Lung Cancer in a Rural Area of China: Rapid Rise in Incidence and Poor Improvement in Survival

The cost-effectiveness of iruplinalkib versus alectinib in anaplastic lymphoma kinase-positive crizotinib-resistant advanced non-small-cell lung cancer patients in China

Background

Iruplinalkib is a second-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI) with efficacy in patients with ALK-positive crizotinib-resistant advanced non-small cell lung cancer (NSCLC), which is independently developed by a Chinese pharmaceutical company. This study examined the cost-effectiveness of iruplinalkib versus alectinib in the Chinese healthcare setting.

Methods

A partitioned survival model was developed to project the economic and health outcomes. Efficacy was derived using unanchored matching-adjusted indirect comparison (MAIC). Cost and utility values were obtained from the literature and experts' opinions. Deterministic and probabilistic sensitivity analyses (PSA) were carried out to evaluate the model's robustness.

Results

Treatment with iruplinalkib versus alectinib resulted in a gain of 0.843 quality-adjusted life years (QALYs) with incremental costs of $20,493.27, resulting in an incremental cost-effectiveness ratio (ICER) of $24,313.95/QALY. Parameters related to relative efficacy and drug costs were the main drivers of the model outcomes. From the PSA, iruplinalkib had a 90% probability of being cost-effective at a willingness-to-pay threshold of $37,863.56/QALY.

Conclusion

Compared to alectinib, iruplinalkib is a cost-effective therapy for patients with ALK-positive crizotinib-resistant advanced NSCLC.

Observed and relative survival trends of lung cancer: A systematic review of population-based cancer registration data

BACKGROUND

Using the published survival statistics from cancer registration or population-based studies, we aimed to describe the global pattern and trend of lung cancer survival.

METHODS

By searching SinoMed, PubMed, Web of Science, EMBASE, and SEER, all survival analyses from cancer registration or population-based studies of lung cancer were collected by the end of November 2022. The survival rates were extracted by sex, period, and country. The observed, relative, and net survival rates of lung cancer were applied to describe the pattern and time changes from the late 1990s to the early 21st century.

RESULTS

Age-standardized 5-year relative/net survival rate of lung cancer was typically low, with 10%-20% for most regions. The highest age-standardized relative/net survival rate was observed in Japan (32.9%, 2010-2014), and the lowest was in India (3.7%, 2010-2014). In most countries, the five-year age-standardized relative/net survival rates of lung cancer were higher in females and younger people. The patients with adenocarcinoma had a better prognosis than other groups. In China, the highest 5-year overall relative/net survival rates were 27.90% and 31.62% in men and women in Jiangyin (2012-2013).

CONCLUSION

Over the past decades, the prognosis of lung cancer has gradually improved, but significant variations were also observed globally. Worldwide, a better prognosis of lung cancer can be observed in females and younger patients. It is essential to compare and evaluate the histological or stage-specific survival rates of lung cancer between different regions in the future.

Effect of thoracoscopic and thoracotomy on postoperative wound complications in patients with lung cancer: A meta-analysis

Because of the difficult surgical procedures, patients with lung cancer who have received thoracic surgery tend to have postoperative complications. It may lead to postoperative complications like wound infection, wound haematoma and pneumothorax. A lot of research has assessed the effect of various surgery methods on postoperative complications in pulmonary cancer. The purpose of this meta-analysis is to establish if thoracoscopic is superior to that of thoracotomy in the rate of post-operative complications. From the beginning to the end of June 2023, we performed an exhaustive search on four main databases for key words. The Hazard of Bias in Non-Randomized Interventional Studies (ROBINS-I) was evaluated in the literature. In the end, 13 trials that fulfilled the eligibility criteria underwent further statistical analyses. The results showed that thoracoscopic intervention decreased the risk of post operative wound infection (dominant ratio [OR], 3.00; 95% confidence margin [CI], 1.98, 4.55; p < 0.00001) and air-leakage after operation (OR, 1.30; 95% CI, 1.04, 1.63; p = 0.02). There was no statistically significant difference between the two groups in terms of the rate of haemorrhage after operation (OR, 0.10; 95% CI, 0.73, 1.66; p = 0.63). Our findings indicate that thoracoscopic is less likely to cause post operative infection and gas leakage than thoracotomy, and it does not decrease the risk of postoperative haemorrhage. As some of the chosen trials are too small to conduct meta-analyses, care must be taken when handling the data. In the future, a large number of randomized, controlled trials will be required to provide additional evidence for this research.

