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Chapla D, Chorya HP, Ishfaq L, Khan A, Vr S, Garg S. An Artificial Intelligence (AI)-Integrated Approach to Enhance Early Detection and Personalized Treatment Strategies in Lung Cancer Among Smokers: A Literature Review. Cureus 2024; 16:e66688. [PMID: 39268329 PMCID: PMC11390952 DOI: 10.7759/cureus.66688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 08/11/2024] [Indexed: 09/15/2024] Open
Abstract
Lung cancer (LC) is a significant global health issue, particularly among smokers, and is characterized by high rates of incidence and mortality. This comprehensive review offers detailed insights into the potential of artificial intelligence (AI) to revolutionize early detection and personalized treatment strategies for LC. By critically evaluating the limitations of conventional methodologies, we emphasize the innovative potential of AI-driven risk prediction models and imaging analyses to enhance diagnostic precision and improve patient outcomes. Our in-depth analysis of the current state of AI integration in LC care highlights the achievements and challenges encountered in real-world applications, thereby shedding light on practical implementation. Furthermore, we examined the profound implications of AI on treatment response, survival rates, and patient satisfaction, addressing ethical considerations to ensure responsible deployment. In the future, we will outline emerging technologies, anticipate potential barriers to their adoption, and identify areas for further research, emphasizing the importance of collaborative efforts to fully harness the transformative potential of AI in reshaping LC therapy. Ultimately, this review underscores the transformative impact of AI on LC care and advocates for a collective commitment to innovation, collaboration, and ethical stewardship in healthcare.
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Affiliation(s)
- Deep Chapla
- Medicine, Jiangsu University, Zhenjiang, CHN
| | | | - Lyluma Ishfaq
- Medicine, Directorate of Health Services Kashmir, Srinagar, IND
| | - Afrasayab Khan
- Internal Medicine, Central Michigan University College of Medicine, Saginaw, USA
| | - Subrahmanyan Vr
- Internal Medicine Pediatrics, Armed Forces Medical College, Pune, IND
| | - Sheenam Garg
- Medicine, Punjab Institute of Medical Sciences, Jalandhar, IND
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Takam Kamga P. Editorial: Influence of potential diagnostic biomarkers in lung cancer. Front Oncol 2023; 13:1271211. [PMID: 37655104 PMCID: PMC10466122 DOI: 10.3389/fonc.2023.1271211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Paul Takam Kamga
- Université Paris-Saclay, UVSQ, EA4340 BECCOH, Boulogne-Billancourt, France
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Risk Assessment of Early Lung Cancer with LDCT and Health Examinations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084633. [PMID: 35457500 PMCID: PMC9033135 DOI: 10.3390/ijerph19084633] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/10/2022] [Indexed: 12/19/2022]
Abstract
Early detection of lung cancer has a higher likelihood of curative treatment and thus improves survival rate. Low-dose computed tomography (LDCT) screening has been shown to be effective for high-risk individuals in several clinical trials, but has high false positive rates. To evaluate the risk of stage I lung cancer in the general population not limited to smokers, a retrospective study of 133 subjects was conducted in a medical center in Taiwan. Regularized regression was used to build the risk prediction model by using LDCT and health examinations. The proposed model selected seven variables related to nodule morphology, counts and location, and ten variables related to blood tests and medical history, achieving an area under the curve (AUC) value of 0.93. The higher the age, white blood cell count (WBC), blood urea nitrogen (BUN), diabetes, gout, chronic obstructive pulmonary disease (COPD), other cancers, and the presence of spiculation, ground-glass opacity (GGO), and part solid nodules, the higher the risk of lung cancer. Subjects with calcification, solid nodules, nodules in the middle lobes, more nodules, and diseases related to thyroid, liver, and digestive systems were at a lower risk. The selected variables did not indicate causation.
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Li L, Ye Z, Yang S, Yang H, Jin J, Zhu Y, Tao J, Chen S, Xu J, Liu Y, Liang W, Wang B, Yang M, Huang Q, Chen Z, Li W, Fan JB, Liu D. Diagnosis of pulmonary nodules by DNA methylation analysis in bronchoalveolar lavage fluids. Clin Epigenetics 2021; 13:185. [PMID: 34620221 PMCID: PMC8499516 DOI: 10.1186/s13148-021-01163-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/30/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related mortality. The alteration of DNA methylation plays a major role in the development of lung cancer. Methylation biomarkers become a possible method for lung cancer diagnosis. RESULTS We identified eleven lung cancer-specific methylation markers (CDO1, GSHR, HOXA11, HOXB4-1, HOXB4-2, HOXB4-3, HOXB4-4, LHX9, MIR196A1, PTGER4-1, and PTGER4-2), which could differentiate benign and malignant pulmonary nodules. The methylation levels of these markers are significantly higher in malignant tissues. In bronchoalveolar lavage fluid (BALF) samples, the methylation signals maintain the same differential trend as in tissues. An optimal 5-marker model for pulmonary nodule diagnosis (malignant vs. benign) was developed from all possible combinations of the eleven markers. In the test set (57 tissue and 71 BALF samples), the area under curve (AUC) value achieves 0.93, and the overall sensitivity is 82% at the specificity of 91%. In an independent validation set (111 BALF samples), the AUC is 0.82 with a specificity of 82% and a sensitivity of 70%. CONCLUSIONS This model can differentiate pulmonary adenocarcinoma and squamous carcinoma from benign diseases, especially for infection, inflammation, and tuberculosis. The model's performance is not affected by gender, age, smoking history, or the solid components of nodules.
