First insight about the ability of specific glycerophospholipids to discriminate non-small cell lung cancer subtypes

Introduction: Discrimination between adenocarcinoma (ADC) and squamous cell carcinoma (SCC) subtypes in non-small cell lung cancer (NSCLC) patients is a significant challenge in oncology. Lipidomics analysis provides a promising approach for this differentiation. Methods: In an accompanying paper, we explored oxPCs levels in a cohort of 200 NSCLC patients. In this research, we utilized liquid chromatography coupled with mass spectrometry (LC-MS) to analyze the lipidomics profile of matching tissue and plasma samples from 25 NSCLC patients, comprising 11 ADC and 14 SCC cases. This study builds upon our previous findings, which highlighted the elevation of oxidised phosphatidylcholines (oxPCs) in NSCLC patients. Results: We identified eight lipid biomarkers that effectively differentiate between ADC and SCC subtypes using an untargeted approach. Notably, we observed a significant increase in plasma LPA 20:4, LPA 18:1, and LPA 18:2 levels in the ADC group compared to the SCC group. Conversely, tumour PC 16:0/18:2, PC 16:0/4:0; CHO, and plasma PC 16:0/18:2; OH, PC 18:0/20:4; OH, PC 16:0/20:4; OOH levels were significantly higher in the ADC group. Discussion: Our study is the first to report that plasma LPA levels can distinguish between ADC and SCC patients in NSCLC, suggesting a potential role for LPAs in NSCLC subtyping. This finding warrants further investigation into the mechanisms underlying these differences and their clinical implications.

Serum Insights: Leveraging the Power of miRNA Profiling as an Early Diagnostic Tool for Non-Small Cell Lung Cancer

Non-small cell lung cancer is the predominant form of lung cancer and is associated with a poor prognosis. MiRNAs implicated in cancer initiation and progression can be easily detected in liquid biopsy samples and have the potential to serve as non-invasive biomarkers. In this study, we employed next-generation sequencing to globally profile miRNAs in serum samples from 71 early-stage NSCLC patients and 47 non-cancerous pulmonary condition patients. Preliminary analysis of differentially expressed miRNAs revealed 28 upregulated miRNAs in NSCLC compared to the control group. Functional enrichment analyses unveiled their involvement in NSCLC signaling pathways. Subsequently, we developed a gradient-boosting decision tree classifier based on 2588 miRNAs, which demonstrated high accuracy (0.837), sensitivity (0.806), and specificity (0.859) in effectively distinguishing NSCLC from non-cancerous individuals. Shapley Additive exPlanations analysis improved the model metrics by identifying the top 15 miRNAs with the strongest discriminatory value, yielding an AUC of 0.96 ± 0.04, accuracy of 0.896, sensitivity of 0.884, and specificity of 0.903. Our study establishes the potential utility of a non-invasive serum miRNA signature as a supportive tool for early detection of NSCLC while also shedding light on dysregulated miRNAs in NSCLC biology. For enhanced credibility and understanding, further validation in an independent cohort of patients is warranted.

Applied Molecular-Based Quality Control of Biobanked Samples for Multi-Omics Approach

Biobanks are vital for high-throughput translational research, but the rapid development of novel molecular techniques, especially in omics assays, poses challenges to traditional practices and recommendations. In our study, we used biospecimens from oncological patients in Polish clinics and collaborated with the Indivumed Group. For serum/plasma samples, we monitored hemolysis, controlled RNA extraction, assessed cDNA library quality and quantity, and verified NGS raw data. Tissue samples underwent pathologic evaluation to confirm histology and determine tumor content. Molecular quality control measures included evaluating the RNA integrity number, assessing cDNA library quality and quantity, and analyzing NGS raw data. Our study yielded the creation of distinct workflows for conducting preanalytical quality control of serum/plasma and fresh-frozen tissue samples. These workflows offer customization options to suit the capabilities of different biobanking entities. In order to ensure the appropriateness of biospecimens for advanced research applications, we introduced molecular-based quality control methods that align with the demands of high-throughput assays. The novelty of proposed workflows, rooted in innovative molecular techniques, lies in the integration of these QC methods into a comprehensive schema specifically designed for high-throughput research applications.

Neutrophil/Lymphocyte Ratio (NLR) and Lymphocyte/Monocyte Ratio (LMR) - Risk of Death Inflammatory Biomarkers in Patients with COVID-19

Aim

The aim of our retrospective study was search for new prognostic parameters, which can help quickly and cheaply identify patients with risk for severe course of SARS-CoV-2 infection.

Materials and Methods

The following peripheral blood combination biomarkers were calculated: NLR (neutrophil/lymphocytes ratio), LMR (lymphocyte/monocyte ratio), PLR (platelet/lymphocyte ratio), dNLR (neutrophils/(white blood cells - neutrophils)), NLPR (neutrophil/(lymphocyte × platelet ratio)) in 374 patients who were admitted to the Temporary Hospital no 2 of Clinical Hospital in Bialystok (Poland) with COVID-19. The patients were divided into four groups depending on the severity of the course of COVID-19 using MEWS classification.

Results

The NLR and dNLR were significantly increased with the severity of COVID-19, according to MEWS score. The AUC for the assessed parameters was higher in predicting death in patients with COVID-19: NLR (0.656, p=0.0018, cut-off=6.22), dNLR (0.615, p=0.02, cut-off=3.52) and LMR (0.609, p=0.03, cut-off=2.06). Multivariate COX regression analysis showed that NLR median above 5.56 (OR: 1.050, P=0.002), LMR median below 2.23 (OR: 1.021, P=0.011), and age >75 years old (OR: 1.072, P=0.000) had a significant association with high risk of death during COVID-19.

Conclusion

Our results indicate that NLR, dNLR, and LMR calculated on admission to the hospital can quickly and easy identify patients with risk of a more severe course of COVID-19. Increase NLR and decrease LMR have a significant predictive value in COVID-19 patient's mortality and might be a potential biomarker for predicting death in COVID-19 patients.

The Diagnostic Value of Inflammatory Markers (CRP, IL6, CRP/IL6, CRP/L, LCR) for Assessing the Severity of COVID-19 Symptoms Based on the MEWS and Predicting the Risk of Mortality

Introduction

Various diagnostic tools are used to assess the severity of COVID-19 symptoms and the risk of mortality, including laboratory tests and scoring indices such as the Modified Early Warning Score (MEWS). The diagnostic value of inflammatory markers for assessing patients with different severity of COVID-19 symptoms according to the MEWS was evaluated in this study.

