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Kossenkov AV, Qureshi R, Dawany NB, Wickramasinghe J, Liu Q, Majumdar RS, Chang C, Widura S, Kumar T, Horng WH, Konnisto E, Criner G, Tsay JCJ, Pass H, Yendamuri S, Vachani A, Bauer T, Nam B, Rom WN, Showe MK, Showe LC. A Gene Expression Classifier from Whole Blood Distinguishes Benign from Malignant Lung Nodules Detected by Low-Dose CT. Cancer Res 2019; 79:263-273. [PMID: 30487137 PMCID: PMC6317999 DOI: 10.1158/0008-5472.can-18-2032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/20/2018] [Accepted: 10/31/2018] [Indexed: 12/17/2022]
Abstract
Low-dose CT (LDCT) is widely accepted as the preferred method for detecting pulmonary nodules. However, the determination of whether a nodule is benign or malignant involves either repeated scans or invasive procedures that sample the lung tissue. Noninvasive methods to assess these nodules are needed to reduce unnecessary invasive tests. In this study, we have developed a pulmonary nodule classifier (PNC) using RNA from whole blood collected in RNA-stabilizing PAXgene tubes that addresses this need. Samples were prospectively collected from high-risk and incidental subjects with a positive lung CT scan. A total of 821 samples from 5 clinical sites were analyzed. Malignant samples were predominantly stage 1 by pathologic diagnosis and 97% of the benign samples were confirmed by 4 years of follow-up. A panel of diagnostic biomarkers was selected from a subset of the samples assayed on Illumina microarrays that achieved a ROC-AUC of 0.847 on independent validation. The microarray data were then used to design a biomarker panel of 559 gene probes to be validated on the clinically tested NanoString nCounter platform. RNA from 583 patients was used to assess and refine the NanoString PNC (nPNC), which was then validated on 158 independent samples (ROC-AUC = 0.825). The nPNC outperformed three clinical algorithms in discriminating malignant from benign pulmonary nodules ranging from 6-20 mm using just 41 diagnostic biomarkers. Overall, this platform provides an accurate, noninvasive method for the diagnosis of pulmonary nodules in patients with non-small cell lung cancer. SIGNIFICANCE: These findings describe a minimally invasive and clinically practical pulmonary nodule classifier that has good diagnostic ability at distinguishing benign from malignant pulmonary nodules.
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Affiliation(s)
| | | | | | | | - Qin Liu
- The Wistar Institute, Philadelphia, Pennsylvania
| | | | - Celia Chang
- The Wistar Institute, Philadelphia, Pennsylvania
| | - Sandy Widura
- The Wistar Institute, Philadelphia, Pennsylvania
| | - Trisha Kumar
- The Wistar Institute, Philadelphia, Pennsylvania
| | | | - Eric Konnisto
- Roswell Park Comprehensive Cancer Center Buffalo, New York
| | | | | | - Harvey Pass
- NYU Langone Medical Center, New York, New York
| | - Sai Yendamuri
- Roswell Park Comprehensive Cancer Center Buffalo, New York
| | - Anil Vachani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Brian Nam
- Helen F. Graham Cancer Center, Newark, Delaware
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Wang X, Zhang Y, Sun L, Wang S, Nie J, Zhao W, Zheng G. Evaluation of the clinical application of multiple tumor marker protein chip in the diagnostic of lung cancer. J Clin Lab Anal 2018; 32:e22565. [PMID: 29736949 DOI: 10.1002/jcla.22565] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/11/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The early diagnostic of lung cancer plays an important role in the prognosis of surgical treatment among lung cancer patients. To evaluate the clinical application of multi-tumor markers protein biochip in the diagnosis of lung cancer, 12 tumor markers were detected in patients with different stages of lung cancer. METHODS Serum CA125, CA19-9, Ferritin, CA15-3, CA242, CEA, AFP, NSE, PSA, f-PSA, HGH, and β-HGH were assessed in 506 patients, with 224 patients with lung cancer (including 123 cases of adenocarcinoma, 30 squamous cell carcinoma, 54 small-cell carcinoma, and 17 non classification), 159 patients with benign lung disease and 90 healthy people control by the C-12 multiple tumor protein-chip detective system. RESULTS The positive rate of C-12 (77.23%) in lung cancer was significantly higher than that of benign lung disease (13.84%) and healthy people (9.76%) (P < .01). In lung cancer, the positive rate of CA199, NSE, CEA, CA242, Ferritin, f-PSA, and CA125 were significantly higher than that of benign lung disease and healthy people. In adenocarcinoma, the positive rate of CA125 (73.53%) was significantly higher than that of squamous cell carcinoma (36.67%) and small-cell carcinoma (56.62%). CONCLUSION The C-12 multiple tumor protein-chip detective system has acceptable sensitivity in the diagnostic of lung cancer.
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Affiliation(s)
- Xiaochuan Wang
- Department of Clinical Laboratory, No. 150 Central Hospital of PLA, Luoyang, China
| | - Yi Zhang
- Department of Clinical Laboratory, No. 150 Central Hospital of PLA, Luoyang, China
| | - Liangqi Sun
- Department of Clinical Laboratory, No. 150 Central Hospital of PLA, Luoyang, China
| | - Shuaiping Wang
- Department of Clinical Laboratory, No. 150 Central Hospital of PLA, Luoyang, China
| | - Jing Nie
- Department of Clinical Laboratory, No. 150 Central Hospital of PLA, Luoyang, China
| | - Wenqing Zhao
- Luoyang First Hospital of Traditional Chinese Medicine, Luoyang, China
| | - Guobao Zheng
- Department of Oncology, No. 150 Central Hospital of PLA, Luoyang, China
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Sutton BC, Birse RT, Maggert K, Ray T, Hobbs J, Ezenekwe A, Kazmierczak J, Mosko M, Kish J, Bullock A, Shi Z, Stack MS, Irwin D. Assessment of common somatic mutations of EGFR, KRAS, BRAF, NRAS in pulmonary non-small cell carcinoma using iPLEX® HS, a new highly sensitive assay for the MassARRAY® System. PLoS One 2017; 12:e0183715. [PMID: 28926605 PMCID: PMC5604939 DOI: 10.1371/journal.pone.0183715] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/09/2017] [Indexed: 11/19/2022] Open
Abstract
Increased early detection and personalized therapy for lung cancer have coincided with greater use of minimally invasive sampling techniques such as endobronchial ultrasound-guided biopsy (EBUS), endoscopic ultrasound-guided biopsy (EUS), and navigational biopsy, as well as thin needle core biopsies. As many lung cancer patients have late stage disease and other comorbidities that make open surgical procedures hazardous, the least invasive biopsy technique with the highest potential specimen yield is now the preferred first diagnostic study. However, use of these less invasive procedures generates significant analytical challenges for the laboratory, such as a requirement for robust detection of low level somatic mutations, particularly when the starting sample is very small or demonstrates few intact tumor cells. In this study, we assessed 179 clinical cases of non-small cell lung carcinoma (NSCLC) that had been previously tested for EGFR, KRAS, NRAS, and BRAF mutations using a novel multiplexed analytic approach that reduces wild-type signal and allows for detection of low mutation load approaching 1%, iPLEX® HS panel for the MassARRAY® System (Agena Bioscience, San Diego, CA). This highly sensitive system identified approximately 10% more KRAS, NRAS, EGFR and BRAF mutations than were detected by the original test platform, which had a sensitivity range of 5-10% variant allele frequency (VAF).
