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An W, Fan W, Zhong F, Wang B, Wang S, Gan T, Tian S, Liao M. Development and Validation of a Concise Prediction Scoring System for Asian Lung Cancer Patients with EGFR Mutation Before Treatment. Technol Cancer Res Treat 2022; 21:15330338221078732. [PMID: 35234540 PMCID: PMC8894628 DOI: 10.1177/15330338221078732] [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] [Indexed: 11/16/2022] Open
Abstract
Purpose We aimed to determine the epidermal growth factor receptor
(EGFR) genetic profile of lung cancer in Asians, and
develop and validate a non-invasive prediction scoring system for
EGFR mutation before treatment. Methods This
was a single-center retrospective cohort study using data of patients with lung
cancer who underwent EGFR detection (n = 1450) from December
2014 to October 2020. Independent predictors were filtered using univariate and
multivariate logistic regression analyses. According to the weight of each
factor, a prediction scoring system for EGFR mutation was
constructed. The model was internally validated using bootstrapping techniques
and temporally validated using prospectively collected data (n = 210) between
November 2020 and June 2021.Results In 1450 patients with lung
cancer, 723 single mutations and 51 compound mutations were observed in
EGFR. Thirty-nine cases had two or more synchronous gene
mutations. We developed a scoring system according to the independent clinical
predictors and stratified patients into risk groups according to their scores:
low-risk (score <4), moderate-risk (score 4-8), and high-risk (score >8)
groups. The C-statistics of the scoring system model was 0.754 (95% CI
0.729-0.778). The factors in the validation group were introduced into the
prediction model to test the predictive power of the model. The results showed
that the C-statistics was 0.710 (95% CI 0.638-0.782). The Hosmer–Lemeshow
goodness-of-fit showed that χ2 = 6.733, P = 0.566.
Conclusions The scoring system constructed in our study may be
a non-invasive tool to initially predict the EGFR mutation
status for those who are not available for gene detection in clinical
practice.
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Affiliation(s)
- Wenting An
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Fan
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Feiyang Zhong
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Binchen Wang
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shan Wang
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tian Gan
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Sufang Tian
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Meiyan Liao
- 89674Zhongnan Hospital of Wuhan University, Wuhan, China
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Wei Z, Wang Z, Nie Y, Zhang K, Shen H, Wang X, Wu M, Yang F, Chen K. Molecular Alterations in Lung Adenocarcinoma With Ground-Glass Nodules: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:724692. [PMID: 34589430 PMCID: PMC8475014 DOI: 10.3389/fonc.2021.724692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Aims Nodular ground-glass lesions have become increasingly common with the increased use of computed tomography (CT), while the genomic features of ground-glass opacities (GGOs) remain unclear. This study aims to comprehensively investigate the molecular alterations of GGOs and their correlation with radiological progression. Methods Studies from PubMed, Embase, Cochrane Library, and Web of Science, using PCR, targeted panel sequencing, whole exosome sequencing, and immunohistochemistry, and reporting genomic alterations or PD-L1 expressions in lung nodules presenting as GGOs until January 21, 2021 were included in this study. Chi-square test, random-effects model, and Z-test analysis were adopted to analyze the data. Results A total of 22 studies describing mutations in lung adenocarcinoma (LUAD) with GGOs were analyzed. EGFR was the most frequently mutative gene (51%, 95%CI 47%-56%), followed by TP53 (18%, 95%CI 6%-31%), HER2 (10%, 95%CI 0%-21%), ROS1 (6%, 95%CI 0%-18%), and KRAS (6%, 95%CI 3%-9%). The correlation between the frequency of EGFR mutation and radiological was observed and the differences were found to be not statistically significant in the subgroups, which are listed as below: radiological: gGGO 47.40%, 95%CI [38.48%; 56.40%]; sGGO 51.94%, 95%CI [45.15%; 58.69%]. The differences of the frequency of KRAS mutation in the different subgroups were also consistent with this conclusion, which are listed as: radiological gGGO 3.42, 95%CI [1.35%; 6.13%]; sGGO 12.27%, 95%CI [3.89%; 23.96%]. The pooled estimated rate of PD-L1 was 8.82%, 95%CI [5.20%-13.23%]. A total of 11.54% (3/26) of the SMGGNs were confirmed to be intrapulmonary spread by WES. Conclusions Somatic genetic alterations are considered in early-stage GGO patients without distinct changes of the frequency following the progress of the tumor. This review sheds insight on molecular alterations in LUAD with GGOs.
