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Tang YJ, Xu H, Hughes NW, Kim SH, Ruiz P, Shuldiner EG, Lopez SS, Hebert JD, Karmakar S, Andrejka L, Dolcen DN, Boross G, Chu P, Detrick C, Pierce S, Ashkin EL, Greenleaf WJ, Voss AK, Thomas T, van de Rijn M, Petrov DA, Winslow MM. Functional mapping of epigenetic regulators uncovers coordinated tumor suppression by the HBO1 and MLL1 complexes. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.08.19.607671. [PMID: 39229041 PMCID: PMC11370414 DOI: 10.1101/2024.08.19.607671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Epigenetic dysregulation is widespread in cancer. However, the specific epigenetic regulators and the processes they control to drive cancer phenotypes are poorly understood. Here, we employed a novel, scalable and high-throughput in vivo method to perform iterative functional screens of over 250 epigenetic regulatory genes within autochthonous oncogenic KRAS-driven lung tumors. We identified multiple novel epigenetic tumor suppressor and tumor dependency genes. We show that a specific HBO1 complex and the MLL1 complex are among the most impactful tumor suppressive epigenetic regulators in lung. The histone modifications generated by the HBO1 complex are frequently absent or reduced in human lung adenocarcinomas. The HBO1 and MLL1 complexes regulate chromatin accessibility of shared genomic regions, lineage fidelity and the expression of canonical tumor suppressor genes. The HBO1 and MLL1 complexes are epistatic during lung tumorigenesis, and their functional correlation is conserved in human cancer cell lines. Together, these results demonstrate the value of quantitative methods to generate a phenotypic roadmap of epigenetic regulatory genes in tumorigenesis in vivo .
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Frank EA, Meek MEB. Procedural application of mode-of-action and human relevance analysis: styrene-induced lung tumors in mice. Crit Rev Toxicol 2024; 54:134-151. [PMID: 38440945 DOI: 10.1080/10408444.2024.2310600] [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: 06/20/2023] [Accepted: 01/18/2024] [Indexed: 03/06/2024]
Abstract
Risk assessment of human health hazards has traditionally relied on experiments that use animal models. Although exposure studies in rats and mice are a major basis for determining risk in many cases, observations made in animals do not always reflect health hazards in humans due to differences in biology. In this critical review, we use the mode-of-action (MOA) human relevance framework to assess the likelihood that bronchiolar lung tumors observed in mice chronically exposed to styrene represent a plausible tumor risk in humans. Using available datasets, we analyze the weight-of-evidence 1) that styrene-induced tumors in mice occur through a MOA based on metabolism of styrene by Cyp2F2; and 2) whether the hypothesized key event relationships are likely to occur in humans. This assessment describes how the five modified Hill causality considerations support that a Cyp2F2-dependent MOA causing lung tumors is active in mice, but only results in tumorigenicity in susceptible strains. Comparison of the key event relationships assessed in the mouse was compared to an analogous MOA hypothesis staged in the human lung. While some biological concordance was recognized between key events in mice and humans, the MOA as hypothesized in the mouse appears unlikely in humans due to quantitative differences in the metabolic capacity of the airways and qualitative uncertainties in the toxicological and prognostic concordance of pre-neoplastic and neoplastic lesions arising in either species. This analysis serves as a rigorous demonstration of the framework's utility in increasing transparency and consistency in evidence-based assessment of MOA hypotheses in toxicological models and determining relevance to human health.
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Affiliation(s)
- Evan A Frank
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - M E Bette Meek
- School of Epidemiology and Public Health in the Faculty of Medicine, University of Ottawa, Ottawa, Canada
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3
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Akhtar Z, Laageide L, Robles J, Winters C, Wall GC, Mallen J, Jawa Z. Unusual presentation of lepidic adenocarcinoma in a healthy female. BMC Pulm Med 2022; 22:197. [PMID: 35578218 PMCID: PMC9109452 DOI: 10.1186/s12890-022-01969-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 04/24/2022] [Indexed: 11/26/2022] Open
Abstract
Background Lepidic adenocarcinoma represents a histologic pattern of non-small cell lung cancer that characteristically arises in the lung periphery with tracking alongside pre-existing alveolar walls. Noninvasive and invasive variants of lepidic adenocarcinoma are dependent on parenchymal destruction, vascular, or pleural invasion. The lepidic-predominant lung malignancies are collectively recognized as slow growing with rare metastasis and excellent prognosis. The World Health Organization classification of lung malignancies depends on molecular and histopathological findings. CT findings most commonly include ground-glass characteristics, commonly mistaken for inflammatory or infectious etiology. These tumors are generally surgically resectable and associated with better survival given infrequent nodal and extrathoracic involvement. Rarely these tumors present with diffuse pneumonic-type involvement associated with worse outcomes despite lack of nodal and distant metastases. Case presentation A 63-year-old Caucasian athletic immunocompetent female presented with 2 months of progressive shortness of breath, fatigue, loss of appetite and 15 pound weight loss. History was only notable for well controlled essential hypertension and hypothyroidism. Contrast computed tomography angiogram and positron emission tomography revealed diffuse hypermetabolic interstitial and airspace abnormalities of the lungs without lymphadenopathy (or distant involvement) in addition to right hydropneumothorax and left pleural effusion. Baseline laboratory testing was unremarkable, and extensive bacterial and fungal testing returned negative. Bronchoscopy and video-assisted thoracoscopic surgery was subsequently performed with pleural fluid cytology, lung and pleural biopsies returning positive for lepidic adenocarcinoma with 2% programmed death ligand 1 expression and genomic testing positive for PTEN gene deletion. Prior to treatment, the patient perished on day 15 of admission. Conclusion We present a rare case of lepidic predominant adenocarcinoma with extensive bilateral aerogenous spread in the context of no lymphovascular invasion in a healthy, low risk patient. This case presentation may add to the body of knowledge regarding the different behavior patterns of lepidic predominant adenocarcinomas.
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Affiliation(s)
- Zaheer Akhtar
- PGY3 Internal Medicine Resident, Department of Medical Education, UnityPoint Health, Des Moines, IA, USA. .,Department of Medicine, UnityPoint Health, Des Moines, IA, USA.
| | - Leah Laageide
- Department of Medicine, UnityPoint Health, Des Moines, IA, USA
| | - Julian Robles
- Department of Medicine, UnityPoint Health, Des Moines, IA, USA
| | | | - Geoffrey C Wall
- Drake College of Pharmacy and Health Sciences, Des Moines, IA, USA
| | - James Mallen
- Department of Pulmonology, The Iowa Clinic and UnityPoint Health, Des Moines, IA, USA
| | - Zeeshan Jawa
- John Stoddard and Mission Cancer Center, Des Moines, IA, USA
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Bryant AS, Lavrentovich MO. Survival in branching cellular populations. Theor Popul Biol 2022; 144:13-23. [PMID: 35093390 DOI: 10.1016/j.tpb.2022.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/15/2022] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
We analyze evolutionary dynamics in a confluent, branching cellular population, such as in a growing duct, vasculature, or in a branching microbial colony. We focus on the coarse-grained features of the evolution and build a statistical model that captures the essential features of the dynamics. Using simulations and analytic approaches, we show that the survival probability of strains within the growing population is sensitive to the branching geometry: Branch bifurcations enhance survival probability due to an overall population growth (i.e., "inflation"), while branch termination and the small effective population size at the growing branch tips increase the probability of strain extinction. We show that the evolutionary dynamics may be captured on a wide range of branch geometries parameterized just by the branch diameter N0 and branching rate b. We find that the survival probability of neutral cell strains is largest at an "optimal" branching rate, which balances the effects of inflation and branch termination. We find that increasing the selective advantage s of the cell strain mitigates the inflationary effect by decreasing the average time at which the mutant cell fate is determined. For sufficiently large selective advantages, the survival probability of the advantageous mutant decreases monotonically with the branching rate.
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Affiliation(s)
- Adam S Bryant
- Department of Physics & Astronomy, University of Tennessee, Knoxville, TN 37966, USA
| | - Maxim O Lavrentovich
- Department of Physics & Astronomy, University of Tennessee, Knoxville, TN 37966, USA.
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Loss of Fer Jeopardizes Metabolic Plasticity and Mitochondrial Homeostasis in Lung and Breast Carcinoma Cells. Int J Mol Sci 2021; 22:ijms22073387. [PMID: 33806191 PMCID: PMC8037256 DOI: 10.3390/ijms22073387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 12/18/2022] Open
Abstract
Metabolic plasticity is a hallmark of the ability of metastatic cancer cells to survive under stressful conditions. The intracellular Fer kinase is a selective constituent of the reprogramed mitochondria and metabolic system of cancer cells. In the current work, we deciphered the modulatory roles of Fer in the reprogrammed metabolic systems of metastatic, lung (H358), non-small cell lung cancer (NSCLC), and breast (MDA-MB-231), triple-negative breast cancer (TNBC), carcinoma cells. We show that H358 cells devoid of Fer (H358ΔFer), strictly depend on glucose for their proliferation and growth, and fail to compensate for glucose withdrawal by oxidizing and metabolizing glutamine. Furthermore, glucose deficiency caused increased reactive oxygen species (ROS) production and induction of a DNA damage response (DDR), accompanied by the onset of apoptosis and attenuated cell-cycle progression. Analysis of mitochondrial function revealed impaired respiratory and electron transport chain (ETC) complex 1 (comp. I) activity in the Fer-deficient H358ΔFer cells. This was manifested by decreased levels of NAD+ and ATP and relatively low abundance of tricarboxylic acid (TCA) cycle metabolites. Impaired electron transport chain comp. I activity and dependence on glucose were also confirmed in Fer-deficient, MDA-MB-231ΔFer cells. Although both H358ΔFer and MDA-MB-231ΔFer cells showed a decreased aspartate level, this seemed to be compensated by the predominance of pyrimidines synthesis over the urea cycle progression. Notably, absence of Fer significantly impeded the growth of H358ΔFer and MDA-MB-231ΔFer xenografts in mice provided with a carb-deficient, ketogenic diet. Thus, Fer plays a key role in the sustention of metabolic plasticity of malignant cells. In compliance with this notion, targeting Fer attenuates the progression of H358 and MDA-MB-231 tumors, an effect that is potentiated by a glucose-restrictive diet.