Materials and Methods

The concentrations of CRP (C-reactive protein) (immunoassay) and IL6 (interleukin 6) (electrochemiluminescence assay) were determined, and CRP/IL6, CRP/L, and LCR ratios were calculated in blood serum samples collected from 374 COVID-19 patients.

Results

We demonstrated that CRP, IL6, CRP/IL6, CRP/L, LCR inflammatory markers increase significantly with disease progression assessed based on the MEWS in COVID-19 patients and may be used to differentiating patients with severe and non-severe COVID-19 and to assess the mortality.

Conclusion

The diagnostic value of inflammatory markers for assessing the risk of mortality and differentiating between patients with mild and severe COVID-19 was confirmed.

Recommendations for COPD management in Central and Eastern Europe

INTRODUCTION

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy report provides guidance on effective management of chronic obstructive pulmonary disease (COPD) according to local healthcare systems. However, COPD is a heterogenous disease and certain aspects, including prevalence, disease-time course and phenotype distribution, can differ between countries. Moreover, features of clinical practice and healthcare systems for COPD patients can vary widely, even in geographically close and economically similar countries.

AREAS COVERED

Based on an initial workshop of respiratory physicians from eleven countries across Central and Eastern Europe (CEE) in December 2018 and subsequent discussions, this article offers region-specific insights from clinical practice and healthcare systems in CEE. Taking GOLD 2020 recommendations into account, we suggest approaches to adapt these into national clinical guidelines for COPD management in CEE.

EXPERT OPINION

Several factors should be considered when optimizing management of COPD in CEE compared with other regions, including differences in smoking status, vaccination uptake, prevalence of tuberculosis and nontuberculous mycobacteria, and variations in healthcare systems. We provide guidance and algorithms for pharmacologic and non-pharmacologic management of COPD for the following scenarios: initial and follow-up treatment, treatment of patients with frequent exacerbations, and withdrawal of inhaled corticosteroids where appropriate.

The Ability of Metabolomics to Discriminate Non-Small-Cell Lung Cancer Subtypes Depends on the Stage of the Disease and the Type of Material Studied

Identification of the NSCLC subtype at an early stage is still quite sophisticated. Metabolomics analysis of tissue and plasma of NSCLC patients may indicate new, and yet unknown, metabolic pathways active in the NSCLC. Our research characterized the metabolomics profile of tissue and plasma of patients with early and advanced NSCLC stage. Samples were subjected to thorough metabolomics analyses using liquid chromatography-mass spectrometry (LC-MS) technique. Tissue and/or plasma samples from 137 NSCLC patients were analyzed. Based on the early stage tissue analysis, more than 200 metabolites differentiating adenocarcinoma (ADC) and squamous cell lung carcinoma (SCC) subtypes as well as normal tissue, were identified. Most of the identified metabolites were amino acids, fatty acids, carnitines, lysoglycerophospholipids, sphingomyelins, plasmalogens and glycerophospholipids. Moreover, metabolites related to N-acyl ethanolamine (NAE) biosynthesis, namely glycerophospho (N-acyl) ethanolamines (GP-NAE), which discriminated early-stage SCC from ADC, have also been identified. On the other hand, the analysis of plasma of chronic obstructive pulmonary disease (COPD) and NSCLC patients allowed exclusion of the metabolites related to the inflammatory state in lungs and the identification of compounds (lysoglycerophospholipids, glycerophospholipids and sphingomyelins) truly characteristic to cancer. Our results, among already known, showed novel, thus far not described, metabolites discriminating NSCLC subtypes, especially in the early stage of cancer. Moreover, the presented results also indicated the activity of new metabolic pathways in NSCLC. Further investigations on the role of NAE biosynthesis pathways in the early stage of NSCLC may reveal new prognostic and diagnostic targets.

Systematic biobanking, novel imaging techniques, and advanced molecular analysis for precise tumor diagnosis and therapy: The Polish MOBIT project

Personalized and precision medicine is gaining recognition due to the limitations by standard diagnosis and treatment; many areas of medicine, from cancer to psychiatry, are moving towards tailored and individualized treatment for patients based on their clinical characteristics and genetic signatures as well as novel imaging techniques. Advances in whole genome sequencing have led to identification of genes involved in a variety of diseases. Moreover, biomarkers indicating severity of disease or susceptibility to treatment are increasingly being characterized. The continued identification of new genes and biomarkers specific to disease subtypes and individual patients is essential and inevitable for translation into personalized medicine, in estimating both, disease risk and response to therapy. Taking into consideration the mostly unsolved necessity of tailored therapy in oncology the innovative project MOBIT (molecular biomarkers for individualized therapy) was designed. The aims of the project are: (i) establishing integrative management of precise tumor diagnosis and therapy including systematic biobanking, novel imaging techniques, and advanced molecular analysis by collecting comprehensive tumor tissues, liquid biopsies (whole blood, serum, plasma), and urine specimens (supernatant; sediment) as well as (ii) developing personalized lung cancer diagnostics based on tumor heterogeneity and integrated genomics, transcriptomics, metabolomics, and radiomics PET/MRI analysis. It will consist of 5 work packages. In this paper the rationale of the Polish MOBIT project as well as its design is presented. (iii) The project is to draw interest in and to invite national and international, private and public, preclinical and clinical initiatives to establish individualized and precise procedures for integrating novel targeted therapies and advanced imaging techniques.

Gene Expression Signature Differentiates Histology But Not Progression Status of Early-Stage NSCLC

Advances in molecular analyses based on high-throughput technologies can contribute to a more accurate classification of non-small cell lung cancer (NSCLC), as well as a better prediction of both the disease course and the efficacy of targeted therapies. Here we set out to analyze whether global gene expression profiling performed in a group of early-stage NSCLC patients can contribute to classifying tumor subtypes and predicting the disease prognosis. Gene expression profiling was performed with the use of the microarray technology in a training set of 108 NSCLC samples. Subsequently, the recorded findings were validated further in an independent cohort of 44 samples. We demonstrated that the specific gene patterns differed significantly between lung adenocarcinoma (AC) and squamous cell lung carcinoma (SCC) samples. Furthermore, we developed and validated a novel 53-gene signature distinguishing SCC from AC with 93% accuracy. Evaluation of the classifier performance in the validation set showed that our predictor classified the AC patients with 100% sensitivity and 88% specificity. We revealed that gene expression patterns observed in the early stages of NSCLC may help elucidate the histological distinctions of tumors through identification of different gene-mediated biological processes involved in the pathogenesis of histologically distinct tumors. However, we showed here that the gene expression profiles did not provide additional value in predicting the progression status of the early-stage NSCLC. Nevertheless, the gene expression signature analysis enabled us to perform a reliable subclassification of NSCLC tumors, and it can therefore become a useful diagnostic tool for a more accurate selection of patients for targeted therapies.