Effect of single-port video-assisted thoracoscopy on surgical site wound infection and healing in patients with lung cancer: A meta-analysis

We performed a meta-analysis to comprehensively assess the effect of single-port video-assisted thoracoscopy on surgical site wound infection and healing in patients with lung cancer. A computerised search for studies on single-port video-assisted thoracoscopy treatment of lung cancer was conducted from the time of database creation through February 2023 using the PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases. Two investigators independently screened the literature, extracted information, and evaluated the quality of studies according to inclusion and exclusion criteria. Either a fixed or random-effects model was used in calculating the relative risk (RR) with 95% confidence intervals (CIs). Meta-analysis was performed using RevMan 5.4 software. The results showed that, compared with multi-port video-assisted thoracoscopy, single-port video-assisted thoracoscopy significantly reduced surgical site wound infection (RR: 0.38, 95% CI: 0.19-0.77, P = .007) and significantly promoted wound healing (RR: 0.37, 95% CI: 0.22-0.64, P < .001). Compared with multi-port video-assisted thoracoscopy, single-port video-assisted thoracoscopy significantly reduced surgical site wound infections and also promoted wound healing. However, because of large variations in study sample sizes, some of the literature reported methods of inferior quality. Additional high-quality studies containing large sample sizes are needed to further validate these results.

Comparison of the performance of the GLIM criteria, PG-SGA and mPG-SGA in diagnosing malnutrition and predicting survival among lung cancer patients: A multicenter study

BACKGROUND & AIMS

The present study aimed to compare the ability of the GLIM criteria, PG-SGA and mPG-SGA to diagnose malnutrition and predict survival among Chinese lung cancer (LC) patients.

METHODS

This was a secondary analysis of a multicenter, prospective, nationwide cohort study, 6697 LC inpatients were enrolled between July 2013 and June 2020. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under the curve (AUC), and quadratic weighted Kappa coefficients were calculated to compare the ability to diagnose malnutrition. There were 754 patients who underwent follow-up for a median duration of 4.5 years. The associations between the nutritional status and survival were analyzed by the Kaplan-Meier method and multivariable Cox proportional hazard regression models.

RESULTS

The median age of LC patients was 60 (53, 66), and 4456 (66.5%) were male. There were 617 (9.2%), 752 (11.2%), 1866 (27.9%), and 3462 (51.7%) patients with clinical stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ LC, respectively. Malnutrition was present in 36.1%-54.2% (as evaluated using different tools). Compared with the PG-SGA (used as the diagnostic reference), the sensitivity of the mPG-SGA and GLIM was 93.7% and 48.3%; the specificity was 99.8% and 78.4%; and the AUC was 0.989 and 0.633 (P < 0.001). The weighted Kappa coefficients were 0.41 for the PG-SGA vs. GLIM, 0.44 for the mPG-SGA vs. GLIM, and 0.94 for the mPG-SGA vs PG-SGA in patients with stage Ⅰ-Ⅱ LC. These values were respectively 0.38, 0.39, and 0.93 in patients with stage Ⅲ-Ⅳ of LC. In a multivariable Cox analysis, the mPG-SGA (HR = 1.661, 95%CI = 1.348-2.046, P < 0.001), PG-SGA (HR = 1.701, 95%CI = 1.379-2.097, P < 0.001) and GLIM (HR = 1.657, 95%CI = 1.347-2.038, P < 0.001) showed similar death hazard ratios.

CONCLUSIONS

The mPG-SGA provides nearly equivalent power to predict the survival of LC patients as the PG-SGA and the GLIM, indicating that all three tools are applicable for LC patients. The mPG-SGA has the potential to be an alternative replacement for quick nutritional assessment among LC patients.

