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Terlizzi M, Colarusso C, De Rosa I, De Rosa N, Somma P, Curcio C, Sanduzzi A, Micheli P, Molino A, Saccomanno A, Salvi R, Aquino RP, Pinto A, Sorrentino R. Circulating and tumor-associated caspase-4: a novel diagnostic and prognostic biomarker for non-small cell lung cancer. Oncotarget 2018; 9:19356-19367. [PMID: 29721208 PMCID: PMC5922402 DOI: 10.18632/oncotarget.25049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/17/2018] [Indexed: 02/06/2023] Open
Abstract
Late diagnosis limits therapeutic options and survival rate of non-small cell lung cancer (NSCLC) patients. Therefore the identification of biomarkers represents an emerging medical need. A highly sensitive and specific test was developed to identify/quantify a novel/selective diagnostic biomarker for NSCLC patients, caspase-4. This test was validated by using i) plasma from 125 NSCLC patients and 79 healthy (non-pathological) subjects, ii) plasma from 139 smokers and iii) from 70 chronic-obstructive pulmonary disease (COPD) patients. Caspase-4 quantification was also assessed in the lung tumor mass of 98 paired NSCLC patients compared to 10 non-tumor lung tissues (i.e. tuberculosis). Circulating caspase-4 was detected in both healthy and NSCLC patients; however at different range values: 2.603–3.372 ng/ml for NSCLC patients (95% CI) compared to 0.3994-0.6219 ng/ml for healthy subjects (95% CI). The sensitivity of the test ranged from 97.07% to 100%; the specificity was 88.1% with a positive predictive value of 92.54%, accuracy of 95.19% and AUC of 0.971. Smokers (95% CI, 0.3947–0.6197 ng/ml) and COPD patients (95% CI, 1.703–2.995 ng/ml) showed intermediate values of circulating caspase-4. Tissue levels of caspase-4 in the tumor mass showed that 72 (72.7%) out of 99 patients were positive. More importantly, higher levels (cut-off value = 0.307 ng/ml) of caspase-4 in the tumor mass were associated to reduced overall survival (median 0.92 years) compared to NSCLC patients with lower levels (median 3.02 years). We report for the first time caspase-4 as a novel diagnostic and prognostic biomarker, opening new therapeutic perspectives for NSCLC patients.
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Affiliation(s)
- Michela Terlizzi
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy
| | - Chiara Colarusso
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy.,PhD Program in Drug Discovery and Development, Department of Pharmacy, University of Salerno, Fisciano, SA, Italy
| | - Ilaria De Rosa
- Anatomy and Pathology Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Nicolina De Rosa
- Anatomy and Pathology Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Pasquale Somma
- Anatomy and Pathology Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Carlo Curcio
- Thoracic Surgery Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Alessandro Sanduzzi
- Department of Respiratory Medicine, Respiratory Division, University of Naples Federico II, Fisciano, SA, Italy
| | - Pietro Micheli
- Anatomy and Pathology Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Antonio Molino
- Department of Respiratory Medicine, Respiratory Division, University of Naples Federico II, Fisciano, SA, Italy
| | - Antonello Saccomanno
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy
| | - Rosario Salvi
- Thoracic Surgery Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Rita P Aquino
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy
| | - Aldo Pinto
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy
| | - Rosalinda Sorrentino
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy
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Xu RH, Liao CZ, Luo Y, Xu WL, Li K, Chen JX, Huang YF, Chen YC, Zhu L, Yuan WB. Optimal cut-off values for CYFRA 21-1 expression in NSCLC patients depend on the presence of benign pulmonary diseases. Clin Chim Acta 2014; 440:188-92. [PMID: 25304744 DOI: 10.1016/j.cca.2014.09.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 09/23/2014] [Accepted: 09/30/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Serum cytokeratin fragment 21-1 (CYFRA 21-1) expression levels are reported to be useful in the diagnosis of lung cancer, especially non-small cell lung cancer (NSCLC). However, the clinical value of CYFRA 21-1 as a tumor marker remains unclear, and no optimal cut-off value has been determined thus far. The purpose of this study was to establish a potential clinical cut-off value for serum CYFRA 21-1 as a diagnostic marker in patients with NSCLC. METHODS A total of 90 patients with NSCLC, 237 patients with benign pulmonary disease (BPD), and 1296 healthy controls were enrolled in this study. Among BPD there are 84 with chronic obstructive pulmonary disease (COPD), 81 with pneumonia, 38 with tuberculosis and 34 with chronic bronchitis. CYFRA 21-1 was measured in sera with an electrochemiluminescence (ECL) E170 analyzer. Comparisons were conducted using the chi-squared test and the Mann-Whitney test (two-sided). A receiver operating characteristic (ROC) curve was constructed to investigate the diagnostic power of CYFRA 21-1 expression, and the recommended cut-off value was chosen to calculate its sensitivity and specificity. RESULTS The cut-off values of CYFRA 21-1 in NSCLC by the ROC curve were 4.70 ng/mL when compared with COPD, which was obviously greater than that found with pneumonia (2.79 ng/mL) (P<0.05), tuberculosis (2.66 ng/mL) (P<0.05), and chronic bronchitis (3.94 ng/mL) (P<0.05) patients. Therefore, a cut-off value of 4.24 ng/mL in NSCLC was suggested. CONCLUSIONS The presence of various BPDs may be one of the main reasons that no optimal cut-off value for CYFRA 21-1 expression in NSCLC has been determined previously.