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Affiliation(s)
- Lei Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Zhujia Ye
- AnchorDx. Medical Co., Ltd. Unit 502, 3rd Luoxuan Road, International Bio-Island, Guangzhou, 510300, Guangdong, China
| | - Sai Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Hao Yang
- AnchorDx. Medical Co., Ltd. Unit 502, 3rd Luoxuan Road, International Bio-Island, Guangzhou, 510300, Guangdong, China
| | - Jing Jin
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yingying Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Jinsheng Tao
- AnchorDx. Medical Co., Ltd. Unit 502, 3rd Luoxuan Road, International Bio-Island, Guangzhou, 510300, Guangdong, China
| | - Siyu Chen
- AnchorDx. Medical Co., Ltd. Unit 502, 3rd Luoxuan Road, International Bio-Island, Guangzhou, 510300, Guangdong, China
| | - Jiehan Xu
- AnchorDx. Medical Co., Ltd. Unit 502, 3rd Luoxuan Road, International Bio-Island, Guangzhou, 510300, Guangdong, China
| | - Yanying Liu
- AnchorDx. Medical Co., Ltd. Unit 502, 3rd Luoxuan Road, International Bio-Island, Guangzhou, 510300, Guangdong, China
| | - Weihe Liang
- AnchorDx. Medical Co., Ltd. Unit 502, 3rd Luoxuan Road, International Bio-Island, Guangzhou, 510300, Guangdong, China
| | - Bo Wang
- AnchorDx. Medical Co., Ltd. Unit 502, 3rd Luoxuan Road, International Bio-Island, Guangzhou, 510300, Guangdong, China
| | - Mengzhu Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Qiaoyun Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Zhiwei Chen
- AnchorDx. Medical Co., Ltd. Unit 502, 3rd Luoxuan Road, International Bio-Island, Guangzhou, 510300, Guangdong, China.
- AnchorDx, Inc., 46305 Landing Pkwy, Fremont, CA, 94538, USA.
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
| | - Jian-Bing Fan
- AnchorDx. Medical Co., Ltd. Unit 502, 3rd Luoxuan Road, International Bio-Island, Guangzhou, 510300, Guangdong, China.
- Department of Pathology, School of Basic Medical Science, Southern Medical University, 1838 ShaTai Road, Guangzhou, 510515, China.
| | - Dan Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
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Cheng YY, Rath EM, Linton A, Yuen ML, Takahashi K, Lee K. The Current Understanding Of Asbestos-Induced Epigenetic Changes Associated With Lung Cancer. LUNG CANCER (AUCKLAND, N.Z.) 2020; 11:1-11. [PMID: 32021524 PMCID: PMC6955579 DOI: 10.2147/lctt.s186843] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/08/2019] [Indexed: 12/19/2022]
Abstract
Asbestos is a naturally occurring mineral consisting of extremely fine fibres that can become trapped in the lungs after inhalation. Occupational and environmental exposures to asbestos are linked to development of lung cancer and malignant mesothelioma, a cancer of the lining surrounding the lung. This review discusses the factors that are making asbestos-induced lung cancer a continuing problem, including the extensive historic use of asbestos and decades long latency between exposure and disease development. Genomic mutations of DNA nucleotides and gene rearrangements driving lung cancer are well-studied, with biomarkers and targeted therapies already in clinical use for some of these mutations. The genes involved in these mutation biomarkers and targeted therapies are also involved in epigenetic mechanisms and are discussed in this review as it is hoped that identification of epigenetic aberrations in these genes will enable the same gene biomarkers and targeted therapies to be used. Currently, understanding of how asbestos fibres trapped in the lungs leads to epigenetic changes and lung cancer is incomplete. It has been shown that oxidoreduction reactions on fibre surfaces generate reactive oxygen species (ROS) which in turn damage DNA, leading to genetic and epigenetic alterations that reduce the activity of tumour suppressor genes. Epigenetic DNA methylation changes associated with lung cancer are summarised in this review, and some of these changes will be due to asbestos exposure. So far, little research has been carried out to separate the asbestos driven epigenetic changes from those due to non-asbestos causes of lung cancer. Asbestos-associated lung cancers exhibit less methylation variability than lung cancers in general, and in a large proportion of samples variability has been found to be restricted to promoter regions. Epigenetic aberrations in cancer are proving to be promising biomarkers for diagnosing cancers. It is hoped that further understanding of epigenetic changes in lung cancer can result in useful asbestos-associated lung cancer biomarkers to guide treatment. Research is ongoing into the detection of lung cancer epigenetic alterations using non-invasive samples of blood and sputum. These efforts hold the promise of non-invasive cancer diagnosis in the future. Efforts to reverse epigenetic aberrations in lung cancer by epigenetic therapies are ongoing but have not yet yielded success.