Fat mass assessment using the triceps skinfold thickness enhances the prognostic value of the Global Leadership Initiative on Malnutrition criteria in patients with lung cancer

The present study evaluated whether fat mass assessment using the triceps skinfold (TSF) thickness provides additional prognostic value to the Global Leadership Initiative on Malnutrition (GLIM) framework in patients with lung cancer (LC). We performed an observational cohort study including 2672 LC patients in China. Comprehensive demographic, disease and nutritional characteristics were collected. Malnutrition was retrospectively defined using the GLIM criteria, and optimal stratification was used to determine the best thresholds for the TSF. The associations of malnutrition and TSF categories with survival were estimated independently and jointly by calculating multivariable-adjusted hazard ratios (HR). Malnutrition was identified in 808 (30·2 %) patients, and the best TSF thresholds were 9·5 mm in men and 12 mm in women. Accordingly, 496 (18·6 %) patients were identified as having a low TSF. Patients with concurrent malnutrition and a low TSF had a 54 % (HR = 1·54, 95 % CI = 1·25, 1·88) greater death hazard compared with well-nourished individuals, which was also greater compared with malnourished patients with a normal TSF (HR = 1·23, 95 % CI = 1·06, 1·43) or malnourished patients without TSF assessment (HR = 1·31, 95 % CI = 1·14, 1·50). These associations were concentrated among those patients with adequate muscle mass (as indicated by the calf circumference). Additional fat mass assessment using the TSF enhances the prognostic value of the GLIM criteria. Using the population-derived thresholds for the TSF may provide significant prognostic value when used in combination with the GLIM criteria to guide strategies to optimise the long-term outcomes in patients with LC.

Serum β-klotho is a potential biomarker in the prediction of clinical outcomes among patients with NSCLC

Background

We aimed to investigate the β-klotho (KLB) expression in non-small cell lung cancer (NSCLC) and to determine its value as a novel molecular target for survival prognosis in patients with NSCLC.

Methods

The serum KLB concentrations in 50 patients with NSCLC and the 20 healthy persons were measured by enzyme-linked immunosorbent assay (ELISA) methods. The relationship between serum KLB level, including the level change after therapy, and the progression-free survival (PFS) and overall survival (OS) were analyzed. The KLB expression in A549 cells was measured by real-time polymerase chain reaction (RT-PCR) and western blotting. The function of cells was revealed by in vitro studies.

Results

The concentrations of serum KLB in patients with NSCLC were obviously lower than those in healthy subjects. KLB expression was significantly increased in patients after chemotherapy and epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) targeted therapy. In addition, expression of KLB was positively related with PFS and OS. Compared with 16-human bronchial epithelial (HBE) cells, the expression level of KLB was significantly decreased in A549 cells. Overexpression of KLB suppressed the proliferation of A549 cells, along with G1-to-S phase arrest and apoptosis induction.

Conclusions

KLB plays an anti-tumorigenic role in NSCLC. KLB may be a candidate target for the diagnosis and treatment of NSCLC and may serve a potentially significant role in future clinical applications.

Comparison of the AWGS and optimal stratification-defined handgrip strength thresholds for predicting survival in patients with lung cancer

OBJECTIVES

Handgrip strength (HGS) is related to cancer mortality. The aim of this study was to compare the performance of the Asian Working Group for Sarcopenia 2019 (AWGS)- and optimal stratification (OS)-defined HGS thresholds for predicting the survival of patients with lung cancer (LC).

METHODS

We performed an observational cohort study including 3230 patients with LC admitted to five institutions in China from November 2011 to January 2019. Comprehensive baseline and follow-up information was documented. Sex-specific thresholds for identifying patients with a low HGS were defined based on the AWGS (<28 kg in men and <18 kg in women) and the OS. The associations of a low HGS with survival were estimated by calculating multivariable-adjusted hazard ratios (HRs), and the relationships were flexibly modeled using restricted cubic splines.

RESULTS

The study included 1041 women and 2189 men with a mean age of 60 y and a median follow-up time of 761 d. The OS-calculated HGS thresholds were <31.2 kg in men and <22.4 kg in women. There were significant associations between a low HGS defined by the AWGS (n = 1392; 43.1%) or the OS (n = 2034; 63%) and various nutritional characteristics. An AWGS-defined low HGS was associated with prolonged hospitalization. The OS-defined low HGS group was associated with a 23% greater death hazard than the normal HGS group (HR, 1.23; 95% confidence interval, 1.08-1.40). An n-shaped non-linear association was observed between the HGS and survival in women (P = 0.003).

CONCLUSIONS

The OS-defined HGS thresholds show better performance than the AWGS for predicting the survival of patients with LC. Additionally, the HGS had n-shaped associations with the overall mortality among female patients with LC.

