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Kamtam DN, Shrager JB. We should be considering lung cancer screening for never-smoking Asian American females. J Thorac Cardiovasc Surg 2024; 168:272-277.e1. [PMID: 37844730 DOI: 10.1016/j.jtcvs.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Devanish N Kamtam
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif; Department of Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif.
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Tang Y, Zhou L, Wang F, Huang Y, Wang J, Zhao S, Qi L, Liu L, Liang M, Hou D, Xu Z, Zhang K, Tang W, Wu N. Assessing the efficiency of eligibility criteria for low-dose computed tomography lung screening in China according to current guidelines. BMC Med 2024; 22:267. [PMID: 38926820 PMCID: PMC11210050 DOI: 10.1186/s12916-024-03445-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Evidence from observational studies indicates that lung cancer screening (LCS) guidelines with high rates of lung cancer (LC) underdiagnosis, and although current screening guidelines have been updated and eligibility criteria for screening have been expanded, there are no studies comparing the efficiency of LCS guidelines in Chinese population. METHODS Between 2005 and 2022, 31,394 asymptomatic individuals were screened using low-dose computed tomography (LDCT) at our institution. Demographic data and relevant LC risk factors were collected. The efficiency of the LCS for each guideline criteria was expressed as the efficiency ratio (ER). The inclusion rates, eligibility rates, LC detection rates, and ER based on the different eligibility criteria of the four guidelines were comparatively analyzed. The four guidelines were as follows: China guideline for the screening and early detection of lung cancer (CGSL), the National Comprehensive Cancer Network (NCCN), the United States Preventive Services Task Force (USPSTF), and International Early Lung Cancer Action Program (I-ELCAP). RESULTS Of 31,394 participants, 298 (155 women, 143 men) were diagnosed with LC. For CGSL, NCCN, USPSTF, and I-ELCAP guidelines, the eligibility rates for guidelines were 13.92%, 6.97%, 6.81%, and 53.46%; ERe for eligibility criteria were 1.46%, 1.64%, 1.51%, and 1.13%, respectively; and for the inclusion rates, they were 19.0%, 9.5%, 9.3%, and 73.0%, respectively. LCs which met the screening criteria of CGSL, NCCN, USPSTF, and I-ELCAP guidelines were 29.2%, 16.4%, 14.8%, and 86.6%, respectively. The age and smoking criteria for CGSL were stricter, hence resulting in lower rates of LC meeting the screening criteria. The CGSL, NCCN, and USPSTF guidelines showed the highest underdiagnosis in the 45-49 age group (17.4%), while the I-ELCAP guideline displayed the highest missed diagnosis rate (3.0%) in the 35-39 age group. Males and females significantly differed in eligibility based on the criteria of the four guidelines (P < 0.001). CONCLUSIONS The I-ELCAP guideline has the highest eligibility rate for both males and females. But its actual efficiency ratio for those deemed eligible by the guideline was the lowest. Whereas the NCCN guideline has the highest ERe value for those deemed eligible by the guideline.
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Affiliation(s)
- Yanyan Tang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lina Zhou
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Fei Wang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yao Huang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jianwei Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shijun Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Linlin Qi
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Li Liu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Min Liang
- Department of Diagnostic Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Donghui Hou
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhijian Xu
- Department of Cancer Prevention, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100020, China
| | - Kai Zhang
- Department of Cancer Prevention, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100020, China
| | - Wei Tang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Ning Wu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
- Department of Nuclear Medicine (PET-CT Center), National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Wang Z, Xue F, Sui X, Han W, Song W, Jiang J. Personalised follow-up and management schema for patients with screen-detected pulmonary nodules: A dynamic modelling study. Pulmonology 2024:S2531-0437(24)00040-0. [PMID: 38614860 DOI: 10.1016/j.pulmoe.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Selecting the time target for follow-up testing in lung cancer screening is challenging. We aim to devise dynamic, personalized lung cancer screening schema for patients with pulmonary nodules detected through low-dose computed tomography. METHODS We developed and validated dynamic models using data of pulmonary nodule patients (aged 55-74 years) from the National Lung Screening Trial. We predicted patient-specific risk profiles at baseline (R0) and updated the risk evaluation results in repeated screening rounds (R1 and R2). We used risk cutoffs to optimize time-dependent sensitivity at an early decision point (3 months) and time-dependent specificity at a late decision point (1 year). RESULTS In validation, area under receiver operating characteristic curve for predicting 12-month lung cancer onset was 0.867 (95 % confidence interval: 0.827-0.894) and 0.807 (0.765-0.948) at R0 and R1-R2, respectively. The personalized schema, compared with National Comprehensive Cancer Network (NCCN) guideline and Lung-RADS, yielded lower rates of delayed diagnosis (1.7% vs. 1.7% vs. 6.9 %) and over-testing (4.9% vs. 5.6% vs. 5.6 %) at R0, and lower rates of delayed diagnosis (0.0% vs. 18.2% vs. 18.2 %) and over-testing (2.6% vs. 8.3% vs. 7.3 %) at R2. Earlier test recommendation among cancer patients was more frequent using the personalized schema (vs. NCCN: 29.8% vs. 20.9 %, p = 0.0065; vs. Lung-RADS: 33.2% vs. 22.8 %, p = 0.0025), especially for women, patients aged ≥65 years, and part-solid or non-solid nodules. CONCLUSIONS The personalized schema is easy-to-implement and more accurate compared with rule-based protocols. The results highlight value of personalized approaches in realizing efficient nodule management.
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Affiliation(s)
- Z Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College. No. 5 Dongdansantiao Street, Dongcheng District, Beijing, China; Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases. No. 11 Xizhimen South Street, Beijing, China
| | - F Xue
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College. No. 5 Dongdansantiao Street, Dongcheng District, Beijing, China
| | - X Sui
- Department of Radiology, Peking Union Medical College Hospital. No.1 Shuaifuyuan Street, Dongcheng District, Beijing, China
| | - W Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College. No. 5 Dongdansantiao Street, Dongcheng District, Beijing, China
| | - W Song
- Department of Radiology, Peking Union Medical College Hospital. No.1 Shuaifuyuan Street, Dongcheng District, Beijing, China
| | - J Jiang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College. No. 5 Dongdansantiao Street, Dongcheng District, Beijing, China.
