4823107 DOI: 10.18632/oncotarget.6489] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/16/2015] [Indexed: 01/22/2023] Open
Abstract
AKT is a serine-threonine kinase that becomes hyperactivated in a number of cancers including lung cancer. Based on AKT's association with malignancy, molecules targeting AKT have entered clinical trials for solid tumors including lung cancer. However, the AKT inhibitors being evaluated in clinical trials indiscriminately inhibit all three AKT isoforms (AKT1-3) and it remains unclear whether AKT isoforms have overlapping or divergent functions. Using a transgenic mouse model where IGF-IR overexpression drives lung tumorigenesis, we found that loss of Akt1 inhibited while loss of Akt2 enhanced lung tumor development. Lung tumors that developed in the absence of Akt2 were less likely to appear as discrete nodules and more frequently displayed a dispersed growth pattern. RNA sequencing revealed a number of genes differentially expressed in lung tumors lacking Akt2 and five of these genes, Actc1, Bpifa1, Mmp2, Ntrk2, and Scgb3a2 have been implicated in human lung cancer. Using 2 human lung cancer cell lines, we observed that a selective AKT1 inhibitor, A-674563, was a more potent regulator of cell survival than the pan-AKT inhibitor, MK-2206. This study suggests that compounds selectively targeting AKT1 may prove more effective than compounds that inhibit all three AKT isoforms at least in the treatment of lung adenocarcinoma.
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Affiliation(s)
- S Elizabeth Franks
- Department of Biomedical Science, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Ritesh Briah
- Department of Biomedical Science, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Robert A Jones
- Department of Biomedical Science, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Roger A Moorehead
- Department of Biomedical Science, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Britto CJ, Cohn L. Bactericidal/Permeability-increasing protein fold-containing family member A1 in airway host protection and respiratory disease. Am J Respir Cell Mol Biol 2015; 52:525-34. [PMID: 25265466 DOI: 10.1165/rcmb.2014-0297rt] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Bactericidal/permeability-increasing protein fold-containing family member A1 (BPIFA1), formerly known as SPLUNC1, is one of the most abundant proteins in respiratory secretions and has been identified with increasing frequency in studies of pulmonary disease. Its expression is largely restricted to the respiratory tract, being highly concentrated in the upper airways and proximal trachea. BPIFA1 is highly responsive to airborne pathogens, allergens, and irritants. BPIFA1 actively participates in host protection through antimicrobial, surfactant, airway surface liquid regulation, and immunomodulatory properties. Its expression is modulated in multiple lung diseases, including cystic fibrosis, chronic obstructive pulmonary disease, respiratory malignancies, and idiopathic pulmonary fibrosis. However, the role of BPIFA1 in pulmonary pathogenesis remains to be elucidated. This review highlights the versatile properties of BPIFA1 in antimicrobial protection and its roles as a sensor of environmental exposure and regulator of immune cell function. A greater understanding of the contribution of BPIFA1 to disease pathogenesis and activity may clarify if BPIFA1 is a biomarker and potential drug target in pulmonary disease.
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Affiliation(s)
- Clemente J Britto
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
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Xue JL, Yi L, Yan ZH, Li X, Wang XJ, Wei PJ, Zeng JE, Zhao YL, Zhang HT. SPLUNC1 Is a Significant Marker in Pleural Effusion from Lung Cancer Compared to Tuberculosis. Monoclon Antib Immunodiagn Immunother 2015; 34:206-12. [PMID: 26090599 DOI: 10.1089/mab.2014.0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
SPLUNC1 (Short palate, lung and nasal epithelium clone1) protein is an abundant secretory product of epithelia present throughout the conducting airways. Although its function is still not fully known, most studies have focused on its defensive effect in the infection of human airways and its potential to serve as a molecular marker for lung cancer. In this study, we further evaluated the SPLUNC1 expression in patients with lung disease to explore its role in cancer or tuberculosis at the protein level. We generated a panel of antibodies by using protein from a eukaryotic expression system as the immunogen to mice. It was the panel of SPLUNC1 monoclonal antibodies that allowed us to comparatively determine SPLUNC1 protein in lung cancer and tuberculosis infection by detecting sera and pleural effusion other than airway surface. The results showed that the SPLUNC1 level was not significantly changed either from sera of lung cancer or control. There was a significant increase in pleural effusion from lung cancer when compared to tuberculosis. These results indicate that SPLUNC1 may be a useful marker for tracing lung cancer cells, based on its epithelial origin property in pleural effusion.