Prognostic Value of Osteoprotegerin and sRANKL in Bronchoalveolar Lavage Fluid of Patients with Advanced Non-small Cell Lung Cancer

Osteoprotegerin (OPG) is a soluble decoy receptor for receptor activator of nuclear factor-kappa B ligand (sRANKL). OPG promotes endothelial cell survival and neoangiogenesis. Dysregulation of the OPG/RANKL system has been detected in several tumors. In the present study, we evaluated the clinical usefulness of OPG and sRANKL assessment in bronchoalveolar lavage fluid (BALF) of patients with advanced non-small cell lung cancer (NSCLC). We measured the concentration of OPG and sRANKL in BALF of 44 NSCLC patients and 15 healthy volunteers taken as control subjects. The OPG content was higher in the NSCLC group than that in controls [0.48 (0.12-1.45) vs. 0.23 (0.14-0.75) pmol/l; p = 0.0001]. There were no significant differences in sRANKL content between the NSCLC and control groups [1.22 (0.74-23.00) vs. 1.12 (0.79-4.39) pmol/l; p = 0.67]. However, we found that the greater the level of sRANKL in NSCLC patients, the shorter the overall survival. We found a correlation between the content of sRANKL and the percentage of lymphocytes in BALF of NSCLC patients (r = 0.52; p = 0.041). We conclude that NSCLC patients have a higher content of OPG in BALF than healthy people. A high level of sRANKL in BALF of NSCLC patients may predict worse survival.

Clinical Implications of Hepatocyte Growth Factor, Interleukin-20, and Interleukin-22 in Serum and Bronchoalveolar Fluid of Patients with Non-Small Cell Lung Cancer

Hepatocyte growth factor (HGF) is involved in tumorigenesis, interleukin-20 (IL-20) is an inhibitor of angiogenesis, and interleukin-22 (IL-22) stimulates tumor growth. The aim of this study was to determine the level of HGF, IL-20, and IL-22 in both serum and bronchoalveolar lavage fluid (BALF) of non-small cell lung cancer (NSCLC) patients before onset of chemotherapy, the nature of the interrelationships between these markers, and their prognostic significance regarding post-chemotherapy survival time. We studied 46 NSCLC patients and 15 healthy subjects as a control group. We found significantly higher serum levels of HGF and IL-22 in the NSCLC patients than those in controls [pg/ml: HGF - 1911 (693-6510) vs. 1333 (838-3667), p = 0.0004; IL-22 - 10.66 (1.44-70.34) vs. 4.69 (0.35-12.29), p = 0.0007]. In contrast, concentrations of HGF and IL-22 in BALF were lower in NSCLC patients than those in controls [pg/ml: HGF - 72 (6-561) vs. 488 (14-2003), p = 0.0002; IL-22 - 2.28 (0.70-6.52) vs. 3.72 (2.76-5.64), p = 0.002]. In the NSCLC patients, there was a negative correlation between the serum level of IL-20 and time to tumor progression (r = -0.405, p = 0.04) and between the serum level of HGF and survival time (r = -0.41, p = 0.005). In addition, a higher serum level of HGF and a higher BALF level of IL-22 in patients were linked with a shorter overall survival. We conclude that HGF, IL-20, and IL-22 in the serum and BALF of NSCLC patients before chemotherapy may be a prognostic of cancer progression.

Prognostic value of vascular endothelial growth factor-C and podoplanin mRNA expression in esophageal cancer

Vascular endothelial growth factor-C (VEGF-C), VEGF-D, VEGF receptor-3 (VEGFR-3) and podoplanin (PDPN) are involved in the spread of cancer. The current study evaluated VEGF-C, VEGF-D, VEGFR-3 and PDPN mRNA expression levels in 84 esophageal cancer samples from patients who had undergone surgery according to reverse transcription-quantitative polymerase chain reaction, and correlated the results with the clinicopathological features. The effects on lymph node metastasis and survival were identified by performing univariate and multivariate analyses. VEGF-C, PDPN, VEGF-D and VEGFR-3 were overexpressed in 52.4, 52.4, 32.1 and 51.2% of esophageal cancer samples, respectively. Furthermore, the expression of VEGF-C and PDPN was significantly correlated with lymph node metastasis, depth of tumor invasion and tumor stage (P<0.05). Logistic regression analysis identified tumor size (P=0.001), depth of invasion (P=0.002) and PDPN mRNA expression (P=0.022) as significant multivariable predictors of regional lymph node metastasis. Upon univariate survival analysis, the depth of tumor invasion, lymph node metastasis, histological grade, tumor stage, tumor size, residual tumor, and VEGF-C and PDPN mRNA expression were identified to be significant independent prognostic factors for overall survival (OS) time. Additionally, multivariate analysis identified tumor size (P=0.049), residual tumor (P<0.001) and PDPN mRNA expression (P=0.02) as independent factors for poor OS time. Thus, it was concluded that PDPN mRNA expression may serve as predictor for regional lymph node metastasis, and that VEGF-C and PDPN may be prognostic factors in patients with resected esophageal cancer.

Angiogenic axis angiopoietin-1 and angiopoietin-2/Tie-2 in non-small cell lung cancer: a bronchoalveolar lavage and serum study

Angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2), ligands for the Tie-2 receptor expressed on endothelial cells, play a critical role in angiogenesis, in concert with vascular endothelial growth factor (VEGF). Angiogenesis is important for tumor growth and development and also is implicated in the pathogenesis of interstitial lung diseases. The aim of this study was to evaluate the concentration of Ang-1, Ang-2, Tie-2, interleukin-18 (IL-18), transforming growth factor beta-1 (TGF β1), and VEGF domain in both serum and bronchoalveolar lavage fluid (BALF) of lung cancer patients before chemotherapy. We studied 45 non-small cell lung cancer (NSCLC) patients (M/F; 38/7; mean age 62 ± 4 years). The age-matched control groups consisted of 15 sarcoidosis (BBS), 15 hypersensivity pneumonitis (HP), and 15 healthy subjects. The patients with NSCLC had a significantly higher level of Ang-1 compared with the BBS and healthy subjects, and a higher level of Ang-2 compared with the healthy subjects in both serum and BALF. BALF level of IL-18 was lower in the NSCLC than that in the HP group, but higher than that in the BBS patients. Serum level of IL-18 was higher in the NSCLC than in the healthy subjects. The NSCLC group had lower VEGF in BALF than that in healthy subjects. Receiver-operating characteristics (ROC) curves were applied to find the cut-off the serum levels of Ang-1 and Ang-2 levels in BALF. We did not find any correlation between the levels of Ang-1, Ang-2, Tie-2, and the stage of tumor or treatment response (prospectively). We conclude that the angiogenic axis Ang-1 and Ang-2/Tie-2 may play an important role in lung cancer development and their concentrations may be a useful marker at the time of initial diagnosis of lung cancer.