Development and validation of a rapid-decision pathway to diagnose malnutrition in patients with lung cancer

OBJECTIVES

Malnutrition is frequently developed and outcome-related in patients with lung cancer (LC). Making a rapid and accurate diagnosis of malnutrition is the major concern for dietitians and clinicians.

METHODS

We performed a multicenter, observational cohort study including 1219 patients with LC. Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition criteria, and the study population was randomly divided into a training group (n = 914) and a validation group (n = 305). A nomogram (to diagnose malnutrition) and two decision trees (to diagnose and grade malnutrition, respectively) were independently developed and tested. A random forest algorithm was used to calculate relative variable importance.

RESULTS

The Global Leadership Initiative on Malnutrition criteria identified 292 patients with malnutrition (24%). Sex, body mass index, weight loss within 6 mo, weight loss beyond 6 mo, calf circumference, and handgrip strength to weight ratio were screened for model development. The nomogram showed good discrimination with an area under the curve (AUC) of 0.982 (95% confidence interval, 0.969-0.995) and good calibration in the validation group. A decision curve analysis demonstrated that the nomogram was clinically useful. The diagnostic tree showed an accuracy of 0.98 (Kappa = 0.942; AUC = 0.978; 95% confidence interval, 0.964-0.992), and the classification tree showed an accuracy of 0.98 (Kappa = 0.955; AUC = 0.987) in the validation group. Weight loss within 6 mo contributed the largest importance to both trees.

CONCLUSIONS

This study presents a rapid-decision pathway, including a set of tools that can be conveniently used to facilitate the diagnosis and severity grading of malnutrition in patients with LC.

Optimizations of a novel fluorescence polarization-based high-throughput screening assay for β-catenin/LEF1 interaction inhibitors

Aberrant activation of the Wnt/β-catenin signaling pathway is prominent in the development and metastasis of non-small cell lung cancer (NSCLC). Highly effective inhibition of this pathway highlights a therapeutic avenue against NSCLC. Moreover, β-catenin/LEF1 interaction regulates β-catenin nuclear transport as well as the transcriptions of the key oncogenes in Wnt/β-catenin signaling pathway. Therefore, interruption of this interaction would be a promising therapeutic strategy for NSCLC metastasis. To date, no economical and rapid high-throughput screening (HTS) assay has been reported for the discovery of β-catenin/LEF1 interaction inhibitors. In this study, we developed a novel fluorescence polarization (FP)-based HTS assay to identify β-catenin/LEF1 interaction inhibitors. The FITC-LEF1 sequence, incubation time, temperature, and DMSO resistance were optimized, and then a high Z' factor of 0.77 was achieved. A pilot screening of a natural product library via this established FP screening assay identified sanguinarine analogues as potential β-catenin/LEF1 interaction inhibitors. GST pull-down and surface plasmon resonance (SPR) assay demonstrated that β-catenin/LEF1 interaction is a potential anticancer target of sanguinarine in vitro. This newly developed FP screening assay will be vital for the rapid discovery of novel Wnt inhibitors targeting β-catenin/LEF1 interaction.

Trend analysis of lung cancer mortality and years of life lost (YLL) rate from 1999 to 2016 in Tianjin, China: Does the lung cancer burden in rural areas exceed that of urban areas?

BACKGROUND

The aim of this study was to examine the trends in the mortality rate and years of life lost (YLL) rate of lung cancer in Tianjin, China, during the period from 1999 to 2016.

METHODS

Lung cancer death data were obtained from Tianjin residents' all-cause death monitoring system, which covers the whole population of Tianjin. Crude mortality rate, age-standardized mortality rate, truncated rate (35-64 years), YLL and age-standardized YLL rate data were calculated and trends examined.

RESULTS

From 1999 to 2016, a total of 93 358 lung cancer deaths were reported in Tianjin, which accounted for 38.0% of all cancer deaths (93 358/245744). The crude mortality rate of lung cancer had increased 58.5% from 1999 (40.15/100000) to 2016 (63.64/100000), average annual percent change (AACP) = 2.9%, P < 0.01. However, the age-standard YLL rate had decreased to 13.3% in 2016 than in 1999, AACP = -0.8%, P < 0.01, with a stable trend in males (AACP = -0.2%), and noticeable decreasing trend in females (AACP = -1.4%). The lung cancer mortality rate (ASRW) in urban areas was higher than that in rural areas in 1999, with a ratio of 1.99:1. However, it was lower in 2016, with the ratio of 0.98:1. For the truncated rate (35-64 years), it had decreased in urban areas compared with rural areas since the year 2013.