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Affiliation(s)
- Yuen Yee Cheng
- Asbestos Disease Research Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Emma M Rath
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Anthony Linton
- Asbestos Disease Research Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Man Lee Yuen
- Asbestos Disease Research Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Ken Takahashi
- Asbestos Disease Research Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kenneth Lee
- Asbestos Disease Research Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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Lung cancer screening with low-dose spiral computed tomography: evidence from a pooled analysis of two Italian randomized trials. Eur J Cancer Prev 2018; 26:324-329. [PMID: 27222939 DOI: 10.1097/cej.0000000000000264] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The benefits and harms of lung cancer (LC) screening with low-dose computed tomography (LDCT) are debatable. Positive results from the US National Lung Screening Trial were not evident in the European trials, possibly due to their smaller sample sizes. To address this issue, we conducted a patient-level pooled analysis of two Italian randomized controlled trials. Data from DANTE and MILD trials were combined for a total of 3640 individuals in the LDCT arm and 2909 in the control arm. LC and overall mortality were analyzed using multivariate hazard ratios (HRs) and log-rank tests stratified by study. The median follow-up was 8.2 years, with a total of 30 480 person-years in the LDCT arm and 22 157 in the control arm. A total of 192 patients developed LC in the LDCT arm and 105 in the control arm. Half of the LC cases in the LDCT arm had stage IA or IB cancer, as compared with 21% in the control arm. Overall mortality rates/100 000 person-years were 925 in the LDCT arm and 1074 in the control arm, and LC mortality rates were 299 and 357, respectively. The multivariate pooled overall mortality HR was 0.89 (95% confidence interval: 0.74-1.06) and the LC mortality HR was 0.83 (95% confidence interval: 0.61-1.12) for the LDCT arm as compared with the control arm. The present pooled analysis shows a nonsignificant 11% reduction in overall mortality in individuals undergoing LDCT screening as compared with the control arm. A pooled analysis of all European trials would be a useful contribution to assess the real benefit of LDCT screening.
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Chen X, Wang F, Lin L, Dong H, Huang F, Ghulam Muhammad K, Chen L, Gorlova OY. Association of Smoking with Metabolic Volatile Organic Compounds in Exhaled Breath. Int J Mol Sci 2017; 18:ijms18112235. [PMID: 29068415 PMCID: PMC5713205 DOI: 10.3390/ijms18112235] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/16/2017] [Accepted: 10/20/2017] [Indexed: 12/26/2022] Open
Abstract
Lung cancer (LC) screening will be more efficient if it is applied to a well-defined high-risk population. Characteristics including metabolic byproducts may be taken into account to access LC risk more precisely. Breath examination provides a non-invasive method to monitor metabolic byproducts. However, the association between volatile organic compounds (VOCs) in exhaled breath and LC risk or LC risk factors is not studied. Exhaled breath samples from 122 healthy persons, who were given routine annual exam from December 2015 to December 2016, were analyzed using thermal desorption coupled with gas chromatography mass spectrometry (TD-GC-MS). Smoking characteristics, air quality, and other risk factors for lung cancer were collected. Univariate and multivariate analyses were used to evaluate the relationship between VOCs and LC risk factors. 7, 7, 11, and 27 VOCs were correlated with smoking status, smoking intensity, years of smoking, and depth of inhalation, respectively. Exhaled VOCs are related to smoking and might have a potential to evaluate LC risk more precisely. Both an assessment of temporal stability and testing in a prospective study are needed to establish the performance of VOCs such as 2,5-dimethylfuranm and 4-methyloctane as lung cancer risk biomarkers.
