Lung cancer: epidemiology, etiology, and prevention

CircRUNX1 enhances the Warburg effect and immune evasion in non-small cell lung cancer through the miR-145/HK2 pathway

Non-small cell lung cancer (NSCLC) is acknowledged as the primary subtype of lung cancer. The Warburg effect, marked by elevated glucose consumption and lactate fermentation, is a prevalent characteristic of NSCLC. The mechanisms by which circRNA mediates the regulation of the Warburg effect and immune evasion in NSCLC remain unclear. This study found an elevated circRNA, circRUNX1, whiche promotes glycolysis and lactate generation, resulting in the infiltration of regulatory T cell (Treg) in NSCLC. circRUNX1 acts as a miR-145 sponge, inhibiting its negative regulation of the target gene HK2, therefore facilitating glycolysis and lactate generation. The accumulation of lactic acid in the tumor microenvironment promotes Treg cell proliferation and aids immune evasion. Functionally, the suppression of circRUNX1 significantly impedes tumor development both in vitro and in vivo. These findings collectively clarity a previously unexamined mechanism linking the circRUNX1/miR-145/HK2 axis in regulation of the Warburg effect and immune evasion in NSCLC.

Smoking induces different expression of miR-320b and miR-10b-5p in plasma extracellular vesicles of non-small cell lung cancer patients

Background

Previous studies found that cigarette smoke (CS) exposure could induce NSCLC malignancy and miRNA dysregulation. Yet, the association of CS-induced miRNA dysregulation and NSCLC malignancy has not been clearly understood. This study aimed to evaluate the effect of CS exposure in smokers on the expression of miR-10b-5p and miR-320b in extracellular vesicles (EVs) from NSCLC patients.

Material and methods

Bioinformatic analysis was conducted to validate miRNA candidates. Blood and tissue samples were collected from NSCLC patients (n = 21) with smoking and non-smoking history. EVs were isolated from plasma and miRNAs were extracted from the isolated EVs. The miRNAs relative expression was analyzed and compared.

Results

In silico analysis identified miR-320b and miR-10b-5p as potential biomarkers for diagnosing NSCLC in smokers. Experimental analysis revealed differential expression of EVs-associated miRNAs in NSCLC patients with smoking and non-smoking histories. EVs-associated miR-10b-5p was significantly overexpressed in smoker NSCLC patients (p = 0.000), while miR-320b expression was significantly lower in this group (p = 0.018). Additionally, smoking intensity influenced miRNA expression, with higher smoking intensity correlating with increased miR-10b-5p expression and decreased miR-320b expression. ROC analysis demonstrated that EVs were a superior source of miRNAs compared to plasma for NSCLC diagnostics. miR-10b-5p and miR-320b in EVs showed higher diagnostic performance (AUC 0.878; 0.739) compared to plasma (AUC 0.628; 0.559).

Conclusion

CS exposure induces different expression of miR-10b-5p and miR-320b in EVs of NSCLC patients with smoking history. EV-related miR-10b-5p and miR-320b showed potential to be utilized as prognostic biomarker for smokers NSCLC patients.

Isolation, characterization and therapeutic potentials of exosomes in lung cancer: Opportunities and challenges

Lung cancer (LC) signifies the primary cause of cancer-related mortality, representing 24 % of all cancer fatalities. LC is intricate and necessitates innovative approaches for early detection, precise diagnosis, and tailored treatment. Exosomes (EXOs), a subclass of extracellular vesicles (EVs), are integral to LC advancement, intercellular communication, tumor spread, and resistance to anticancer therapies. EXOs represent a viable drug delivery strategy owing to their distinctive biological characteristics, such as natural origin, biocompatibility, stability in blood circulation, minimal immunogenicity, and potential for modification. They can function as vehicles for targeted pharmaceuticals and facilitate the advancement of targeted therapeutics. EXOs are pivotal in the metastatic cascade, facilitating communication between cancer cells and augmenting their invasive capacity. Nonetheless, obstacles such as enhancing cargo loading efficiency, addressing homogeneity concerns during preparation, and facilitating large-scale clinical translation persist. Interdisciplinary collaboration in research is crucial for enhancing the efficacy of EXOs drug delivery systems. This review explores the role of EXOs in LC, their potential as therapeutic agents, and challenges in their development, aiming to advance targeted treatments. Future research should concentrate on engineering optimization and developing innovative EXOs to improve flexibility and effectiveness in clinical applications.