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Zhou J, Yu B, Guo P, Wang S. The insufficiency of CT examination in early detection of central lung squamous cell carcinoma and squamous epithelial precancerous lesions. BMC Cancer 2024; 24:299. [PMID: 38443800 PMCID: PMC10916110 DOI: 10.1186/s12885-024-12052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/25/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND CT examination for lung cancer has been carried out for more than 20 years and great achievements have been made in the early detection of lung cancer. However, in the clinical work, a large number of advanced central lung squamous cell carcinoma are still detected through bronchoscopy. Meanwhile, a part of CT-occult central lung squamous cell carcinoma and squamous epithelial precancerous lesions are also accidentally detected through bronchoscopy. METHODS This study retrospectively collects the medical records of patients in the bronchoscopy room of the Endoscopy Department of Zhejiang Cancer Hospital from January 2014 to December 2018. The inclusion criteria for patients includes: 1.Patient medical records completed, 2.Without history of lung cancer before the diagnosis and first pathological diagnosis of primary lung cancer, 3.Have the lung CT data of the same period, 4.Have the bronchoscopy records and related pathological diagnosis, 5.The patients undergoing radical surgical treatment must have a complete postoperative pathological diagnosis. Finally, a total of 10,851 patients with primary lung cancer are included in the study, including 7175 males and 3676 females, aged 22-98 years. Firstly, 130 patients with CT-occult lesions are extracted and their clinical features are analyzed. Then, 604 cases of single central squamous cell carcinoma and 3569 cases of peripheral adenocarcinoma are extracted and compares in postoperative tumor diameter and lymph node metastasis. RESULTS 115 cases of CT-occult central lung squamous cell carcinoma and 15 cases of squamous epithelial precancerous lesions are found. In the total lung cancer, the proportion of CT-occult lesions is 130/10,851 (1.20%). Meanwhile, all these patients are middle-aged and elderly men with a history of heavy smoking. There are statistically significant differences in postoperative median tumor diameter (3.65 cm vs.1.70 cm, P < 0.0001) and lymph node metastasis rate (50.99% vs.13.06%, P < 0.0001) between 604 patients with operable single central lung squamous cell carcinoma and 3569 patients with operable peripheral lung adenocarcinoma. Of the 604 patients with squamous cell carcinoma, 96.52% (583/604) are male with a history of heavy smoking and aged 40-82 years with a median age of 64 years. CONCLUSIONS This study indicates that the current lung CT examination of lung cancer is indeed insufficiency for the early diagnosis of central squamous cell carcinoma and squamous epithelial precancerous lesions. Further bronchoscopy in middle-aged and elderly men with a history of heavy smoking can make up for the lack of routine lung CT examination.
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Affiliation(s)
- Jiaming Zhou
- Department of Endoscopy, Zhejiang Cancer Hospital, Hangzhou, China
| | - Bijun Yu
- Department of Endoscopy, Zhejiang Cancer Hospital, Hangzhou, China
| | - Peng Guo
- Department of Endoscopy, Zhejiang Cancer Hospital, Hangzhou, China
| | - Shi Wang
- Department of Endoscopy, Zhejiang Cancer Hospital, Hangzhou, China.
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Bao T, Liu B, Li R, Li Z, Ji G, Wang Y, Yang H, Li W, Huang W, Huang Y, Tang H. LDCT screening results among eligible and ineligible screening candidates in preventive health check-ups population: a real world study in West China. Sci Rep 2024; 14:4848. [PMID: 38418532 PMCID: PMC10902338 DOI: 10.1038/s41598-024-55475-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/23/2024] [Indexed: 03/01/2024] Open
Abstract
To compare the LDCT screening results between eligible and ineligible screening candidates in preventive health check-ups population. Using a real-world LDCT screening results among people who took yearly health check-up in health management center of West China Hospital between 2006 and 2017. Objects were classified according to the China National Lung Cancer Screening Guideline with Low-dose Computed Tomography (2018 version) eligibility criteria. Descriptive analysis were performed between eligible and ineligible screening candidates. The proportion of ineligible screening candidates was 64.13% (10,259), and among them there were 4005 (39.04%) subjects with positive screenings, 80 cases had a surgical lung biopsy. Pathology results from lung biopsy revealed 154 cancers (true-positive) and 26 benign results (false-positive), the surgical false-positive biopsy rate was 4.17%, and ineligible group (7.69%) was higher than eligible group (2.47%), P < 0.05. Further, in ineligible screening candidates, the proportion of current smokers was higher among males compared to females (53.85% vs. 4.88%, P < 0.05). Of the 69 lung cancer patients detected in ineligible screening candidates, lung adenocarcinoma accounts for a high proportion of lung cancers both in male (75.00%) and female (85.00%). The proportion of ineligible screening candidates and the surgical false-positive biopsy rate in ineligible candidates were both high in health check-ups population.