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Affiliation(s)
- Bobbie C. Sutton
- Pathology Department, South Bend Medical Foundation, South Bend, IN, United States of America
| | - Ryan T. Birse
- Agena Bioscience, San Diego, CA, United States of America
| | - Kevin Maggert
- Pathology Department, South Bend Medical Foundation, South Bend, IN, United States of America
| | - Tammy Ray
- Pathology Department, South Bend Medical Foundation, South Bend, IN, United States of America
| | - Jessica Hobbs
- Pathology Department, South Bend Medical Foundation, South Bend, IN, United States of America
| | - Amobi Ezenekwe
- Pathology Department, South Bend Medical Foundation, South Bend, IN, United States of America
| | | | - Michael Mosko
- Agena Bioscience, San Diego, CA, United States of America
| | - Joan Kish
- Pathology Department, South Bend Medical Foundation, South Bend, IN, United States of America
| | - Andrew Bullock
- Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN, United States of America
| | - Zonggao Shi
- Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN, United States of America
| | - M. Sharon Stack
- Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN, United States of America
| | - Darryl Irwin
- Agena Bioscience, San Diego, CA, United States of America
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Ma X, Siegelman J, Paik DS, Mulshine JL, St Pierre S, Buckler AJ. Volumes Learned: It Takes More Than Size to "Size Up" Pulmonary Lesions. Acad Radiol 2016; 23:1190-8. [PMID: 27287713 DOI: 10.1016/j.acra.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/08/2016] [Accepted: 04/10/2016] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to review the current understanding and capabilities regarding use of imaging for noninvasive lesion characterization and its relationship to lung cancer screening and treatment. MATERIALS AND METHODS Our review of the state of the art was broken down into questions about the different lung cancer image phenotypes being characterized, the role of imaging and requirements for increasing its value with respect to increasing diagnostic confidence and quantitative assessment, and a review of the current capabilities with respect to those needs. RESULTS The preponderance of the literature has so far been focused on the measurement of lesion size, with increasing contributions being made to determine the formal performance of scanners, measurement tools, and human operators in terms of bias and variability. Concurrently, an increasing number of investigators are reporting utility and predictive value of measures other than size, and sensitivity and specificity is being reported. Relatively little has been documented on quantitative measurement of non-size features with corresponding estimation of measurement performance and reproducibility. CONCLUSIONS The weight of the evidence suggests characterization of pulmonary lesions built on quantitative measures adds value to the screening for, and treatment of, lung cancer. Advanced image analysis techniques may identify patterns or biomarkers not readily assessed by eye and may also facilitate management of multidimensional imaging data in such a way as to efficiently integrate it into the clinical workflow.
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Affiliation(s)
- Xiaonan Ma
- Elucid Bioimaging Inc., 225 Main Street, Wenham, MA 01984.
| | - Jenifer Siegelman
- Department of Radiology, Brigham and Women's Hospital, Boston Massachusetts; Department of Radiology (hospital-based), Harvard Medical School, Boston, Massachusetts
| | - David S Paik
- Elucid Bioimaging Inc., 225 Main Street, Wenham, MA 01984
| | - James L Mulshine
- Department of Internal Medicine, Rush University, Chicago, Illinois
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Adamek M, Wachuła E, Szabłowska-Siwik S, Boratyn-Nowicka A, Czyżewski D. Risk factors assessment and risk prediction models in lung cancer screening candidates. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:151. [PMID: 27195269 DOI: 10.21037/atm.2016.04.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
From February 2015, low-dose computed tomography (LDCT) screening entered the armamentarium of diagnostic tools broadly available to individuals at high-risk of developing lung cancer. While a huge number of pulmonary nodules are identified, only a small fraction turns out to be early lung cancers. The majority of them constitute a variety of benign lesions. Although it entails a burden of the diagnostic work-up, the undisputable benefit emerges from: (I) lung cancer diagnosis at earlier stages (stage shift); (II) additional findings enabling the implementation of a preventive action beyond the realm of thoracic oncology. This review presents how to utilize the risk factors from distinct categories such as epidemiology, radiology and biomarkers to target the fraction of population, which may benefit most from the introduced screening modality.
