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Tas F, Ozturk A, Erturk K. Comorbidity in Small Cell Lung Cancer: Prognostic Impacts of Hypertension/Coronary Artery Disease, Diabetes Mellitus, and Chronic Obstructive Pulmonary Disease. Cancer Invest 2024; 42:21-33. [PMID: 38299573 DOI: 10.1080/07357907.2024.2310574] [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: 01/31/2023] [Accepted: 01/22/2024] [Indexed: 02/02/2024]
Abstract
Comorbidity, the most important components of which are hypertension/coronary artery disease (HTN/CAD), diabetes mellitus (DM), and chronic obstructive pulmonary disease (COPD), is frequently encountered in small cell lung cancer (SCLC) patients. We aimed to assess the possible impacts of these major comorbidities on the prognoses of SCLC patients. A total of 378 SCLC patients were analyzed retrospectively. We did not ascertain the effect of comorbidity on survival in SCLC patients in general; and similarly, the presence of HTN/CAD and COPD did not adversely affect the outcome. However, lower survival rates were observed in patients with SCLC coexisting with DM.
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Affiliation(s)
- Faruk Tas
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Akin Ozturk
- Department of Medical Oncology outpatient clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kayhan Erturk
- Department of Medical Oncology, Koc University, Istanbul, Turkey
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Liao KM, Lee CS, Wu YC, Shu CC, Ho CH. Prior treated tuberculosis and mortality risk in lung cancer. Front Med (Lausanne) 2023; 10:1121257. [PMID: 37064038 PMCID: PMC10090669 DOI: 10.3389/fmed.2023.1121257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/03/2023] [Indexed: 03/31/2023] Open
Abstract
BackgroundLung cancer is one of the leading causes of cancer death worldwide, and tuberculosis (TB) is a common pre-existing disease. However, there is scarce literature studying the mortality risk in patients with prior TB and subsequent lung cancer.MethodsWe recruited lung cancer patients from the Taiwan Cancer Registry from 2011 to 2015 and classified them into two groups according to presence or absence of prior TB. We then matched them in a ratio of 1:4 using the exact matching approach. The mortality risk within 3 years after diagnosis of lung cancer was analyzed and compared between these two groups.ResultsDuring the study period, 43,472 patients with lung cancer were recruited, and of these, 1,211 (2.79%) patients had prior TB. After matching, this cohort included 5,935 patients with lung cancer in two groups: patients with prior TB before lung cancer (n = 1,187) and those without (n = 4,748). After controlling for demographic factors and comorbidities, the patients with prior TB had increased adjusted hazard ratios of 1.13 (95% CI: 1.04–1.23) and 1.11 (1.02–1.21) for all-cause and cancer-specific 3-year mortality, respectively, compared to the lung cancer patients without prior TB. Duration between TB and lung cancer (<1 year vs. 1–3 years vs. >3 years) had no differences for mortality risk.ConclusionIn the present study, 2.79% patients with lung cancer had prior TB, which was associated with higher 3-year mortality after they developed lung cancer. The mortality risk with prior TB did not decrease even if >3 years passed before diagnosis of lung cancer.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
| | - Chung-Shu Lee
- Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tu Cheng Hospital, New Taipei City, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan
| | - Yu-Cih Wu
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- *Correspondence: Chin-Chung Shu,
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
- Chung-Han Ho,
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Kahnert K, Lempert LM, Behr J, Elsner L, Bolt T, Tufman A, Kauffmann-Guerrero D. Hyperinflation and reduced diffusing capacity predict prognosis in SCLC: value of extended pre-therapeutic lung function testing. Ther Adv Respir Dis 2023; 17:17534666231199670. [PMID: 37997884 PMCID: PMC10676075 DOI: 10.1177/17534666231199670] [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: 02/16/2023] [Accepted: 08/03/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Small cell lung cancer (SCLC) is characterized by aggressive growth and poor prognosis. Although SCLC affects nearly exclusively heavy smokers and leads to frequent respiratory symptoms, the impact of pre-therapeutic lung function testing in SCLC is sparely investigated until now. Therefore, we sought to examine whether we could find prognostic markers in pre-therapeutic lung function testing of SCLC patients. PATIENTS AND METHODS We retrospectively analysed a cohort of 205 patients with the diagnosis of SCLC between 2010 and 2018. Pre-therapeutic values of spirometry, body plethysmography and measurement of diffusing capacity was extracted from patients' charts. Comparisons between groups were performed using the Mann-Whitney U-test or by chi-square tests as appropriate. Kaplan-Meier analyses and COX-regression models were performed to correlate lung function parameters with patients' outcome. RESULTS Airway obstruction itself, or the diagnosis chronic obstructive pulmonary disease (COPD) based on GOLD definitions did not correlate with survival in SCLC patients. Hyperinflation measured by increased residual volume and residual volume to total lung capacity ratio (log-rank p < 0.001) and reduced diffusing capacity (log-rank p = 0.007) were associated with reduced survival. Furthermore, patients with hyperinflation as well as impairments in gas exchange representing an emphysematic phenotype had the worst outcome (log-rank p < 0.001). CONCLUSION We recommend including body plethysmography and measurement of diffusing capacity in the pre-therapeutic assessment of SCLC patients. Our findings suggest that reduction of hyperinflation may lead to better outcome in SCLC patients. Thus, in addition to effective tumour therapy, adequate therapy of the comorbidity of COPD should also be provided. In particular, measures to reduce hyperinflation by means of dual bronchodilation as well as respiratory physiotherapy should be further assessed in this setting.