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Affiliation(s)
- Ting Bao
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Translational Informatics Center, Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610212, China
| | - Bingqing Liu
- West China School of Public Health, Department of Epidemiology and Health Statistics, Sichuan University, Chengdu, 610041, China
| | - Ruicen Li
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zhenzhen Li
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Guiyi Ji
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Youjuan Wang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hanwei Yang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, Sichuan University West China Hospital, Chengdu, 610041, China
| | - Wenxia Huang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Yan Huang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Huairong Tang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Lei F. Stakeholders' Voices of Lung Cancer Screening in Hong Kong: Study Protocol for a Mixed Methods Study. Healthcare (Basel) 2024; 12:142. [PMID: 38255030 PMCID: PMC10815317 DOI: 10.3390/healthcare12020142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/29/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
Introduction: This study aims to (1) explore physicians' perceptions and experiences of lung cancer screening in Hong Kong, (2) evaluate physicians' readiness of implementing lung cancer screening in Hong Kong, (3) explore high-risk smokers' health beliefs of lung cancer and screening, (4) identify barriers and facilitators for high-risk Hong Kong smokers to screening for lung cancer, and (5) validate the Chinese Lung Cancer Screening Health Belief Scale in relation to high-risk smokers in Hong Kong. Methods and analysis: A mixed methods design will be used in this study. Individual qualitative interviews will be conducted with physicians who have experience with high-risk smokers. Physicians' perceptions and experiences of lung cancer screening, and their readiness to accept lung cancer screening in Hong Kong, will be gathered through the qualitative interviews. A semi-structured interview guide will be used in the qualitative interviews. In addition, a quantitative survey with qualitative questions will be conducted on high-risk smokers to investigate their health beliefs of lung cancer and screening and barriers and facilitators for them to screening lung cancer. A lung cancer screening health belief scale, sociodemographic questionnaire, smoking and lung cancer screening history questionnaire, lung cancer and screening knowledge questionnaire, lung cancer stigma scale, generalized anxiety disorder scale, patient health questionnaire-9, patients' medical trust scale and preferred lung cancer screening intervention delivery questionnaire will be conducted in the quantitative survey. Constant comparison and content analysis will be used to analyze the qualitative data. Descriptive data analysis, validity and reliability analysis, one-way analysis of variance and post hoc analyses will be used to analyze quantitative data. Discussions: This study explores physicians' and high-risk smokers' perceptions and experiences toward lung cancer screening in Hong Kong. Findings from this study can help healthcare providers and policy makers become aware of the stakeholder's voices. In addition, these findings can help to inform the design of future interventional lung cancer screening programs and provide a tool to measure Chinese high-risk smokers' health beliefs toward lung cancer screening. A major limitation of this mixed methods study is the amount of time taken to complete the overall study. Also, its complexity requires more collaboration and networking among researchers. Ethics and dissemination: This study has minimal risk to the participants. It will be submitted to the university IRB for ethical approval. Findings related to physicians' perceptions and experiences of lung cancer screening in Hong Kong, physicians' readiness of implementing lung cancer screening, high-risk smokers' health beliefs of lung cancer and screening, barriers, and facilitators for high-risk Hong Kong smokers to screening lung cancer will be disseminated in journals and conferences. The reliability and validity of the Chinese lung cancer screening health belief scale will be reported in methodological research journals.
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Affiliation(s)
- Fang Lei
- School of Nursing, University of Minnesota Twin Cities, Minneapolis, MN 55455, USA
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Huang Y, Bao T, Zhang T, Ji G, Wang Y, Ling Z, Li W. Machine Learning Study of SNPs in Noncoding Regions to Predict Non-small Cell Lung Cancer Susceptibility. Clin Oncol (R Coll Radiol) 2023; 35:701-712. [PMID: 37689528 DOI: 10.1016/j.clon.2023.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/23/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
Non-small cell lung cancer (NSCLC) is the most common pathological subtype of lung cancer. Both environmental and genetic factors have been reported to impact the lung cancer susceptibility. We conducted a genome-wide association study (GWAS) of 287 NSCLC patients and 467 healthy controls in a Chinese population using the Illumina Genome-Wide Asian Screening Array Chip on 712,095 SNPs (single nucleotide polymorphisms). Using logistic regression modeling, GWAS identified 17 new noncoding region SNP loci associated with the NSCLC risk, and the top three (rs80040741, rs9568547, rs6010259) were under a stringent p-value (<3.02e-6). Notably, rs80040741 and rs6010259 were annotated from the intron regions of MUC3A and MLC1, respectively. Together with another five SNPs previously reported in Chinese NSCLC patients and another four covariates (e.g., smoking status, age, low dose CT screening, sex), a predictive model by machine learning methods can separate the NSCLC from healthy controls with an accuracy of 86%. This is the first time to apply machine learning method in predicting the NSCLC susceptibility using both genetic and clinical characteristics. Our findings will provide a promising method in NSCLC early diagnosis and improve our understanding of applying machine learning methods in precision medicine.
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Affiliation(s)
- Y Huang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Institute of Respiratory Healthy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - T Bao
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Institute of Respiratory Healthy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - T Zhang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Institute of Respiratory Healthy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - G Ji
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Institute of Respiratory Healthy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Y Wang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Institute of Respiratory Healthy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Z Ling
- Chengdu Genepre Technology Co., LTD, Chengdu, Sichuan, China
| | - W Li
- Institute of Respiratory Healthy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Department of Respiratory and Critical Care Medicine, Institute of Respiratory Healthy, Precision Medicine Key Laboratory of Sichuan Province, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Precision Medicine Center, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; The Research Units of West China, Chinese Academy of Medical Sciences, West China Hospital, Chengdu, Sichuan 610041, China; State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu, Sichuan 610041, West China Hospital, China.
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Zhang T, Chen X, Li C, Wen X, Lin T, Huang J, He J, Zhong N, Jiang J, Liang W. Cost-Effectiveness Analysis of Risk Factor-Based Lung Cancer Screening Program by Low-Dose Computer Tomography in Current Smokers in China. Cancers (Basel) 2023; 15:4445. [PMID: 37760416 PMCID: PMC10527380 DOI: 10.3390/cancers15184445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/10/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Although the effectiveness of lung cancer screening by low-dose computed tomography (LDCT) could be shown in China, there could be variation in the evidence concerning the economic impact. Our study explores the cost-effectiveness of lung cancer screening and optimizes the best definition of a high-risk population. A Markov model consisting of the natural history and post-diagnosis states was constructed to estimate the costs and quality-adjusted life years (QALYs) of LDCT screening compared with no screening. A total of 36 distinct risk factor-based screening strategies were assessed by incorporating starting ages of 40, 45, 50, 55, 60 and 65 years, stopping ages of 69, 74 and 79 years as well as smoking eligibility criteria. Screening data came from community-based mass screening with LDCT for lung cancer in Guangzhou. Compared with no screening, all screening scenarios led to incremental costs and QALYs. When the willingness-to-pay (WTP) threshold was USD37,653, three times the gross domestic product (GDP) per capita in China, six of nine strategies on the efficiency frontier may be cost-effective. Annual screening between 55 and 79 years of age for those who smoked more than 20 pack-years, which yielded an incremental cost-effectiveness ratio (ICER) of USD35,000.00 per QALY gained, was considered optimal. In sensitivity analyses, the result was stable in most cases. The trends of the results are roughly the same in scenario analyses. According to the WTP threshold of different regions, the optimal screening strategies were annual screening for those who smoked more than 20 pack-years, between 50 and 79 years of age in Zhejiang province, 55-79 years in Guangdong province and 65-74 years in Yunnan province. However, annual screening was unlikely to be cost-effective in Heilongjiang province under our modelling assumptions, indicating that tailored screening policies should be made regionally according to the local epidemiological and economic situation.