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Affiliation(s)
- Mariusz Adamek
- 1 The Chair and Department of Thoracic Surgery, The Professor S. Szyszko Teaching Hospital No. 1, Zabrze, Poland ; 2 Department of Clinical Oncology, Medical University of Silesia, Katowice, Poland
| | - Ewa Wachuła
- 1 The Chair and Department of Thoracic Surgery, The Professor S. Szyszko Teaching Hospital No. 1, Zabrze, Poland ; 2 Department of Clinical Oncology, Medical University of Silesia, Katowice, Poland
| | - Sylwia Szabłowska-Siwik
- 1 The Chair and Department of Thoracic Surgery, The Professor S. Szyszko Teaching Hospital No. 1, Zabrze, Poland ; 2 Department of Clinical Oncology, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Boratyn-Nowicka
- 1 The Chair and Department of Thoracic Surgery, The Professor S. Szyszko Teaching Hospital No. 1, Zabrze, Poland ; 2 Department of Clinical Oncology, Medical University of Silesia, Katowice, Poland
| | - Damian Czyżewski
- 1 The Chair and Department of Thoracic Surgery, The Professor S. Szyszko Teaching Hospital No. 1, Zabrze, Poland ; 2 Department of Clinical Oncology, Medical University of Silesia, Katowice, Poland
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Yang-Chun F, Min F, Di Z, Yan-Chun H. Retrospective Study to Determine Diagnostic Utility of 6 Commonly Used Lung Cancer Biomarkers Among Han and Uygur Population in Xinjiang Uygur Autonomous Region of People's Republic of China. Medicine (Baltimore) 2016; 95:e3568. [PMID: 27149479 PMCID: PMC4863796 DOI: 10.1097/md.0000000000003568] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Early diagnosis was the main way to improve the survival rate of lung cancer patients. At present, the methods to diagnose lung cancer were varied, but early diagnosis of lung cancer was still difficult. In experimental and clinical studies, lung cancer related tumor markers were helpful to the early diagnosis of lung cancer. So far, there were many studies about lung cancer related tumor markers in China, but the subjects in these studies were almost the Han population. There were few studies about the Uygur population. Xinjiang was a multi-ethnic region in China, the ratios of Han and Uygur population were 40% and 45%, respectively. Xinjiang also was a high incidence area of lung cancer in China. The purpose of this study was to research the application of 6 tumor markers in Uygur and Han lung cancer patients in XinJiang, China.The study collected 342 cases who were diagnosed as lung cancer in Tumor Hospital Affiliated to XinJiang Medical University from May 2012 to December 2012. Serum concentrations of squamous cell carcinoma (SCC), cytokeratin fragment 19 (CYFRA21-1), carcino-embryonic antigen (CEA), carbohydrate antigen 125 (CA125), precursor of gastrin-releasing peptide (Pro-GRP), and neuron-specific enolase (NSE) were tested for every patient before radiation, chemotherapy, or surgery. The serum concentrations of SCC, CYFRA21-1, CEA, CA125, and Pro-GRP were assayed using the micro-particle luminescence analysis testing by the Abbott ARHCITECT i2000SR immunoanalyzer. NSE was assayed by the electrochemical luminescence analysis testing using Roche Cobas E601 electrochemical luminescence analyzer.Serum levels of SCC were different between 2 ethnic populations, smoking should be the influence factor to create the difference. Cluster analysis showed that the NSE and Pro-GRP were helpful to identify small cell lung cancer (SCLC), and CEA, CA125, SCC, CYFRA21-1 were beneficial to diagnose non-small cell lung cancer (NSCLC). The compare of diagnosis value about serum tumor markers also proved the result of cluster analysis. No matter SCLC or NSCLC, the positives rate of all tumor markers were increasing as clinical stage advancing. Pro-GRP had higher positive rate than NSE in limited stage of SCLC. CA125 had the highest positive rate in I and II stage of NSCLC, and CYFRA21-1 had the highest positive rate in III and IV stage of NSCLC. CEA and CA125 were beneficial to diagnose adenocarcinoma, CYFRA21-1, and SCC identified squamous cell cancer better.Only SCC level was higher in Han population than Uygur population because of the differences of smoking constituent ratio between 2 populations. So, it could be unified to research the application value of the 6 indicators for the Han and Uygur population. Then, we suggested a primary diagnostic utility of 6 commonly by lung cancer biomarkers in both the Han and Uygur populations in Xinjiang Uygur Autonomous Region of People's Republic of China.
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Affiliation(s)
- Feng Yang-Chun
- From the Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, People's Republic of China
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Ma L, Xie XW, Wang HY, Ma LY, Wen ZG. Clinical Evaluation of Tumor Markers for Diagnosis in Patients with Non-small Cell Lung Cancer in China. Asian Pac J Cancer Prev 2016; 16:4891-4. [PMID: 26163610 DOI: 10.7314/apjcp.2015.16.12.4891] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the value of combined detection of serum carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1), and carbohydrateantigen 125 (CA125) for the clinical diagnosis of non- small cell lung cancer (NSCLC). MATERIALS AND METHODS Serum CEA, CYFRA21-1 and CA125 were assessed in 140 patients with NSCLC, 90 patients with benign lung disease and 90 normal control subjects, and differences of expression were compared in each group, and joint effects of these tumor markers in the diagnosis of NSCLC were analyzed. RESULTS Serum CEA, CYFRA21-1 and CA125 in patients with NSCLC were significantly higher than those with benign lung disease and normal controls (P<0.05). The sensitivity of CEA, CYFRA21-1 and CA125 were 49.45%, 59.67%, and 44.87% respectively. As expected, combinations of these tumor markers improved their sensitivity for NSCLC. The combined detection of CEA+CYFRA21-1 was the most cost-effective combination which had higher sensitivity and specificity in NSCLC. Elevation of serum CEA and CYFRA21-1 was significantly associated with pathological types (P<0.05) and elevation of serum CEA, CYFRA21-1 and CA125 was significantly associated with TNM staging (P<0.05). CONCLUSIONS Single measurement of CEA, CYFRA21-1 and CA125 is of diagnostic value in the diagnosis of lung cancer, and a joint detection of these three tumor markers, could greatly improve the sensitivity of diagnosis on NSCLC. Combined detection of CEA+CYFRA21-1 proved to be the most economic and practical strategy in diagnosis of NSCLC, which can be used to screen the high-risk group.
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Affiliation(s)
- Li Ma
- PLA General Hospital , Beijing, China E-mail :
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Zeng Q, Liu M, Zhou N, Liu L, Song X. Serum human epididymis protein 4 (HE4) may be a better tumor marker in early lung cancer. Clin Chim Acta 2016; 455:102-6. [PMID: 26851650 DOI: 10.1016/j.cca.2016.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Human epididymis protein 4 (HE4) had been shown to be an ideal biomarker in ovarian cancer. However, there were fewer reports on its application in lung cancer. We explored the diagnostic value of serum HE4 as a biomarker in early lung cancer by comparing it with other biomarkers. METHODS 162 individuals including 112 cases of lung cancer at early stage and 50 healthy people as controls were enrolled. The serum concentrations of biomarkers were determined with the Roche Elecsys assays. RESULTS In comparison to the other biomarkers such as carcinoembryonic antigen (CEA), neuron-specific-enolase (NSE), serum cytokeratin 19 fragment (CYFRA 21-1) and progastrinreleasing peptide (proGRP), serum HE4 was one of the biomarkers with the highest sensitivity (43.8%) and specificity (95.0%) for early lung cancer diagnosis. In terms of histological results, serum HE4 was the best biomarker both in adenocarcinoma (AC) and squamous carcinoma (SC), and serum proGRP was the best in small cell lung cancer (SCLC). The combination of proGRP, NSE and HE4 could determine the histological type of lung cancer with a very high accuracy of 93.8%. CONCLUSIONS These findings suggested that serum HE4 was a better biomarker in early lung cancer than other frequently-used biomarkers.
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Affiliation(s)
- Qian Zeng
- Clinical laboratory of Shandong Cancer Hospital & Institute, PR China; School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medicine Science, PR China
| | - Meiqin Liu
- Clinical laboratory of Shandong Cancer Hospital & Institute, PR China
| | - Na Zhou
- Clinical laboratory of Shandong Cancer Hospital & Institute, PR China; School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medicine Science, PR China
| | - Lisheng Liu
- Clinical laboratory of Shandong Cancer Hospital & Institute, PR China
| | - Xianrang Song
- Clinical laboratory of Shandong Cancer Hospital & Institute, PR China.