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Affiliation(s)
- Jun L Xue
- 1 Department of Endocrinology, Jingzhou Clinical Medical College, Yangtze University , Jingzhou, People's Republic of China
| | - Ling Yi
- 2 Department of Central Laboratory, Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Capital Medical University and Beijing Tuberculosis and Thoracic Tumor Research Institute , Beijing, People's Republic of China
| | - Zhou H Yan
- 2 Department of Central Laboratory, Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Capital Medical University and Beijing Tuberculosis and Thoracic Tumor Research Institute , Beijing, People's Republic of China
| | - Xin Li
- 3 Hebei Chest Hospital , Shijiazhuang, People's Republic of China
| | - Xiao J Wang
- 2 Department of Central Laboratory, Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Capital Medical University and Beijing Tuberculosis and Thoracic Tumor Research Institute , Beijing, People's Republic of China
| | - Pang J Wei
- 2 Department of Central Laboratory, Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Capital Medical University and Beijing Tuberculosis and Thoracic Tumor Research Institute , Beijing, People's Republic of China
| | - Jiao E Zeng
- 1 Department of Endocrinology, Jingzhou Clinical Medical College, Yangtze University , Jingzhou, People's Republic of China
| | - Yan L Zhao
- 4 Chinese Center for Disease Control and Prevention , Beijing, People's Republic of China
| | - Hong T Zhang
- 2 Department of Central Laboratory, Beijing Key Laboratory for Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Capital Medical University and Beijing Tuberculosis and Thoracic Tumor Research Institute , Beijing, People's Republic of China
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Sun W, Li J, Jiang HG, Ge LP, Wang Y. Diagnostic value of MUC1 and EpCAM mRNA as tumor markers in differentiating benign from malignant pleural effusion. QJM 2014; 107:1001-7. [PMID: 24939190 DOI: 10.1093/qjmed/hcu130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The sensitivity of conventional cytology for the detection of tumor cells in pleural effusion (PE) is inadequate. Mucine 1 (MUC1) and epithelial cell adhesion molecule (EpCAM) are two frequently and intensely expressed tumor-associated antigens in malignancies of epithelial origin. OBJECTIVE To evaluate the diagnostic value of pleural fluid MUC1 and EpCAM mRNA in differentiating benign and malignant PE. METHOD Fifty-eight patients with malignant PE and 40 patients with benign PE were included in this study. Pleural fluid MUC1 and EpCAM mRNA levels were measured by quantitative real-time PCR. Carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (Cyfra21-1) were also detected simultaneously. The receiver operating characteristic (ROC) curves were constructed to assess diagnostic performance of the four tumor markers in PE. RESULTS For the diagnosis of malignant PE, MUC1 and EpCAM mRNA had larger area under ROC curves (0.916 and 0.922) and higher sensitivity (67.2 and 70.7%) with the same specificity, when compared with CEA and Cyfra21-1 (0.821 and 0.780; 48.3 and 44.8%, respectively). By combining cytology with MUC and EpCAM, a positive result indicating the presence of malignancy was achieved in 87.9%, with a good specificity of 95%. CONCLUSIONS Compared with CEA and Cyfra21-1, the performance of MUC1 and EpCAM mRNA in malignant PE diagnosis was better. MUC1 and EpCAM mRNA in combination with cytology is a highly sensitive and specific diagnostic tool for detecting malignancy in PE.
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Affiliation(s)
- W Sun
- From the Department of Pulmonary Medicine and Center of Experimental Medicine, Affiliated Hospital of Jiangsu University, 438 North Jiefang Street, Zhenjiang 212001, China
| | - J Li
- From the Department of Pulmonary Medicine and Center of Experimental Medicine, Affiliated Hospital of Jiangsu University, 438 North Jiefang Street, Zhenjiang 212001, China
| | - H-G Jiang
- From the Department of Pulmonary Medicine and Center of Experimental Medicine, Affiliated Hospital of Jiangsu University, 438 North Jiefang Street, Zhenjiang 212001, China
| | - L-P Ge
- From the Department of Pulmonary Medicine and Center of Experimental Medicine, Affiliated Hospital of Jiangsu University, 438 North Jiefang Street, Zhenjiang 212001, China
| | - Y Wang
- From the Department of Pulmonary Medicine and Center of Experimental Medicine, Affiliated Hospital of Jiangsu University, 438 North Jiefang Street, Zhenjiang 212001, China
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Yan J, Wei Q, Jian W, Liu J, Tang H, Ge J, Zhou J, Zhao T. A fine decision tree consisted of CK5/6, IMP3 and TTF1 for cytological diagnosis among reactive mesothelial cells, metastatic adenocarcinoma of lung and non-lung origin in pleural effusion. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:5810-5818. [PMID: 25337222 PMCID: PMC4203193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 08/20/2014] [Indexed: 06/04/2023]
Abstract
The utility of combination with CK5/6, IMP3 and TTF1 to differentiate among reactive mesothelial cells (RMs), metastatic adenocarcinoma of lung (LAC) and non-lung (NLAC) origin was investigated by using immunocytochemistry (ICC) and conventional PCR (C-PCR) in pleural effusion. A total of 108 cell blocks (32 RMs, 51 LAC and 25 NLAC were evaluated by ICC for CK5/6, IMP3 and TTF1 protein expression. In addition, we further performed C-PCR for amplification of CK5/6, IMP3 and TTF1 DNA from 28 specimens (9 MAC and 7 RMs, 6 LAC and 6 NLAC) for molecular diagnosis. CK5/6 staining was observed in the majority of reactive specimens (78.1%) and was rare in adenocarcinoma cells (14.5%), whereas the opposite was true for IMP3 and TTF1. We found a high frequency of TTF1 positivity (76.5%) in LAC, but not in NLAC (4.0%); while there was no significant difference of IMP3 expression in LAC (88.2%) and NLAC (88.0%). The 487 bp DNA fragments of IMP3 was expected to be amplified in 6/9 of adenocarcinoma cases showed negative in ICC; and the 394 bp DNA fragments of CK5/6 was also expected to be amplified in 4/7 of RMs cases showed negative in ICC. Consistent with ICC results, there was significant difference of TTF1 expression in the LAC and NLAC compared with IMP3 expression. The combination with CK5/6, IMP3 and TTF1 immunostaining appears to be useful to improve the accuracy of cytological diagnoses between RMs, metastatic adenocarcinoma of lung and non-lung origin in pleural effusion. In addition, C-PCR may act as a useful supplemental approach for ICC, especially negative cases in ICC for differential cytological diagnosis.