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Affiliation(s)
- Zihan Wei
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.,Health Science Center, Peking University, Beijing, China
| | - Ziyang Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.,Health Science Center, Peking University, Beijing, China
| | - Yuntao Nie
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Kai Zhang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Haifeng Shen
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Xin Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.,Health Science Center, Peking University, Beijing, China
| | - Manqi Wu
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.,Health Science Center, Peking University, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Kezhong Chen
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
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3
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Qin X, Gu X, Lu Y, Zhou W. EGFR-TKI-sensitive mutations in lung carcinomas: are they related to clinical features and CT findings? Cancer Manag Res 2018; 10:4019-4027. [PMID: 30323660 PMCID: PMC6173510 DOI: 10.2147/cmar.s174623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Epidermal growth factor receptor (EGFR) mutation testing is restricted to several limitations. In this study, we examined the relationship between EGFR mutation status and clinicoradiological characteristics in a Chinese cohort of patients. Materials and methods The data of patients who were diagnosed with lung carcinoma and underwent both EGFR testing and chest computed tomography (CT) at our hospital between January 1, 2011, and November 31, 2015, were retrospectively analyzed. The age, sex, and smoking index of the patients, the size, margin, and density of the tumor, and the presence of specific signs visible on the CT images were assessed. Results The results showed a higher rate of EGFR-tyrosine kinase inhibitor (TKI)-sensitive group than nonsensitive group in female patients and patients with a low smoking index (P<0.001, both). In logistic regression analyses, tumor size (P<0.001), smooth margins (P=0.015), and angular margins (P<0.001) were independent negative predictors of EGFR-TKI-sensitive group. Pleural indentation (P<0.001) and air bronchogram (P=0.025) were independent positive predictors of EGFR-TKI-sensitive group. Patients with squamous cell carcinoma had fewer sensitive mutations than those with either adenocarcinoma (P<0.001) or adenosquamous carcinoma (P<0.001). Conclusion Clinical and CT characteristics differed significantly between EGFR-TKI-sensitive and nonsensitive groups. Our findings may be useful in deciding therapeutic strategies for patients in whom EGFR testing is not possible.
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Affiliation(s)
- Xiaoyi Qin
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xiaolong Gu
- Department of Pneumology, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Yingru Lu
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China,
| | - Wei Zhou
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China,
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Lv J, Zhang H, Ma J, Ma Y, Gao G, Song Z, Yang Y. Comparison of CT radiogenomic and clinical characteristics between EGFR and KRAS mutations in lung adenocarcinomas. Clin Radiol 2018; 73:590.e1-590.e8. [DOI: 10.1016/j.crad.2018.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/11/2018] [Indexed: 01/26/2023]
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Wang LY, Cui JJ, Guo AX, Yin JY. Clinical efficacy and safety of afatinib in the treatment of non-small-cell lung cancer in Chinese patients. Onco Targets Ther 2018; 11:529-538. [PMID: 29416353 PMCID: PMC5790073 DOI: 10.2147/ott.s136579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Compared with various malignant tumors, lung cancer has high incidence and the highest mortality worldwide. Non-small-cell lung cancer (NSCLC), the most common kind of lung cancer, is still a great threat to the world, including China. Surgery, platinum-based chemotherapy, and radiotherapy are still the primary treatments for NSCLC patients in the clinic, whereas immunotherapy and targeted therapy are gradually playing more important roles. A next-generation tyrosine kinase inhibitor (TKI), afatinib, was developed as a targeted reagent for epidermal growth factor receptor (EGFR). This targeted drug was effective in a series of trials. The US Food and Drug Administration then approved afatinib as a new first-line treatment for EGFR L858R and exon 19 deletion mutant patients in 2013. This review focused on current clinical studies of afatinib. Although this TKI was not widely available in China until recently, we aim to provide a reference for its future use in China.