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Han J, Wu C, Wu Y, Deng H, Gao J, Han H, Xue X. Comparative study of imaging and pathological evaluation of pneumonic mucinous adenocarcinoma. Oncol Lett 2021; 21:125. [PMID: 33552246 PMCID: PMC7798099 DOI: 10.3892/ol.2020.12386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/12/2020] [Indexed: 01/15/2023] Open
Abstract
Patients with pneumonia-type lung cancer (PTLC) do not exhibit specific clinical features, which makes imaging diagnosis difficult. Therefore, the aetiology of the pathological changes occurring during PTLC remains unclear. The current study aimed to explore the possible mechanism of PTLC formation by CT scans and pathological analysis of the lungs. A retrospective analysis was conducted on the CT and pathological data of 17 cases of PTLC. The diagnosis of lung cancer was confirmed by pathology. The CT scans of nine patients indicated diffuse distribution of lesions in the lungs, whereas those of three patients indicated single-lung multi-leaf distribution, and those of the remaining five patients included single-leaf distribution. All patients demonstrated increased plaque or patchy density in the majority of the lesions located near the heart. The pathological types of the identified tumours were mucinous adenocarcinoma with adherent growth as the main sub-type. A large number of mucus lakes were observed, containing floating tumour cells, as determined by optical microscopy. In addition, a number of tumour cells were located in the residual alveolar wall of the observed mucus lakes. The results of the present study suggested that the mucinous adenocarcinoma tumour cells produced substantial quantities of mucus, and that the cells were scattered and planted along with the mucus through the airway, which led to possible development of pneumonia-type mucinous adenocarcinoma.
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Affiliation(s)
- Jun Han
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, P.R. China
| | - Chongchong Wu
- Department of Radiology, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Yuxin Wu
- Department of Radiology, The Traditional Chinese Medicine Hospital of Changshou District, Chongqing 401220, P.R. China
| | - Hui Deng
- Department of Respiratory Diseases, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Jie Gao
- Department of Pathology, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Hua Han
- Department of Radiology, The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121001, P.R. China
| | - Xinying Xue
- Department of Respiratory Diseases, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
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Azzeddine R, Rhorfi IA, Zegmout A, Souhi H, Elouazzani H, Abid A, Chahdi H, Tbouda M. Typical presentation of pulmonary lepidic adenocarcinoma: a rare case report. Pan Afr Med J 2020; 36:11. [PMID: 32550974 PMCID: PMC7282614 DOI: 10.11604/pamj.2020.36.11.22660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/04/2020] [Indexed: 11/15/2022] Open
Abstract
Bronchioloalveolar carcinoma (BAC) is a rare subtype of adenocarcinoma of lung with distinct features and distinctive characteristics. It accounts approximately for 4% of lung cancers. In the following study we report a rare observation of a 50 years old female with a clinical, radiological and histological presentation, which is typical of an invasive mucinous lepidic adenocarcinoma formerly named BAC.
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Affiliation(s)
- Rajae Azzeddine
- Department of Pneumology, Military Hospital Mohamed V, Rabat, Morocco
| | | | - Adil Zegmout
- Department of Pneumology, Military Hospital Mohamed V, Rabat, Morocco
| | - Hicham Souhi
- Department of Pneumology, Military Hospital Mohamed V, Rabat, Morocco
| | - Hanane Elouazzani
- Department of Pneumology, Military Hospital Mohamed V, Rabat, Morocco
| | - Ahmed Abid
- Department of Pneumology, Military Hospital Mohamed V, Rabat, Morocco
| | - Hafsa Chahdi
- Department of Pathology, Military Hospital Mohamed V, Rabat, Morocco
| | - Mohamed Tbouda
- Department of Pathology, Military Hospital Mohamed V, Rabat, Morocco
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Frega S, Dal Maso A, Ferro A, Bonanno L, Conte P, Pasello G. Heterogeneous tumor features and treatment outcome between males and females with lung cancer (LC): Do gender and sex matter? Crit Rev Oncol Hematol 2019; 138:87-103. [PMID: 31092389 DOI: 10.1016/j.critrevonc.2019.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 12/24/2022] Open
Abstract
Lung cancer (LC) is the leading cause of cancer-related death worldwide, despite a decreasing incidence rate in recent years, especially in men. Most risk factors for LC could be linked to an individual's reproductive system and secondary sex characteristics ('sex-related') and/or to some physical, behavioral and personality traits ('gender-related') peculiar to males rather than females or vice versa. An imbalance of these etiologic factors could explain why some LC features may differ between sexes. For this review, an extended literature data collection was performed, using keywords to identify 'sex/gender' and 'LC'. Differences between genders in LC epidemiology, pathological and molecular characteristics, loco-regional and/or systemic treatments outcome and prognosis were systematically analyzed. The possible predictive role of physio-pathological factors in males and females paves the way for a personalized therapeutic approach, emphasizing the need to include gender as a stratification factor in future clinical trials design.
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Affiliation(s)
- Stefano Frega
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Alessandro Dal Maso
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Alessandra Ferro
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Laura Bonanno
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy
| | - PierFranco Conte
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Giulia Pasello
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy.
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Balzer BW, Loo C, Lewis CR, Trahair TN, Anazodo AC. Adenocarcinoma of the Lung in Childhood and Adolescence: A Systematic Review. J Thorac Oncol 2018; 13:1832-1841. [DOI: 10.1016/j.jtho.2018.08.2020] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/10/2018] [Accepted: 08/26/2018] [Indexed: 11/28/2022]
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10
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Bronchioalveolar carcinoma: Role of Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in detection of its recurrence and verifying its subtypes. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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11
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Chang HW, Lin ZM, Wu MJ, Wang LY, Chow YH, Jiang SS, Ch’ang HJ, Chang VHS. Characterization of a transgenic mouse model exhibiting spontaneous lung adenocarcinomas with a metastatic phenotype. PLoS One 2017; 12:e0175586. [PMID: 28419107 PMCID: PMC5395147 DOI: 10.1371/journal.pone.0175586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/28/2017] [Indexed: 01/19/2023] Open
Abstract
Developing lung cancer in mouse models that display similarities of both phenotype and genotype will undoubtedly provide further and better insights into lung tumor biology. Moreover, a high degree of pathophysiological similarity between lung tumors from mouse models and their human counterparts will make it possible to use these mouse models for preclinical tests. Ovine pulmonary adenocarcinomas (OPAs) present the same symptoms as adenocarcinomas in humans and are caused by a betaretrovirus. OPAs have served as an exquisite model of carcinogenesis for human lung adenocarcinomas. In this study, we characterized the histopathology and transcriptome profiles of a jaagsiekte sheep retrovirus (JSRV)-envelope protein (Env) transgenic mouse model with spontaneous lung tumors, and associations of the transcriptome profiles with tumor invasion/metastasis, especially the phenomenon of the epithelial-mesenchymal transition (EMT). Genetic information obtained from an expression array was analyzed using an ingenuity pathways analysis (IPA) and human disease database (MalaCards). By careful examination, several novel EMT-related genes were identified from tumor cells using RT-qPCR, and these genes also scored high in MalaCards. We concluded that the JSRV-Env mouse model could serve as a spontaneous lung adenocarcinoma model with a metastatic phenotype, which will benefit the study of early-onset and progression of lung adenocarcinoma. In addition, it can also be a valuable tool for biomarkers and drug screening, which will be helpful in developing intervention therapies.
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Affiliation(s)
- Hsuen-Wen Chang
- Laboratory Animal Center, Office of Research and Development, Taipei Medical University, Taipei, Taiwan
| | - Zih-Miao Lin
- The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Min-Ju Wu
- Laboratory Animal Center, Office of Research and Development, Taipei Medical University, Taipei, Taiwan
| | - Li-Yu Wang
- The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Yen-Hung Chow
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Shih Sheng Jiang
- National Institute of Cancer Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Hui-Ju Ch’ang
- National Institute of Cancer Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Vincent HS Chang
- The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
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Sun BS, Yao YQ, Pei BX, Zhang ZF, Wang CL. Claudin-1 correlates with poor prognosis in lung adenocarcinoma. Thorac Cancer 2016; 7:556-563. [PMID: 27766775 PMCID: PMC5130200 DOI: 10.1111/1759-7714.12368] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/01/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND This study was conducted to investigate the clinical significance of claudin-1 (CLDN1) expression in patients with lung adenocarcinoma. METHODS We examined CLDN1 protein expression by immunohistochemistry in a tissue microarray from 258 patients with lung adenocarcinoma. We investigated messenger ribonucleic acid (mRNA) expression in H358 (formerly bronchioloalveolar carcinoma) and lung adenocarcinoma cell lines (A549) by real-time reverse transcriptase-polymerase chain reaction. RESULTS Multivariate analysis showed that prognostic factors for lung adenocarcinoma were histologic type, CLDN1, T stage and N stage. Patients with positive CLDN1 expression had a poorer prognosis than patients with negative CLDN1 expression. CLDN1 expression was correlated with Ras and epidermal growth factor receptor (EGFR) expression. Patients with positive expressions of both CLDN1 and Ras/EGFR had a poorer prognosis than patients with CLDN1 (+) Ras/EGFR(-) or CLDN1 (-) Ras/EGFR(+) and patients with negative expressions of both CLDN1 and Ras/EGFR. CLDN1 mRNA expression was lower in the H358 compared with the lung adenocarcinoma cell line (A549). CONCLUSION The combination of CLDN1 and Ras/EGFR is a valuable independent prognostic predictor for lung adenocarcinoma.
