Curbing the burden of lung cancer

Tracheal, bronchus, and lung cancer among older adults: thirty-year global burden trends, precision medicine breakthroughs, and lingering barriers

BACKGROUND

Tracheal, bronchial, and lung (TBL) cancer presents significant health challenges for individuals aged 70 and older. However, comprehensive insights into the epidemiological patterns of and risk factors for TBL cancer in this population remain limited. This study aimed to analyze the global, regional, and national burdens and trends of TBL cancer patients aged ≥ 70 years from 1990-2021.

METHODS

The incidence, mortality, and disability-adjusted life years (DALYs) for TBL cancer patients aged ≥ 70 years from 1990-2021 were obtained from the 2021 Global Burden of Disease study. Global trends were stratified age, sex, and sociodemographic index (SDI). Decomposition analysis identified the primary drivers of burden changes, and a global risk attribution analysis was conducted. The Bayesian Age‒Period‒Cohort (BAPC) model forecasted trends over the next 14 years. The analyses were performed with Joinpoint software and the R software.

RESULTS

From 1990-2021, the ASIRs, ASMRs, and ASDRs of TBL cancer among patients ≥ 70 years increase significantly, mainly due to aging and population growth. In the precision medicine era (2015-2021), these indicators for both sexes and males have declined, but the burden among females has increased. The burden varies across regions, with the incidence of TBL cancer increasing more severely in middle-SDI regions, East Asia, and western sub-Saharan Africa, whereas high-SDI regions have shown a decline after peaking. Although the DALY proportion of smoking decreased, it was still the main cause of TBL cancer. However, the burden of environmental particulate pollution has increased. The BAPC model predicted that in the future, the ASIR, ASMR, and ASDR for males and both sexes would decrease, whereas these indicators would either remain stable or increase among females.

CONCLUSIONS

The burden of TBL cancer is increasing significantly among patients aged ≥ 70 years. Despite new hopes and approaches from precision medicine, environmental and behavioral factors still critically influence the TBL cancer burden. Future strategies could enhance subgroup-specific management and promote effective control of known risk factors.

The Top 100 Most Frequently Cited Publications Concerning Anti-PD-1/PD-L1 Therapy for Lung Cancer: A Bibliometric Analysis

Background

Globally lung cancer is one of the most common cancers, and is responsible for almost 20% of all cancer care costs. As a potential treatment for lung cancer, anti-PD-1/PD-L1 therapy has become a novel scientific hotspot in recent decades. The present study aims at exploring the status and trends of the top frequently cited publications about the anti-PD-1/PD-L1 therapy for lung cancer via bibliometric analysis.

Methods

The publications concerning anti-PD-1/PD-L1 therapy for lung cancer were searched on the core collection database of Web of Science, setting the time period for retrieval from 1950 to 2019. The top 100 most frequently cited publications were retrieved, and the bibliometric data were mainly accessed through an open online analysis platform and VOSviewer software.

Results

The cited frequencies about the top 100 cited publications ranged from 218 to 6248. These articles were published in 39 publications, which were mainly ranked in Q1. The top journal in terms of the number of the articles was the New England Journal of Medicine (16 articles). The most frequently nominated author was Brahmer, JR from Sidney Kimmel Comprehensive Cancer Center, while the most contributing institution was Memorial Sloan Kettering Cancer. The United States acted as the pioneer in this new field of research and led plentiful of national and international co-operations. Immunotherapy, nivolumab, cell lung-cancer, safety, and docetaxel appeared more frequently as keywords.

Discussions

To sum up, high quality journals, influential authors and institutions and research with high quality evidence were apt to attract more attention and possess more public credibility. Moreover, the bibliometric analysis is yielding up its advantage of identifying and analyzing the characteristics and changes in the intellectual structures of a special topic.

Temporal trends of the lung cancer mortality attributable to smoking from 1990 to 2017: A global, regional and national analysis

OBJECTIVES

Understanding the global trend of lung cancer deaths attributable to smoking is crucial for prioritizing global lung cancer prevention, as well as tobacco control. We assessed patterns of smoking-induced lung cancer deaths at global, regional, and national levels from 1990 to 2017.

MATERIALS AND METHODS

We extracted detailed data on lung cancer deaths attributable to smoking from the Global Burden of Disease 2017 Study. The estimated annual percentage change (EAPC) was used to quantify temporal trends in the age-standardized mortality rate (ASMR) of smoking-induced lung cancer.