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Affiliation(s)
- Tiantian Zhang
- College of Pharmacy/Guangdong-Hong Kong-Marco Greater Bay Area (GBA), Institue for Real-World Value and Evidence of Drugs and Medical Devices/Southern Institute of Pharmacoeconomics and Health Technology Assessment/International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug, Development of Ministry of Education (MOE) of China, Jinan University, Guangzhou 510632, China
- Guangzhou Huabo Biopharmaceutical Research Institute, Guangzhou 510010, China
| | - Xudong Chen
- College of Pharmacy/Guangdong-Hong Kong-Marco Greater Bay Area (GBA), Institue for Real-World Value and Evidence of Drugs and Medical Devices/Southern Institute of Pharmacoeconomics and Health Technology Assessment/International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug, Development of Ministry of Education (MOE) of China, Jinan University, Guangzhou 510632, China
| | - Caichen Li
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Xiaoqin Wen
- College of Pharmacy/Guangdong-Hong Kong-Marco Greater Bay Area (GBA), Institue for Real-World Value and Evidence of Drugs and Medical Devices/Southern Institute of Pharmacoeconomics and Health Technology Assessment/International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug, Development of Ministry of Education (MOE) of China, Jinan University, Guangzhou 510632, China
| | - Tengfei Lin
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518000, China
| | - Jiaxing Huang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Nanshan Zhong
- Department of Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jie Jiang
- College of Pharmacy/Guangdong-Hong Kong-Marco Greater Bay Area (GBA), Institue for Real-World Value and Evidence of Drugs and Medical Devices/Southern Institute of Pharmacoeconomics and Health Technology Assessment/International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug, Development of Ministry of Education (MOE) of China, Jinan University, Guangzhou 510632, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
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9
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Craig DJ, Crawford EL, Chen H, Grogan EL, Deppen SA, Morrison T, Antic SL, Massion PP, Willey JC. TP53 mutation prevalence in normal airway epithelium as a biomarker for lung cancer risk. BMC Cancer 2023; 23:783. [PMID: 37612638 PMCID: PMC10464352 DOI: 10.1186/s12885-023-11266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/07/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND There is a need for biomarkers that improve accuracy compared with current demographic risk indices to detect individuals at the highest lung cancer risk. Improved risk determination will enable more effective lung cancer screening and better stratification of lung nodules into high or low-risk category. We previously reported discovery of a biomarker for lung cancer risk characterized by increased prevalence of TP53 somatic mutations in airway epithelial cells (AEC). Here we present results from a validation study in an independent retrospective case-control cohort. METHODS Targeted next generation sequencing was used to identify mutations within three TP53 exons spanning 193 base pairs in AEC genomic DNA. RESULTS TP53 mutation prevalence was associated with cancer status (P < 0.001). The lung cancer detection receiver operator characteristic (ROC) area under the curve (AUC) for the TP53 biomarker was 0.845 (95% confidence limits 0.749-0.942). In contrast, TP53 mutation prevalence was not significantly associated with age or smoking pack-years. The combination of TP53 mutation prevalence with PLCOM2012 risk score had an ROC AUC of 0.916 (0.846-0.986) and this was significantly higher than that for either factor alone (P < 0.03). CONCLUSIONS These results support the validity of the TP53 mutation prevalence biomarker and justify taking additional steps to assess this biomarker in AEC specimens from a prospective cohort and in matched nasal brushing specimens as a potential non-invasive surrogate specimen.
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Affiliation(s)
- Daniel J Craig
- University of Toledo College of Medicine, 3000 Arlington Ave, OH, 43614, Toledo, USA
| | - Erin L Crawford
- University of Toledo College of Medicine, 3000 Arlington Ave, OH, 43614, Toledo, USA
| | - Heidi Chen
- Vanderbilt University Medical Center, 1301 Medical Center Dr., TN, 37232, Nashville, USA
| | - Eric L Grogan
- Vanderbilt University Medical Center, 1301 Medical Center Dr., TN, 37232, Nashville, USA
- Tennessee Valley VA Healthcare System, 1310 24Th Avenue South, Nashville, TN, 37212, USA
| | - Steven A Deppen
- Vanderbilt University Medical Center, 1301 Medical Center Dr., TN, 37232, Nashville, USA
| | - Thomas Morrison
- Accugenomics Inc, 1410 Commonwealth Dr #105, Wilmington, NC, 28403, USA
| | - Sanja L Antic
- Vanderbilt University Medical Center, 1301 Medical Center Dr., TN, 37232, Nashville, USA
| | - Pierre P Massion
- Vanderbilt University Medical Center, 1301 Medical Center Dr., TN, 37232, Nashville, USA
| | - James C Willey
- University of Toledo College of Medicine, 3000 Arlington Ave, OH, 43614, Toledo, USA.
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10
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Zheng Y, Dong J, Yang X, Shuai P, Li Y, Li H, Dong S, Gong Y, Liu M, Zeng Q. Benign-malignant classification of pulmonary nodules by low-dose spiral computerized tomography and clinical data with machine learning in opportunistic screening. Cancer Med 2023. [PMID: 37248730 DOI: 10.1002/cam4.5886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/14/2023] [Accepted: 03/19/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Many people were found with pulmonary nodules during physical examinations. It is of great practical significance to discriminate benign and malignant nodules by using data mining technology. METHODS The subjects' demographic data, baseline examination results, and annual follow-up low-dose spiral computerized tomography (LDCT) results were recorded. The findings from annual physical examinations of positive nodules, including highly suspicious nodules and clinically tentative benign nodules, was analyzed. The extreme gradient boosting (XGBoost) model was constructed and the Grid Search CV method was used to select the super parameters. External unit data were used as an external validation set to evaluate the generalization performance of the model. RESULTS A total of 135,503 physical examinees were enrolled. Baseline testing found that 27,636 (20.40%) participants had clinically tentative benign nodules and 611 (0.45%) participants had highly suspicious nodules. The proportion of highly suspicious nodules in participants with negative baseline was about 0.12%-0.46%, which was lower than the baseline level except the follow-up of >5 years. In the 27,636 participants with clinically tentative benign nodules, only in the first year of LDCT re-examination was the proportion of highly suspicious nodules (1.40%) significantly greater than that of baseline screening (0.45%) (p < 0.001), and the proportion of highly suspicious nodules was not different between the baseline screening and other follow-up years (p > 0.05). Furthermore, 322 cases with benign nodules and 196 patients with malignant nodules confirmed by surgery and pathology were compared. A model and the top 15 most important clinical variables were determined by XGBoost algorithm. The area under the curve (AUC) of the model was 0.76 [95% CI: 0.67-0.84], and the accuracy was 0.75. The sensitivity and specificity of the model under this threshold were 0.78 and 0.73, respectively. In the validation of model using external data, the AUC was 0.87 and the accuracy was 0.80. The sensitivity and specificity were 0.83 and 0.77, respectively. CONCLUSIONS It is important that pulmonary nodules could be more accurately identified at the first LDCT examination. A model with 15 variables which are routinely measured in the clinic could be helpful to distinguish benign and malignant nodules. It could help the radiological team issue a more accurate report; and it may guide the clinical team regarding LDCT follow-up.