Novel cytokines: IL-27, IL-29, IL-31 and IL-33. Can they be useful in clinical practice at the time diagnosis of lung cancer?

There are several antiproliferative and angiogenic factors, recently have been discovered (IL-27, IL-29, IL-31 and IL-33), but they have not been tested yet in lung cancer patients. The aim of this pilot study was to assess the clinical usefulness of determination of IL-27, IL-29, IL-31 and IL-33 in advanced stages of lung cancer.

PATIENTS AND METHODS

The study included 45 patients (38 males; mean age 62 years; 45 with advanced NSCLC). Serum and BALF cytokine concentrations were evaluated by ELISA method before chemotherapy. The comparative groups consisted of patients with sarcoidosis (BBS, n = 15), hypersensivity pneumonitis (HP, n = 8) and healthy subjects (n = 15).

RESULTS

The serum IL-29 levels were higher in NSCLC patients than in the sarcoidosis group. However, serum IL-27, IL-31 and IL-33 did not differ markedly between: NSCLC, BBS, HP and the control group. Concentrations of IL-29 and IL-31 in BALF did not differ significantly between investigated groups. In all groups levels of IL-27 and IL-29 are significantly higher in serum than in BALF. Concentrations of IL-31 in BBS, HP and control groups tended to higher in BALF than in serum. These differences were significantly in NSCLC patients. Patients in stage IIIB of NSCLC had higher serum levels of IL-29 than these in stage IV. Lung cancer patients with partial remission (PR) after chemotherapy had significantly higher concentration of IL-27 in BALF than patients with SD. However, patients with SD had higher levels of IL-29 in BALF than patients with PD. A negative correlation was found between serum IL-31 levels before therapy and time to progression of NSCLC.

CONCLUSION

Determination of IL-27, IL-29 and IL-31 in serum and BALF can be useful in clinical practice, but their practical significance needs further studies.

Vascular endothelial growth factor C and D expression correlates with lymph node metastasis and poor prognosis in patients with resected esophageal cancer

Vascular endothelial growth factors C (VEGF-C) and D (VEGF-D) are important lymphangiogenic factors in human cancers. We studied the expression of VEGF-C and VEGF-D using immunohistochemistry in 73 resected esophageal cancer specimens, and correlated the results with patient clinicopathologic features and survival. High expression of VEGF-C was identified in 40 (54.7%) patients, and it correlated positively with histological grade (p=0.038), tumor stage (p=0.01), depth of tumor invasion (p=0.036) and lymph node metastasis (p=0.001). In 48 of 73 (65.7%) tumors, the VEGF-D protein was also expressed at high levels. VEGF-D immunoreactivity significantly correlated with tumor location (p=0.027), size of tumor (p=0.015), histological grade (p=0.02), depth of invasion (p=0.001) and lymph node metastasis (p=0.018). In logistic multivariate analysis, high expression of VEGF-C (OR 1.941, 95% CI 1.263-7.289, p=0.024) was associated with lymph node metastasis. Calculating the prognostic relevance revealed that both VEGF-C and VEGF-D correlated with decreased overall survival (p=0.01, p=0.003), disease free survival (p=0.02, p=0.006), and cancer-specific survival (p=0.03, p=0.005). In conclusion, our results suggest that high levels of both VEGF-C and VEGF-D proteins are associated with lymph node involvement, and that VEGF-C expression is an independent predictor of risk for lymph node metastasis in esophageal cancer. In locally advanced disease, overexpression of VEGF-C and VEGF-D may be useful in identifying patients who are more likely to have a poor prognosis even after curative resection.

Serum levels of angiopoietin-1, angiopoietin-2, and their receptor tie-2 in patients with nonsmall cell lung cancer during chemotherapy

This pilot study was conducted to investigate the prognostic role and the effects of chemotherapy on serum angiogenic factors enzyme-linked immunosorbent assay consisting of Angiopoietin-1 and 2 (Ang-1, Ang-2) and their receptor Tie-2 in patients with advanced stage nonsmall cell lung cancer (NSCLC). Concentration of Ang-2 was higher in NSCLC (n= 40) than in healthy people (n= 15), whereas Ang-1 and Tie-2 were comparable. In our opinion determination of Ang-1, Ang-2, and Tie-2 concentrations have no clinical significance in the prognosis of the survival time in lung cancer and can not be used as a predictor of response to the chemotherapy.

Serum levels of sFas and sFasL during chemotherapy of lung cancer

THE AIM of this study was to assess the clinical usefulness of determination of soluble Fas (sFas) and soluble Fas Ligand (sFasL) during chemotherapy of lung cancer.

METHODS

The study included 80 patients (69 males; 11 females; mean age 64 years; 48 with non-small cell lung cancer-NSCLC, 32 with small cell lung cancer-SCLC). The control group consisted of 15 healthy volunteers. The peripheral blood samples were taken before and after 4 cycles of chemotherapy. sFas and sFasL levels were assessed by Elisa method.

RESULTS

The serum sFas and sFasL levels observed at the end of the chemotherapy were higher in all patients with lung cancer compared to healthy volunteers. The levels of sFas and sFasL were higher after chemotherapy than before therapy. The levels of sFasL were significantly higher in SCLC patients than in NSCLC ones. There were no significant differences in serum sFasL levels in relation to clinical stage of lung cancer. After chemotherapy the levels of sFas were higher in patients with metastases. There were no significant differences in serum sFasL levels in relation to response to therapy. At the end of the therapy the serum levels of sFas were higher in Partial Response group than in Progressed patients. Before chemotherapy the levels of sFas were higher in Progressive Disease group than in No Change one. The levels of sFas observed after chemotherapy were higher in Partial Response group than in No Change one.

CONCLUSION

Determination of serum sFas and sFasL levels can be useful in clinical practice, but their practical significance needs further studies.