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Affiliation(s)
- Jinhai Yan
- Department of Pathology, School of Basic Medical Science, Southern Medical UniversityGuangzhou, China
| | - Qingzhu Wei
- Department of Pathology, The Third Affiliated Hospital, Southern Medical UniversityGuangzhou, China
| | - Wenjing Jian
- Department of Pathology, School of Basic Medical Science, Southern Medical UniversityGuangzhou, China
| | - Jianghuan Liu
- Department of Pathology, The Third Affiliated Hospital, Southern Medical UniversityGuangzhou, China
| | - Hongping Tang
- Department of Pathology, School of Basic Medical Science, Southern Medical UniversityGuangzhou, China
| | - Juan Ge
- Department of Pathology, School of Basic Medical Science, Southern Medical UniversityGuangzhou, China
| | - Jie Zhou
- Department of Pathology, School of Basic Medical Science, Southern Medical UniversityGuangzhou, China
| | - Tong Zhao
- Department of Pathology, The Third Affiliated Hospital, Southern Medical UniversityGuangzhou, China
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Yu H, Huang X, Zhu Z, Hu Y, Ou W, Zhang L, Zhou N. Significance of combined detection of LunX mRNA and tumor markers in diagnosis of lung carcinoma. Chin J Cancer Res 2014; 26:89-94. [PMID: 24653630 DOI: 10.3978/j.issn.1000-9604.2014.02.04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/07/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate the significance of combined detection of LunX mRNA, carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and cytokeratin 21-1 fragment (CYFRA21-1) in clinical diagnosis of lung carcinoma. METHODS Based on the quantitative RT-PCR and chemiluminescence immunoassay, the expression levels of LunX mRNA, CEA, NSE, and CYFRA21-1 in 113 patients with lung carcinoma (case group) and 30 healthy participants (control group) were detected. Meantime, the sensitivity, specificity, and accuracy of the combination detection were also explored. RESULTS The positive rates of LunX mRNA in peripheral blood and CEA, NSE, and CYFRA21-1 in serum were significantly higher in case group than those in control group ((χ) (2)=17.295, 16.825, 19.148, and 17.450; P<0.05). There was no statistical significance when positive rate of LunX mRNA was evaluated among different pathological types ((χ) (2)=0.047, P>0.05). The positive rate of LunX mRNA in stage I + II, III, and IV had a significantly increasing tendency ((χ) (2)=10.565, 32.462, P<0.05). The positive rate of CYFRA21-1 was highest in squamous carcinoma (78.5%), the positive rate of NSE was highest in small cell carcinoma (86.7%), and the positive rate of CEA wag highest in lung adenocarcinoma (80.4%). The sensitivity and accuracy of the combination detection were 91.1% and 88.1%, respectively. CONCLUSIONS The combined detection of LunX mRNA and tumor markers (TMs) including CEA, NSE, and CYFRA21-1 in peripheral blood is helpful to increase the diagnostic accuracy of lung cancer. Also, it can inform the pathological typing of lung carcinoma.
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Affiliation(s)
- Hui Yu
- 1 Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China ; 2 Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
| | - Xiuying Huang
- 1 Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China ; 2 Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
| | - Zhihua Zhu
- 1 Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China ; 2 Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
| | - Yi Hu
- 1 Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China ; 2 Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
| | - Wei Ou
- 1 Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China ; 2 Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
| | - Lanjun Zhang
- 1 Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China ; 2 Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
| | - Ningning Zhou
- 1 Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China ; 2 Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China ; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
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