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Kubasiak JC, Seder CW, Pithadia R, Basu S, Fhied C, Phillips WW, Daly S, Shersher DD, Yoder MA, Chmielewski G, Edell ES, Maldonado F, Liptay MJ, Borgia JA. Value of circulating insulin-like growth factor–associated proteins for the detection of stage I non–small cell lung cancer. J Thorac Cardiovasc Surg 2015; 149:727-34.e1-3; discussion 734. [DOI: 10.1016/j.jtcvs.2014.08.085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 08/13/2014] [Accepted: 08/30/2014] [Indexed: 02/02/2023]
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Abd-El-Fattah AA, Sadik NAH, Shaker OG, Aboulftouh ML. Differential microRNAs expression in serum of patients with lung cancer, pulmonary tuberculosis, and pneumonia. Cell Biochem Biophys 2014; 67:875-84. [PMID: 23559272 DOI: 10.1007/s12013-013-9575-y] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
MicroRNAs (miRNAs) play critical regulatory roles in the physiological and pathological processes. The high stability of miRNAs in human serum represents attractive novel diagnostic biomarkers of clinical conditions. Several studies have shown that aberrant expression of miRNAs in human cancer including lung cancer, but little is known about their effects on some infectious lung diseases such as pulmonary tuberculosis (TB) and pneumonia. In this study, we investigated miRNA expression pattern in serum of Egyptian patients with lung cancer, TB, and pneumonia compared with matched healthy controls. Using microarray-based expression profiling followed by real-time quantitative polymerase chain reaction validation, we compared the levels of a series of circulating miRNAs (miR-21, miR-155, miR-182, and miR-197) in serum from patients with lung cancer (n = 65), pulmonary tuberculosis (n = 29), pneumonia (n = 29), and transudate (n = 16) compared with matched healthy controls (n = 37). MiRNA SNORD68 was the housekeeping endogenous control. We found that the serum levels of miR-21, miR-155, and miR-197 were significantly elevated in the patients with lung cancer and pneumonia whereas miR-182 and miR-197 levels were increased only in patients with lung cancer and TB, respectively, compared with controls. Receiver operating characteristic analysis revealed that miR-182, miR-155, and miR-197 have superior diagnostic potential in discriminating patients with lung cancer, pneumonia, and TB, respectively, from controls. Our results conclude that the differential expression of the four studied miRNAs can be potential non-invasive biomarkers for patients with lung cancer, TB and pneumonia.
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Affiliation(s)
- Amal A Abd-El-Fattah
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Einy Street, Cairo, Egypt
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Clinical evaluation and cost-effectiveness analysis of serum tumor markers in lung cancer. BIOMED RESEARCH INTERNATIONAL 2013; 2013:195692. [PMID: 24167812 PMCID: PMC3792518 DOI: 10.1155/2013/195692] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/22/2013] [Indexed: 12/17/2022]
Abstract
The detection of serum tumor markers is valuable for the early diagnosis of lung cancer. Tumor markers are frequently used for the management of cancer patients. However, single markers are less efficient but marker combinations increase the cost, which is troublesome for clinics. To find an optimal serum marker combination panel that benefits the patients and the medical management system as well, four routine lung cancer serum markers (SCCA, NSE, CEA, and CYFRA21-1) were evaluated individually and in combination. Meanwhile, the costs and effects of these markers in clinical practice in China were assessed by cost-effectiveness analysis. As expected, combinations of these tumor markers improved their sensitivity for lung cancer and different combination panels had their own usefulness. NSE + CEA + CYFRA21-1 was the optimal combination panel with highest Youden's index (0.64), higher sensitivity (75.76%), and specificity (88.57%), which can aid the clinical diagnosis of lung cancer. Nevertheless, the most cost-effective combination was SCCA + CEA, which can be used to screen the high-risk group.
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Shmueli A, Fraifeld S, Peretz T, Gutfeld O, Gips M, Sosna J, Shaham D. Cost-effectiveness of baseline low-dose computed tomography screening for lung cancer: the Israeli experience. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:922-931. [PMID: 24041342 DOI: 10.1016/j.jval.2013.05.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 04/20/2013] [Accepted: 05/04/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Reduced mortality with low-dose computed tomography (LDCT) lung cancer screening was demonstrated in a large randomized controlled study of high-risk individuals. Cost-effectiveness must be assessed before routine LDCT screening is considered. We aimed to evaluate the cost-effectiveness of LDCT lung cancer screening in Israel. METHODS A decision analytic framework was used to evaluate the decision to screen or not screen from the health system perspective. The screening arm included 842 moderate-to-heavy smokers aged 45 years or older, screened at Hadassah-Hebrew University Medical Center from 1998 to 2004. In the usual-care arm, stage distribution and stage-specific life expectancy were obtained from the Israel National Cancer Registry data for 1994 to 2006. Lifetime stage-specific costs were estimated from medical records of patients diagnosed and treated at Hadassah Medical Center in the period 2003 to 2004. The analysis considered possible biases-lead time, overdiagnosis, and self-selection. Cost per quality-adjusted-life-year (QALY) gained by screening was estimated. RESULTS Base-case incremental cost per QALY gained was $1464 (2011 prices). Extensive sensitivity analysis affirmed the low cost per QALY gained. The cost per QALY gained is lower than $10,000 with probability 0.937 and is lower than $20,000 with probability 0.978. CONCLUSIONS Our analysis suggests that baseline LDCT lung cancer screening in Israel presents a good value for the money and should be considered for inclusion in the National List of Health Services financed publicly.
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Affiliation(s)
- Amir Shmueli
- The Braun Hebrew University-Hadassah School of Public Health, Jerusalem, Israel.
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Development and validation of a plasma biomarker panel for discerning clinical significance of indeterminate pulmonary nodules. J Thorac Oncol 2013. [PMID: 23201823 DOI: 10.1097/jto.0b013e31827627f8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The recent findings of the National Lung Screening Trial showed 24.2% of individuals at high risk for lung cancer having one or more indeterminate nodules detected by low-dose computed tomography-based screening, 96.4% of which were eventually confirmed as false positives. These positive scans necessitate additional diagnostic procedures to establish a definitive diagnosis that adds cost and risk to the paradigm. A plasma test able to assign benign versus malignant pathology in high-risk patients would be an invaluable tool to complement low-dose computed tomography-based screening and promote its rapid implementation. METHODS We evaluated 17 biomarkers, previously shown to have value in detecting lung cancer, against a discovery cohort, comprising benign (n = 67) cases and lung cancer (n = 69) cases. A Random Forest method based analysis was used to identify the optimal biomarker panel for assigning disease status, which was then validated against a cohort from the Mayo Clinic, comprising patients with benign (n = 61) or malignant (n = 20) indeterminate lung nodules. RESULTS Our discovery efforts produced a seven-analyte plasma biomarker panel consisting of interleukin 6 (IL-6), IL-10, IL-1ra, sIL-2Rα, stromal cell-derived factor-1α+β, tumor necrosis factor α, and macrophage inflammatory protein 1 α. The sensitivity and specificity of our panel in our validation cohort is 95.0% and 23.3%, respectively. The validated negative predictive value of our panel was 93.8%. CONCLUSION We developed a seven-analyte plasma biomarker panel able to identify benign nodules, otherwise deemed indeterminate, with a high degree of accuracy. This panel may have clinical utility in risk-stratifying screen-detected lung nodules, decrease unnecessary follow-up imaging or invasive procedures, and potentially avoid unnecessary morbidity, mortality, and health care costs.