Lung lesion detectability on images obtained from decimated and CNN-based denoised [18F]-FDG PET/CT scan: an observer-based study for lung-cancer screening

PURPOSE

To assess feasibility of lung cancer screening, we analysed lung lesion detectability simulating low-dose and convolutional neural network (CNN) denoised [18F]-FDG PET/CT reconstructions.

METHODS

Retrospectively, we analysed lung lesions on full statistics and decimated [18F]-FDG PET/CT. Reduced count PET data were emulated according to various percentage levels of total. Full and reduced statistics datasets were denoised using a CNN algorithm trained to recreate full statistics PET. Two readers assessed a detectability score from 3 to 0 for each lesion. The resulting detectability score and quantitative measurements were compared between full statistics and the different decimation levels (100%, 30%, 5%, 2%, 1%) with and without denoising.

RESULTS

We analysed 141 lung lesions from 49 patients across 588 reconstructions. The dichotomised lung lesion malignancy score was significantly different from 10% decimation without denoising (p < 0.029) and from 5% decimation with denoising (p < 0.001). Compared to full statistics, detectability score distribution differed significantly from 2% decimation without denoising (p < 0.001) and from 5% decimation with denoising (p < 0.001). Detectability scores at same decimation levels with or without denoising differed significantly at 10%, 2%, and 1% decimation (p < 0.019); dichotomised scores did not differ significantly. Denoising significantly increased the proportion of lung lesion scores with a high diagnostic confidence (3 and 0) (p < 0.038).

CONCLUSION

Lung lesion detectability was preserved down to 30% of injected activity without denoising and to 10% with denoising. These results support the feasibility of reduced-activity [18F]-FDG PET/CT as a potential tool for lung lesion detection. Further studies are warranted to compare this approach with low-dose CT in screening settings.

Intratumor fungi specific mechanisms to influence cell death pathways and trigger tumor cell apoptosis

Cancer, uncontrolled cell growth due to the loss of cell cycle regulation, is often found to be associated with viral infections and, as recent studies show, with bacterial infections as well. Emerging reports also suggest a strong link between fungi and cancer. The crucial virulence trait of fungi, the switch from yeast (Y) to hyphal (H) form, is found to be associated with carcinogenesis. The physicochemical properties and signal transduction pathways involved in the switch to the hyphal form overlap with those of tumor cell formation. Inhibiting differentiation causes apoptosis in fungi, whereas preventing apoptosis leads to cancer in multicellular organisms. Literature on the fungi-cancer linkage, though limited, is increasing rapidly. This review examines cancer-specific fungal communities, the impact of fungal microbiome on cancer cell progression, similarities between fungal differentiation and cells turning cancerous at biochemical and molecular levels, including the overlaps in signal transduction pathways between fungi and cancer. Based on the available evidence, we suggest that molecules inhibiting the yeast-hyphal transition in fungi can be combined with those targeting tumor cell apoptosis for effective cancer treatment. The review points out fertile research areas where mycologists and cancer researchers can collaborate to unravel common molecular mechanisms. Moreover, antibodies targeting fungal-specific chitin and glucan can be used for the selective neutralization of tumor cells. These new combinations of potential therapies are expected to facilitate the development of target-specific, less harmful and commercially feasible anticancer therapies. We bring together available evidence to argue that fungal infections could either trigger cancer or have a significant role in the development and progression of cancer. Hence, cancer-associated fungal populations could be utilized as a target for a combination therapy involving the integration of anticancer and antifungal drugs as well as inhibitors of fungal morphogenesis to develop more effective anticancer therapies.

Treatment of lung diseases via nanoparticles and nanorobots: Are these viable alternatives to overcome current treatments?

Challenges

Respiratory diseases remain challenging to treat, with current efforts primarily focused on managing symptoms rather than maintaining overall lung health. Traditional treatment methods, such as oral or parenteral administration of antiviral, antibacterial, and anti-inflammatory drugs, face limitations. These include difficulty in delivering therapeutic agents to pathogens residing deep in the airways and the risk of severe side effects due to high systemic drug concentrations. The growing threat of drug-resistant pathogens further complicates infection management.