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Affiliation(s)
- Lei-Yun Wang
- Department of Clinical Pharmacology, XiangYa Hospital, Central South University, Changsha.,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, China
| | - Jia-Jia Cui
- Department of Clinical Pharmacology, XiangYa Hospital, Central South University, Changsha.,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, China
| | - Ao-Xiang Guo
- Department of Clinical Pharmacology, XiangYa Hospital, Central South University, Changsha.,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, China
| | - Ji-Ye Yin
- Department of Clinical Pharmacology, XiangYa Hospital, Central South University, Changsha.,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, China
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Chalela R, Curull V, Enríquez C, Pijuan L, Bellosillo B, Gea J. Lung adenocarcinoma: from molecular basis to genome-guided therapy and immunotherapy. J Thorac Dis 2017; 9:2142-2158. [PMID: 28840016 PMCID: PMC5542927 DOI: 10.21037/jtd.2017.06.20] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/21/2017] [Indexed: 12/14/2022]
Abstract
Although adenocarcinoma (ADC) is the most frequent lung cancer, its diagnosis is often late, when the local invasion is important and/or the metastases have already appeared. Therefore, the mortality at 5 years is still very high, ranging from 51% to 99%, depending on the stage. The implementation of different molecular techniques has allowed genomic studies even in relatively small histological samples such as obtained with non-invasive or minimally invasive techniques, facilitating a better phenotyping of lung ADC. Thus, current classification differentiates between preinvasive lesions (atypical adenomatous hyperplasia and in situ ADC), minimally invasive ADC (MIA) and invasive ADC. 'Field cancerization' is a concept that refers to progressive loco-regional changes occurring in tissues exposed to carcinogens, due to the interaction of the latter with a predisposing genetic background and an appropriate tissue microenvironment. Somatic genetic alterations, including mutations but also other changes, are necessary for oncogenesis, being especially frequent in lung ADC. Changes in the epidermal growth factor receptor (EGFR) gene, Kirsten rat sarcoma viral oncogene (KRAS), v-Raf murine sarcoma viral oncogene homolog B (BRAF), gene encoding neurofibromin (NF1), anaplastic lymphoma kinase (ALK) and ROS1 are the main genes that suffer alterations in the tumors of patients with ADC. Molecular profiling of these tumors allows more targeted treatments through two distinct strategies, genome-guided therapy and immunotherapy. The former, targets the aberrant pathways secondary to the genomic alteration, whereas the latter may be based on the administration of antibodies [such as those against cytotoxic T-lymphocyte antigen 4 (CTLA-4) or the programmed cell death ligand 1/protein 1 pathway (PD-L1/PD-1)] or the stimulation of the patient's own immune system to produce a specific response. These strategies are obtaining better results in selected ADC patients.
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Affiliation(s)
- Roberto Chalela
- Respiratory Medicine Department, Hospital del Mar; and CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Víctor Curull
- Respiratory Medicine Department, Hospital del Mar; and CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Lara Pijuan
- Department of Pathology, Hospital del Mar, Barcelona, Spain
| | - Beatriz Bellosillo
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Department of Pathology, Hospital del Mar, Barcelona, Spain
| | - Joaquim Gea
- Respiratory Medicine Department, Hospital del Mar; and CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
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Sabri A, Batool M, Xu Z, Bethune D, Abdolell M, Manos D. Predicting EGFR mutation status in lung cancer:Proposal for a scoring model using imaging and demographic characteristics. Eur Radiol 2016; 26:4141-4147. [PMID: 27027313 DOI: 10.1007/s00330-016-4252-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 01/16/2016] [Accepted: 01/26/2016] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine if a combination of CT and demographic features can predict EGFR mutation status in bronchogenic carcinoma. METHODS We reviewed demographic and CT features for patients with molecular profiling for resected non-small cell lung carcinoma. Using multivariate logistic regression, we identified features predictive of EGFR mutation. Prognostic factors identified from the logistic regression model were then used to build a more practical scoring system. RESULTS A scoring system awarding 5 points for no or minimal smoking history, 3 points for tumours with ground glass component, 3 points for airbronchograms, 2 points for absence of preoperative evidence of nodal enlargement or metastases and 1 point for doubling time of more than a year, resulted in an AUROC of 0.861. A total score of at least 8 yielded a specificity of 95 %. On multivariate analysis sex was not found to be predictor of EGFR status. CONCLUSIONS A weighted scoring system combining imaging and demographic data holds promise as a predictor of EGFR status. Further studies are necessary to determine reproducibility in other patient groups. A predictive score may help determine which patients would benefit from molecular profiling and may help inform treatment decisions when molecular profiling is not possible. KEY POINTS • EGFR mutation-targeted chemotherapy for bronchogenic carcinoma has a high success rate. • Mutation testing is not possible in all patients. • EGFR associations include subsolid density, slow tumour growth and minimal/no smoking history. • Demographic or imaging features alone are weak predictors of EGFR status. • A scoring system, using imaging and demographic features, is more predictive.