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Affiliation(s)
- Yansong Zheng
- Department of Health Medicine, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jing Dong
- Research of Medical Big Data Center & National Engineering Laboratory for Medical Big Data Application Technology, Chinese PLA General Hospital, Beijing, China
| | - Xue Yang
- Department of Health Medicine, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ping Shuai
- Health Management Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yongli Li
- Department of Health Management/ Henan Provincial People's Hospital of Zhengzhou University, Henan Key Laboratory of Chronic Disease Management, Zhengzhou, China
| | - Hailin Li
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China
| | - Shengyong Dong
- Department of Health Medicine, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yan Gong
- Department of Health Medicine, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Miao Liu
- Graduate School, Chinese PLA general hospital, Beijing, China
| | - Qiang Zeng
- Department of Health Medicine, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army General Hospital, Beijing, China
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11
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Sandler KL, Henry TS, Amini A, Elojeimy S, Kelly AM, Kuzniewski CT, Lee E, Martin MD, Morris MF, Peterson NB, Raptis CA, Silvestri GA, Sirajuddin A, Tong BC, Wiener RS, Witt LJ, Donnelly EF. ACR Appropriateness Criteria® Lung Cancer Screening: 2022 Update. J Am Coll Radiol 2023; 20:S94-S101. [PMID: 37236754 DOI: 10.1016/j.jacr.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Lung cancer remains the leading cause of cancer-related mortality for men and women in the United States. Screening for lung cancer with annual low-dose CT is saving lives, and the continued implementation of lung screening can save many more. In 2015, the CMS began covering annual lung screening for those who qualified based on the original United States Preventive Services Task Force (USPSTF) lung screening criteria, which included patients 55 to 77 year of age with a 30 pack-year history of smoking, who were either currently using tobacco or who had smoked within the previous 15 years. In 2021, the USPSTF issued new screening guidelines, decreasing the age of eligibility to 80 years of age and pack-years to 20. Lung screening remains controversial for those who do not meet the updated USPSTF criteria, but who have additional risk factors for the development of lung cancer. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Kim L Sandler
- Vanderbilt University Medical Center, Nashville, Tennessee.
| | | | - Arya Amini
- City of Hope National Medical Center, Duarte, California; Commission on Radiation Oncology
| | - Saeed Elojeimy
- Medical University of South Carolina, Charleston, South Carolina; Commission on Nuclear Medicine and Molecular Imaging
| | | | | | - Elizabeth Lee
- University of Michigan Health System, Ann Arbor, Michigan
| | - Maria D Martin
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Neeraja B Peterson
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, Primary care physician
| | | | - Gerard A Silvestri
- Medical University of South Carolina, Charleston, South Carolina; American College of Chest Physicians
| | | | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | - Renda Soylemez Wiener
- Boston University School of Medicine and Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts; American College of Chest Physicians
| | - Leah J Witt
- University of California San Francisco, San Francisco, California; American Geriatrics Society
| | - Edwin F Donnelly
- Specialty Chair, Ohio State University Wexner Medical Center, Columbus, Ohio
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12
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Voigt W, Prosch H, Silva M. Clinical Scores, Biomarkers and IT Tools in Lung Cancer Screening-Can an Integrated Approach Overcome Current Challenges? Cancers (Basel) 2023; 15:cancers15041218. [PMID: 36831559 PMCID: PMC9954060 DOI: 10.3390/cancers15041218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/05/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
As most lung cancer (LC) cases are still detected at advanced and incurable stages, there are increasing efforts to foster detection at earlier stages by low dose computed tomography (LDCT) based LC screening. In this scoping review, we describe current advances in candidate selection for screening (selection phase), technical aspects (screening), and probability evaluation of malignancy of CT-detected pulmonary nodules (PN management). Literature was non-systematically assessed and reviewed for suitability by the authors. For the selection phase, we describe current eligibility criteria for screening, along with their limitations and potential refinements through advanced clinical scores and biomarker assessments. For LC screening, we discuss how the accuracy of computerized tomography (CT) scan reading might be augmented by IT tools, helping radiologists to cope with increasing workloads. For PN management, we evaluate the precision of follow-up scans by semi-automatic volume measurements of CT-detected PN. Moreover, we present an integrative approach to evaluate the probability of PN malignancy to enable safe decisions on further management. As a clear limitation, additional validation studies are required for most innovative diagnostic approaches presented in this article, but the integration of clinical risk models, current imaging techniques, and advancing biomarker research has the potential to improve the LC screening performance generally.