Advancements

The lung's large surface area offers an attractive target for inhalation-based drug delivery. Nanoparticles (NP) enable uniform and sustained drug distribution across the alveolar network, overcoming challenges posed by complex lung anatomy. Recent breakthroughs in nanorobots (NR) have demonstrated precise navigation through biological environments, delivering therapies directly to affected lung areas with enhanced accuracy. Nanotechnology has also shown promise in treating lung cancer, with nanoparticles engineered to overcome biological barriers, improve drug solubility, and enable controlled drug release.

Future scope

This review explores the progress of NP and NR in addressing challenges in pulmonary drug delivery. These innovations allow targeted delivery of nucleic acids, drugs, or peptides to the pulmonary epithelium with unprecedented accuracy, offering significant potential for improving therapeutic effectiveness in respiratory disorders.

Clinical TNM Lung Cancer Staging: A Diagnostic Algorithm with a Pictorial Review

Lung cancer is a prevalent malignant disease with the highest mortality rate among oncological conditions. The assessment of its clinical TNM staging primarily relies on contrast-enhanced computed tomography (CT) of the thorax and proximal abdomen, sometimes with the addition of positron emission tomography/CT scans, mainly for better evaluation of mediastinal lymph node involvement and detection of distant metastases. The purpose of TNM staging is to establish a universal nomenclature for the anatomical extent of lung cancer, facilitating interdisciplinary communication for treatment decisions and research advancements. Recent studies utilizing a large international database and multidisciplinary insights indicate a need to update the TNM classification to enhance the anatomical categorization of lung cancer, ultimately optimizing treatment strategies. The eighth edition of the TNM classification, issued by the International Association for the Study of Lung Cancer (IASLC), transitioned to the ninth edition on 1 January 2025. Key changes include a more detailed classification of the N and M descriptor categories, whereas the T descriptor remains unchanged. Notably, the N2 category will be split into N2a and N2b based on the single-station or multi-station involvement of ipsilateral mediastinal and/or subcarinal lymph nodes, respectively. The M1c category will differentiate between single (M1c1) and multiple (M1c2) organ system involvement for extrathoracic metastases. This review article emphasizes the role of radiologists in implementing the updated TNM classification through CT imaging for correct clinical lung cancer staging and optimal patient management.

Estimated worldwide variation and trends in incidence of lung cancer by histological subtype in 2022 and over time: a population-based study

BACKGROUND

Lung cancer is the most common cancer worldwide, yet the current epidemiological profile of lung-cancer incidence by histological subtype is only partly understood. We aimed to assess geographical variation in incidence of lung cancer by subtype worldwide in 2022, geographical variation in adenocarcinoma incidence attributable to ambient particulate matter (PM) pollution worldwide in 2022, temporal trends in lung-cancer incidence by subtype from 1988 to 2017 in 19 countries, and generational changes.

METHODS

For this population-based study, we used data from the Global Cancer Observatory (GLOBOCAN) 2022, Cancer Incidence in Five Continents Volumes VII-XII, and members of the African Cancer Registry Network. To obtain national estimates of lung cancer in 2022 for the four main histological subtypes (ie, adenocarcinoma, squamous cell carcinoma [SCC], small-cell carcinoma, and large-cell carcinoma) by year, sex, and age group, we combined national estimates with representative, subsite-specific incidence proportions of lung cancer on the basis of recorded incidence data compiled in Cancer Incidence in Five Continents Volume XII and from members of the African Cancer Registry Network. We calculated country-specific, sex-specific, and age-specific proportions of and sex-specific and age-specific incidence rates per 100 000 people for all four histological subtypes. To account for differences in age composition between populations by country, we calculated age-standardised incidence rates (ASRs) per 100 000 people for lung cancer by subtype and sex at national and regional levels. We also quantified the burden of adenocarcinoma incidence attributable to ambient PM pollution for 179 countries in 2022. We conducted joinpoint regression and age-period-cohort analysis to assess temporal trends in ASRs in 19 countries by sex.