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Affiliation(s)
- Bing-Sheng Sun
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University, Tianjin, China
| | - Yi-Qun Yao
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Bao-Xiang Pei
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University, Tianjin, China
| | - Zhen-Fa Zhang
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University, Tianjin, China
| | - Chang-Li Wang
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University, Tianjin, China
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Kim CH, Lee YCA, Hung RJ, Boffetta P, Xie D, Wampfler JA, Cote ML, Chang SC, Ugolini D, Neri M, Le Marchand L, Schwartz AG, Morgenstern H, Christiani DC, Yang P, Zhang ZF. Secondhand Tobacco Smoke Exposure and Lung Adenocarcinoma In Situ/Minimally Invasive Adenocarcinoma (AIS/MIA). Cancer Epidemiol Biomarkers Prev 2015; 24:1902-6. [PMID: 26503035 DOI: 10.1158/1055-9965.epi-15-0436] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 09/28/2015] [Indexed: 01/15/2023] Open
Abstract
The aim of this study was to estimate the effect of exposure to secondhand tobacco smoke on the incidence of lung adenocarcinoma in situ/minimally invasive adenocarcinoma (AIS/MIA). Data from seven case-control studies participating in the International Lung Cancer Consortium (ILCCO) were pooled, resulting in 625 cases of AIS/MIA and 7,403 controls, of whom 170 cases and 3,035 controls were never smokers. Unconditional logistic regression was used to estimate adjusted ORs (ORadj) and 95% confidence intervals (CI), controlling for age, sex, race, smoking status (ever/never), and pack-years of smoking. Study center was included in the models as a random-effects intercept term. Ever versus never exposure to secondhand tobacco smoke was positively associated with AIS/MIA incidence in all subjects (ORadj = 1.48; 95% CI, 1.14-1.93) and in never smokers (ORadj = 1.45; 95% CI, 1.00-2.12). There was, however, appreciable heterogeneity of ORadj across studies (P = 0.01), and the pooled estimates were largely influenced by one large study (40% of all cases and 30% of all controls). These findings provide weak evidence for an effect of secondhand tobacco smoke exposure on AIS/MIA incidence. Further studies are needed to assess the impact of secondhand tobacco smoke exposure using the newly recommended classification of subtypes of lung adenocarcinoma.
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Affiliation(s)
- Claire H Kim
- Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles (UCLA), Los Angeles, California
| | - Yuan-Chin Amy Lee
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
| | - Rayjean J Hung
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Canada
| | - Paolo Boffetta
- The Tisch Cancer Institute and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dong Xie
- Department of Thoracic Surgery, ShangHai Pulmonary Hospital, ShangHai, China. Mayo Clinic Cancer Center, Rochester, Minnesota
| | | | - Michele L Cote
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan
| | - Shen-Chih Chang
- Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles (UCLA), Los Angeles, California
| | - Donatella Ugolini
- Internal Medicine, University of Genoa, Genoa, Italy. Unit of Epidemiology, Biostatistics, and Clinical Trials, IRCSS Azienda Ospedaliera Universitaria San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Monica Neri
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Loic Le Marchand
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Ann G Schwartz
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan
| | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health, and Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - David C Christiani
- Department of Environmental Health, Harvard University School of Public Health, Boston, Massachusetts
| | - Ping Yang
- Mayo Clinic Cancer Center, Rochester, Minnesota
| | - Zuo-Feng Zhang
- Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles (UCLA), Los Angeles, California.
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Usuda K, Sagawa M, Motono N, Ueno M, Tanaka M, Machida Y, Matoba M, Taniguchi M, Tonami H, Ueda Y, Sakuma T. Relationships between EGFR mutation status of lung cancer and preoperative factors - are they predictive? Asian Pac J Cancer Prev 2014; 15:657-62. [PMID: 24568474 DOI: 10.7314/apjcp.2014.15.2.657] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The epidermal growth factor receptor (EGFR) mutation status of lung cancer is important because it means that EGFR-tyrosine kinase inhibitor treatment is indicated. The purpose of this prospective study is to determine whether EGFR mutation status could be identified with reference to preoperative factors. MATERIALS AND METHODS One hundred-forty eight patients with lung cancer (111 adenocarcinomas, 25 squamous cell carcinomas and 12 other cell types) were enrolled in this study. The EGFR mutation status of each lung cancer was analyzed postoperatively. RESULTS There were 58 patients with mutant EGFR lung cancers (mutant LC) and 90 patients with wild-type EGFR lung cancers (wild-type LC). There were significant differences in gender, smoking status, maximum tumor diameter in chest CT, type of tumor shadow, clinical stage between mutant LC and wild-type LC. EGFR mutations were detected only in adenocarcinomas. Maximum standardized uptake value (SUVmax:3.66±4.53) in positron emission tomography-computed tomography of mutant LC was significantly lower than that (8.26±6.11) of wild-type LC (p<0.0001). Concerning type of tumor shadow, the percentage of mutant LC was 85.7% (6/7) in lung cancers with pure ground glass opacity (GGO), 65.3%(32/49) in lung cancers with mixed GGO and 21.7%(20/92) in lung cancers with solid shadow (p<0.0001). For the results of discriminant analysis, type of tumor shadow (p=0.00036) was most significantly associated with mutant EGFR. Tumor histology (p=0.0028), smoking status (p=0.0051) and maximum diameter of tumor shadow in chest CT (p=0.047) were also significantly associated with mutant EGFR. The accuracy for evaluating EGFR mutation status by discriminant analysis was 77.0% (114/148). CONCLUSIONS Mutant EGFR is significantly associated with lung cancer with pure or mixed GGO, adenocarcinoma, never-smoker, smaller tumor diameter in chest CT. Preoperatively, EGFR mutation status can be identified correctly in about 77 % of lung cancers.
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Affiliation(s)
- Katsuo Usuda
- Department of Thoracic Surgery, Kanazawa Medical University, Daigaku, Uchinada, Ishikawa, Japan E-mail :
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Jaagsiekte sheep retrovirus detected in human lung cancer tissue arrays. BMC Res Notes 2014; 7:160. [PMID: 24642139 PMCID: PMC3995318 DOI: 10.1186/1756-0500-7-160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 03/13/2014] [Indexed: 01/15/2023] Open
Abstract
Background Adenocarcinoma is the most common type of non-small cell lung cancer and is frequently observed in non-smoking patients. Adenocarcinoma in-situ (formerly referred to as bronchioloalveolar carcinoma) is a subset of lung adenocarcinoma characterized by growth along alveolar septae without evidence of stromal, vascular, or pleural invasion, that disproportionately affects never-smokers, women, and Asians. Adenocarcinoma in-situ is morphologically and histologically similar to a contagious lung neoplasm of sheep called ovine pulmonary adenocarcinoma (OPA). OPA is caused by infection with the exogenous betaretrovirus, jaagsiekte sheep retrovirus (JSRV), whose envelope protein (Env) is a potent oncogene. Several studies have reported that a proportion of human lung adenocarcinomas are immunopositive for an antigen related to the Gag protein of JSRV, however other groups have been unable to verify these observations by PCR. Methods Here we examine human lung cancer tissue arrays (TA) for evidence of JSRV Env protein and DNA by immunohistochemical staining and PCR, respectively. Results Our results reveal that a subset of human lung cancers express an antigen that reacts with a JSRV Env-specific monoclonal antibody in immunohistochemistry and that exogenous JSRV-like env and gag sequences can be amplified from TA tumor samples, albeit inefficiently. Conclusions While a causative role has not been established, these data suggest that a JSRV-like virus might infect humans. With next generation sequencing approaches, a JSRV-like virus in human lung cancers may be identified which could have profound implications for prevention, diagnosis and therapy.