RESULTS

In 2017, estimated 1.19 million lung cancer deaths were attributable to smoking, accounting for 63.17 % of all lung cancer deaths. The corresponding ASMR decreased by 13.36 % from 17.29/100,000 in 1990 to 14.98/100,000 in 2017, with an EAPC of -0.59 (95 % confidence interval: -0.66, -0.53). The ASMR of lung cancer in most geographic regions has significantly decreased since 1990; however, the EAPC of ASMR in 20 countries exceeded 1 during the same period. The reductions in the ASMR were pronounced in areas with high Socio-demographic Index and high disease burden, and kept pace with the decrease of smoking prevalence at least 10 years ago.

CONCLUSION

Despite the decline in lung cancer ASMR attributable to smoking over the past 28 years, the corresponding number of lung cancer deaths increased steadily due to population aging and growth. Tobacco prevention needs to be strengthened, especially in countries with high smoking prevalence and countries where the ASMR of smoking-induced lung cancer is increasing.

Overexpression of FYN suppresses the epithelial-to-mesenchymal transition through down-regulating PI3K/AKT pathway in lung adenocarcinoma

BACKGROUND

Tyrosine-protein kinase Fyn (FYN) plays a crucial role in Src family, which participates in the signal transduction of brain nerves and the development and activation of T lymphocytes in physiological conditions. We probed into the roles and mechanisms of FYN in lung adenocarcinoma (LUAD).

METHODS

Cell activity, apoptosis, invasion, and migration were detected by CCK-8, FCM, transwell, and wound-healing assays, respectively. The angiogenesis capacity was evaluated by in vitro angiogenesis test. Relative mRNA and protein expressions were determined by qRT-PCR, Western blot, and immunohistochemistry assays, respectively. Insulin-like growth factors-I (IGF-I) was used as an agonist of PI3K/AKT pathway.

RESULTS

We demonstrated that FYN expression correlated with LUAD prognosis and was down-regulated in LUAD tissues and LUAD cells. Overexpression of FYN suppressed the cell viability, together with invasion and migration abilities of A549 cells. FYN overexpression accelerated the cell apoptosis and reduced the angiogenesis capacity of A549 cells. Overexpression of FYN suppressed E-cadherin, Vimentin, Snail, and PI3K/AKT expressions in A549 cells. High expression level of FYN reduced the migration and invasion capacities of A549 cells via down-regulating the PI3K/AKT pathway.

CONCLUSION

Collectively, our findings reveal that overexpression of FYN inhibits the epithelial-to-mesenchymal transition (EMT) through down-regulating the PI3K/AKT pathway in A549 cells.

A 10-year prediagnostic follow-up study shows that serum RNA signals are highly dynamic in lung carcinogenesis

The majority of lung cancer (LC) patients are diagnosed at a late stage, and survival is poor. Circulating RNA molecules are known to have a role in cancer; however, their involvement before diagnosis remains an open question. In this study, we investigated circulating RNA dynamics in prediagnostic LC samples, focusing on smokers, to identify if and when disease-related signals can be detected in serum. We sequenced small RNAs in 542 serum LC samples donated up to 10 years before diagnosis and 519 matched cancer-free controls coming from 905 individuals in the Janus Serum Bank. This sample size provided sufficient statistical power to independently analyze time to diagnosis, stage, and histology. The results showed dynamic changes in differentially expressed circulating RNAs specific to LC histology and stage. The greatest number of differentially expressed RNAs was identified around 7 years before diagnosis for early-stage LC and 1-4 years prior to diagnosis for locally advanced and advanced-stage LC, regardless of LC histology. Furthermore, NSCLC and SCLC histologies have distinct prediagnostic signals. The majority of differentially expressed RNAs were associated with cancer-related pathways. The dynamic RNA signals pinpointed different phases of tumor development over time. Stage-specific RNA profiles may be associated with tumor aggressiveness. Our results improve the molecular understanding of carcinogenesis. They indicate substantial opportunity for screening and improved treatment and will guide further research on early detection of LC. However, the dynamic nature of the RNA signals also suggests challenges for prediagnostic biomarker discovery.

PTX-loaded three-layer PLGA/CS/ALG nanoparticle based on layer-by-layer method for cancer therapy

Poly (lactic-co-glycolic acid) (PLGA) nanoparticles are an ideal paclitaxel (PTX)-carrying system due to its biocompatibility and biodegradability. But it possessed disadvantage of drug burst release. In this research, a layer-by-layer deposition of chitosan (CS) and sodium alginate (ALG) was applied to modify the PLGA nanoparticles. The surface charges and morphology of the PLGA, PLGA/CS and PLGA/CS/ALG particles was measured by capillary electrophoresis and SEM and TEM, respectively. The drug encapsulation and loading efficiency were confirmed by ultraviolet spectrophotometer. The nanoparticles were stable and exhibited controlled drug release performance, with good cytotoxicity to human lung carcinoma cells (HepG 2). Cumulatively, our research suggests that this kind of three-layer nanoparticle with LbL-coated shield has great properties to act as a novel drug-loaded system.