FINDINGS

In 2022, we estimated that there were 1 572 045 new cases of lung cancer worldwide among male individuals, of which 717 211 (45·6%) were adenocarcinoma, 461 171 (29·4%) were SCC, 180 063 (11·5%) were small-cell carcinoma, and 101 861 (6·5%) were large-cell carcinoma. In 2022, we estimated that there were 908 630 new cases of lung cancer worldwide among female individuals, of which 541 971 (59·7%) were adenocarcinoma, 155 598 (17·1%) were SCC, 87 902 (9·7%) were small-cell carcinoma, and 59 271 (6·5%) were large-cell carcinoma. Among male individuals, the highest ASRs were in east Asia for adenocarcinoma (27·12 [95% CI 27·04-27·21] per 100 000 people), east Europe for SCC (21·70 [21·51-21·89] per 100 000 people) and small-cell carcinoma (9·85 [9·72-9·98] per 100 000 people), and north Africa for large-cell carcinoma (4·33 [4·20-4·45] per 100 000 people). Among female individuals, the highest ASRs were in east Asia for adenocarcinoma (19·04 [18·97-19·11] per 100 000 people), north America for SCC (5·28 [5·21-5·35] per 100 000 people) and small-cell carcinoma (4·28 [4·21-4·35] per 100 000 people), and north Europe for large-cell carcinoma (2·87 [2·78-2·96] per 100 000 people). We estimated that 114 486 adenocarcinoma cases among male individuals and 80 378 adenocarcinoma cases among female individuals were attributable to ambient PM pollution worldwide in 2022, with ASRs of 2·35 (95% CI 2·33-2·36) per 100 000 male individuals and 1·46 (1·45-1·47) per 100 000 female individuals. Temporal trends in lung-cancer incidence by subtype and sex during 1988-2017 varied considerably across the 19 countries.

INTERPRETATION

Estimated geographical and temporal distribution of lung-cancer incidence varied across the four main subtypes worldwide. Our study highlights the need for future studies that identify possible causal factors that contribute to the changing risk patterns of lung cancer.

FUNDING

Natural Science Foundation of China Young Scientist Fund, Medical Scientific Research Foundation of Guangdong Province in China, and Young Innovative Talents Project of General Universities in Guangdong Province in China.

Synergistic suppression of cell growth: Phenmiazine derivatives targeting p53 and MDM2 unveiled through hybrid computational method

Lung cancer is the leading cause of mortality in both men and women due to genetic and epigenetic modifications. Our study focuses on fabricating phenmiazine ring leads by a functional group-based drug design to inhibit p53 -7A1W and MDM2-7AU9 proteins responsible for cancer cell growth. One hundred molecules are designed and allowed to bind inside the active site of 7A1W and 7AU9 protein using a glide dock platform and subjected to find MMGBSA. The stability and interaction were confirmed by MD simulation analysis at 100 ns and DFTB chemical stability study. The result gave the best binding energy of -8.16 kcal/mol for aminobenzoic acid substituted molecule and the MD simulation head map illustrates that majorly 9 amino acids form hydrophobic and h-bond interactions. DFTB analysis reveals the energy gaps of 0.0508 signifying stability and lower chemical reactivity of the Phenmiazine ring derivatives. These findings conclude that the Phenmiazine ring derivative will be a better lead molecule to eradicate lung cancer.

Coronary Artery Calcium Score and Incident Lung Cancer in a Population-based Cohort: The Screening Perspective

Purpose To estimate the extent in which coronary artery calcium (CAC) score and incident lung cancer diagnosis are associated and determine if use of CAC score to predict lung cancer could improve lung cancer screening (LCS). Materials and Methods This retrospective analysis analyzed data from an ongoing, prospective, population-based cohort study (Heinz Nixdorf Recall study) in which participants aged 45-75 years underwent electron-beam CT of the heart. The association between CAC score and incident lung cancer was assessed using Cox proportional hazard regression models adjusted for potential confounders. The area under the receiver operating characteristic curve (AUC) was used to assess predictive performance of CAC score for lung cancer in all participants, eligible participants, and ineligible participants for LCS. Results The study included 4605 participants (mean age, 59.7 [SD, 7.8] years; 2328 female). During a median follow-up time of 15.2 years, incident lung cancer was diagnosed in 111 participants. CAC score as a continuous variable (log CAC+1) was associated with incident lung cancer (hazard ratio [HR] in the fully adjusted model: 1.21 [95% CI: 1.10, 1.32]). A CAC score of 400 or higher versus 0 was associated with a more than fourfold higher risk of lung cancer (adjusted HR: 4.31 [95% CI: 2.19, 8.51]). CAC score alone showed poor performance for predicting lung cancer in the total study sample (AUC, 0.63) and subgroups of participants eligible (AUC, 0.56) and ineligible (AUC, 0.61) for LCS. Conclusion CAC score was associated with incident lung cancer but did not demonstrate potential to improve the efficiency of LCS. Keywords: Epidemiology, Screening, Arteriosclerosis, Cardiac, Thorax, CT, Lung Cancer Supplemental material is available for this article. © RSNA, 2025.