CONCLUSION

Lung cancer remains the most fatal cancer in Tianjin. However, the age-standard YLL rate of lung cancer has decreased considerably accompanied by a decline in smoking rate years ago, especially in women and people living in urban areas. Considerable attention is therefore needed in the rural areas where cases of lung cancer are still rapidly increasing.

Diagnostic Value of Plasma MicroRNAs for Lung Cancer Using Support Vector Machine Model

Aim: Small single-stranded non-coding RNAs (miRNAs) play an important role in carcinogenesis through degrading target mRNAs. However, the diagnostic value of miRNAs was not explored in lung cancers. In this study, a support-vector-machine (SVM) model for diagnosis of lung cancer was established based on plasma miRNAs biomarkers, clinical symptoms and epidemiology material.

Methods: The expressions of plasma miRNA were examined with SYBR Green-based quantitative real-time PCR.

Results: We identified that the expressions of 10 plasma miRNAs (miR-21, miR-20a, miR-210, miR-145, miR-126, miR-223, miR-197, miR-30a, miR-30d, miR-25), smoking status, fever, cough, chest pain or tightness, bloody phlegm, haemoptysis, were significantly different between lung cancer and control groups (P<0.05). The accuracies of the combined SVM, miRNAs SVM, symptom SVM, combined Fisher, miRNAs Fisher and symptom Fisher were 96.34%, 80.49%, 84.15%, 84.15%, 75.61%, and 80.49%, respectively; AUC of these six model were 0.976, 0.841, 0.838, 0.865, 0.750, and 0.801, respectively. The accuracy and AUC of combined SVM were higher than the other 5 models (P<0.05).

Conclusions: Our findings indicate that SVM model based on plasma miRNAs biomarkers may serve as a novel, accurate, noninvasive method for auxiliary diagnosis of lung cancer.

miR‑195 suppresses metastasis and angiogenesis of squamous cell lung cancer by inhibiting the expression of VEGF

MicroRNAs (miRNAs) are small, noncoding RNAs that are ~22 nucleotides in length. Accumulating evidence has revealed that miRNAs act as oncogenes or tumor suppressors in various human cancers. In order to investigate the role of miR-195- in squamous cell lung cancer (SQCLC) cells, and to determine the underlying mechanism, the present study utilized RT-qPCR, western blot analysis, luciferase assay, MTT assay, cell migration assay, and in vitro angiogenesis techniques. The results obtained revealed that miR-195-5p acted as a tumor suppressor in SQCLC cells. The expression levels of miR-195 were decreased in two SQCLC cell lines (H520 and SK-Mes-1) compared with a normal lung cell line, and miR-195 directly targeted the 3′-untranslated region of vascular endothelial growth factor (VEGF) in SQCLC cells. Additionally, miR-195 upregulation suppressed the viability and migration of SQCLC cells. Furthermore, miR-195 inhibited the growth and tube formation of endothelial vascular cells. Collectively, the findings indicated that miR-195 downregulated VEGF, and that targeting this miRNA may provide an effective approach to inhibit angiogenesis in tumors.

Silk fibroin peptide suppresses proliferation and induces apoptosis and cell cycle arrest in human lung cancer cells

Silkworm cocoon was recorded to cure carbuncle in the Compendium of Materia Medica. Previous studies have demonstrated that the supplemental silk protein sericin exhibits anticancer activity. In the present study, we investigated the effects of silk fibroin peptide (SFP) extracted from silkworm cocoons against human lung cancer cells in vitro and in vivo and its possible anticancer mechanisms. SFP that we prepared had high content of glycine (~ 30%) and showed a molecular weight of ~ 10 kDa. Intragastric administration of SFP (30 g/kg/d) for 14 days did not affect the weights, vital signs, routine blood indices, and blood biochemical parameters in mice. MTT assay showed that SFP dose-dependently inhibited the growth of human lung cancer A549 and H460 cells in vitro with IC₅₀ values of 9.921 and 9.083 mg/mL, respectively. SFP also dose-dependently suppressed the clonogenic activity of the two cell lines. In lung cancer H460 xenograft mice, intraperitoneal injection of SFP (200 or 500 mg/kg/d) for 40 days significantly suppressed the tumor growth, but did not induce significant changes in the body weight. We further examined the effects of SFP on cell cycle and apoptosis in H460 cells using flow cytometry, which revealed that SFP-induced cell cycle arrest at the S phase, and then promoted cell apoptosis. We demonstrated that SFP (20-50 mg/mL) dose-dependently downregulates Bcl-2 protein expression and upregulates Bax protein in H460 cells during cell apoptosis. The results suggest that SFP should be studied further as a novel therapeutic agent for the treatment of lung cancer.