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Affiliation(s)
- Ali Sabri
- Department of Diagnostic Radiology, Dalhousie University, Victoria Building, room 307, 1276 South Park Street, PO BOX 9000, Halifax, Nova Scotia, B3H 2Y9, Canada. .,Halifax Infirmary, Room 3510, 1796 Summer Street, Halifax, NS, Canada.
| | - Madiha Batool
- Department of Diagnostic Radiology, Dalhousie University, Victoria Building, room 307, 1276 South Park Street, PO BOX 9000, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Zhaolin Xu
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Drew Bethune
- Department of Surgery, Dalhousie University, QEII Health Sciences center, Halifax, Nova Scotia, Canada
| | - Mohamed Abdolell
- Department of Diagnostic Radiology, Dalhousie University, Victoria Building, room 307, 1276 South Park Street, PO BOX 9000, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Daria Manos
- Department of Diagnostic Radiology, Dalhousie University, Victoria Building, room 307, 1276 South Park Street, PO BOX 9000, Halifax, Nova Scotia, B3H 2Y9, Canada
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Zhao S, Guo T, Li J, Uramoto H, Guan H, Deng W, Gu C. Expression and prognostic value of GalNAc-T3 in patients with completely resected small (≤2 cm) peripheral lung adenocarcinoma after IASLC/ATS/ERS classification. Onco Targets Ther 2015; 8:3143-52. [PMID: 26604783 PMCID: PMC4629976 DOI: 10.2147/ott.s93486] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background GalNAc-T3 catalyzes initial glycosylation of mucin-type O-linked protein involved in proliferation, adhesion, and migration of tumor cells. This study was performed to explore the relationships of the expression of GalNAc-T3 in small peripheral lung adenocarcinoma, especially as an indicator of prognosis. Materials and methods A retrospective analysis of the patients with small peripheral lung lesions, including 106 adenocarcinoma and two precancerous lesions (atypical adenomatous hyperplasia and adenocarcinoma in situ) after complete surgical resection, was launched. Expression of GalNAc-T3 was examined using immunohistochemistry staining on primary tumor specimens, and the tumors were reclassified in light of the IASLC/ATS/ERS (International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society) adenocarcinoma classifications followed by grading and scoring. Moreover, reverse transcription polymerase chain reaction and Western blot were used to study the expression of GalNAc-T3 in vivo. Results The low expression of GalNAc-T3 was found in the cytoplasm of tumor cells in 56 of 108 patients (51.9%) and was associated with IASLC/ATS/ERS classification of high risk groups (P=0.007), high Sica score (P=0.036), poorly differentiated tumor (P=0.023), poor tumor-node-metastasis (TNM) stage (P=0.007), pleural invasion (P=0.007), and vascular invasion (P<0.001) by Pearson’s chi-squared test, but not with sex, age, smoking status, concentration of carcinoembryonic antigen, and lymph node metastasis. In logistic regression analysis, low GalNAc-T3 expression was only correlated with high-ranking TNM stage (odds ratio [OR] =8.975, 95% confidence interval [CI]: 1.797–44.661), vascular invasion (OR =5.668, 95% CI: 1.827–17.578), and the higher risk grade (low risk grade: OR =0.141, 95% CI: 0.027–0.719; moderate risk grade: OR =0.122, 95% CI: 0.017–40.871). The low expression of the GalNAc-T3 usually in adenocarcinoma cell lines was compared with normal bronchial epithelium cell line. Based on the univariate and multivariate analysis, poor TNM stage (P<0.001), pleural invasion (hazard ratio [HR]: 7.958, P=0.021), vascular invasion (HR: 2.403, P=0.040), and low GalNAc-T3 expression (HR: 3.317, P=0.016) were shown to be independently associated with an unfavorable prognosis. However, IASLC/ATS/ERS classification of risk groups and Sica score (P=0.034 and P=0.032, respectively) was correlated with overall survival on Kaplan–Meier method but not Cox regression model. Conclusion GalNAc-T3 expression was correlated with the IASLC/ATS/ERS classification and also associated with prognosis of patients with completely resected small (≤2 cm) peripheral lung adenocarcinoma.
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Affiliation(s)
- Shilei Zhao
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China ; Lung Cancer Diagnosis and Treatment Center, Dalian, People's Republic of China
| | - Tao Guo
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China ; Lung Cancer Diagnosis and Treatment Center, Dalian, People's Republic of China
| | - Jinxiu Li
- Lung Cancer Diagnosis and Treatment Center, Dalian, People's Republic of China
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan
| | - Hongwei Guan
- Department of Pathology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Wuguo Deng
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Chundong Gu
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China ; Lung Cancer Diagnosis and Treatment Center, Dalian, People's Republic of China
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