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Affiliation(s)
- Rui Huan Xu
- Clinical Laboratory, Longgang Central Hospital of Shenzhen, Guangdong, China
| | - Chang Zhen Liao
- Clinical Laboratory, Longgang Central Hospital of Shenzhen, Guangdong, China
| | - Yi Luo
- Clinical Laboratory, Longgang Central Hospital of Shenzhen, Guangdong, China
| | - Wen Li Xu
- Clinical Laboratory, Longgang Central Hospital of Shenzhen, Guangdong, China
| | - Kang Li
- Clinical Laboratory, Longgang Central Hospital of Shenzhen, Guangdong, China
| | - Jian Xia Chen
- Clinical Laboratory, Longgang Central Hospital of Shenzhen, Guangdong, China
| | - Yan Feng Huang
- Clinical Laboratory, Longgang Central Hospital of Shenzhen, Guangdong, China
| | | | - Lei Zhu
- Zhunyi Medical College, Guizhou, China
| | - Wen Bin Yuan
- Clinical Laboratory, Longgang Central Hospital of Shenzhen, Guangdong, China.
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Klabunde CN, Marcus PM, Han PKJ, Richards TB, Vernon SW, Yuan G, Silvestri GA. Lung cancer screening practices of primary care physicians: results from a national survey. Ann Fam Med 2012; 10:102-10. [PMID: 22412001 PMCID: PMC3315128 DOI: 10.1370/afm.1340] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 08/02/2011] [Accepted: 08/23/2011] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Although current practice guidelines do not recommend screening asymptomatic patients for lung cancer, physicians may still order lung cancer screening tests. No recent national survey of health care professionals has focused on lung cancer screening. In this study, we examined the lung cancer screening practices of US primary care physicians and characteristics of those who order lung cancer screening tests. METHODS We conducted a nationally representative survey of practicing primary care physicians in 2006-2007. Mailed questionnaires assessed the physicians' knowledge of lung cancer screening guidelines, beliefs about the effectiveness of screening tests, and ordering of screening chest radiograph, low-dose spiral computed tomography, or sputum cytology in the past 12 months. Clinical vignettes were used to assess the physicians' intentions to screen asymptomatic 50-year-old patients with varying smoking histories for lung cancer. RESULTS A total of 962 family physicians, general practitioners, and general internists completed questionnaires (cooperation rate = 76.8%). Overall, 38% had ordered no lung cancer screening tests; 55% had ordered chest radiograph, 22% low-dose spiral computed tomography, and less than 5% sputum cytology. In multivariate modeling, physicians were more likely to have ordered lung cancer screening tests if they believed that expert groups recommend lung cancer screening or that screening tests are effective; if they would recommend screening for asymptomatic patients, including patients without substantial smoking exposure; and if their patients had asked them about screening. CONCLUSIONS Primary care physicians in the United States frequently order lung cancer screening tests for asymptomatic patients, even though expert groups do not recommend it. Primary care physicians and patients need more information about lung cancer screening's evidence base, guidelines, potential harms, and costs to avert inappropriate ordering.
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Affiliation(s)
- Carrie N Klabunde
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-7344, USA.
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Klabunde CN, Marcus PM, Silvestri GA, Han PKJ, Richards TB, Yuan G, Marcus SE, Vernon SW. U.S. primary care physicians' lung cancer screening beliefs and recommendations. Am J Prev Med 2010; 39:411-20. [PMID: 20965378 PMCID: PMC3133954 DOI: 10.1016/j.amepre.2010.07.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 04/21/2010] [Accepted: 07/02/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND No high-quality study to date has shown that screening reduces lung cancer mortality, and expert groups do not recommend screening for asymptomatic individuals. Nevertheless, lung cancer screening tests are available in the U.S., and primary care physicians (PCPs) may have a role in recommending them to patients. PURPOSE This study describes U.S. PCPs' beliefs about and recommendations for lung cancer screening and examines characteristics of PCPs who recommend screening. METHODS A nationally representative survey of practicing PCPs was conducted in 2006-2007. Mailed questionnaires were used to assess PCPs' beliefs about lung cancer screening guidelines and the effectiveness of screening tests and to determine whether PCPs would recommend screening for asymptomatic patients. Data were analyzed in 2009. RESULTS Nine hundred sixty-two PCPs completed the survey (absolute response rate=70.6%; cooperation rate=76.8%). One quarter said that major guidelines support lung cancer screening. Two thirds said that low-radiation dose spiral computed tomography (LDCT) screening is very or somewhat effective in reducing lung cancer mortality in current smokers; LDCT was perceived as more effective than chest x-ray or sputum cytology. Responding to vignettes describing asymptomatic patients of varying smoking exposure, 67% of PCPs recommended lung cancer screening for at least one of the vignettes. Most PCPs recommending screening said they would use chest x-ray; up to 26% would use LDCT. In adjusted analyses, PCPs' beliefs and practice style were strongly associated with their lung cancer screening recommendations. CONCLUSIONS Many PCPs' lung cancer screening beliefs and recommendations are inconsistent with current evidence and guidelines. Provider education regarding the evidence base and guideline content of lung cancer screening is indicated.
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Affiliation(s)
- Carrie N Klabunde
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-7344, USA.
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