MiR-205 as a promising biomarker in the diagnosis and prognosis of lung cancer

MicroRNA-205 (miR-205) was revealed as a novel diagnostic and prognostic biomarker for lung cancer, but the results in the published papers were inconsistent. This meta-analysis aimed to investigate the diagnostic and prognostic roles of miR-205 in patients with lung cancer. Totally, 16 eligible articles were included, among which 10 articles investigated the diagnostic value of miR-205, 5 articles examined its prognostic values, and 1 article studied both diagnostic and prognostic values. For the diagnostic meta-analysis, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the overall area under the curve of miR-205 for patients with lung cancer were 0.88 (95% CI = 0.78 – 0.94), 0.78 (95% CI = 0.66 – 0.86), 4.00 (95% CI = 2.47 – 6.49), 0.16 (95% CI = 0.08 – 0.30), 25.86 (95% CI = 9.29 – 71.95), and 0.90 (95% CI = 0.87 – 0.92), respectively, indicating that miR-205 is a useful biomarker for diagnostic of lung cancer. The subgroup analysis further demonstrated that miR-205 had an excellent overall accuracy for detection with tissue samples compare with blood samples. For the prognostic meta-analysis, the pooled outcome of the disease-free survival and recurrence-free survival analyses revealed that increased miR-205 levels had a protective role in the prognosis of patients with lung cancer (pooled HR = 0.86, 95% CI: 0.78-0.96, z = 2.83, P = 0.005). In conclusion, miR-205 may be a promising biomarker for detection, predicting the recurrence of patients with lung cancer.

Effect of etoposide-induced alteration of the Mdm2-Rb signaling pathway on cellular senescence in A549 lung adenocarcinoma cells

The present study aimed to investigate the effect of various concentrations of etoposide (VP-16) on the E3 ubiquitin-protein ligase Mdm2 (Mdm2)-retinoblastoma (Rb) signaling pathway in the cellular senescence of A549 lung adenocarcinoma cells. A549 cells were randomly divided into the following four groups: Control group (no treatment), group 1 (1 µmol/l VP-16), group 2 (5 µmol/l VP-16) and group 3 (25 µmol/l VP-16). Each group was cultured for 48 h after treatment prior to observation of the alterations to cellular morphology. The cell cycle distribution of each group was also detected by flow cytometry. In addition, the activity of cellular senescence-associated β-galactosidase, and the expression of Mdm2 and phosphorylated (p-) Rb protein, was measured. The percentage of senescent cells was significantly higher following VP-16 treatment compared with the control group. The percentage of G₁ phase cells, and p-Rb protein and Mdm2 protein expression were also significantly different following VP-16 treatment compared with the control group. VP-16 increased the activity of β-galactosidase in the A459 cells. VP-16 also decreased the expression level of Mdm2 and p-Rb protein and inhibited cell cycle progression in G₁. These results indicate that VP-16 induces the cellular senescence of A549 cells via the Mdm2-Rb signaling pathway. However, further investigations are required to validate the mechanisms underlying these effects of VP-16.

Correlation between microRNA expression, clinicopathological characteristics, and prognosis in patients with Non-small cell Lung Cancer: A retrospective study

Background

Lung cancer prognosis is related to various factors; however, the comprehensive relationship between these factors, including microRNAs (miRNAs), and lung cancer prognosis has not been determined. Thus, the aim of this study was to identify the key factors associated with lung cancer prognosis.

Methods

We retrospectively analyzed prognosis and relevant factors in 216 non‐small cell lung cancer (NSCLC) patients diagnosed from January 2008 to December 2014. Paraffin‐embedded lung tissue samples were used to detect miRNA‐21 and miRNA‐155. Clinical information was collected, including tumor malignancy, tumor node metastasis (TNM) classification, pathological type, site of the original tumor, and lung involvement. The association between factors and overall survival was analyzed. A Cox proportional hazard model was used to perform univariate and multivariate analyses.