Impact of intermittent high-dose radon exposures on lung epithelial cells: proteomic analysis and biomarker identification

Lung cancer is the most prevalent cancer worldwide, and radon exposure is ranked as the second risk factor after cigarette smoking. It has been reported that radon induces deoxyribonucleic acid damage and oxidative stress in cells. However, the protein profile and potential biomarkers for early detection of radon-induced lung cancer remain unknown. In this study, we aimed to investigate the effects of intermittent high-dose radon exposure on lung epithelial cells, analyze protein profiles and identify potential biomarkers for diagnosis of radon-related lung cancer. Human lung epithelial cells (A549) were exposed to radon (1000 Bq/m3) for 30 min daily for 7 days. Cell viability was measured using the WST-1 assay, and liquid chromatography-mass spectrometry proteomic analysis was performed. Differentially expressed proteins and gene ontology (GO) enrichment were analyzed. Our findings showed that intermittent high-radon exposure reduced A549 cell viability over time. Proteomic analysis identified proteins associated with stressed-induced apoptosis, mitochondrial adaptation, nuclear integrity and lysosomal degradation. These proteins are related to catabolism, stress response, gene expression and metabolic processes in the biological process of GO analysis. We highlighted specific proteins, including AKR1B1, CDK2, DAPK1, PRDX1 and ALHD2 with potential as biomarkers for radon-related lung cancer. In summary, intermittent high-dose radon exposure affects cellular adaptions of lung epithelial cells including stress-induced apoptosis, mitochondrial dysfunctions and immune regulation. The identified proteins may serve as diagnostic biomarkers or therapeutic targets for radon-related lung cancer.

The Role of [18F]FDG PET/CT in Monitoring of Therapy Response in Lung Cancer

Lung cancer remains a leading cause of cancer deaths worldwide, with an all stage 5-year relative survival rate of less than 30%. Multiple treatment strategies are available and continue to evolve, with therapy primarily tailored to the type and stage of the disease. Accurate monitoring of therapy response is crucial for optimizing treatment outcomes. PET/CT imaging with [18F]FDG has become the standard of care across various phases of lung cancer management due to its ability to assess metabolic activity. This review underscores the pivotal role of [18F]FDG PET/CT in evaluating therapy response in lung cancer, particularly in non-small cell lung cancer (NSCLC). It examines conventional response criteria and their adaptations in the era of immunotherapy, highlighting the value of integrating metabolic imaging with established criteria to improve treatment assessment and guide clinical decisions. The potential of non-[18F]FDG PET tracers targeting diverse biological pathways to provide deeper insights into tumor biology, therapy response and predictive outcomes is also explored. Additionally, the emerging role of radiomics in enhancing treatment efficacy assessment and improving patient management is briefly highlighted. Despite the challenges in the routine clinical application of various metabolic response criteria, [18F]FDG PET/CT remains a crucial tool in monitoring therapy response in lung cancer. Ongoing advancements in therapeutic strategies, radiopharmaceuticals, and imaging techniques continue to drive progress in lung cancer management, promising improved patient outcomes.

Lung Cancer-Epidemiology, Pathogenesis, Treatment and Molecular Aspect (Review of Literature)

Lung cancer is one of the most common malignant cancers in most countries and is the leading cause of death among cancer diseases worldwide. Despite constant progress in diagnosis and therapy, survival rates of patients diagnosed with lung cancer remain unsatisfactory. Numerous epidemiological and experimental studies conducted as early as the 1970s confirm that the most important risk factor for the development of lung cancer is long-term smoking, which remains valid to this day. In the paper, the authors present the latest data on the epidemiology, pathogenesis, treatment and molecular aspects of this cancer. In the last decade, many molecular alterations that are effective in the development of lung cancer have been discovered. In adenocarcinoma, tyrosine kinase inhibitors were developed for EGFR mutations and ALK and ROS1 translocations and were approved for use in the treatment of advanced stage adenocarcinomas. In the case of squamous cell carcinoma, the evaluation of these mutations is not yet being used in clinical practice. In addition, there are ongoing studies concerning many potential therapeutic molecular targets, such as ROS, MET, FGFR, DDR-2 and RET. Constant progress in diagnostic and therapeutic methods gives rise to hopes for an improved prognosis in patients with lung cancer.