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Tran HN, Li Y, Siu S, Baer D, Friedman GD, Udaltsova N, Klatsky AL. Predictors of lung cancer: noteworthy cell type differences. Perm J 2013; 17:23-9. [PMID: 23704839 DOI: 10.7812/tpp/12-104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study risk factors for cell types of lung cancer. METHODS Cohort study of 126,293 persons with 1852 subjects with incident cancer. We performed Cox proportional hazards models (8 covariates) to estimate risk of the 4 most numerous specific cell types: adenocarcinoma, squamous cell carcinoma, small cell carcinoma, and bronchioloalveolar carcinoma. RESULTS Smoking 1 or more cigarette packs per day was a powerful predictor (p < 0.0001) of all cell types, with hazard ratios ranging from 5.8 for bronchioloalveolar to 62.7 for squamous cell carcinoma. Other hazard ratio ranges included male/female from 0.6 (bronchioloalveolar, p < 0.05) to 2.0 (squamous, p < 0.001); black/white from 0.8 (small cell, p < 0.05) to 1.7 (squamous, p < 0.001); Asian/white from 0.8 (small cell) to 1.9 (bronchioloalveolar); and alcohol intake of 3 or more drinks per day from 1.0 (squamous) to 1.5 (adenocarcinoma, p < 0.01). College graduation and increasing body mass index were inversely related to risk of several cell types. Noteworthy sex-specific associations included increased risk of Asian vs white women for adenocarcinoma, squamous cell carcinoma and bronchioloalveolar carcinoma and substantially increased risk of adenocarcinoma in women with alcohol intake of 3 or more drinks per day. CONCLUSIONS These risk factor disparities for lung cancer cell types presumably reflect biologic differences. Future investigation may contribute to increased understanding of tumorigenesis and optimal treatment.
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Mo ML, Okamoto J, Chen Z, Hirata T, Mikami I, Bosco-Clément G, Li H, Zhou HM, Jablons DM, He B. Down-regulation of SIX3 is associated with clinical outcome in lung adenocarcinoma. PLoS One 2013; 8:e71816. [PMID: 23977152 PMCID: PMC3745425 DOI: 10.1371/journal.pone.0071816] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 07/03/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Lung cancer is a common cancer and the leading cause of cancer-related death worldwide. SIX3 is a human homologue of the highly conserved sine oculis gene family essential during embryonic development in vertebrates, and encodes a homeo-domain containing transcription factor. Little is known about the role of SIX3 in human tumorigenesis. This study is to assess the expression/function of SIX3 and the significance of SIX3 as a prognostic biomarker in lung adenocarcinoma. METHODS Quantitative real-time RT-PCR was used to analyze SIX3 mRNA expression and quantitative methylation specific PCR (MSP) was used to examine promoter methylation. MTS and colony formation assays were performed to examine cell proliferation. Wound healing assays were used to assess cell migration, and microarrays were utilized to examine genes regulated by SIX3 in lung cancer cells. Association of SIX3 expression levels with clinical outcomes of patients with lung adenocarcinoma was evaluated using the Kaplan-Meier method and a multivariate Cox proportional hazards regression model. RESULTS SIX3 was down-regulated in lung adenocarcinoma tissues compared to their matched adjacent normal tissues, and this down-regulation was associated with methylation of the SIX3 promoter. SIX3 was also methylation-silenced in lung cancer cell lines. Restoration of SIX3 in lung cancer cells lacking endogenous SIX3 suppressed cell proliferation and migration, and downregulated a number of genes involved in proliferation and metastasis such as S100P, TGFB3, GINS3 and BAG1. Moreover, SIX3 mRNA expression was associated with significantly improved overall survival (OS) and progression-free survival (PFS) in adenocarcinoma patients and patients with bronchioloalveolar carcinoma (BAC) features. CONCLUSIONS SIX3 may play an important role as a novel suppressor in human lung cancer. SIX3 has potential as a novel prognostic biomarker for patients with lung adenocarcinomas.
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Affiliation(s)
- Min-Li Mo
- School of Life Sciences, Tsinghua University, Beijing, China
| | - Junichi Okamoto
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, United States of America
- Department of Surgery, Division of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
| | - Zhao Chen
- School of Life Sciences, Tsinghua University, Beijing, China
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, United States of America
| | - Tomomi Hirata
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, United States of America
- Department of Surgery, Division of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
| | - Iwao Mikami
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, United States of America
- Department of Surgery, Division of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
| | - Geneviève Bosco-Clément
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, United States of America
| | - Hui Li
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, United States of America
| | - Hai-Meng Zhou
- School of Life Sciences, Tsinghua University, Beijing, China
- Zhejiang Provincial Key Laboratory of Applied Enzymology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, China
| | - David M. Jablons
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, United States of America
| | - Biao He
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, United States of America
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Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y, Ishikawa Y, Wistuba I, Flieder DB, Franklin W, Gazdar A, Hasleton PS, Henderson DW, Kerr KM, Nakatani Y, Petersen I, Roggli V, Thunnissen E, Tsao M. Diagnosis of lung adenocarcinoma in resected specimens: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Arch Pathol Lab Med 2013; 137:685-705. [PMID: 22913371 DOI: 10.5858/arpa.2012-0264-ra] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A new lung adenocarcinoma classification has been published by the International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society. This new classification is needed to provide uniform terminology and diagnostic criteria, most especially for bronchioloalveolar carcinoma. It was developed by an international core panel of experts representing all 3 societies with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons.This summary focuses on the aspects of this classification that address resection specimens. The terms bronchioloalveolar carcinoma and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced, such as adenocarcinoma in situ and minimally invasive adenocarcinoma for small solitary adenocarcinomas with either pure lepidic growth (adenocarcinoma in situ) and predominant lepidic growth with invasion of 5 mm or less (minimally invasive adenocarcinoma), to define the condition of patients who will have 100% or near 100% disease-specific survival, respectively, if they undergo complete lesion resection. Adenocarcinoma in situ and minimally invasive adenocarcinoma are usually nonmucinous, but rarely may be mucinous. Invasive adenocarcinomas are now classified by predominant pattern after using comprehensive histologic subtyping with lepidic (formerly most mixed subtype tumors with nonmucinous bronchioloalveolar carcinoma), acinar, papillary, and solid patterns; micropapillary is added as a new histologic subtype. Variants include invasive mucinous adenocarcinoma (formerly mucinous bronchioloalveolar carcinoma), colloid, fetal, and enteric adenocarcinoma.It is possible that this classification may impact the next revision of the TNM staging classification, with adjustment of the size T factor according to only the invasive component pathologically in adenocarcinomas with lepidic areas.
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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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Expression of CLDN1 and CLDN10 in lung adenocarcinoma in situ and invasive lepidic predominant adenocarcinoma. J Cardiothorac Surg 2013; 8:95. [PMID: 23591077 PMCID: PMC3639873 DOI: 10.1186/1749-8090-8-95] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 04/08/2013] [Indexed: 01/11/2023] Open
Abstract
Background Non-mucinous bronchioloalveolar carcinoma (BAC) is considered the early stage of lung adenocarcinoma and is classified as the lung adenocarcioma in situ (AIS) by the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society. This study was designed to investigate the gene expression differences between AIS (formerly non–mucinous BAC) and invasive lepidic predominant adenocarcinoma (LPA, formerly non-mucinous BAC pattern with >5 mm invasion, mixed type adenocarcinoma with BAC features) and to investigate the mechanism of the progression of lung adenocarcinoma in situ to invasive adenocarcinoma. Methods Gene expression analysis was performed by using Agilent 4 × 44 K Whole Human Genome Oligo Microarray on 10 fresh frozen tissue samples of AIS and LPA, respectively. Real time RT-PCR was used to validate the differential expression of 13 genes selected by cDNA microarray on fresh frozen tissue samples from 41 patients with lung adenocarcinoma and 4 genes were confirmed. These 4 genes were then validated by western blotting. Immunohistochemical staining for these validated genes was performed on formalin-fixed, paraffin-embedded tissue samples from 81 cases of lung adenocarcinomna. Results We identified a 13 gene expression signature by comparative analysis of gene expression. Expression of these genes strongly differed between AIS and LPA. Four genes (MMP-2, c-fos, claudin 1 (CLDN1) and claudin 10(CLDN10)) were correlated with the results of microarray and real time RT-PCR analyses for the gene-expression data in samples from 41 patients with lung adenocarcinoma. As confirmed by western blotting, the expression levels of MMP-2 and c-fos were higher in LPA than those in AIS; the expression levels of CLDN1 and CLDN10 in LPA were lower than those in AIS. Immunohistochemical staining for these genes in samples from 81 cases of lung adenocarcinoma demonstrated the expressions of CLDN1 and CLDN10 were correlated with overall survival of patients with lung adenocarcinoma. Conclusions CLDN1 and CLDN10 may play important roles in the development of AIS to LPA. Overexpression of CLDN1 and CLDN10 indicates a favorable prognosis for overall survival in some patients with lung adenocarcinoma. Expression of CLDN10 may be regulated by the c-fos pathway.
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Skoura E, Datseris IE, Exarhos D, Chatziioannou S, Oikonomopoulos G, Samartzis A, Giannopoulou C, Syrigos KN. Clinical importance of [ 18F]fluorodeoxyglucose positron emission tomography/computed tomography in the management of patients with bronchoalveolar carcinoma: Role in the detection of recurrence. Oncol Lett 2013; 5:1687-1693. [PMID: 23761835 PMCID: PMC3678597 DOI: 10.3892/ol.2013.1257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 02/05/2013] [Indexed: 11/30/2022] Open
Abstract
[18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) has been reported to have a low sensitivity in the initial diagnosis of bronchoalveolar carcinoma (BAC) due to BAC’s low metabolic activity. The aim of this study was to assess the value of [18F]FDG-PET/CT in the detection of BAC recurrence. Between February 2007 and September 2011, the [18F]FDG-PET/CT scans that were performed on patients with known, histologically proven BAC were studied. A total of 24 [18F]FDG-PET/CT scans were performed in 22 patients, including 16 males and 6 females, with a mean age of 65±9 years. Among the scans, 15 were performed to assess for possible recurrence with equivocal findings in conventional imaging methods and 9 for restaging post-therapy. In all cases conventional imaging studies (CT and MRI) were performed 5–30 days prior to PET/CT. Among the 24 [18F]FDG-PET/CT scans, 18 were positive and 6 negative. Among the 15 [18F]FDG-PET/CT scans performed for suspected recurrence, 34 lesions were detected and the mean maximum standardized uptake value (SUVmax) was 6.8±3.26. In nine scans, upstaging was observed, while two were in agreement with the findings of the conventional modalities. A greater number of lesions were detected in two scans and fewer lesions were detected in one, with no change in staging. Only one scan was negative. By contrast, in patients examined for restaging, there were only five lesions with a mean SUVmax of 4.86±3.18. Agreement between the findings of [18F]FDG-PET/CT and the conventional modalities was observed in 8 out of 9 cases. Although [18F]FDG-PET/CT has been reported to have a low sensitivity in the initial diagnosis of BAC, the present results indicate that when there is recurrence, the lesions become [18F]FDG avid. [18F]FDG-PET/CT may provide further information in patients evaluated for recurrence and thus improve patient management.