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Affiliation(s)
- Wieland Voigt
- Medical Innovation and Management, Steinbeis University Berlin, Ernst-Augustin-Strasse 15, 12489 Berlin, Germany
- Correspondence:
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, General Hospital, 1090 Vienna, Austria
| | - Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, 43121 Parma, Italy
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13
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Li J, Li J, Hao H, Lu F, Wang J, Ma M, Jia B, Zhuo M, Wang J, Chi Y, Zhai X, Wang Y, Wu M, An T, Zhao J, Yang F, Wang Z. Secreted proteins MDK, WFDC2, and CXCL14 as candidate biomarkers for early diagnosis of lung adenocarcinoma. BMC Cancer 2023; 23:110. [PMID: 36721112 PMCID: PMC9887767 DOI: 10.1186/s12885-023-10523-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/09/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Early diagnosis of lung adenocarcinoma (LUAD), one of the most common types of lung cancer, is very important to improve the prognosis of patients. The current methods can't meet the requirements of early diagnosis. There is a pressing need to identify novel diagnostic biomarkers. Secretory proteins are the richest source for biomarker research. This study aimed to identify candidate secretory protein biomarkers for early diagnosis of LUAD by integrated bioinformatics analysis and clinical validation. METHODS Differentially expressed genes (DEGs) of GSE31210, gene expression data of early stage of LUAD, were analyzed by GEO2R. Upregulated DEGs predicted to encode secreted proteins were obtained by taking the intersection of the DEGs list with the list of genes encoding secreted proteins predicted by the majority decision-based method (MDSEC). The expressions of the identified secreted proteins in the lung tissues of early-stage LUAD patients were further compared with the healthy control group in mRNA and protein levels by using the UALCAN database (TCGA and CPTAC). The selected proteins expressed in plasma were further validated by using Luminex technology. The diagnostic value of the screened proteins was evaluated by receiver operating characteristic (ROC) analysis. Cell counting kit-8 assay was carried out to investigate the proliferative effects of these screened proteins. RESULTS A total of 2183 DEGs, including 1240 downregulated genes and 943 upregulated genes, were identified in the GSE31210. Of the upregulated genes, 199 genes were predicted to encode secreted proteins. After analysis using the UALCAN database, 16 molecules were selected for further clinical validation. Plasma concentrations of three proteins, Midkine (MDK), WAP four-disulfide core domain 2 (WFDC2), and C-X-C motif chemokine ligand 14 (CXCL14), were significantly higher in LUAD patients than in healthy donors. The area under the curve values was 0.944, 0.881, and 0.809 for MDK, WFDC2, and CXCL14, 0.962 when combined them. Overexpression of the three proteins enhanced the proliferation activity of A549 cells. CONCLUSIONS MDK, WFDC2, and CXCL14 were identified as candidate diagnostic biomarkers for early-stage LUAD and might also play vital roles in tumorigenesis.
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Affiliation(s)
- Junfeng Li
- grid.412474.00000 0001 0027 0586Departments of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Jianjie Li
- grid.412474.00000 0001 0027 0586Departments of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Huifeng Hao
- grid.412474.00000 0001 0027 0586Department of Integration of Chinese and Western Medicine, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Fangliang Lu
- grid.412474.00000 0001 0027 0586Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Jia Wang
- grid.412474.00000 0001 0027 0586Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Menglei Ma
- grid.412474.00000 0001 0027 0586Departments of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Bo Jia
- grid.412474.00000 0001 0027 0586Departments of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Minglei Zhuo
- grid.412474.00000 0001 0027 0586Departments of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Jingjing Wang
- grid.412474.00000 0001 0027 0586Departments of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Yujia Chi
- grid.412474.00000 0001 0027 0586Departments of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Xiaoyu Zhai
- grid.412474.00000 0001 0027 0586Departments of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Yuyan Wang
- grid.412474.00000 0001 0027 0586Departments of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Meina Wu
- grid.412474.00000 0001 0027 0586Departments of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Tongtong An
- grid.412474.00000 0001 0027 0586Departments of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Jun Zhao
- grid.412474.00000 0001 0027 0586Departments of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Fan Yang
- grid.411634.50000 0004 0632 4559Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, 100044 China
| | - Ziping Wang
- grid.412474.00000 0001 0027 0586Departments of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, 100142 China
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14
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Borg M, Nederby L, Wen SWC, Hansen TF, Jakobsen A, Andersen RF, Weinreich UM, Hilberg O. Assessment of circulating biomarkers for detection of lung cancer in a high-risk cohort. Cancer Biomark 2023; 36:63-69. [PMID: 36404535 DOI: 10.3233/cbm-210543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is an urgent need for early detection of lung cancer. Screening with low-dose computed tomography (LDCT) is now implemented in the US. Supplementary use of a lung cancer biomarker with high specificity is desirable. OBJECTIVE To assess the diagnostic properties of a biomarker panel consisting of cytokeratin 19 fragment (CYFRA 21-1), carcinoembryonic antigen (CEA) and cancer antigen 125 (CA125). METHODS A cohort of 250 high-risk patients was investigated on suspicion of lung cancer. Ahead of diagnostic work-up, blood samples taken. Cross-validated prediction models were computed to assess lung cancer detection properties. RESULTS In total 32% (79/250) of patients were diagnosed with lung cancer. Area under the curve (AUC) for the three biomarkers was of 0.795, with sensitivity/specificity of 57%/93% and negative predictive value of 83%. When combining the biomarkers with US screening criteria, the AUC was 0.809, while applying only US screening criteria on the cohort, yielded an AUC of 0.62. The ability of the biomarkers to detect stage I-II lung cancer was substantially lower; AUC 0.54. CONCLUSIONS In a high-risk cohort, the detection properties of the three biomarkers were acceptable compared to current LDCT screening criteria. However, the ability to detect early stage lung cancer was low.
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Affiliation(s)
- Morten Borg
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
| | - Line Nederby
- Department of Clinical Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | - Sara Witting Christensen Wen
- Department of Oncology, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Torben Frøstrup Hansen
- Department of Oncology, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Jakobsen
- Department of Oncology, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Rikke Fredslund Andersen
- Department of Clinical Biochemistry, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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15
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Li R, Chai Q, Chen F, Liu Q, Zhang H. Influencing factors of LDCT recommendation by physicians in Sichuan Province, China. Front Oncol 2023; 12:1049096. [PMID: 36686844 PMCID: PMC9846777 DOI: 10.3389/fonc.2022.1049096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023] Open
Abstract
The study aimed to investigate the influencing factors of physicians in recommending low-dose computed tomography (LDCT) for lung cancer screening to high-risk groups. A total of 1767 participants with good knowledge of LDCT were included in a cross-sectional study. Data about physicians' demographics, perception of barriers on LDCT screening, medical conditions for practicing medicine and the behavior of recommending LDCT were collected by a questionnaire. Physicians who care about the transportation convenience of patients were less likely to recommend LDCT (OR 0.568, 95% CI (0.423 to 0.763), p < 0.05). The physicians who considered LDCT expensive, recommended LDCT less than others (OR 0.308, 95% CI (0.186 to 0.510), p < 0.05). The false positive rate of LDCT can decrease the possibility of physicians' recommending (OR 0.542, 95% CI (0.387 to 0.758), p < 0.05). The physicians in oncology department and health management center were more likely to recommend LDCT (OR 2.282, 95% CI (1.557 to 3.345); OR 2.476, 95% CI (1.618 to 3.791)). The convenience of transportation, the price, and the\ false positive rate may be the main concerns among physicians on recommending LDCT to high-risk groups. The influencing factors of physicians' recommending on LDCT was various. Information technology, government support in price and self-improvement of LDCT should be gathered together to break the barriers on physicians' recommending on LDCT.