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Affiliation(s)
- Xing Chen
- Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education of China, Zhejiang University, 38 Zheda Road, Zhou Yi Qing Building, Hangzhou 310027, China.
| | - Fuyuan Wang
- Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education of China, Zhejiang University, 38 Zheda Road, Zhou Yi Qing Building, Hangzhou 310027, China.
| | - Liquan Lin
- Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education of China, Zhejiang University, 38 Zheda Road, Zhou Yi Qing Building, Hangzhou 310027, China.
| | - Hao Dong
- Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education of China, Zhejiang University, 38 Zheda Road, Zhou Yi Qing Building, Hangzhou 310027, China.
| | - Feifei Huang
- Department of Family Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun E Rd, Hangzhou 310016, China.
| | - Kanhar Ghulam Muhammad
- Department of Biomedical Engineering, Key Laboratory of Biomedical Engineering of Ministry of Education of China, Zhejiang University, 38 Zheda Road, Zhou Yi Qing Building, Hangzhou 310027, China.
| | - Liying Chen
- Department of Family Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun E Rd, Hangzhou 310016, China.
| | - Olga Y Gorlova
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, Lebanon, NH 03756, USA.
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DNA Methylation as a Noninvasive Epigenetic Biomarker for the Detection of Cancer. DISEASE MARKERS 2017; 2017:3726595. [PMID: 29038612 PMCID: PMC5605861 DOI: 10.1155/2017/3726595] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/10/2017] [Accepted: 08/07/2017] [Indexed: 12/30/2022]
Abstract
In light of the high incidence and mortality rates of cancer, early and accurate diagnosis is an important priority for assigning optimal treatment for each individual with suspected illness. Biomarkers are crucial in the screening of patients with a high risk of developing cancer, diagnosing patients with suspicious tumours at the earliest possible stage, establishing an accurate prognosis, and predicting and monitoring the response to specific therapies. Epigenetic alterations are innovative biomarkers for cancer, due to their stability, frequency, and noninvasive accessibility in bodily fluids. Epigenetic modifications are also reversible and potentially useful as therapeutic targets. Despite this, there is still a lack of accurate biomarkers for the conclusive diagnosis of most cancer types; thus, there is a strong need for continued investigation to expand this area of research. In this review, we summarise current knowledge on methylated DNA and its implications in cancer to explore its potential as an epigenetic biomarker to be translated for clinical application. We propose that the identification of biomarkers with higher accuracy and more effective detection methods will enable improved clinical management of patients and the intervention at early-stage disease.
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Gou HF, Liu Y, Yang TX, Zhou C, Chen XZ. Necessity of organized low-dose computed tomography screening for lung cancer: From epidemiologic comparisons between China and the Western nations. Oncotarget 2017; 8:1788-1795. [PMID: 27705946 PMCID: PMC5352097 DOI: 10.18632/oncotarget.12400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 09/13/2016] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To compare the proportion of stage I lung cancer and population mortality in China to those in U.S. and Europe where lung cancer screening by low-dose computed tomography (LDCT) has been already well practiced. METHODS The proportions of stage I lung cancer in LDCT screening population in U.S. and Europe were retrieved from NLST and NELSON trials. The general proportion of stage I lung cancer in China was retrieved from a rapid meta-analysis, based on a literature search in the China National Knowledge Infrastructure database. The lung cancer mortality and prevalence of China, U.S. and Europe was retrieved from Globocan 2012 fact sheet. Mortality-to-prevalence ratio (MPR) was applied to compare the population survival outcome of lung cancer. RESULTS The estimated proportion of stage I lung cancer in China is merely 20.8% among hospital-based cross-sectional population, with relative ratios (RRs) being 2.40 (95% CI 2.18-2.65) and 2.98 (95% CI 2.62-3.38) compared by LDCT-screening population in U.S. and Europe trials, respectively. MPR of lung cancer is as high as 58.9% in China, with RRs being 0.46 (95% CI 0.31-0.67) and 0.58 (95% CI 0.39-0.85) compared by U.S. and Europe, respectively. CONCLUSIONS By the epidemiological inference, the LDCT mass screening might be associated with increasing stage I lung cancer and therefore improving population survival outcome. How to translate the experiences of lung cancer screening by LDCT from developed counties to China in a cost-effective manner needs to be further investigated.
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Affiliation(s)
- Hong-Feng Gou
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Liu
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Tian-Xia Yang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Cheng Zhou
- Translational Radiation Oncology, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Ion Therapy Center (HIT), Department of Radiation Oncology, University Heidelberg Medical School, Heidelberg, Germany
- German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Xin-Zu Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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Young RP, Hopkins RJ. Measures of outcome in lung cancer screening: maximising the benefits. J Thorac Dis 2016; 8:E1317-E1320. [PMID: 27867616 PMCID: PMC5107445 DOI: 10.21037/jtd.2016.10.49] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/22/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Robert Peter Young
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Raewyn Janice Hopkins
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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