Rapid in situ mutation detection in extracellular vesicle DNA

Aim: A PCR- and sequencing-free mutation detection assay facilitates cancer diagnosis and reduces over-reliance on specialized equipment. This benefit was highlighted during the pandemic when high demand for viral nucleic acid testing often sidelined mutation analysis. This shift led to substantial challenges for patients on targeted therapy in tracking mutations. Here, we report a 30-min DNA mutation detection technique using Cas12a-loaded liposomes in a microplate reader, a fundamental laboratory tool. Methods: CRISPR-Cas12a complex and fluorescence-quenching (FQ) probes are introduced into tumor-derived extracellular vesicles (EV) through membrane fusion. When CRISPR-RNA hybridizes with the DNA target, activated Cas12a can trans-cleave FQ probes, resulting in fluorescence signals for the quantification of DNA mutation. Results: This method enables the detection of EGFR L858R mutation in EV DNA within 30 min. Laborious extraction, purification, and other preparation steps for EV DNA are eliminated. The need for advanced data processing is also dispensed with. In a cohort study involving 10 healthy donors and 30 patients with advanced non-small cell lung cancer (NSCLC), the assay achieved a sensitivity of 86.7%, a specificity of 90%, and an accuracy of 87.5%. Conclusion: The limit of detection of our Cas12 assay was ~ 8 × 105 EVs, corresponding to a mutation allele frequency (MAF) of ~ 10%. The MAF in late-stage cancers varies widely but often falls within 5%-50%. Therefore, without amplification of targets, this Cas12 assay can detect mutations in patients with advanced lung cancer. Future advancements in multiplex and high-throughput mutation detection using this assay will streamline self-diagnosis and treatment monitoring at home.

Global and China trends and forecasts of disease burden for female lung Cancer from 1990 to 2021: a study based on the global burden of disease 2021 database

BACKGROUND

In recent years, due to various risk factors, the incidence, prevalence, and mortality rates of female lung cancer have been increasing in both China and globally. This has become a significant public health challenge worldwide. Lung cancer not only poses a severe threat to women's health but also places a heavy burden on families and society.

OBJECTIVE

To conduct an in-depth analysis of the trends in disease burden for female lung cancer in China and globally from 1990 to 2021 and to forecast the next 15 years (2022-2037). The aim is to provide a reliable theoretical basis and reference value for clinical research and practice in female lung cancer and offer guidance for resource allocation and policy-making in society.

METHODS

Based on the Global Burden of Disease (GBD) 2021 database, we analyzed the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of lung cancer in China and globally from 1990 to 2021. These metrics were stratified by gender (BOTH, MALE, FEMALE), and the average annual percentage change (AAPC) was calculated for each metric over this period. The JOINPOINT regression model was used to analyze the trends in female lung cancer in China and globally from 1990 to 2021. The ARIMA model was applied to forecast the changes in age-standardized incidence rates (ASIR) and age-standardized mortality rates (ASDR) for the next fifteen years (2022-2037) for female lung cancer in China and globally.

RESULTS

The results indicate an upward trend in incidence, prevalence, mortality, and DALYs for lung cancer in China. Globally, the prevalence of lung cancer showed an increasing trend, while the incidence, mortality, and DALYs demonstrated a declining trend. Both in China and globally, the incidence, prevalence, mortality, and DALY trends for female lung cancer were higher than those for males. From 1990 to 2021, the incidence, prevalence, mortality, and DALYs of female lung cancer in China exhibited an upward trend, with AAPC growth rates of 1.151%, 2.086%, 0.508%, and 0.210%, respectively. Similarly, globally, the incidence, prevalence, and mortality of female lung cancer also showed an upward trend, with growth rates of 0.576%, 1.123%, and 0.276%, respectively, while DALYs showed a slight decline with an AAPC of -0.029%.