Serum levels of VEGF-C, VEGF-D, and sVEGF-R2 in patients with lung cancer during chemotherapy

The aim of this study was to assess serum levels of vascular endothelial growth factor C and D (VEGF-C, VEGF-D) and soluble VEGF receptor 2 (sVEGFR-2) in patients with lung cancer during chemotherapy. The study included 80 patients (64 men and 16 women; mean age 61.1) diagnosed histologically with lung cancer. Forty-four (55%) had non-small cell lung cancer (NSCLC) and 36 (45%) had small cell lung cancer (SCLC). Squamous cell carcinoma was established in 56% (25 patients) of all patients with NSCLC, adenocarcinoma in 20% (9 patients), and non-small cell lung cancer in 23% (10 patients). The control group consisted of 20 healthy volunteers. Peripheral blood samples were taken before and after four cycles of chemotherapy. VEGF-C, VEGF-D, and sVEGFR-2 levels were assessed by ELISA method. Serum levels of VEGF-C and VEGF-D were significantly higher in both NSCLC and SCLC groups in comparison with controls. VEGF-C concentration decreased after chemotherapy, whereas VEGF-D concentration was at the same level. No correlation was found between VEGF-C and VEGF-D concentrations and the effect of treatment. Patients with lung cancer and progression after chemotherapy (PD) had the higher concentration of sVEGFR-2 than patients with partial remission (PR). The levels of sVEGFR-2 were lower before and after treatment than in controls. No relation was found between VEGF-C, VEGF-D, and sVEGFR-2 concentrations and the histological type and staging of lung cancer. Summing up, serum concentrations of VEGF-C and VEGF-D were higher in patients with lung cancer both before and after chemotherapy than in healthy controls, whereas sVEGFR-2 concentration was lower than in healthy controls. An increase in concentration of sVEGFR-2 during chemotherapy may suggest progression of the disease. However, it requires further examination.

Detection of DNA methylation in eucaryotic cells

The methods of molecular biology allow for analyzing the methylation pattern in the whole genome and in particular genes. We differentiate methylated sequences from unmethylated ones by means of cutting the genomic template with methylation-sensitive restriction enzymes or by sodium bisulfite DNA modification. Chemical modification precedes most quantitative and qualitative PCR techniques: MS-PCR, MS-nested PCR, Real-Time PCR, QAMA, HeavyMethyl, MSHRM. Restriction enzymes, on the other hand, may be used together with PCR or hybridisation methods (Southern blot and microarrays). PCRs are conducted with primers specific for methylated and unmethylated sequences and sometimes, similarly to hybridisation techniques, with specifically labeled probes or dyes intercalating to double-stranded nucleic acids. The most advanced methylation detection techniques (MALDI-TOF MS and HPLC) significantly reduce the amount of biological material used for tests, but they require specialist equipment.

DNA methylation in states of cell physiology and pathology

DNA methylation is one of epigenetic mechanisms regulating gene expression. The methylation pattern is determined during embryogenesis and passed over to differentiating cells and tissues. In a normal cell, a significant degree of methylation is characteristic for extragenic DNA (cytosine within the CG dinucleotide) while CpG islands located in gene promoters are unmethylated, except for inactive genes of the X chromosome and the genes subjected to genomic imprinting. The changes in the methylation pattern, which may appear as the organism age and in early stages of cancerogenesis, may lead to the silencing of over ninety endogenic genes. It has been found, that these disorders consist not only of the methylation of CpG islands, which are normally unmethylated, but also of the methylation of other dinucleotides, e.g. CpA. Such methylation has been observed in non-small cell lung cancer, in three regions of the exon 5 of the p53 gene (so-called "non-CpG" methylation). The knowledge of a normal methylation process and its aberrations appeared to be useful while searching for new markers enabling an early detection of cancer. With the application of the Real-Time PCR technique (using primers for methylated and unmethylated sequences) five new genes which are potential biomarkers of lung cancer have been presented.

Immunohistochemical markers of cancerogenesis in the lung

Lung cancer is the leading cause of cancer deaths for people of both sexes worldwide. Early diagnosis of precancer lesions may be of crucial significance to lowering lung cancer mortality. The World Health Organization has defined three preneoplastic lesions of the bronchial epithelium: squamous dysplasia and carcinoma in situ, atypical adenomatous hyperplasia and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. These lesions are believed to progress to squamous cell carcinoma, adenocarcinoma and carcinoid tumors, respectively. Apart from WHO classification, two other lesions such as bronchiolization and bronchiolar columnar cell dysplasia (BCCD) can be observed and thought to be preneoplastic lesions leading to adenocarcinoma. In this review we summarize the data of morphological and cell cycle related proteins changes in both central and peripheral compartments of lung. Many molecular changes, which accompany the multistep process of the development of invasive types of cancer, may be observed thanks to the application of immunohistochemical markers. A deeper knowledge of molecular and genetic changes accompanying pre-cancer states may show new directions of early diagnostics of cancer development.

Angiogenesis and Neoangiogenesis—The Role in Lung Cancer and Other Tumors

Nowe naczynia tworzone są w dwóch procesach: waskulogenezy i angiogenezy [...]

Serum Levels of IGF-I and IGFBP-3 in Patients With Lung Cancer During Chemotherapy

The aim of this study was to assess serum levels of insulin-like growth factors (IGF-I and IGFBP-3) in patients with lung cancer during chemotherapy. The study included 38 patients (33 males and 5 females; mean age 59.8) diagnosed histologically with lung cancer. Twenty-five patients (65%) had non-small cell lung cancer (NSCLC) and 13 patients (35%) had small cell lung cancer (SCLC). Squamous cell carcinoma was established in 30% (11 patients) of all patients with NSCLC, adenocarcinoma in 13% (5 patients), and non-small cell cancer in 36% (9 patients). The control group consisted of 10 healthy volunteers. Peripheral blood samples were taken before and after four cycles of chemotherapy. IGF-I and IGFBP-3 levels were assessed by ELISA method. Serum levels of IGF-I measured before chemotherapy were significantly higher in both NSCLC and SCLC groups in comparison with controls. No significant differences were observed in serum IGF-I levels before and after four cycles of chemotherapy. The levels were still high after chemotherapy in patients with NSCLC and SCLC. Serum levels of IGFBP-3 were markedly lower in patients with NSCLC both before and after treatment compared to controls. No significant differences were found in patients with NSCLC before and after cytoreduction treatment. Prior to treatment, serum IGFBP-3 levels were significantly lower in patients with SCLC in comparison with controls. After cytoreduction treatment, the levels were decreased when compared to controls but without statistical significance. In conclusion, both before and after chemotherapy serum levels of IGF-I were significantly higher, whereas IGFBP-3 levels were lower in patients with NSCLC and SCLC compared to controls. Chemotherapy had no influence on the serum levels of IGF-I and IGFBP-3. Neither a histological type of NSCLC nor clinical staging had any effect on the serum levels of IGF-I and IGFBP-3.