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Affiliation(s)
- Evangelia Skoura
- Departments of Nuclear Medicine, Evangelismos General Hospital, Athens, Greece
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Cigarette smoking associated with lung adenocarcinoma in situ in a large case-control study (SFBALCS). J Thorac Oncol 2013; 7:1352-60. [PMID: 22814813 DOI: 10.1097/jto.0b013e31825aba47] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Adenocarcinoma in situ (AIS), formerly bronchioloalveolar carcinoma, is an uncommon subtype of lung adenocarcinoma and accounts for approximately 3% to 4% of lung cancers. Compared with other lung cancer histologies, AIS patients are less likely to be smokers, yet associations with other lung cancer risk factors and differences by sex have not been determined. METHODS A total of 338 AIS patients and frequency-matched controls from the parent study (cases = 6039, controls = 2073) were included in these analyses. Odds ratios and 95% confidence intervals as estimates of the relative risk were obtained from multivariable unconditional logistic regression analyses. RESULTS Risk of AIS was associated with ever smoking (OR = 2.7, 95% confidence intervals: 2.1, 3.6), increased 20% to 30% for each 10-year increase in pack-years of smoking and decreased with increased years since quitting (p for trend <0.0001). There was no evidence that risk differed by sex but there was some suggestion that risk may differ by exposure to asbestos and by second-hand tobacco smoke exposure in whites. CONCLUSION There is an association between AIS and smoking, which is smaller in magnitude than the association between other subtypes of non-small-cell lung cancer and smoking. Our findings suggesting that effects may differ by exposure to asbestos and second-hand tobacco smoke should be interpreted conservatively and warrant validation and further evaluation in larger studies of AIS.
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Badiyan SN, Bierhals AJ, Olsen JR, Creach KM, Garsa AA, Dewees T, Bradley JD, Robinson CG. Stereotactic body radiation therapy for the treatment of early-stage minimally invasive adenocarcinoma or adenocarcnioma in situ (formerly bronchioloalveolar carcinoma): a patterns of failure analysis. Radiat Oncol 2013; 8:4. [PMID: 23286648 PMCID: PMC3552761 DOI: 10.1186/1748-717x-8-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 12/20/2012] [Indexed: 11/19/2022] Open
Abstract
Introduction Ongoing prospective trials exploring stereotactic body radiation therapy (SBRT) for early stage non-small cell lung cancer (NSCLC) often exclude minimally invasive adenocarcinoma or adenocarcnioma in situ, formerly bronchioloalveolar carcinoma (BAC), due to concerns for accurate target delineation on CT. We performed a patterns of failure analysis to compare outcomes between BAC and other NSCLC subtypes. Methods One hundred twenty patients with early stage NSCLC were treated with SBRT from 2004–2009. Pathologic confirmation of NSCLC was obtained in 97 patients. Radiotherapy was delivered according to RTOG guidelines. The log-rank test was used to compare outcomes between BAC and other NSCLC. Results Median follow-up was 29 months. The median SBRT dose was 5400 cGy. Thirteen patients had radiographically diagnosed BAC and five patients had biopsy confirmed BAC, of which two had both. The three-year local control was 100% for biopsy-proven or radiographically diagnosed BAC (n = 18) and 86% for all other NSCLC subtypes (n = 102) (p = 0.13). Likewise, no significant difference was detected between BAC and other NSCLC for 3-year regional failure (12% vs. 20%, p = 0.45), progression-free survival (57.6% vs. 53.5%, p = 0.84) or overall survival (35% vs. 47%, p = 0.66). There was a trend towards lower three-year rates of freedom from distant failure in patients with any diagnosis of BAC compared to those without (26% vs. 38%, p = 0.053). Conclusions Compared to other NSCLC subtypes, BAC appears to have similar patterns of failure and survival after treatment with SBRT, however there may be an increased risk of distant metastases with BAC. RTOG guideline-based target delineation provides encouraging local control rates for patients with BAC.
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Affiliation(s)
- Shahed N Badiyan
- Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University in St, Louis, 4921 Parkview Place, Campus Box 8224, St, Louis, MO 63110, USA.
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‘Bronchioloalveolar carcinoma’: is the term really dead? A critical review of a new classification system for pulmonary adenocarcinomas. Pathology 2012; 44:497-505. [DOI: 10.1097/pat.0b013e3283579fda] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shiels MS, Engels EA. Increased risk of histologically defined cancer subtypes in human immunodeficiency virus-infected individuals: clues for possible immunosuppression-related or infectious etiology. Cancer 2012; 118:4869-76. [PMID: 22359254 PMCID: PMC3366173 DOI: 10.1002/cncr.27454] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 11/09/2011] [Accepted: 12/29/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND Malignancies that occur in excess among human immunodeficiency virus (HIV)-infected individuals may be caused by immunosuppression or infections. Because histologically defined cancer subtypes have not been systematically evaluated, their risk was assessed among people with acquired immunodeficiency syndrome (AIDS). METHODS Analyses included 569,268 people with AIDS from the HIV/AIDS Cancer Match Study, a linkage of 15 US population-based HIV/AIDS and cancer registries during 1980 to 2007. Standardized incidence ratios (SIRs) were estimated to compare cancer risk in people with AIDS to the general population overall, and stratified by age, calendar period (a proxy of changing HIV therapies), and time since onset of AIDS (a proxy of immunosuppression). RESULTS Sixteen individual cancer histologies or histology groupings manifested significantly elevated SIRs. Risks were most elevated for adult T cell leukemia/lymphoma (SIR = 11.3), neoplasms of histiocytes and accessory lymphoid cells (SIR = 10.7), giant cell carcinoma (SIR = 7.51), and leukemia not otherwise specified (SIR = 6.69). SIRs ranged from 1.4 to 4.6 for spindle cell carcinoma, bronchioloalveolar adenocarcinoma, adnexal and skin appendage neoplasms, sarcoma not otherwise specified, spindle cell sarcoma, leiomyosarcoma, mesothelioma, germ cell tumors, plasma cell tumors, immunoproliferative diseases, acute lymphocytic leukemia, and myeloid leukemias. For several of these cancer subtypes, significant declines in SIRs were observed across calendar periods (consistent with decreasing risk with improved HIV therapies) or increase in SIRs with time since onset of AIDS (ie, prolonged immunosuppression). CONCLUSIONS The elevated risk of certain cancer subtypes in people with AIDS may point to an etiologic role of immunosuppression or infection. Future studies are needed to further investigate these associations and evaluate candidate infectious agents.
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Affiliation(s)
- Meredith S Shiels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
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Zhang WC, Zhang ZF, You J, Wang CL. Global gene expression differentiating pure bronchioloalveolar carcinoma from adenocarcinoma with bronchioloalveolar carcinoma features. Eur J Cardiothorac Surg 2012; 43:765-71. [PMID: 22864788 DOI: 10.1093/ejcts/ezs427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Pure bronchioloalveolar carcinoma (BAC) is considered the early stage of lung adenocarcinoma, and is even regarded as lung adenocarcinoma in situ. This study was designed to investigate the differences in the gene expression of pure BAC and that of adenocarcinoma with bronchioloalveolar features and explore the mechanism of BAC progression to adenocarcinoma with bronchioloalveolar features METHODS Total RNA was extracted from 16 tissue specimens. Expression analysis was carried out using Agilent 4 × 44 k arrays. Gene ontology analysis was used to define pathways altered in bronchioloalveolar progression. Differentially expressed candidate genes were validated using quantitative real-time PCR. The statistical analysis was carried out according to the methods of the paired t-test. RESULTS Adenocarcinoma with bronchioloalveolar features demonstrated an increased expression of 23 genes and reduced expression of 20 genes compared with BAC. These genes were considered candidate marker genes for tumour progression and metastasis. Genes overexpressed in adenocarcinoma with bronchioloalveolar features included fibroblast growth factor receptor 1, and CLDN18 (claudin 18), whereas those overexpressed in BAC included ataxia telangiectasia and Rad3 related (ataxia telangiectasia mutated and Rad3-related), and activating transcription factor 2. Mitogen-activated protein kinase (MAPK) pathway seemed dysregulated in adenocarcinoma with bronchioloalveolar features compared with pure BAC. CONCLUSIONS Microarray-based expression profiling revealed interesting novel candidate genes in BAC and adenocarcinoma with bronchioloalveolar features. The MAPK pathway seemed dysregulated in adenocarcinoma with bronchioloalveolar features compared with the pure BAC pathway, which is worthy of being explored because it could partially explain the mechanism of the progression of BAC to adenocarcinoma with bronchioloalveolar features.