Results

Age at surgery (hazard ratio [HR] 1.021, 95% confidence interval [CI] 1.003–1.040), TNM stages II (HR 3.858, 95% CI 2.449–6.078) and III (HR 3.099, 95% CI 1.911–5.023), and miRNA‐21 (HR 1.002, 95% CI 1.001–1.003) and miRNA‐155 expression (HR 1.131, 95% CI 1.064–1.202) were independent prognostic factors in NSCLC patients. MiRNA‐21 expression with TNM stages II (HR 1.282, 95% CI 1.197–1.372) and III (HR 1.247, 95% CI 1.149–1.354) interacted to affect prognosis in NSCLC patients.

Conclusions

Older age, higher clinical TNM stage, and increased miRNA‐21 and miRNA‐155 expression in NSCLC tissue were independently associated with poor survival in NSCLC patients. MiRNA‐21 expression and clinical TNM stage interacted to affect prognosis.

Coping with stigma: the experiences of Chinese patients living with lung cancer

PURPOSE/OBJECTIVES

To describe the experiences of stigma and coping strategies among patients with lung cancer in China.

RESEARCH APPROACH

Qualitative.

SETTING

The oncology department at Liaocheng Peoples Hospital.

PARTICIPANTS

A purposive sample of 17 patients experiencing stigma related to lung cancer voluntarily participated in data collection.

METHODOLOGIC APPROACH

Individual, semistructured qualitative interviews were chosen. Participants completed about a 30-min focused interview. Exploratory qualitative approach guided data analysis.

FINDINGS

Three main thematic elements emerged from the interview data:(1) sources of stigma, such as smoking, decreased ability to work, difficulties caring for self and family, damage to self-image, and cough and expectoration; (2) experiences of stigma, including feelings of stigma, remorse, loss of dignity, uselessness, social isolation, perceived exclusion, rejection, and discrimination; and (3) coping strategies, such as concealing the fact of sickness, reducing social activities, seeking medical assistance, adhering to treatment, and disclosing dissatisfaction.

CONCLUSIONS

Our results indicate the presence of perceived stigma among patients with lung cancer. Future work should address the stigma associated with lung cancer and its related factors.

INTERPRETATION

As point-of-care providers, staff nurses are well positioned to develop effective interventions to help patients deal with stigma and to accomplish the goal of providing holistic nursing care.

Decreased Level of Klotho Contributes to Drug Resistance in Lung Cancer Cells: Involving in Klotho-Mediated Cell Autophagy

Klotho is originally discovered as an anti-aging gene and recently identified as a tumor suppressor in various human cancers. Drug resistance is a major obstacle to affect the treatment of chemotherapy. In the present study, we explore the role of klotho on drug resistance in human lung cancers and investigate the mechanism of klotho on drug resistance in lung cancer cells. First, we detected a panel of six human lung cancer cell lines, including H460, SK-MES-1, cisplatin (DDP)-resistant A549/DDP, its parental subline A549, docetaxel (DTX)-resistant SPC-A-1/DTX, and SPC-A-1 by western blotting analysis. The results showed that klotho level was significantly decreased in chemotherapeutic drug-resistant lung cancer cells. Next, klotho was overexpressed in drug-resistant cancer cell lines and the results showed that overexpression of klotho significantly inhibited cell proliferation of A549/DDP and SPC-A-1/DTX. Conversely, knockdown of the expression of klotho significantly promoted cell growth of lung cancer cells. Furthermore, overexpression of klotho had synergistic effects with cisplatin to inhibit the proliferation of drug-resistant lung cancer cells in a dose- and time-dependent manner. The molecular mechanism was explored by western blotting analysis and the results revealed that the levels of beclin 1 and LC3-II were obviously increased, suggesting cell autophagy enhanced in drug-resistant cancer cells. Importantly, overexpression of klotho would inhibit cell autophagy in A549/DDP cells. All the results demonstrated that the levels of klotho were significantly decreased, which was accompanied by the increased cell autophagy in drug-resistant lung cancer cells. Overexpression of klotho would inhibit cell autophagy in drug-resistant lung cancers, which may probably contribute to reverse drug resistance in lung cancer cells.

