The narrow path to organized LDCT lung cancer screening programs in Europe

Exosomal miR-21/Let-7a ratio distinguishes non-small cell lung cancer from benign pulmonary diseases

Aim

To assess the exosomal miR‐21/Let‐7a ratio, a noninvasive method, in distinguishing non‐small cell lung cancer (NSCLC) from benign pulmonary diseases.

Methods

The exosomes were extracted from the peripheral blood serum using serum exosomal extraction kit. miR‐21 and Let‐7a levels were evaluated by quantitative reverse transcription polymerase chain reaction.

Results

We found that miR‐21/Let‐7a ratio of NSCLC patients was significantly higher than that of healthy people, patients with pulmonary inflammation diseases, and benign pulmonary nodules, respectively. Receiver‐operating characteristic analysis revealed that as compared with healthy controls, miR‐21/Let‐7a produced the area under the curve (AUC) at 0.8029 in patients with NSCLC, which helped to distinguish NSCLC from healthy controls with 81.33% sensitivity and 69.57% specificity. In addition, the AUC of miR‐21/Let‐7a in NSCLC patients was 0.8196 in comparison to patients with pulmonary inflammation diseases. Meanwhile, the sensitivity and specificity were 56.00% and 100%, respectively. Furthermore, compared with patients with benign pulmonary nodules, the AUC of miR‐21/Let‐7a in NSCLC patients was 0.7539. The sensitivity and specificity were 56.00% and 82.61%, respectively.

Conclusion

In the present study, our findings revealed that exosomal miR‐21/Let‐7a ratio holds considerable promise as a noninvasive biomarker for the diagnosis of NSCLC from benign pulmonary diseases.

Prognostic selection and long-term survival analysis to assess overdiagnosis risk in lung cancer screening randomized trials

OBJECTIVES

Overdiagnosis in low-dose computed tomography randomized screening trials varies from 0 to 67%. The National Lung Screening Trial (extended follow-up) and ITALUNG (Italian Lung Cancer Screening Trial) have reported cumulative incidence estimates at long-term follow-up showing low or no overdiagnosis. The Danish Lung Cancer Screening Trial attributed the high overdiagnosis estimate to a likely selection for risk of the active arm. Here, we applied a method already used in benefit and overdiagnosis assessments to compute the long-term survival rates in the ITALUNG arms in order to confirm incidence-excess method assessment.

METHODS

Subjects in the active arm were invited for four screening rounds, while controls were in usual care. Follow-up was extended to 11.3 years. Kaplan-Meyer 5- and 10-year survivals of "resected and early" (stage I or II and resected) and "unresected or late" (stage III or IV or not resected or unclassified) lung cancer cases were compared between arms.

RESULTS

The updated ITALUNG control arm cumulative incidence rate was lower than in the active arm, but this was not statistically significant (RR: 0.89; 95% CI: 0.67-1.18). A compensatory drop of late cases was observed after baseline screening. The proportion of "resected and early" cases was 38% and 19%, in the active and control arms, respectively. The 10-year survival rates were 64% and 60% in the active and control arms, respectively (p = 0.689). The five-year survival rates for "unresected or late" cases were 10% and 7% in the active and control arms, respectively (p = 0.679).

CONCLUSIONS

This long-term survival analysis, by prognostic categories, concluded against the long-term risk of overdiagnosis and contributed to revealing how screening works.

Decreased cardiovascular mortality in the ITALUNG lung cancer screening trial: Analysis of underlying factors

OBJECTIVES

In the ITALUNG lung cancer screening trial after 9.3 years of follow-up we observed an unexpected significant decrease of cardiovascular (CV) mortality in subjects invited for low-dose CT (LDCT) screening as compared to controls undergoing usual care. Herein we extended the mortality follow-up and analyzed the potential factors underlying such a decrease.

MATERIALS AND METHODS

The following factors were assessed in screenes and controls: burden of CV disease at baseline, changes in smoking habits, use of CV drugs and frequency of planned vascular procedures after randomisation. Moreover, in the screenes we evaluated inclusion of presence of coronary artery calcification (CAC) in the LDCT report form that was transmitted to the participant and his/her General Practitioner.

RESULTS

The 2-years extension of follow-up confirmed a significant decrease of CV mortality in the subjects of the active group compared to control subjects (15.6 vs 34.0 per 10,000; p = 0.001) that was not observed in the drops-out of the active group. None of the explaining factors we considered significantly differed between active and control group. However, the subjects of the active group with reported CAC experienced a not significantly lower CV mortality and showed a significantly higher use of CV drugs and frequency of planned vascular procedures than the control group.

CONCLUSIONS

LDCT screening for lung cancer offers the opportunity for detection of CAC that is an important CV risk factor. Although the underlying mechanisms are not clear, our results suggest that the inclusion of information about CAC presence in the LDCT report may represent a candidate factor to explain the decreased CV mortality observed in screened subjects of the ITALUNG trial, possibly resulting in intervention for patient care to prevent CV deaths. Further studies investigating whether prospective reporting and rating of CAC have independent impact on such interventions and CV mortality are worthy.

Identificazione dei lavoratori ex-esposti ad amianto in Toscana da inserire nel programma di sorveglianza sanitaria

BACKGROUND

In 2016 the Administration of the Tuscany Region, Italy, established a health surveillance programme for workers with past asbestos exposure. The programme includes two levels of activities, a local basic health evaluation, and a centralized in-depth evaluation of specific cases.

OBJECTIVES

To estimate the number and identify the workers with past exposure to asbestos in Tuscan industrial settings entitled to participate in the health surveillance programme.

METHODS

The number of formerly-exposed workers was estimated from the records of the working population of 15,441 workers of thirteen Tuscan asbestos industrial plants and from the existing data bases of the Local Health Administrations (USLs) and the Institute for Study, Prevention and Cancer Network (ISPRO), and from national data bases such as Social Security Administration (INPS) and National Institute for Insurance against Accidents at Work (INAIL). The expected number of medical examinations per year was estimated from the adhesion rates seen in previous comparable programmes.

RESULTS

The estimated number of workers with past asbestos exposure eligible to the programme was 5,446. The estimated number of health examinations in the first and second phases of the surveillance programme during 2016-24 was 7,275 and 7,155, respectively, follow-up examinations included. The number of workers identified from local data bases was 4,713: They had been operating in 129 plants that had been using asbestos in the past. Further 1,395 workers were identified from previous health surveillance activities.

CONCLUSIONS

The use of several sources of information and the cooperation between occupational health services made it possible to identify a high proportion of former asbestos workers and plants., It is, nevertheless, still necessary to complete the list of eligible workers, and to facilitate their participation by making the programme more widely known.

Diagnosi precoce del cancro del polmone in lavoratori esposti a cancerogeni

Following the publication of results of NLST (National Lung Screening Trial, USA) and ELCAP (Early Lung Cancer Action Project, USA), lung cancer screening with low-dose computed tomography (LDCT) in high-risk subjects has been recommended in North-America. Conversely, the European Community has been waiting for further evidence. The recently concluded Dutch-Belgian Lung Cancer Screening trial (NELSON) confirmed the efficacy of LDCT screening in reducing lung cancer mortality. Two recent studies in the USA and Italy showed positive results in occupational settings among workers formerly exposed to asbestos. The available evidence seems to suggest the need to implement lung cancer screening programs among heavy smokers and workers substantively exposed to occupational carcinogens.