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Affiliation(s)
- Wen-Cheng Zhang
- Department of Surgery, Bao Di Hospital, Bao Di Clinical College of Tianjin Medical University, Tianjin, China
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Abstract
Lung cancer classification is of paramount importance in determining the treatment for oncologic patients. Most lung cancers are non-small cell lung carcinomas (NSCLC), which are further subclassified into squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Lung neuroendocrine tumors are subclassified into typical carcinoid, atypical carcinoid, small cell carcinoma, and large cell neuroendocrine carcinoma. In NSCLC in particular, the histologic classification and tumor mutation analysis are central to today's targeted therapy and personalized treatment. This article discusses the current diagnostic criteria for classification of NSCLC and lung neuroendocrine tumors and implications for oncologic treatment.
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Affiliation(s)
- Zhen Fan
- Department of Pathology, St Joseph Pathology Associates, St Joseph Medical Center, 7601 Osler Drive, Towson, MD 21204, USA.
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Bar J, Onn A. Overcoming molecular mechanisms of resistance to first-generation epidermal growth factor receptor tyrosine kinase inhibitors. Clin Lung Cancer 2011; 13:267-79. [PMID: 22154113 DOI: 10.1016/j.cllc.2011.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 09/07/2011] [Accepted: 09/12/2011] [Indexed: 10/14/2022]
Abstract
The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) gefitinib and erlotinib have provided substantial benefits to patients with advanced non-small cell lung cancer (NSCLC). However resistance to these agents has emerged as a significant clinical issue; most patients who initially respond to treatment eventually experience relapse. The mechanisms underlying gefitinib and erlotinib resistance are multifactorial and several have been described. Clearly there is a need for novel and more effective therapies that can overcome resistance to the currently available TKIs. Several agents are in clinical development, including irreversible EGFR TKIs, inhibitors of the MET pathway, and others. In this review we discuss the various underlying mechanisms of gefitinib and erlotinib resistance and highlight the agents currently in clinical development that may have potential for overcoming this resistance.
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Affiliation(s)
- Jair Bar
- Division of Medical Oncology, The Ottawa Hospital Cancer Center, Ottawa, Ontario, Canada.
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Sigua NL, Cummings O, Lahm T. A 42-year-old woman with diffuse pulmonary infiltrates and bilateral pneumothoraces. Chest 2011; 140:550-553. [PMID: 21813536 DOI: 10.1378/chest.10-3116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Ninotchka L Sigua
- Division of Pulmonary, Critical Care, Allergy and Occupational Medicine, Indiana University, Indianapolis, IN.
| | - Oscar Cummings
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN
| | - Tim Lahm
- Division of Pulmonary, Critical Care, Allergy and Occupational Medicine, Indiana University, Indianapolis, IN; Richard L. Roudebush VA Medical Center, Indianapolis, IN
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Miki Y, Abe K, Suzuki S, Suzuki T, Sasano H. Suppression of estrogen actions in human lung cancer. Mol Cell Endocrinol 2011; 340:168-74. [PMID: 21354461 DOI: 10.1016/j.mce.2011.02.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 02/08/2011] [Accepted: 02/13/2011] [Indexed: 11/21/2022]
Abstract
Estrogen plays a critical role in female reproduction but has also been reported to have important roles in various target tissues expressing estrogen receptor (ER) α and/or ERβ in both male and female. ERs especially ERβ have been demonstrated to be present and functional in both normal human lung and its disorders including cancer. Non-small cell lung carcinomas (NSCLCs) are well-known to be composed of heterogeneous groups. Squamous cell carcinoma is the most common subtype in men, but adenocarcinoma is the most common histologic subtype in women. Therefore, sex steroid hormones such as estrogens have been considered to play some roles in NSCLC. In particular, results of several epidemiological analyses pointed out the association between physiological or artificial alterations of hormone status such as menstruation and postmenopausal administration of hormone replacement therapy and lung cancer risks or its development especially in female subjects. In NSCLC tissues, intratumoral estrogen synthesis via aromatase, which is a key enzyme in the estrogen synthesis involved in aromatization of androgens into estrogens, has recently become of clinical interest as a possible target of therapy. Therefore, in this review, we focused on the potential of an endocrine therapy in NSCLC using clinically available inhibitors of estrogen and aromatase actions.
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Affiliation(s)
- Yasuhiro Miki
- Department of Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
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Okamoto J, Kratz JR, Hirata T, Mikami I, Raz D, Segal M, Chen Z, Zhou HM, Pham P, Li H, Yagui-Beltran A, Ray MR, Koizumi K, Shimizu K, Jablons D, He B. Downregulation of EMX2 is associated with clinical outcomes in lung adenocarcinoma patients. Clin Lung Cancer 2011; 12:237-44. [PMID: 21726823 DOI: 10.1016/j.cllc.2011.03.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 12/21/2010] [Accepted: 01/28/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND The 5-year survival rate for stage I non-small-cell lung cancer (NSCLC) of 50% to 70% indicates that our current staging methods do not adequately predict outcome. Empty spiracles homeobox 2 (EMX2) is a homeo-domain-containing transcription factor that regulates a key developmental pathway known to promote lung tumorigenesis. This study assessed the significance of EMX2 as a prognostic biomarker in lung adenocarcinoma including bronchioloalveolar carcinoma (BAC). PATIENTS AND METHODS 144 patients with lung adenocarcinoma undergoing surgical resection were studied. Quantitative real-time reverse transcriptase polymerase chain reaction and Immunohistochemistry were used to analyze EMX2 mRNA and protein expression, respectively. Association of EMX2 mRNA expression levels with clinical outcomes was evaluated using the Kaplan-Meier method and a multivariate Cox proportional hazards regression model. RESULTS EMX2 mRNA expression was significantly downregulated in lung adenocarcinoma compared with matched adjacent normal tissue (P < .001). EMX2 protein expression was similarly found to be downregulated in lung adenocarcinoma. The EMX2-high mRNA expressing group had statistically significant better overall survival (OS) than the EMX2-low mRNA expressing group (P = .005). Subgroup analysis also demonstrated improved survival in stage I patients (P = .01) and patients with BAC (P = .03). Lastly, the EMX2-high mRNA expressing group had statistically significant better recurrence-free survival (RFS) than the EMX2-low mRNA expression group in patients with adenocarcinoma (P < .001). CONCLUSION EMX2 expression is downregulated in lung adenocarcinoma. Low EMX2 mRNA expression is significantly associated with decreased OS and RFS in patients with lung adenocarcinoma, particularly with stage I disease and BAC.
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Affiliation(s)
- Junichi Okamoto
- Thoracic Oncology Program, Department of Surgery, University of California, San Francisco, California; Department of Surgery, Division of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
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Abstract
Lung cancer in never smokers (LCINS) has lately been recognized as a unique disease based on rapidly gained knowledge from genomic changes to treatment responses. The focus of this article is on current knowledge and challenges with regard to LCINS expanded from recent reviews highlighting five areas: (1) distribution of LCINS by temporal trends, geographic regions, and populations; (2) three well-recognized environmental risk factors; (3) other plausible environmental risk factors; (4) prior chronic lung diseases and infectious diseases as risk factors; and (5) lifestyles as risk or protective factors. This article will also bring attention to recently published literature in two pioneering areas: (1) histological characteristics, clinical features with emerging new effective therapies, and social and psychological stigma; and (2) searching for susceptibility genes using integrated genomic approaches.
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Affiliation(s)
- Ping Yang
- Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Sterlacci W, Tzankov A, Veits L, Oberaigner W, Schmid T, Hilbe W, Fiegl M. The Prognostic Impact of Sex on Surgically Resected Non–Small Cell Lung Cancer Depends on Clinicopathologic Characteristics. Am J Clin Pathol 2011; 135:611-8. [DOI: 10.1309/ajcpqf24nywnmvmg] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Surgical resection for patients with mucinous bronchioloalveolar carcinoma. Asian J Surg 2011; 33:89-93. [PMID: 21029945 DOI: 10.1016/s1015-9584(10)60015-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2010] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The clinical features of mucinous bronchioloalveolar carcinoma (BAC) have remained unclear due to the low incidence of this disease. This study investigated the clinicopathological features and the surgical outcome in patients with mucinous BAC. METHODS We clinicopathologically evaluated 782 patients who underwent resection for nonsmall cell carcinoma between 1999 and 2008, of whom, 13 (1.6%) demonstrated to have mucinous BAC. RESULTS The patients with mucinous BAC included six men and seven women. The mean age was 69.1 years (range: 55-78 years). Eight patients (61.5%) had a smoking habit. No patients had any subjective symptoms. The tumour diameter ranged from 1.2 cm to 10 cm. The surgical procedures included 11 lobectomies, and two partial resections of affected lobes. The pathological stage was IA in eight patients, IB in two, IIA in two, and IIIA in one. None of the patients had lymph node metastases or lymphovascular invasion. The overall postoperative 5-year survival rate was 52.5%. The 5-year survival rate according to tumour diameter was 100% in patients with tumours ≤ 3 cm, and 25.1% in patients with tumours > 3 cm. Two patients died due to pulmonary metastases, and one died from carcinomatous pleuritis and pulmonary metastases. CONCLUSION Patients with small mucinous BAC (≤ 3 cm) in diameter showed excellent prognosis after surgical resection. However, mucinous BAC > 3 cm in diameter tended to recur with pulmonary metastasis.