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Affiliation(s)
- Kathrin Kahnert
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | | | - Jürgen Behr
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Laura Elsner
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Toki Bolt
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Amanda Tufman
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Diego Kauffmann-Guerrero
- Department of Internal Medicine V (Pneumology/Thoracic Oncology), University Hospital, LMU Munich, Ziemssenstraße 1, Munich 80336, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Abstract
The mammalian respiratory system or lung is a tree-like branching structure, and the main site of gas exchange with the external environment. Structurally, the lung is broadly classified into the proximal (or conducting) airways and the distal alveolar region, where the gas exchange occurs. In parallel with the respiratory tree, the pulmonary vasculature starts with large pulmonary arteries that subdivide rapidly ending in capillaries adjacent to alveolar structures to enable gas exchange. The NOTCH signalling pathway plays an important role in lung development, differentiation and regeneration post-injury. Signalling via the NOTCH pathway is mediated through activation of four NOTCH receptors (NOTCH1-4), with each receptor capable of regulating unique biological processes. Dysregulation of the NOTCH pathway has been associated with development and pathophysiology of multiple adult acute and chronic lung diseases. This includes accumulating evidence that alteration of NOTCH3 signalling plays an important role in the development and pathogenesis of chronic obstructive pulmonary disease, lung cancer, asthma, idiopathic pulmonary fibrosis and pulmonary arterial hypertension. Herein, we provide a comprehensive summary of the role of NOTCH3 signalling in regulating repair/regeneration of the adult lung, its association with development of lung disease and potential therapeutic strategies to target its signalling activity.
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Wu XQ, Li JY, Du WJ. Causes of death following small cell lung cancer diagnosis: a population-based analysis. BMC Pulm Med 2022; 22:262. [PMID: 35787685 PMCID: PMC9254402 DOI: 10.1186/s12890-022-02053-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/21/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To examine the distribution of causes of death (CODs) in patients with small cell lung cancer (SCLC). METHODS Patients diagnosed with SCLC were identified from the Surveillance, Epidemiology, and End Results Program database during 2004-2015. Standardized mortality rates (SMRs) were performed for each COD to present changes in risk for a particular COD following SCLC diagnosis. RESULTS A total of 44,506 patients diagnosed with SCLC were identified in this study, and 42,476 patients died during the follow-up. Of total deaths, 69.5% occurred within the first years after diagnosis, 26% occurred from 1 to 3 years, and 4.5% individuals survived longer than 3 years. In addition, 88.7% of deaths were caused by SCLC, followed by non-cancer causes (7.1%) and other cancers (4.2%). Moreover, non-cancer CODs increased from 6.3 to 30% over time after 3 years of diagnosis. As for non-cancer CODs, cardiovascular diseases, COPD, and septicemia were the most common in SCLC. CONCLUSION Non-cancer CODs, such as cardiovascular events, COPD and septicemia, contribute to a considerable proportion of deaths among long-term SCLC survivors, supporting the involvement of multidisciplinary care for the follow-up strategy in SCLC.
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Affiliation(s)
- Xue-Qin Wu
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Taiyuan, 030000, Shanxi, China.,Department of Radiotherapy, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, 030000, Shanxi, China.,Department of Radiotherapy, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Jing-Yi Li
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Taiyuan, 030000, Shanxi, China.,Department of Radiotherapy, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, 030000, Shanxi, China.,Department of Radiotherapy, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Wen-Jing Du
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Taiyuan, 030000, Shanxi, China. .,Department of Radiotherapy, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, 030000, Shanxi, China. .,Department of Radiotherapy, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030000, Shanxi, China.
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