Serum endostatin levels in patients with lung carcinoma

The purpose of our study was to evaluate the clinical usefulness of serum endostatin levels during chemotherapy of lung cancer in relation to the histopathological type of the tumor, clinical stage and response to therapy.

MATERIALS AND METHODS

Serum concentrations of endostatin were determined in 37 patients (24 with non-small cell lung cancer and 13 with small cell lung cancer), 10 healthy subjects constituted controls. To determine endostatin levels (ELISA), venous blood samples were collected from each patient before treatment and after 4-6 courses of chemotherapy.

RESULTS

The serum concentrations of endostatin were found significantly higher in patients in comparison with controls (p=0.003). No statistically significant differences were established between the concentrations of endostatin with regard to such clinical features, as: performance status, clinical stage (III and IV) and histopathological type (non-small cell lung cancer and small cell lung cancer). The concentrations of endostatin did not change after chemotherapy. There was no change of endostatin concentration caused by the response to treatment.

CONCLUSIONS

The serum endostatin concentrations were elevated in lung cancer patients.

[Evaluation of some functions of polymorphonuclear granulocytes in lung cancer patients during chemotherapy]

Lung cancer (NSCLC and SCLC) is one of most frequent carcinoma. Lung cancer is at the top of the list of cancers causing mortality in males. Many patients are qualified to chemotherapy which causes neutropenia. The aim of this work was to evaluate the number and function of (phagocytosis, test of NBT reduction and MPO activity) of leukocytes in patients with lung cancer before chemotherapy, during leukopenia and after stimulation with granulocyte colony stimulating factor (G-CSF). Patients with lung cancer have increased number of leukocytes before the treatment. After chemotherapy the number of leukocytes decreases. Treatment with G-CSF increases the number of leukocytes but it doesn't increase their ability to phagocytosis and to NBT reduction.

Serum levels of IGF-I and IGF-II in patients with lung cancer during chemotherapy

The AIM of this study was to assess the influence of chemotherapy on the serum levels of IGF-I and IGF-II in patients with lung cancer.

METHODS

The study included 38 patients (33 males and 5 females) at mean age of 59.8, diagnosed histologically with lung cancer. Twenty five patients had non-small cell lung cancer (NSCLC) including 11 patients with squamous cell carcinoma (SCC), 5 patients with adenocarcinoma and 9 patients without an essential histological type of NSCLC. A total of 13 patients had small cell lung cancer (SCLC). The control group consisted of 10 healthy volunteers. The peripheral blood samples were taken before and after 4 cycles of chemotherapy. IGF-I and IGF-II levels were assessed by ELISA method.

RESULTS

Serum levels of IGF-I and IGF-II measured before chemotherapy were significantly higher in both NSCLC and SCLC groups in comparison with controls. There were no significant differences of serum levels of both growth factors before and after 4 cycles of chemotherapy. Serum levels of IGF-I and IGF-II were still high after chemotherapy in patients with NSCLC and SCLC. Patients with SCC and adenocarcinoma had similar serum levels of IGF-I and IGF-II without statistical differences.

CONCLUSION

Serum levels of IGF-I and IGF-II were significantly higher in patients with NSCLC and SCLC before chemotherapy than in controls. Chemotherapy had no influence on the serum levels of insulin-like growth factors (IGFs). Serum levels of IGF-I and IGF-II did not depend on a histological type of NSCLC either.

The epidemiology of asbestos-related diseases

Asbestos has been recognised as a potential health hazard since the 1940s. Of the two major species of asbestos; white asbestos (chrysotile) and blue asbestos (crocidolite), both of which are hazardous. The workers at extraction facilities are at the greatest risk of exposure to asbestos and, therefore, the development of asbestos-related diseases, commonly mesothelioma. However, other individuals at a high risk of exposure include asbestos-cement workers, insulation workers and ship-yard workers. Environmental exposure to asbestos can occur as a result of living in areas either characterised by natural outcrops of asbestos or asbestos-related materials, or those close to asbestos-producing or -using plants. Unfortunately, man-made fibre alternatives to asbestos, such as rock and slag-wool and glass wool, have also been shown to have a detrimental effect on human health. A characteristic of mesothelioma is that there is a long latency period (20-30 years) before the signs and symptoms of the disease become apparent. In addition, diagnosis of the disease can be difficult. The use of biological markers, such as tissue polypeptide antigen, may play a useful role in the early detection of the disease in individuals at risk.

[Circulating VEGF and its soluble receptor sVEGFR-1 in patients with lung cancer]

Angiogenesis plays an important role in the pathogenesis of lung cancer. This process is caused by the imbalance between stimulating and inhibiting agents. VEGF is a key stimulator having a biologic effect via two different receptors of tyrosine kinase: VEGF-R1 and VEGF-R2. A soluble form of sVEGF-R1 is a negative regulator of VEGF activity. The serum concentrations of VEGF, sVEGF-R1 were assayed in 24 patients with NSCLC and 13 patients with SCLC and 10 healthy volunteers by means of ELISA method. The serum concentrations of VEGF were significantly higher in patients than in controls (p=0.016). The concentration of sVEGF-R1 was not significantly different in patients and controls. No statistically significant differences were established between the concentrations of VEGF, and sVEGF-R1 with regard to such clinical features, as: performance staging, clinical staging (stage III vs. stage IV) and histological pattern (NSCLC vs. SCLC). The significantly higher VEGF concentrations were reported in patients with the tumor of more than 7.5 cm in the diameter (p=0.027). Analyzing the influence of the response to treatment on the concentrations of parameters examined, a significant increase in VEGF concentration was demonstrated in the case of disease progression (p=0.034). The concentrations of sVEGF-R1 did not change after treatment. No correlation was found between parameters examined.

Serum levels of interleukin-18 (IL-18) and soluble interleukin-2 receptor (sIL-2R) in lung cancer

PURPOSE

We evaluated the clinical usefulness of interleukin-18 (IL-18) and soluble interleukin-2 receptor (sIL-2R) during chemotherapy of lung cancer in relation to the histological type of the tumor, clinical stage, response to therapy and time survival.