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Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, Beer DG, Powell CA, Riely GJ, Van Schil PE, Garg K, Austin JHM, Asamura H, Rusch VW, Hirsch FR, Scagliotti G, Mitsudomi T, Huber RM, Ishikawa Y, Jett J, Sanchez-Cespedes M, Sculier JP, Takahashi T, Tsuboi M, Vansteenkiste J, Wistuba I, Yang PC, Aberle D, Brambilla C, Flieder D, Franklin W, Gazdar A, Gould M, Hasleton P, Henderson D, Johnson B, Johnson D, Kerr K, Kuriyama K, Lee JS, Miller VA, Petersen I, Roggli V, Rosell R, Saijo N, Thunnissen E, Tsao M, Yankelewitz D. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011; 6:244-85. [PMID: 21252716 PMCID: PMC4513953 DOI: 10.1097/jto.0b013e318206a221] [Citation(s) in RCA: 3470] [Impact Index Per Article: 266.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Adenocarcinoma is the most common histologic type of lung cancer. To address advances in oncology, molecular biology, pathology, radiology, and surgery of lung adenocarcinoma, an international multidisciplinary classification was sponsored by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. This new adenocarcinoma classification is needed to provide uniform terminology and diagnostic criteria, especially for bronchioloalveolar carcinoma (BAC), the overall approach to small nonresection cancer specimens, and for multidisciplinary strategic management of tissue for molecular and immunohistochemical studies. METHODS An international core panel of experts representing all three societies was formed with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons. A systematic review was performed under the guidance of the American Thoracic Society Documents Development and Implementation Committee. The search strategy identified 11,368 citations of which 312 articles met specified eligibility criteria and were retrieved for full text review. A series of meetings were held to discuss the development of the new classification, to develop the recommendations, and to write the current document. Recommendations for key questions were graded by strength and quality of the evidence according to the Grades of Recommendation, Assessment, Development, and Evaluation approach. RESULTS The classification addresses both resection specimens, and small biopsies and cytology. The terms BAC and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced such as adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) for small solitary adenocarcinomas with either pure lepidic growth (AIS) or predominant lepidic growth with ≤ 5 mm invasion (MIA) to define patients who, if they undergo complete resection, will have 100% or near 100% disease-specific survival, respectively. AIS and MIA are usually nonmucinous but rarely may be mucinous. Invasive adenocarcinomas are classified by predominant pattern after using comprehensive histologic subtyping with lepidic (formerly most mixed subtype tumors with nonmucinous BAC), acinar, papillary, and solid patterns; micropapillary is added as a new histologic subtype. Variants include invasive mucinous adenocarcinoma (formerly mucinous BAC), colloid, fetal, and enteric adenocarcinoma. This classification provides guidance for small biopsies and cytology specimens, as approximately 70% of lung cancers are diagnosed in such samples. Non-small cell lung carcinomas (NSCLCs), in patients with advanced-stage disease, are to be classified into more specific types such as adenocarcinoma or squamous cell carcinoma, whenever possible for several reasons: (1) adenocarcinoma or NSCLC not otherwise specified should be tested for epidermal growth factor receptor (EGFR) mutations as the presence of these mutations is predictive of responsiveness to EGFR tyrosine kinase inhibitors, (2) adenocarcinoma histology is a strong predictor for improved outcome with pemetrexed therapy compared with squamous cell carcinoma, and (3) potential life-threatening hemorrhage may occur in patients with squamous cell carcinoma who receive bevacizumab. If the tumor cannot be classified based on light microscopy alone, special studies such as immunohistochemistry and/or mucin stains should be applied to classify the tumor further. Use of the term NSCLC not otherwise specified should be minimized. CONCLUSIONS This new classification strategy is based on a multidisciplinary approach to diagnosis of lung adenocarcinoma that incorporates clinical, molecular, radiologic, and surgical issues, but it is primarily based on histology. This classification is intended to support clinical practice, and research investigation and clinical trials. As EGFR mutation is a validated predictive marker for response and progression-free survival with EGFR tyrosine kinase inhibitors in advanced lung adenocarcinoma, we recommend that patients with advanced adenocarcinomas be tested for EGFR mutation. This has implications for strategic management of tissue, particularly for small biopsies and cytology samples, to maximize high-quality tissue available for molecular studies. Potential impact for tumor, node, and metastasis staging include adjustment of the size T factor according to only the invasive component (1) pathologically in invasive tumors with lepidic areas or (2) radiologically by measuring the solid component of part-solid nodules.
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Zhong WZ, Wu YL, Yang XN, Guo AL, Su J, Zhang XC, Luo DL, Wang Z, Chen HJ, Zhou Q, Xu CR, Qiao GB, Liao RQ, Yang JJ, Mok TS. Genetic evolution of epidermal growth factor receptor in adenocarcinoma with a bronchioloalveolar carcinoma component. Clin Lung Cancer 2010; 11:160-8. [PMID: 20439191 DOI: 10.3816/clc.2010.n.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) mutations may accumulate during the multistage progression of bronchioloalveolar carcinoma (BAC), leading to heterogeneity within the tumor. This study sought to determine whether metachronous adenocarcinomas with a BAC component emerging in the lung field arise from a single or multiple clones in the same individual. MATERIALS AND METHODS Samples of adenocarcinomas exhibiting various degrees of BAC were obtained by thoracotomy. Sequential specimens were obtained upon detection of metachronous lesions in the lung field. Genomic DNA was extracted from specimens, and the presence of activating mutations in EGFR was determined via direct sequencing. Our pathologic findings, sequential image information, and genetic data were compared to track evidence of cancer evolution. RESULTS Based on EGFR gene analyses of tumor specimens from 431 patients, 17 cases of sequential BAC-related adenocarcinomas, obtained by thoracotomy, were noteworthy. Upon alteration of the BAC/adenocarcinoma components, the EGFR tyrosine kinase inhibitor-untreated series, which had at least one episode of an EGFR-activating mutation, represented 3 potential hypotheses: no significant EGFR evolution for a single clone, genetic alterations from mutant to wild-type EGFR for multifocal lesions, or a switch from wild-type to mutant EGFR, leading to indeterminable cancer progression. CONCLUSION Genetic analysis, in conjunction with pathologic and radiologic diagnoses, can be used to explore the origin of multifocal BAC. The single-clone model indicates subsequent disease progression, whereas genetic alterations from mutations to wild-type EGFR are suggestive of second primary carcinoma. In cases when additional lesions emerge after the radical resection of BAC-related lung cancer, sequential tumor samples should be obtained for further evaluation.
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Affiliation(s)
- Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
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Sclerosing variant of the bronchioloalveolar carcinoma: imaging findings in an atypical case. Case Rep Med 2010; 2010:361265. [PMID: 20589217 PMCID: PMC2892667 DOI: 10.1155/2010/361265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 05/21/2010] [Accepted: 06/03/2010] [Indexed: 11/21/2022] Open
Abstract
Bronchioloalveolar carcinoma remains one of the most enigmatic lung cancers, demonstrating varied growth patterns, mixed histological features, and confusing clinical manifestations. This paper reports a case of an unusual form of presentation: a sclerosing type associated with desmoplastic reaction and cicatrization. A 75-year-old woman was admitted with persistent dry cough and progressive dyspnea. Physical examination showed bilateral inspiratory crackles. A chest radiograph and high-resolution computed tomography demonstrated confluent airspace nodules, forming areas of consolidation in both lungs, with signs of architectural distortion. The lung biopsy revealed a nonmucinous sclerosing bronchioloalveolar carcinoma.
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Hanagiri T, Baba T, So T, Yasuda M, Sugaya M, Ono K, So T, Uramoto H, Takenoyama M, Yasumoto K. Time Trends of Surgical Outcome in Patients with Non-small Cell Lung Cancer. J Thorac Oncol 2010; 5:825-9. [DOI: 10.1097/jto.0b013e3181d5e47f] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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West H, Harpole D, Travis W. Histologic considerations for individualized systemic therapy approaches for the management of non-small cell lung cancer. Chest 2009; 136:1112-1118. [PMID: 19809052 DOI: 10.1378/chest.08-2484] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Over the past 5 to 10 years, we have reached a treatment plateau using standard platinum-based doublets in an unselected population of patients with advanced non-small cell lung cancer (NSCLC). Recent studies have focused on improving patient outcomes with new chemotherapeutic or targeted agents, as well as on individualizing therapy on the basis of patient characteristics such as tumor histology and biomarker analysis. This article summarizes recent data on histologic response determinants to chemotherapy and targeted therapy, with particular attention to the importance of standardized tissue collection, handling, storage, and analysis techniques, in order to best apply the results of tumor analysis to patient-care decisions. Such decisions are related to both improving patient safety and optimizing efficacy with standard chemotherapy as well as newer targeted therapy agents. This entails a change from a generalized approach in treating patients with NSCLC to an individualized strategy based on tumor histology.
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Affiliation(s)
- Howard West
- Thoracic Oncology Program, Swedish Cancer Institute, Seattle, WA.