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Affiliation(s)
- Ruicen Li
- Department of Health Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China,Department of Industrial Engineering and Engineering Management, College of Business, Sichuan University, Chengdu, Sichuan, China
| | - Qi Chai
- Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Feng Chen
- Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China,*Correspondence: Feng Chen,
| | - Qing Liu
- Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Zhang
- Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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16
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Liu Z, Liu X, Ni L. Analysis of pulmonary nodules detected by annual low-dose computed tomography in the elderly during a 10-year follow-up. Geriatr Gerontol Int 2022; 22:865-869. [PMID: 36065163 DOI: 10.1111/ggi.14479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
AIM To describe pulmonary nodules detected by annual low-dose computed tomography (LDCT) in the elderly during a 10-year follow-up, and to provide a basis for clinical decision-making in the elderly. METHODS In this retrospective study, patients who completed at least a 3-year follow-up visit with annual LDCT imaging data were eligible for inclusion. The evolution of pulmonary nodules was evaluated, including malignant, suspicious malignant, benign and undetermined nodules. Additionally, the nature and outcome of new nodules during the follow-up were analyzed. RESULTS For the 365 subjects included, 899 positive pulmonary nodules were detected in 286 patients. Among these there were 788 solid nodules, 20 part-solid nodules and 91 nonsolid nodules. The detection rate of positive nodules and of lung cancer was 78.4% and 5.5%, respectively. 99.7% (786/788) of solid nodules were benign, and 75% (15/20) of part-solid nodules and 28.6% (26/91) of nonsolid nodules were malignant or suspected malignant. 124 new positive nodules appeared during the annual follow-up, but 58.9% of them subsequently disappeared. Significant higher detection rates of 10-20-mm nodules (P = 0.0485) and suspicious malignant nodules (P = 0.017) were observed in subjects over 75 years old as compared with those under 75 years old. CONCLUSIONS Solid nodules accounted for the highest proportion of lung nodules screened at baseline, and most of them were benign. The malignant probability of part-solid nodules was the highest. Most newly appeared nodules disappeared during subsequent follow-up. The proportions of suspicious malignant nodules and 10-20-mm nodules in subjects over 75 years old were higher than in those under 75 years old. Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Zhonghui Liu
- The Geriatrics Department, Peking University First Hospital, Beijing, China
| | - Xinmin Liu
- The Geriatrics Department, Peking University First Hospital, Beijing, China
| | - Lianfang Ni
- The Geriatrics Department, Peking University First Hospital, Beijing, China
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17
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CT characteristics of solid pulmonary nodules of never smokers versus smokers: A population-based study. Eur J Radiol 2022; 154:110410. [DOI: 10.1016/j.ejrad.2022.110410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022]
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18
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Noguera CAL, Lopes AJ, Mathias Filho I, Higa C, Nunes RA, Lima CET, Saito EH. The importance of endobag use with incision-protective devices in VATS lung resection: a preliminary study. BMC Res Notes 2022; 15:158. [PMID: 35538583 PMCID: PMC9092789 DOI: 10.1186/s13104-022-06047-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 04/24/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The advent of new techniques such as video-assisted thoracoscopic surgery (VATS) for the removal of lung segments leads to compression of the surgical specimen, with the possible dissemination of neoplastic cells. The sheer volume of surgeries performed using these techniques has caused many institutions to stop removing the surgical specimen using an endobag, even when retractors/protectors are used in the instrumentalization incision. This study aimed to collect data from patients undergoing lung resection by VATS and analyze the cytopathological results of the collected material. RESULTS A total of 47 endobag fluid samples were collected from patients who underwent VATS. The surgical specimen was subjected to histopathological analysis, and all patients underwent pathological TNM staging. In the cytopathological analyses, only 2 (4.3%) specimens of endobag fluid aspirate were positive for neoplastic cells. In these two cases, the tumors were peripheral, both with diagnoses of moderately differentiated adenocarcinoma and with classifications of T1bN0M0 and T3N0M0. These results indicate that although there is a low incidence of tumor cells in endobag fluid, it is always better to perform surgery using all available protective measures to avoid tumor implantation in the thoracic cavity to the greatest extent possible.
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Affiliation(s)
- Carlos Andrés Latorre Noguera
- Pedro Ernesto University Hospital, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, 20551-030, Brazil
| | - Agnaldo José Lopes
- Pedro Ernesto University Hospital, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, 20551-030, Brazil. .,Medical Sciences Post-Graduation Program, School of Medical Sciences, State University of Rio de Janeiro (UERJ), Av. Prof. Manoel de Abreu, 444, 2º andar, Vila Isabel, Rio de Janeiro, 20550-170, Brazil.