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Ruano-Ravina A, Pérez Ríos M, Fernández-Villar A. Lung Cancer Screening With Low-Dose Computed Tomography After the National Lung Screening Trial. The Debate is Still Open. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2013.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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Lung cancer screening with low-dose computed tomography after the National Lung Screening Trial. The debate is still open. Arch Bronconeumol 2013; 49:158-65. [PMID: 23317766 DOI: 10.1016/j.arbres.2012.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/02/2012] [Accepted: 10/15/2012] [Indexed: 01/05/2023]
Abstract
The aim of this article is to highlight some concerns regarding lung cancer screening with CT through a thorough analysis of scientific literature. The publication of the National Lung Screening Trial in 2011 has revealed that CT screening of smokers and ex-smokers in three annual rounds reduces lung cancer mortality a 20% when compared with thorax x-ray screening. The first limitation of this screening modality is its lack of downstaging in successive screening rounds compared with the initial round. Also, lung cancer screening with CT has a low positive predictive value, similar to the percentage of unnecessary surgeries performed in false positives. Another problem is that, at present, the burden of lung cancer overdiagnosis is not known. It is to be expected that if overdiagnosis occurs when thorax x-ray screening is used it will be greater when using CT. CT, even at low doses, exposes patients to high levels of radiation. Dealing with positive nodules entails an even higher radiation dose and the number of cancer cases induced by radiation in patients screened with CT is not known. Lastly, published studies on lung cancer CT screening are vastly heterogeneous. They include different age groups, different types of smokers and ex-smokers and different tomogram thickness, making the results hardly comparable. In this context we do not recommend lung cancer screening with CT for smokers or ex-smokers outside of the context of individual counseling.
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Lai JH, She TF, Juang YM, Tsay YG, Huang AH, Yu SL, Chen JJW, Lai CC. Comparative proteomic profiling of human lung adenocarcinoma cells (CL 1-0) expressing miR-372. Electrophoresis 2012; 33:675-88. [PMID: 22451061 DOI: 10.1002/elps.201100329] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Lung cancer is a common malignancy and has a poor overall prognosis. Widespread metastasis is a common phenomenon in non-small cell lung cancer (NSCLC). It has been demonstrated that cancer relapse and survival can be predicted by the presence of a five-microRNA (miRNA) signature independent of stage or histologic type in NSCLC patients. Among the five miRNAs in the signature, miR-372 has been shown to play a significant role in metastasis and in the development of human testicular germ cell tumors. In addition, there is evidence that miR-372 posttranscriptionally downregulates large tumor suppressor, homolog 2 (Lats2), resulting in tumorigenesis and proliferation. To further investigate the cellular mechanisms involved in miR-372-induced silencing, we conducted a comparative proteomic analysis of NSCLC CL 1-0 cells expressing miRNA-372 and/or vector only by using two-dimensional gel electrophoresis (2DE), two-dimensional difference gel electrophoresis (2D-DIGE), and LC/MS/MS. Proteins identified as being up- or downregulated were further classified according to their biological functions. Many of the proteins identified in our study may be potential diagnostic biomarkers of NSCLC, particularly phosphorylated eIF4A-I.
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Affiliation(s)
- Juo-Hsin Lai
- Institute of Molecular Biology, National Chung Hsing University, Taichung, Taiwan
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Chu ZG, Yang ZG, Shao H, Zhu ZY, Deng W, Tang SS, Chen J, Li Y. Small peripheral lung adenocarcinoma: CT and histopathologic characteristics and prognostic implications. Cancer Imaging 2011; 11:237-46. [PMID: 22201671 PMCID: PMC3266590 DOI: 10.1102/1470-7330.2011.0033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Since the introduction of computed tomography (CT), detection of small lung cancer, especially small peripheral adenocarcinoma, is common. Recently, the morphological characteristics, including thin-section CT and pathologic findings, and prognosis of small peripheral lung adenocarcinomas have been studied extensively. The radiologic and microscopic findings correlate well with each other and are closely associated with tumour prognosis. Most importantly, some subtypes of small lung adenocarcinomas with specific CT or pathologic features are curable. Therefore, all defining characteristics (CT, pathologic and prognostic) of this kind of tumour should be integrated to improve our understanding, provide guidelines for management and accurately assess its prognosis.
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Affiliation(s)
- Zhi-gang Chu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Dalphin JC. Quels sont les objectifs du suivi post-professionnel, les bénéfices attendus et les risques possibles ? Objectifs médicaux en termes de morbidité, mortalité et qualité de vie. Rev Mal Respir 2011; 28:1230-40. [DOI: 10.1016/j.rmr.2011.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 06/25/2011] [Indexed: 11/25/2022]
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Esposito L, Conti D, Ailavajhala R, Khalil N, Giordano A. Lung Cancer: Are we up to the Challenge? Curr Genomics 2011; 11:513-8. [PMID: 21532835 PMCID: PMC3048313 DOI: 10.2174/138920210793175903] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Revised: 06/08/2010] [Accepted: 07/26/2010] [Indexed: 12/31/2022] Open
Abstract
Lung cancer is the leading cause of cancer deaths worldwide among both men and women, with more than 1 million deaths annually. Non–small cell lung cancer (NSCLC) accounts for about 80% of all lung cancers. Although recent advances have been made in diagnosis and treatment strategies, the prognosis of NSCLC patients is poor and it is basically due to a lack of early diagnostic tools. However, in the last years genetic and biochemical studies have provided more information about the protein and gene’s mutations involved in lung tumors. Additionally, recent proteomic and microRNA’s approaches have been introduced to help biomarker discovery. Here we would like to discuss the most recent discoveries in lung cancer pathways, focusing on the genetic and epigenetic factors that play a crucial role in malignant cell proliferation, and how they could be helpful in diagnosis and targeted therapy.