MATERIAL AND METHODS

Serum levels of IL-18 and sIL-2R were determined in 73 patients (62 males; mean age 64 years; 41 with non-small cell lung cancer-NSCLC, 32 with small cell lung cancer-SCLC); 12 healthy subjects served as controls. To determine IL-18 serum concentrations (Elisa), venous blood samples were collected from each patient before and after chemotherapy.

RESULTS

The mean serum IL-18 level in all patients with lung cancer was significantly higher compared with healthy volunteers (p = 0.0001; NSCLC vs control p = 0.0001; SCLC vs control p = 0.004). In NSCLC group with stage IV the mean IL-18 level was significantly higher than those with stage IIIB (p = 0.04). Regarding tumor stage and response to therapy, no significant differences in IL-18 were observed. Using cut-off serum IL-18 concentration of 319.6 pg/ml, the prognoses of the two groups were different, but it was not statistically significant. The serum levels of sIL-2R in NSCLC patients were significantly higher than in controls (p = 0.018). There were no significant differences in serum sIL-2R levels in relation to clinical stage of lung cancer and response to therapy. The cut-off value between high and low serum sIL-2R concentration was defined as 582.27 U/ml. The difference in survival rate between the high and low sIL-2R groups was not significant.

CONCLUSIONS

Serum IL-18 and sIL-2R levels can be useful in clinical practice, but their practical significance needs further studies.

Serum levels of osteoprotegerin (OPG) and pro gastrin releasing peptide (ProGRP) during chemotherapy of lung cancer

The aim of our study was to evaluate the usefulness of serum OPG and ProGRP during chemotherapy of lung cancer in relation to the histological type of the tumour, its clinical stage and the response to therapy. The levels of OPG and ProGRP were determined in 39 patients (20 NSCLC, 19 SCLC) and 10 healthy subjects. Blood samples were collected from each patient before and after chemotherapy. OPG and ProGRP levels in all the patients with lung cancer were higher than those in the controls. ProGRP were higher in SCLC group than in those NSCLC. In NSCLC group (after chemotherapy), OPG level in patients with Stage IV tumour was higher than in those with Stage IIIB (p=0.03). OPG in ED SCLC were higher than those in LD SCLC (p=0.04). In SCLC group, ProGRP were higher in LD patients than those with ED (p=0.04). Concluding, the measuring of OPG and ProGRP in lung cancer patients may be useful in clinical practice.

K-ras codon 12 mutations may be detected in serum of patients suffering from adeno- and large cell lung carcinoma. A preliminary report

We investigated the presence of K-ras mutations in the serum of 40 patients with respectable stages of adeno- and large cell lung carcinomas. Mutations in codon 12 of the K-ras gene were examined by enriched PCR method in DNA extracts from surgical specimens and serum samples. K-ras mutations were detected in 20 (51%) of 39 analyzed tumours, and in 7 (35%) of 20 patients with K-ras gene mutation positive tumours, a mutation was found in the serum DNA. We also found K-ras mutation in two (10.5%) of 19 serum samples obtained from patients whose tumours were not found to harbor mutation and in one serum sample from patient without tumour sample available for investigation. All of the 14 control healthy persons were negative for serum DNA K-ras mutation assay. Although our results are preliminary they show that K-ras mutation may be detected in serum of patients suffering from adeno- and large cell lung carcinomas and confirm the suggestion that at least a part of a free-cell extracellular blood DNA in cancer patients has neoplastic origin and may become a noninvasive target for genetic investigations of lung cancer patients.

The clinical significance of serum soluble interleukin 2 receptor (sIL-2R) concentration in lung cancer

The activated mononuclear cells can release a soluble form of interleukin 2 receptor (sIL-2R) in the blood. Serum sIL-2R level is a sensitive and quantitative marker of circulating peripheral blood mononuclear cell activation. This molecule acts as an antagonist of IL-2-mediated responses. The present study was carried out to analyze the circulating levels of sIL-2R in lung cancer in relation to the histological type of the tumour, clinical stage, response to therapy, time survival for patients. The study included 62 patients (30 SCLC, 32 NSCLC) and 10 healthy subjects as controls. SIL-2R serum levels were measured with a sandwich enzyme immunoassay using commercial kits (ENDOGEN). The mean serum values of sIL-2R were significantly higher in cancer patients than in controls (p=0.01). There was no significant difference in relation to tumour histological type. Within the NSCLC chemotherapy group, sIL-2R mean levels observed at the end of chemotherapy were higher in the progressing patients than in the responding patients. The metastatic patients had higher levels of sIL-2R than those with locally limited disease. In the case of SCLC classified to extensive disease mean levels of sIL-2R were higher than SCLC classified to limited disease. The mean serum values of sIL-2R were significantly higher in weight loss patients than no weight ones (p=0.03). Within NSCLC group there was a correlation between sIL-2R mean levels and the age of patients (p=0.04). In SCLC group there was a correlation between levels of sIL-2R and time survival for patients (p=0.009).

P16INK4a point mutations and promoter hypermetylation in bronchial preneoplastic lesions

The aim of this study was to determine p16INK4a point mutations and promoter hypermethylation in tumour cells and bronchial preneoplastic lesions in 32 surgically resected lungs due to primary squamous cell carcinoma. P16 point mutations were detected in 1 (3%) and promoter hypermethylation in 12 (31%) of 32 squamous cell carcinomas. The status of p16 was further characterized in 38 premalignant lesions including squamous metaplasias without dysplasia, squamous metaplasias with mild, moderate and severe dysplasias and 4 carcinomas in situ. No p16 point mutations have been found in premalignant or CIS lesions. Methylation of p16 was detected in 1 of 8 (12.5%) cases of squamous metaplasias without dysplasia, in 1 of 10 (10%) cases of squamous metaplasias with mild dysplasia, in 1 of 9 (11%) cases of squamous metaplasia with moderate dysplasia and in 2 of 7 (28.5%) cases of severe dysplasias, as well as in 1 of 4 (25%) carcinomas in situ. This investigation indicates that P16INK4a supressor gene point mutations are rather late event and inactivation of this gene by promoter hypermethylation is early and likely critical in bronchial cancerogenesis.