Role of plasma MicroRNAs in the early diagnosis of non-small-cell lung cancers: a case-control study

BACKGROUND

Lung cancer is a leading cause of cancer death worldwide. Early diagnosis is essential for improvements of prognosis and survival of the patients. Altered expressions in many cancer types including lung cancer and stable existence in plasma make microRNAs (miRNAs) a group of potentially useful biomarkers for clinical assessments of patients with lung cancer. In this study, we evaluate the potential values of miRNAs as plasma biomarkers for early diagnosis in non-small-cell lung cancers (NSCLC) by comparing with other typical plasma biomarkers.

METHODS

We analyzed the clinical and laboratory characteristics of 59 early-staged NSCLC (I-IIIA) patients and non-cancer controls by 1:1 matching age and gender from January 2012 to February 2014 in Xuanwu Hospital, Beijing, China. Peripheral blood samples from patients and controls before surgery were collected, and plasma was separated. Expression of ten miRNAs in the plasma of the patients and controls was detected by quantitative real-time polymerase chain reaction. Other typical markers, such as SCC, CEA, and CYFRA21-1 in plasma were also detected. The early diagnostic ability of miRNAs and other markers were evaluated by receiver-operating-characteristic (ROC) curve analysis. The sensitivity, specificity, and area under the curve were calculated for the cut-off value.

RESULTS

Plasma CYFRA21-1, miRNA-486 and miRNA-210 levels were significantly different in patients with NSCLC than those in controls (CYFRA21-1: 8.896±7.681 vs. 5.892±6.028, P=0.020; miR-486: 2.778±0.778 vs. 1.746±0.892, P<0.001; miR-210: 4.836±3.374 vs. 2.829±2.503, P<0.001). Area under ROC curve of CYFRA21-1, miR-486 and miR-210 were 0.624 (sensitivity: 0.576, specificity: 0.797), 0.848 (sensitivity: 0.831, specificity: 0.780) and 0.751 (sensitivity: 0.746, specificity: 0.746), respectively. The optimal cut-off value of CYFRA21-1, miRNA-486 and miRNA-210 were 6.595, 1.988 and 3.341, respectively to discriminate patients from controls. Plasma markers combined diagnosis ability had the highest sensitivity: 0.983, but the specificity was low. miR-486, miR-210 and CYFRA21-1 combined diagnosis ability was the highest, and the AUC was 0.924 (sensitivity: 0.847; specificity: 0.728).

CONCLUSIONS

The results suggest that miRNA-486 and miR-210 could be potential blood-based biomarkers for early diagnosis of NSCLC. miRNAs and other lab indexes may be combined to early diagnose NSCLC, which showed better ability of screening patients.

Manipulations in HIWI level exerts influence on the proliferation of human non-small cell lung cancer cells

Lung cancer is the leading cause of cancer-associated mortality worldwide, although molecular imaging techniques, including fludeoxyglucose positron emission tomography, have markedly improved the diagnosis of lung cancer. HIWI is a member of the human piwi family, members of which are known for their roles in RNA silencing. HIWI has been shown to serve a crucial function in stem cell self-renewal, and previous studies have reported HIWI overexpression in lung cancers. Furthermore, HIWI has been proposed to regulate the maintenance of cancer stem cell populations in lung cancers. The present study investigated the mRNA and protein expression levels of HIWI in non-small cell lung cancer (NSCLC) specimens harvested from 57 patients, using reverse transcription-quantitative polymerase chain reaction and western blot analysis, respectively. Subsequently, the HIWI expression level was manipulated using gain-of-function and loss-of-function strategies, and the role of HIWI in the proliferation of human A549 NSCLC cells was investigated using Cell Counting Kit-8 and colony formation assays. The mRNA and protein expression levels of HIWI were significantly upregulated in the intratumor NSCLC specimens, as compared with the peritumor specimens. Furthermore, the mRNA and protein expression levels of HIWI in A549 cells were successfully manipulated using the two strategies. Overexpression and knockout of HIWI were associated with the promotion and inhibition of A549 cell proliferation, respectively. The results of the present study suggested that HIWI is overexpressed in NSCLC tissues and demonstrated that upregulation of HIWI may promote the growth of lung cancer cells; thus suggesting that HIWI may have an oncogenic role in lung cancer.