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Affiliation(s)
- Luca Esposito
- Oncology Research Centre of Mercogliano, Avellino, Italy
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21
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Bach PB. Inconsistencies in findings from the early lung cancer action project studies of lung cancer screening. J Natl Cancer Inst 2011; 103:1002-6. [PMID: 21685356 DOI: 10.1093/jnci/djr202] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Long-standing guidelines against screening high-risk individuals for lung cancer may change following the publication of the randomized National Lung Screening Trial (NLST), which shows a benefit of computed tomography compared with chest x-ray screening. Guideline panels will likely also seek additional information from nonrandomized studies of computed tomography screening, such as the Early Lung Cancer Action Project (ELCAP). However, for the ELCAP findings to be incorporated into new guidelines, some inconsistencies in the published data should first be resolved. Specifically, some of the reports from ELCAP appear to contradict others in terms of important endpoints, and several findings from ELCAP appear to be statistically improbable or outliers when compared with analyses and studies by other research groups. Clarification of both internal and external inconsistencies is a prerequisite for evaluation of the body of work published by ELCAP investigators.
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Affiliation(s)
- Peter B Bach
- Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 E 63rd St, 2nd Floor, New York, NY 10021, USA
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Sinsuat M, Saita S, Kawata Y, Niki N, Ohmatsu H, Tsuchida T, Kakinuma R, Kusumoto M, Eguchi K, Kaneko M, Morikubo H, Moriyama N. Influence of slice thickness on diagnoses of pulmonary nodules using low-dose CT: potential dependence of detection and diagnostic agreement on features and location of nodule. Acad Radiol 2011; 18:594-604. [PMID: 21377905 DOI: 10.1016/j.acra.2011.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 12/03/2010] [Accepted: 01/14/2011] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVES The aims of this study were to assess the influence of slice thickness on the ability of radiologists to detect or not detect nodules and to agree or disagree on the diagnosis and also to investigate the potential dependence of these relations on the sizes, average computed tomographic (CT) values, and locations of the nodules. MATERIALS AND METHODS Six radiologists performed qualitative diagnostic readings of multislice CT images with a slice thickness of 2 or 10 mm obtained from 360 subjects. The nodules were diagnosed as nodules for further examination (NFEs), inactive nodules for no further examination (INNFEs), or no abnormality. The results of the diagnoses were cross-tabulated and quantitatively analyzed using the average CT values, sizes, and locations of the nodules with reference to the 2-mm slices. Multivariate logistic regression analyses were used to estimate the significant associations of these parameters with the ability of radiologists to detect or not detect nodules and to agree or disagree on the diagnosis. RESULTS Totals of 130 NFEs and 403 INNFEs for 2-mm slice thickness and 142 NFEs and 338 INNFEs for 10-mm slice thickness were diagnosed. Nodule classifications were as follows: the same diagnosis on both slice thickness images (67.6%), different diagnoses on two slice thickness images (21%), missed on 10-mm slice thickness images (10.6%), and misinterpreted on 10-mm slice thickness images (0.7%). Regarding detection and nondetection, NFE diagnoses were influenced by size (odds ratio [OR], 132.50; 95% confidence interval [CI], 4.77-4711) and the average CT value (OR, 27.20; 95% CI, 3.21-645.3), and INNFE diagnoses were influenced by size (OR, 16.10; 95% CI, 6.18-55.19) and the average CT value (OR, 7.67; 95% CI, 2.19-30.91). Regarding diagnostic agreement and disagreement, the NFE diagnoses were influenced by size (OR, 3.60; 95% CI, 1.29-11.04), nodule distance from the lung border (OR, 2.85; 95% CI, 1.27-6.65), and nodule location in the right upper lobe (OR, 0.07; 95% CI, 0.003-0.477), while the INNFE diagnoses were influenced by the average CT value (OR, 11.84; 95% CI, 3.33-55.86), size (OR, 0.42; 95% CI, 0.25-0.70), and nodule distance from the lung border (OR, 0.41; 95% CI, 0.25-0.66). CONCLUSIONS The influence of slice thickness on the ability of radiologists to detect or not detect nodules and to agree or disagree on the diagnosis was quantitatively evaluated. Detection and nondetection of NFEs and INNFEs are influenced by size and average CT value. Agreement and disagreement on NFE and INNFE diagnoses are influenced not only by size and average CT value but also, importantly, by the locations of nodules.
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Shuryak I, Sachs RK, Brenner DJ. Cancer risks after radiation exposure in middle age. J Natl Cancer Inst 2010; 102:1628-36. [PMID: 20975037 PMCID: PMC2970575 DOI: 10.1093/jnci/djq346] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 07/26/2010] [Accepted: 08/06/2010] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Epidemiological data show that radiation exposure during childhood is associated with larger cancer risks compared with exposure at older ages. For exposures in adulthood, however, the relative risks of radiation-induced cancer in Japanese atomic bomb survivors generally do not decrease monotonically with increasing age of adult exposure. These observations are inconsistent with most standard models of radiation-induced cancer, which predict that relative risks decrease monotonically with increasing age at exposure, at all ages. METHODS We analyzed observed cancer risk patterns as a function of age at exposure in Japanese atomic bomb survivors by using a biologically based quantitative model of radiation carcinogenesis that incorporates both radiation induction of premalignant cells (initiation) and radiation-induced promotion of premalignant damage. This approach emphasizes the kinetics of radiation-induced initiation and promotion, and tracks the yields of premalignant cells before, during, shortly after, and long after radiation exposure. RESULTS Radiation risks after exposure in younger individuals are dominated by initiation processes, whereas radiation risks after exposure at later ages are more influenced by promotion of preexisting premalignant cells. Thus, the cancer site-dependent balance between initiation and promotion determines the dependence of cancer risk on age at radiation exposure. For example, in terms of radiation induction of premalignant cells, a quantitative measure of the relative contribution of initiation vs promotion is 10-fold larger for breast cancer than for lung cancer. Reflecting this difference, radiation-induced breast cancer risks decrease with age at exposure at all ages, whereas radiation-induced lung cancer risks do not. CONCLUSION For radiation exposure in middle age, most radiation-induced cancer risks do not, as often assumed, decrease with increasing age at exposure. This observation suggests that promotional processes in radiation carcinogenesis become increasingly important as the age at exposure increases. Radiation-induced cancer risks after exposure in middle age may be up to twice as high as previously estimated, which could have implications for occupational exposure and radiological imaging.