K-ras codon 12 mutations detected with enriched PCR method in operable non-small cell lung cancer

Activated point mutations of the K-ras gene are one of the most common genetic alterations found in human malignancies, including lung cancer, and are largely limited to adenocarcinomas. Using a highly sensitive assay for codon 12 K-ras mutation detection, called enriched PCR, we investigated 130 radically resected stage I-IIIa non-small cell lung cancer (NSCLC). There were statistically less positive results for squamous cell carcinoma (1.3%) than for adenocarcinoma (42.4%) and large cell carcinoma (27.8%). No statistically significant association between results of K-ras mutations and TNM stage of disease was found. In stage I of adenocarcinoma patients the incidence of K-ras mutations was similar to that in stage II or IIIa (40%, 42.9% and 42.9%, respectively). The results of our study showed that K-ras mutations might play an important role in pathogenesis of pulmonary adenocarcinoma due to its high prevalence in the operable tumours.

Endothelial cells and angiogenesis intensity in lung cancer

We focused our studies on single endothelial cells (ECs) scattered in extracellular matrix in lung cancer tumors. Neovascularization was evaluated in 100 tumors obtained from patients operated for lung cancer, in relation to histological type, tumor differentiation and clinical stage of the disease. Angiogenic objects (single endothelial cells and microvessels) were identified by immunohistochemistry using monoclonal antibodies against von Willebrand factor. The count of angiogenic objects per 1 mm2 in each section was determined in a "hot spot" located at the margin of the tumor. We used an arbitrary scale of angiogenesis intensity: 1 - 0-200, 2 - 201-400, 3 - >400 angiogenic objects/mm2. A majority (57%) of the examined cases belonged to the group 2. The angiogenesis intensity measured by the single EC numbers/mm2 correlates with the histological type and the differentiation of the tumors. There was no such a correlation when the angiogenesis intensity was measured by counting total angiogenic objects (microvessels + EC) number/mm2. Single EC number/mm2 in different histological types of cancer were as follows: 162+/-121 in squamous cell (SqCC), 194+/-71 in adenocarcinoma (AdC), 225+/-145 in large cell (LCC), 264+/-52 in small cell (SCC), 279+/-173 in combined cancer. The differences between the EC counts in the different histological types of lung cancers were statistically significant in the following pairs: SqCC vs SCC (p=0.0233) and AdC vs SCC (p=0.0409). The correlation between EC count in the "hot spot" and the grade of tumor differentiation was statistically significant for G1 vs G4 (p=0.0007) and G1 vs G2 (p=0.0411). Our results suggest that higher numbers of EC/mm2 may confirm rapid development of angioneogenesis. These relations should be examined in larger series of cases.

[Allergic broncho-pulmonary tuberculosis--a case without bronchial asthma]

Aspergillus fumigatus can cause a number of lung diseases. One of them is allergic bronchopulmonary aspergillosis (ABPA) characterized by pulmonary eozynophilia, asthma, an allergic type of immune response in the bronchi and proximal bronchiectases. ABPA was recognised in 28-years old man (round shadows in the lung, obturated bronchus with mucoid impaction, positive skin tests with aspergillin and presence of precipitins to Aspergillus fumigatus, elevated serum IgE level). Patient was treated for 6 months with corticosteroids. After 2 years of regression there was an exacerbation of ABPA was recognised. The steroid therapy was repeated.

Morphological aspects of carcinogenesis in the lung

The origins of the various histological types of primary lung cancer are not well understood. Numerous recent studies have indicated that lung cancer is not a result of a sudden transforming event in the bronchial and alveolar epithelium and in the neuroendocrine cells, but a multistep process in which a sequence of morphological and genetic changes is occurring. New modern technical approaches like fluorescence bronchoscopy techniques and microdissection, provide facilities to obtain valuable specimens for morphological and genetic verification of the sequentional changes in lung cancerogenesis. With their help, cells with morphologically recognized changes thought to be preneoplastic, may be removed and prepared for molecular and genetic studies. Therefore, the knowledge of the morphological aspects of lung preneoplastic lesions is crucial to make progress in molecular studies of lung carcinogenesis. Presently the knowledge about the sequence of molecular events in the lung carcinogenesis and their relationship to morphology is not perfect. In this review we will describe morphological aspects of various preneoplastic lesions occurring in the bronchial and bronchiolo-alveolar compartments including neuroendocrine cells.

Morphological and molecular aspects of cancerogenesis in the lung

Morphology and some molecular aspects of hyperplastic (bronchial basal cell hyperplasia and alveolar cell hyperplasia), metaplastic (squamous metaplasia), preneoplastic and early neoplastic (dysplasia in squamous metaplasia, cancer in situ and atypical alveolar cell hyperplasia) changes were studied in 180 lungs resected due to non-small cell lung cancer: 106 cases (58.9%) of squamous cell carcinoma, 42 (23.3%) of adenocarcinoma and 32 (17.8%) of large cell carcinoma. P53 protein and PCNA expressions were detected immunohistochemically (using formalin-fixed, paraffin-embedded sections). DNA extracted from the microdissected P53-positive cells was analysed for point mutations in the P53 gene. No P53 immunostaining was observed in normal mucosa, hyperplasia of basal cells, squamous metaplasia without and with minor and moderate dysplasia of bronchial mucosa as well as alveolar cell hyperplasia. Overexpression of P53 protein occurred in 3 out of 12 (25%) cases of severe bronchial dysplasia, 5 out of 11 (45.5%) cases of intraepithelial carcinoma and 6 out of 45 (13.3%) cases of alveolar cell hyperplasia. Using direct sequencing, mutations in the P53 gene were detected in 11 out of 14 (87%) P53-immunopositive samples, including all severe dysplasias, all carcinomas in situ and 3 of 6 alveolar cell hyperplasias. A significant association was observed between PCNA expression and preinvasive as well as invasive lesions. The data clearly show that lung resected due to primary cancer ought to be treated as "field cancerization" in which one can find early morphologic events of multi-step cancerogenesis. P53 protein alterations and P53 gene mutations can occur before invasion and its frequency depends on the degree of dysplasia.

Detection of human papillomavirus in non-small cell lung carcinoma by polymerase chain reaction

Human papillomavirus (HPV) infection is one of the risk factors contributing to the pathogenesis of lung cancer. The aim of the study was to determine the presence of HPV in non-small cell carcinomas of the lung. The study included 40 tumors: 22 squamous cell carcinomas, 13 adenocarcinomas and 5 large cell carcinomas. HPV was found in 4 cases (10%). High risk HPV was present in 3 tumors: in one squamous cell carcinoma, one large cell carcinoma and one adenocarcinoma, while low risk HPV was detected in one adenocarcinoma.