| | - Ivan Mathias Filho
- Pedro Ernesto University Hospital, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, 20551-030, Brazil.,Hospital Quinta D'Or, Rua Almirante Baltazar, 435, São Cristóvão, Rio de Janeiro, 20941-150, Brazil
| | - Claudio Higa
- Pedro Ernesto University Hospital, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, 20551-030, Brazil
| | - Rodolfo Acatauassú Nunes
- Pedro Ernesto University Hospital, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, 20551-030, Brazil.,Medical Sciences Post-Graduation Program, School of Medical Sciences, State University of Rio de Janeiro (UERJ), Av. Prof. Manoel de Abreu, 444, 2º andar, Vila Isabel, Rio de Janeiro, 20550-170, Brazil
| | - Carlos Eduardo Teixeira Lima
- Pedro Ernesto University Hospital, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, 20551-030, Brazil
| | - Eduardo Haruo Saito
- Pedro Ernesto University Hospital, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, 20551-030, Brazil.,Medical Sciences Post-Graduation Program, School of Medical Sciences, State University of Rio de Janeiro (UERJ), Av. Prof. Manoel de Abreu, 444, 2º andar, Vila Isabel, Rio de Janeiro, 20550-170, Brazil.,Hospital Quinta D'Or, Rua Almirante Baltazar, 435, São Cristóvão, Rio de Janeiro, 20941-150, Brazil
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19
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Zhang Y, Wan H, Richeldi L, Zhu M, Huang Y, Xiong X, Liao J, Zhu W, Mao L, Xu L, Ye D, Chen L, Liu J, Fu L, Li L, Lan L, Li P, Wang L, Tang X, Luo F. Reticulation is a Risk Factor of Progressive Subpleural non-Fibrotic Interstitial Lung Abnormalities. Am J Respir Crit Care Med 2022; 206:178-185. [PMID: 35426779 DOI: 10.1164/rccm.202110-2412oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yuchen Zhang
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Huajing Wan
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Luca Richeldi
- Universita Cattolica del Sacro Cuore Sede di Roma, 96983, Pulmonary Medicine, Roma, Italy
| | - Min Zhu
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Huang
- Department of Health Management Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofeng Xiong
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Junzhe Liao
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjun Zhu
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
- Department of Respiratory Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lingli Mao
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Linrui Xu
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Dongfan Ye
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Chen
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Jia Liu
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Linxi Fu
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Liangyuan Li
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Lan Lan
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Li
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Lixia Wang
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoju Tang
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Fengming Luo
- West China Hospital, Sichuan University, Department of Respiratory Medicine, Chengdu, China
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20
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Ragavan M, Patel MI. The evolving landscape of sex-based differences in lung cancer: a distinct disease in women. Eur Respir Rev 2022; 31:31/163/210100. [PMID: 35022255 PMCID: PMC9488944 DOI: 10.1183/16000617.0100-2021] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/16/2021] [Indexed: 12/11/2022] Open
Abstract
In stark contrast to a few decades ago when lung cancer was predominantly a disease of men who smoke, incidence rates of lung cancer in women are now comparable to or higher than those in men and are rising alarmingly in many parts of the world. Women face a unique set of risk factors for lung cancer compared to men. These include exogenous exposures including radon, prior radiation, and fumes from indoor cooking materials such as coal, in addition to endogenous exposures such as oestrogen and distinct genetic polymorphisms. Current screening guidelines only address tobacco use and likely underrepresent lung cancer risk in women. Women were also not well represented in some of the landmark prospective studies that led to the development of current screening guidelines. Women diagnosed with lung cancer have a clear mortality benefit compared to men even when other clinical and demographic characteristics are accounted for. However, there may be sex-based differences in outcomes and side effects of systemic therapy, particularly with chemotherapy and immunotherapy. Ongoing research is needed to better investigate these differences to address the rapidly changing demographics of lung cancer worldwide. Sex-based differences in lung cancer span the care continuum. This suggests lung cancer may increasingly be viewed as a distinct disease in women, with implications for screening and treatment. Lung cancer research should capture these sex-based differences.https://bit.ly/2WfhaB4
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Affiliation(s)
- Meera Ragavan
- Division of Hematology/Oncology, Dept of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Manali I Patel
- Division of Oncology, Dept of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Division of Oncology, VA Palo Alto Healthcare System, Palo Alto, CA, USA.,Dept of Medicine, Center for Health Policy/Primary Care Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA
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21
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Krzyzaniak K, Sieminski M. Higher frequency of new chest tumor diagnoses in emergency department due to the COVID-19 pandemic. Am J Emerg Med 2022; 54:267-268. [PMID: 35219013 PMCID: PMC8858637 DOI: 10.1016/j.ajem.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/16/2022] [Accepted: 02/16/2022] [Indexed: 10/30/2022] Open
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22
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Management of pulmonary nodules in non-high-risk population: initial evidence from a real-world prospective cohort study in China. Chin Med J (Engl) 2022; 135:994-996. [PMID: 34985012 PMCID: PMC9276125 DOI: 10.1097/cm9.0000000000001848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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23
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Borg M, Wen SWC, Nederby L, Hansen TF, Jakobsen A, Andersen RF, Weinreich UM, Hilberg O. Performance of the EarlyCDT® Lung test in detection of lung cancer and pulmonary metastases in a high-risk cohort. Lung Cancer 2021; 158:85-90. [PMID: 34130044 DOI: 10.1016/j.lungcan.2021.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Early detection of lung cancer is pivotal for an optimal prognosis. CT screening is currently implemented in USA. To decrease the amount of CT scans, the application of a blood-based biomarker as part of screening criteria is desirable. MATERIALS AND METHODS The EarlyCDT® Lung test was performed in a high-risk cohort composed 246 patients referred from their GP on suspicion of lung cancer. Blood samples were taken at first visit and patients underwent diagnostic workup on suspicion of lung cancer resulting in either a malignant diagnosis or ruled out cancer. Sensitivity and specificity of the EarlyCDT® Lung were calculated in the cohort and subgroups based on age, smoking history, sex and lung cancer stage. RESULTS Overall sensitivity in the cohort was 33 % for lung cancer and 31 % for primary lung cancer and lung metastases combined. Sensitivity in age groups was 11 % (60 years or below), 31 % (61-75 years) and 55 % (>75 years). In patients with at least 10 tobacco pack years, sensitivity was 33 % while the sensitivity in patients with at least 50 tobacco pack years was 44 %. The assay sensitivity in stage I-II lung cancer patients was 21 %, while this was 40 % in stage III-IV lung cancer patients. In a subgroup of patients that met current CT screening criteria (age 55-80 years and minimum 30 tobacco pack years) the sensitivity was 37 %. CONCLUSION The rationale of screening for lung cancer is to find patients in an early and resectable stage. However, the EarlyCDT® Lung test performed best in elderly, late stage lung cancer patients with a heavy smoking history. Based on these results, the current study finds insufficient sensitivity of the EarlyCDT® Lung test to be used as part of inclusion criteria in a low-dose CT program for detection of lung cancer.
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Affiliation(s)
- Morten Borg
- Department of Respiratory Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark.
| | - Sara W C Wen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense C, Denmark.
| | - Line Nederby
- Department of Clinical Biochemistry, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark.
| | - Torben Frøstrup Hansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense C, Denmark.
| | - Anders Jakobsen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense C, Denmark.
| | - Rikke Fredslund Andersen
- Department of Clinical Biochemistry, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark.
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark.
| | - Ole Hilberg
- Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense C, Denmark; Department of Internal Medicine, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark.
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