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Affiliation(s)
- Igor Shuryak
- Center for Radiological Research, Department of Radiation Oncology, Columbia University Medical Center, New York, NY, USA
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25
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Mackinnon AC, Tretiakova M, Henderson L, Mehta RG, Yan BC, Joseph L, Krausz T, Husain AN, Reid ME, Salgia R. Paxillin expression and amplification in early lung lesions of high-risk patients, lung adenocarcinoma and metastatic disease. J Clin Pathol 2010; 64:16-24. [PMID: 21045234 PMCID: PMC3002839 DOI: 10.1136/jcp.2010.075853] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Paxillin is a modular protein that localises to cell adhesion sites where it facilitates bidirectional communication between the intracellular actin cytoskeleton and the extracellular matrix. These complex and dynamic interactions are essential for cell adhesion, cell migration and cell survival. The authors have previously demonstrated that paxillin is overexpressed in lung cancer tissues and identified somatic paxillin mutations in 9% of lung cancers. A murine in vivo xenograft model of the most common paxillin mutation (A127T) showed increased cell proliferation and invasive tumour growth, establishing an important role for paxillin in the development of lung cancer. Methods The authors analysed 279 bronchoscopy-aided biopsy specimens from 92 high-risk patients. Adenocarcinoma with bronchioloalveolar features and pure bronchioloalveolar carcinoma (BAC) were analysed with fluorescence in situ hybridisation (FISH) and immunohistochemistry (IHC). Results Paxillin is overexpressed in premalignant areas of hyperplasia, squamous metaplasia and goblet cell metaplasia, as well as dysplastic lesions and carcinoma in high-risk patients. Concordance between increased paxillin gene copy number and paxillin overexpression was observed in cases of adenocarcinoma eusomic for chromosome 12. Conclusions Paxillin overexpression occurs during the earliest stages of lung cancer development. FISH and IHC analysis of lung adenocarcinoma suggests that relatively small-scale genomic rearrangements of chromosome 12 are associated with paxillin overexpression in lung adenocarcinoma.
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Affiliation(s)
- Alexander C Mackinnon
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois 60637, USA.
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[Comparative values of different imaging methods in lung cancer screening]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2010; 13:992-8. [PMID: 20959074 PMCID: PMC6000585 DOI: 10.3779/j.issn.1009-3419.2010.10.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Radiology is the primary lung cancer screening technique. Whether the mortality rate of lung cancer could be markedly reduce by radiological screening was still unknown to us. It was suggested that high-risk individuals should take regular radiological examinations to detect early lung cancers, followed by suitable treatment. In this review, we compared the values of different radiological methods in lung cancer screening.
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Shi CL, Zhang XY, Han BH, He WZ, Shen J, Chu TQ. A clinicopathological study of resected non-small cell lung cancers 2 cm or less in diameter: a prognostic assessment. Med Oncol 2010; 28:1441-6. [PMID: 20661664 DOI: 10.1007/s12032-010-9632-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 07/09/2010] [Indexed: 11/29/2022]
Abstract
The detection and diagnosis of small-sized (2 cm or less) non-small cell lung cancer (NSCLC) has increased with the development of computed tomography (CT). Over 80% of 5-year survival rate has been reported in surgically treated peripheral lung cancer. There are systematic mediastinal and hilar lymph node involvement pleural invasion and intrapulmonary metastasis even with tumor diameter less than 2 cm. The appropriate surgical procedure for such kinds of lung cancer is lobectomy with mediastinal lymph node dissection. To evaluate the prognostic factors and establish the optimal surgical strategy, we analyzed the clinicopathologic features and survival benefit in different tumor size of peripheral small-sized NSCLC. Among the resected lung cancer cases between January 1999 and July 2001, 185 patients were retrospectively analyzed in surgical methods, lymph node involvement, CT scan findings and survival rates. Survival was analyzed by Kaplan-Meier method and log-rank test. Lymph node involvement was recognized in 26(14.05%) patients. There was no statistically significant difference in the incidence of lymph node involvement between tumors 1.6-2.0 cm (17.82%) in diameter than in those 1.0-1.5 cm (11.94%). There was no lymph node metastasis in tumors less than 1.0 cm in diameter. The 5-year survival rates with or without lymph node involvement were 89.98 and 46.15%, respectively, showing significant difference (P=0.000). The overall 5-year survival rate was 83.78%. The 5-year survival rate in tumors 1.6-2.0 cm, 1.0-1.5 cm and less than 1.0 cm in diameter was 80.20, 85.07 and 100%, respectively, and showing significant difference (P=0.035). The 5-year survival rate of 19 patients showing ground-glass opacity (GGO) on CT scan was 94.74% without any metastasis and recurrence after operation. There are systematic mediastinal and hilar lymph node involvement even with tumor diameter less than 2 cm. The results of the present study suggested that systematic lymph node dissection is necessary even for cases with tumor diameter less than 2 cm. However, if the tumor is within 1.0 cm in diameter with obvious GGO showing on chest CT scan, these are good candidates for partial resection without mediastinal lymph node dissection.
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Affiliation(s)
- Chun-Lei Shi
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, No. 241, West Huaihai Rd, 200030, Shanghai, China
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Levine ZH, Borchardt BR, Brandenburg NJ, Clark CW, Muralikrishnan B, Shakarji CM, Chen JJ, Siegel EL. RECIST versus volume measurement in medical CT using ellipsoids of known size. OPTICS EXPRESS 2010; 18:8151-8159. [PMID: 20588660 DOI: 10.1364/oe.18.008151] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Two hundred eighty three uniaxial ellipsoids with sizes from 4 mm to 11 mm were measured with a coordinate measuring matching (CMM) and also scanned using a medical computed tomography (CT) machine. Their volumes were determined by counting voxels over a threshold, as well as using equivalent volumes from the length given by the RECIST 1.1 criterion (Response Evaluation Criteria in Solid Tumors). The volumetric measurements yield an order of magnitude reduction in residuals compared to the CMM measurements than the residuals of the RECIST measurements also compared to the CMM measurements.
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Affiliation(s)
- Zachary H Levine
- National Institute for Standards and Technology, 100 Bureau Drive, Gaithersburg, Maryland 20899, USA.
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Leidinger P, Keller A, Heisel S, Ludwig N, Rheinheimer S, Klein V, Andres C, Staratschek-Jox A, Wolf J, Stoelben E, Stephan B, Stehle I, Hamacher J, Huwer H, Lenhof HP, Meese E. Identification of lung cancer with high sensitivity and specificity by blood testing. Respir Res 2010; 11:18. [PMID: 20146812 PMCID: PMC2832627 DOI: 10.1186/1465-9921-11-18] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 02/10/2010] [Indexed: 02/08/2023] Open
Abstract
Background Lung cancer is a very frequent and lethal tumor with an identifiable risk population. Cytological analysis and chest X-ray failed to reduce mortality, and CT screenings are still controversially discussed. Recent studies provided first evidence for the potential usefulness of autoantigens as markers for lung cancer. Methods We used extended panels of arrayed antigens and determined autoantibody signatures of sera from patients with different kinds of lung cancer, different common non-tumor lung pathologies, and controls without any lung disease by a newly developed computer aided image analysis procedure. The resulting signatures were classified using linear kernel Support Vector Machines and 10-fold cross-validation. Results The novel approach allowed for discriminating lung cancer patients from controls without any lung disease with a specificity of 97.0%, a sensitivity of 97.9%, and an accuracy of 97.6%. The classification of stage IA/IB tumors and controls yielded a specificity of 97.6%, a sensitivity of 75.9%, and an accuracy of 92.9%. The discrimination of lung cancer patients from patients with non-tumor lung pathologies reached an accuracy of 88.5%. Conclusion We were able to separate lung cancer patients from subjects without any lung disease with high accuracy. Furthermore, lung cancer patients could be seprated from patients with other non-tumor lung diseases. These results provide clear evidence that blood-based tests open new avenues for the early diagnosis of lung cancer.