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Fan TWM, Lane AN, Higashi RM, Bousamra M, Kloecker G, Miller DM. Metabolic profiling identifies lung tumor responsiveness to erlotinib. Exp Mol Pathol 2009; 87:83-6. [PMID: 19409891 DOI: 10.1016/j.yexmp.2009.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Accepted: 04/27/2009] [Indexed: 10/20/2022]
Abstract
A subtype of non-small cell lung cancer, bronchioalveolar adenocarcinoma (BAC), is more prevalent in Asian female non-smokers, and is more likely to respond to treatment with tyrosine kinase inhibitors such as erlotinib and gefitinib. Nuclear magnetic resonance and mass spectrometry-based metabolomic analysis of extracts from two different lung lesions and surrounding non-cancerous tissues of a BAC patient showed novel protein and phospholipid-associated metabolic differences that correlated with tumor development as well as PET and erlotinib sensitivity.
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Affiliation(s)
- Teresa W-M Fan
- Department of Chemistry University of Louisville, Louisville, KY 40208, USA
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Expression of FAK and PTEN in Bronchioloalveolar Carcinoma and Lung Adenocarcinoma. Lung 2009; 187:104-9. [DOI: 10.1007/s00408-008-9130-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 11/12/2008] [Indexed: 10/21/2022]
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The Prognostic and Predictive Role of Histology in Advanced Non-small Cell Lung Cancer: A Literature Review. J Thorac Oncol 2008; 3:1468-81. [DOI: 10.1097/jto.0b013e318189f551] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sharma P, Farrell T, Patterson MS, Singh G, Wright JR, Sur R, Rainbow AJ. In vitro survival of nonsmall cell lung cancer cells following combined treatment with ionizing radiation and photofrin-mediated photodynamic therapy. Photochem Photobiol 2008; 85:99-106. [PMID: 18643904 DOI: 10.1111/j.1751-1097.2008.00401.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
It has been suggested that combination high dose rate (HDR) intraluminal brachytherapy and photodynamic therapy (PDT) in nonsmall cell lung cancer (NSCLC) may improve efficacy of treatment, reduce toxicity and enhance quality of life for patients. To provide a cellular basis for this we examined the in vitro sensitivity of MRC5 normal lung fibroblasts and four NSCLC cell lines following HDR radiation, PDT and combined HDR radiation and PDT. HDR radiation was cobalt-60 gamma rays (1.5-1.9 Gy min(-1)). For PDT treatment, cells were exposed to 2.5 microg mL(-1) Photofrin for 18-24 h followed by light exposure (20 mW cm(-2)). For combined treatment cells were exposed to Photofrin and then either exposed to light and 15-30 min later exposed to HDR radiation or exposed to HDR radiation and 15-30 min later exposed to light. D(37) values calculated from clonogenic survival curves indicated a six-fold difference in HDR radiation sensitivity and an eight-fold difference in PDT sensitivity. The effect of combined treatment was not significantly different from an additive effect of the individual treatment modalities for the NSCLC cells, but was significantly less than additive for the MRC5 cells. These results suggest an equivalent tumor cell kill may be possible at reduced systemic effects to patients.
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Affiliation(s)
- Prachi Sharma
- Department of Biology, McMaster University, Hamilton, ON, Canada
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Yousem SA, Beasley MB. Bronchioloalveolar carcinoma: a review of current concepts and evolving issues. Arch Pathol Lab Med 2007; 131:1027-32. [PMID: 17616987 DOI: 10.5858/2007-131-1027-bcaroc] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2007] [Indexed: 11/06/2022]
Abstract
CONTEXT The concept of bronchioloalveolar carcinoma underwent considerable refinement between the publications of the 1981 and 1999 World Health Organization classifications of lung tumors. Both pathologic and clinical aspects of this carcinoma are the subject of considerable interest. OBJECTIVE To review and summarize the evolution of the current concept of bronchioloalveolar carcinoma and evolving issues that are under further investigation. DATA SOURCES Pertinent peer-reviewed literature emphasizing historical classification and evolution as well as current and evolving concepts. CONCLUSIONS Small, solitary, nonmucinous bronchioloalveolar carcinomas are associated with a markedly better prognosis compared with conventional invasive adenocarcinomas. Such tumors may be cured by surgical resection and may be more responsive to epidermal growth factor receptor-targeted therapy. The prognosis and staging of multifocal disease remain unresolved, as does the question of whether a small amount of invasion adversely affects prognosis. Mucinous bronchioloalveolar carcinoma appears to be a markedly different entity than the nonmucinous subtype.
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Affiliation(s)
- Samuel A Yousem
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Raz DJ, Zell JA, Ou SHI, Gandara DR, Anton-Culver H, Jablons DM. Natural History of Stage I Non-Small Cell Lung Cancer. Chest 2007; 132:193-9. [PMID: 17505036 DOI: 10.1378/chest.06-3096] [Citation(s) in RCA: 240] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Concern has been raised that early detection of lung cancer may lead to the treatment of clinically indolent cancers. No population-based study has examined the natural history of patients with stage I NSCLC who receive no surgery, chemotherapy, or radiation therapy. Our hypothesis is that long-term survival in patients with untreated stage I non-small cell lung cancer (NSCLC) is uncommon. METHODS A total of 101,844 incident cases of NSCLC in the California Cancer Center registry between 1989 and 2003 were analyzed; 19,702 patients had stage I disease, of whom 1,432 did not undergo surgical resection or receive treatment with chemotherapy or radiation. Five-year overall survival (OS) and lung cancer-specific survival were determined for this untreated group, for subsets of patients who were recommended but refused surgical resection, and for T1 tumors. RESULTS Only 42 patients with untreated stage I NSCLC were alive 5 years after diagnosis. Five-year OS for untreated stage I NSCLC was 6% overall, 9% for T1 tumors, and 11% for patients who refused surgical resection. Five-year lung cancer-specific survival rates were 16%, 23%, and 22%, respectively. Among these untreated patients, median survival was 9 months overall, 13 months for patients with T1 disease, and 14 months for patients who refused surgical resection. CONCLUSION Long-term survival with untreated stage I NSCLC is uncommon, and the vast majority of untreated patients die of lung cancer. Given that median survival is only 13 months in patients with T1 disease, surgical resection or other ablative therapies should not be delayed even in patients with small lung cancers.
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Affiliation(s)
- Dan J Raz
- University of California, San Francisco, 513 Parnassus Ave, S-321, San Francisco, CA 94131, USA.
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Abstract
PURPOSE OF REVIEW Bronchioloalveolar carcinoma accounts for 5% of lung cancers, although histologically mixed bronchioloalveolar carcinoma and adenocarcinoma account for up to 20%. Bronchioloalveolar carcinoma histology is present in a majority of tumors found on lung-cancer screening by computed tomography. We review issues surrounding the diagnosis and treatment of bronchioloalveolar carcinoma, which often differs from other types of lung cancer. RECENT FINDINGS A spectrum of disease from histologically pure bronchioloalveolar carcinoma to adenocarcinoma exists. The approach to treatment of diseases within this spectrum is still evolving. Evidence on the role of sub-lobar resection, resection of multifocal disease, and pulmonary transplantation is reviewed. We also discuss epidermal growth factor receptor tyrosine kinase inhibitors, and their role in patients with bronchioloalveolar carcinoma. SUMMARY An understanding of recent developments in the diagnosis and treatment of patients with bronchioloalveolar carcinoma histology is important as early detection of lung cancer becomes more common. Ongoing clinical trials will provide important information on the role of limited resection. The use of epidermal growth factor receptor tyrosine kinase inhibitors should currently be limited to patients with advanced or recurrent disease who have failed cytotoxic chemotherapy. New targeted therapies are emerging for patients with bronchioloalveolar carcinoma histology.
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Affiliation(s)
- Dan J Raz
- University of California, San Francisco, Department of Surgery, San Francisco, California 94143-0470, USA.
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Haraguchi N, Satoh H, Kikuchi N, Kagohashi K, Ishikawa H, Ohtsuka M. Prognostic Value of Tumor Disappearance Rate on Computed Tomography in Advanced-Stage Lung Adenocarcinoma. Clin Lung Cancer 2007; 8:327-30. [PMID: 17562232 DOI: 10.3816/clc.2007.n.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The proportion of tumor disappearance rate (TDR) on conventional computed tomography (CT) is associated with less aggressive biology, and patients with small peripheral adenocarcinoma accompanied by the TDR component showed better prognosis. These findings led us to the idea that even advanced-stage adenocarcinomas with a higher TDR in the primary lesion on CT might suggest slowly progressing cancer. This study was designed to determine the value of the TDR area in the primary site of advanced-stage lung adenocarcinoma with CT and correlate the CT findings with clinical outcome. PATIENTS AND METHODS In 103 patients with stage IIIB and IV lung adenocarcinoma, CT appearances and clinical data were reviewed retrospectively. Three methods were used in the evaluation of the TDR area: method I, consolidation on mediastinal windows/mass on lung windows > 75% or not; method II, maximum diameter on mediastinal windows/maximum diameter on lung windows (diameter ratio) > 75% or not; and method III, TDR area on lung windows > 25% or not. RESULTS In univariate analysis, patients with lung adenocarcinoma with TDR have a more favorable prognosis than those without TDR in all 3 methods (method I, P = 0.001; method II, P = 0.024; method III, P = 0.014; log-rank test). In multivariate analysis, a favorable prognosis in patients with adenocarcinoma with TDR was shown in method I (P = 0.015) and method III (P = 0.006). CONCLUSION As shown in patients with small peripheral lung adenocarcinoma, those with TDR on CT tended to have a good prognosis in contrast to those without TDR, even in patients with advanced-stage lung adenocarcinoma. Prospective study to confirm these results will be required.
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Affiliation(s)
- Norihiro Haraguchi
- Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
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