Effect of early palliative care on quality of life in patients with non-small-cell lung cancer

Background

Patients with metastatic non-small-cell lung cancer (nsclc) experience great pain and stress. Our study aimed to explore the effect of early palliative care on quality of life in patients with nsclc.

Methods

A total of 150 patients were randomly divided into two groups: control group with conventional care and study group with early palliative care. The quality of life (qol) rating scale and self-rating scale of life quality (sslq) were used to analyze the patients' quality of life. The Hospital Anxiety and Depression Scale-D/A (hads-d/a) and Patient Health Questionnaire 9 (phq-9) were used to analyze the patients' mood. Pulmonary function indexes of peak expiratory flow (pef), functional residual capacity (frc), and trachea-esophageal fistula 25% (tef 25%) were analyzed using the lung function detector.

Results

The qol and sslq scales scores of patients receiving early palliative care were significantly higher than those in the control group (p < 0.05). Moreover, the questionnaire results of the hads-d/a and phq-9 were better in patients receiving palliative care than in the control group (p < 0.05 or p < 0.01). In addition, analytical results of pulmonary function showed that the levels of pef, frc, and tef 25% in patients assigned to early palliative care were remarkably higher than those in the control group (p < 0.01 or p < 0.001).

Conclusions

These data demonstrate that early palliative care improves life quality, mood, and pulmonary function of nsclc patients, indicating that early palliative care could be used as a clinically meaningful and feasible care model for patients with metastatic nsclc.

SH2B1 promotes epithelial-mesenchymal transition through the IRS1/β-catenin signaling axis in lung adenocarcinoma

Lung adenocarcinoma (LADC), the most prevalent type of human lung cancer, is characterized by many molecular abnormalities. SH2B1, a member of the SH2‐domain containing family, have recently been shown to act as tumor activators in multiple cancers, including LADC. However, the mechanisms underlying SH2B1 overexpression are not completely understood. Here, we reported that SH2B1 expression levels were significantly upregulated and positively associated with EMT markers and poor patient survival in LADC specimens. Modulation of SH2B1 levels had distinct effects on cell proliferation, cell cycle, migration, invasion, and morphology in A549 and H1299 cells in vitro and in vivo. At the molecular level, overexpression of SH2B1 resulted in the upregulation of the EMT markers, especially induced β‐catenin accumulation and activated β‐catenin signaling to promote LADC cell proliferation and metastasis, while silencing SH2B1 had the opposite effect. Furthermore, ectopic expression of SH2B1 in H1299 cells increased IRS1 expression level. Reduced expression of IRS1 considerably inhibited H1299 cell proliferation, migration, and invasion which were driven by SH2B1 overexpression. Collectively, these results provide unequivocal evidence to establish that SH2B1‐IRS1‐β‐catenin axis is required for promoting EMT, and might prove to be a promising strategy for restraining tumor progression in LADC patients.

Long-term survival of early-stage non-small cell lung cancer patients who underwent robotic procedure: a propensity score-matched study

Background

In the past decade, many researchers focused on to robot-assisted surgery. However, on long-term outcomes for patients with early-stage non–small cell lung cancer (NSCLC), whether the robotic procedure is superior to video-assisted thoracic surgery (VATS) and thoracotomy is unclear. Nonetheless, in the article titled “Long-term survival based on the surgical approach to lobectomy for clinical stage I non–small cell lung cancer: comparison of robotic, video assisted thoracic surgery, and thoracotomy lobectomy” by Yang et al. that was recently published in Annals of Surgery, the authors provided convincing evidence that the robotic procedure results in similar long-term survival as compared with VATS and thoracotomy. Minimally invasive procedures typically result in shorter lengths of hospital stay, and the robotic procedure in particular results in superior lymph node assessment.

Main body

Our propensity score-matched study generated high-quality data. Based on our findings, we see promise in expanding patient access to robotic lung resections. In this study, propensity score matching minimized the bias involved between groups. Nevertheless, due to its retrospective nature, bias may still exist. Currently, the concept of rapid rehabilitation is widely accepted, and it is very difficult to set up a randomized controlled trial to compare robotic, VATS, and thoracotomy procedures for the treatment of NSCLC. Therefore, to overcome this limitation and to minimize bias, the best approach is to use a registry and prospectively collected, propensity score-matched data.

Conclusions

Robotic lung resections result in similar long-term survival as compared with VATS and thoracotomy. Robot-assisted and VATS procedures are associated with short lengths of hospital stay, and the robotic procedure in particular results in superior lymph node assessment. Considering the alarming increase in the incidence of lung cancer in China, a nationwide database of prospectively collected data available for clinical research would be especially important.