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Affiliation(s)
- Petra Leidinger
- Department of Human Genetics, Medical School, Saarland University, Building 60, 66421 Homburg/Saar, Germany
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Huppmann MV, Johnson WB, Javitt MC. Radiation Risks from Exposure to Chest Computed Tomography. Semin Ultrasound CT MR 2010; 31:14-28. [DOI: 10.1053/j.sult.2009.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Goldberg SW, Mulshine JL, Hagstrom D, Pyenson BS. An Actuarial Approach to Comparing Early Stage and Late Stage Lung Cancer Mortality and Survival. Popul Health Manag 2010; 13:33-46. [DOI: 10.1089/pop.2009.0010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Dale Hagstrom
- Milliman, Inc., Consultants and Actuaries, New York, New York
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Menezes RJ, Roberts HC, Paul NS, McGregor M, Chung TB, Patsios D, Weisbrod G, Herman S, Pereira A, McGregor A, Dong Z, Sitartchouk I, Boerner S, Tsao MS, Keshavjee S, Shepherd FA. Lung cancer screening using low-dose computed tomography in at-risk individuals: The Toronto experience. Lung Cancer 2010; 67:177-83. [DOI: 10.1016/j.lungcan.2009.03.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 03/24/2009] [Accepted: 03/30/2009] [Indexed: 12/01/2022]
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Keller A, Leidinger P, Borries A, Wendschlag A, Wucherpfennig F, Scheffler M, Huwer H, Lenhof HP, Meese E. miRNAs in lung cancer - studying complex fingerprints in patient's blood cells by microarray experiments. BMC Cancer 2009; 9:353. [PMID: 19807914 PMCID: PMC2764731 DOI: 10.1186/1471-2407-9-353] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 10/06/2009] [Indexed: 12/30/2022] Open
Abstract
Background Deregulated miRNAs are found in cancer cells and recently in blood cells of cancer patients. Due to their inherent stability miRNAs may offer themselves for blood based tumor diagnosis. Here we addressed the question whether there is a sufficient number of miRNAs deregulated in blood cells of cancer patients to be able to distinguish between cancer patients and controls. Methods We synthesized 866 human miRNAs and miRNA star sequences as annotated in the Sanger miRBase onto a microarray designed by febit biomed gmbh. Using the fully automated Geniom Real Time Analyzer platform, we analyzed the miRNA expression in 17 blood cell samples of patients with non-small cell lung carcinomas (NSCLC) and in 19 blood samples of healthy controls. Results Using t-test, we detected 27 miRNAs significantly deregulated in blood cells of lung cancer patients as compared to the controls. Some of these miRNAs were validated using qRT-PCR. To estimate the value of each deregulated miRNA, we grouped all miRNAs according to their diagnostic information that was measured by Mutual Information. Using a subset of 24 miRNAs, a radial basis function Support Vector Machine allowed for discriminating between blood cellsamples of tumor patients and controls with an accuracy of 95.4% [94.9%-95.9%], a specificity of 98.1% [97.3%-98.8%], and a sensitivity of 92.5% [91.8%-92.5%]. Conclusion Our findings support the idea that neoplasia may lead to a deregulation of miRNA expression in blood cells of cancer patients compared to blood cells of healthy individuals. Furthermore, we provide evidence that miRNA patterns can be used to detect human cancers from blood cells.
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Invited commentary on "The air got to it:" exploring a belief about surgery for lung cancer. J Natl Med Assoc 2009; 101:772-3. [PMID: 19715039 DOI: 10.1016/s0027-9684(15)31010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Lung cancer is the most common cause of cancer-related death in the UK. Despite aggressive primary prevention measures and improved medical care, the 5-year survival rate is less than 10% for patients in the UK who present with symptoms. The possibility of CT screening for lung cancer provides some hope of reducing mortality. However, the case for screening remains unproven. This article explores the issues surrounding lung cancer screening in the context of historical studies, trials in progress and tentative plans for a UK CT lung cancer screening trial.
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Affiliation(s)
- A J Edey
- Department of Radiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
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Cost of a 5-year lung cancer survivor: symptomatic tumour identification vs proactive computed tomography screening. Br J Cancer 2009; 101:882-96. [PMID: 19690541 PMCID: PMC2743357 DOI: 10.1038/sj.bjc.6605253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Our objective was to analyse the cost effectiveness of computed tomography (CT) screening for lung cancer in terms of the cost per long-term survivor, which has not been evaluated to date. Methods: Estimations were computed based on data from the Surveillance, Epidemiology, and End Results registries covering years 1999–2003. The design framework of our model allowed for the incorporation of multiple values taken from the epidemiological and clinical literature to be utilised for cost inputs, scope of patients screened, diagnostic staging, and survival percentages applied separately to two cohorts: age 40–79 and 60–79 years. This enabled the analysis of over 1400 scenarios, each containing a unique set of input values, for which the estimated cost per 5-year survivor (CP5YS) was compared between the symptom-detected and proactive screening approaches. Results: Estimated CP5YS were higher for the symptom-detected approach in all 729 scenarios analysed for the cohort ages 60–79 years, ranging from approximately $5800 to $116 700 increased cost per 5-year survivor (CP5YS). For the cohort ages 40–79 years, 75% of the 729 scenarios analysed showed increased CP5YS for the symptom-detected approach ranging from $5700 to $110 000 increased CP5YS. Total costs and total 5-year survivors were higher for the proactive screening method for all scenarios analysed across both cohorts with increases ranging from 50–256% and 98–309%, respectively. Conclusion: The predicted increase in long-term survival with CT screening and the potential for better utilisation of health-care dollars in terms of CP5YS, particularly when screening patients over the age of 60 years, are critically important considerations in directing effective future lung cancer management strategy.
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Granell E, Hidalgo A, Martínez A, Gich I, Bolívar I, Franquet T, Giménez A, Alepuz T. Evaluación del programa de diagnóstico y tratamiento rápido del cáncer de pulmón. RADIOLOGIA 2009; 51:294-9. [DOI: 10.1016/j.rx.2008.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2007] [Accepted: 05/14/2008] [Indexed: 11/25/2022]
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Untreated Patients in “CT Screening for Lung Cancer: Update 2007”. Oncologist 2008; 13:1030-2; author reply 1033. [DOI: 10.1634/theoncologist.2008-0144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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In Reply. Oncologist 2008. [DOI: 10.1634/theoncologist.2008-9000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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