CONCLUSION

Although the overall disease burden of female lung cancer is not as high as that of males, the growth rate for female lung cancer is significantly higher than that for males both in China and globally. The overall disease burden and the growth rates of incidence and prevalence of female lung cancer in China are higher than the global average.

A pan-cancer analysis of homeobox family: expression characteristics and latent significance in prognosis and immune microenvironment

Background

The Homeobox (HOX) gene family are conserved transcription factors that are essential for embryonic development, oncogenesis, and cancer suppression in biological beings. Abnormally expressed HOX genes in cancers are directly associated with prognosis.

Methods

Public databases such as TCGA and the R language were used to perform pan-cancer analyses of the HOX family in terms of expression, prognosis, and immune microenvironment. The HOX score was defined, and potential target compounds in cancers were predicted by Connective Map. Immunohistochemistry was employed to validate protein expression levels. Gene knockdowns were used to verify the effects of HOXB7 and HOXC6 on the proliferation and migration of lung adenocarcinoma (LUAD) cells.

Results

HOX genes play different roles in different cancers. Many HOX genes, especially HOXB7 and HOXC6, have higher expression and lower overall survival in specific cancers and are predicted as risk factors. The high expression of most HOX genes is mainly related to immune subtypes C1-C4 and C6. Potential anti-tumor compounds for down-regulating HOX gene expression were identified, such as HDAC inhibitors and tubulin inhibitors. LUAD Cell migration and proliferation were inhibited when HOXB7 or HOXC6 was knocked down.

Conclusions

Many HOX genes may act as both oncogenes and tumor suppressor genes, necessitating precision medicine based on specific cancers. The HOX gene family plays a crucial role in the development of certain cancers, and their expression patterns are closely related to cancer prognosis and the tumor microenvironment (TME), which may affect cancer prognosis and response to immunotherapy. Compounds that are negatively correlated with the expression levels of the HOX family in various cancers, such as HDAC inhibitors, are potential anti-cancer drugs. HOXB7 and HOXC6 may serve as potential targets for cancer treatment and the development of targeted compounds in the future.

Unravelling the role of tumor microenvironment responsive nanobiomaterials in spatiotemporal controlled drug delivery for lung cancer therapy

Design and development of efficient drug delivery technologies that impart site-specificity is the need of the hour for the effective treatment of lung cancer. The emergence of materials science and nanotechnology partially helped drug delivery scientists to achieve this objective. Various stimuli-responsive materials that undergo degradation at the pathological tumor microenvironment (TME) have been developed and explored for drug delivery applications using nanotechnological approaches. Nanoparticles (NPs), owing to their small size and high surface area to volume ratio, demonstrated enhanced cellular internalization, permeation, and retention at the tumor site. Such passive accumulation of stimuli-responsive materials helped to achieve spatiotemporally controlled and targeted drug delivery within the tumors. In this review, we discussed various stimuli-physical (interstitial pressure, temperature, and stiffness), chemical (pH, hypoxia, oxidative stress, and redox state), and biological (receptor expression, efflux transporters, immune cells, and their receptors or ligands)-that are characteristic to the TME. We mentioned an array of biomaterials-based nanoparticulate delivery systems that respond to these stimuli and control drug release at the TME. Further, we discussed nanoparticle-based combinatorial drug delivery strategies. Finally, we presented our perspectives on challenges related to scale-up, clinical translation, and regulatory approvals.

Influence of air quality on lung cancer in people who have never smoked

OBJECTIVE

Lung cancer is the leading cause of cancer-related death. The percentage of people who have never smoked with lung cancer has risen recently, but alternative risk factors require further study. Our goal was to determine the influence of air quality on incidence of lung cancer in people who have smoked or never smoked.

METHODS

The cancer registry from a large urban medical center was queried to include every new diagnosis of lung cancer from 2013 to 2021. Air quality and pollution data for the county were obtained from the US Environmental Protection Agency from 1980 to 2018. Patient demographics, location of residence, smoking history, and tumor stage were recorded. Bivariate comparison analyses were conducted in R (R Foundation for Statistical Computing).

RESULTS

A total of 2223 new cases of lung cancer were identified. Mean age was 69.2 years. There was a nonsmoking rate of 8.1%. A total of 37% of patients identified as a racial minority. People who have never smoked were more likely to be diagnosed at an advanced stage. When analyzing geographic distribution, incidence of lung cancer among people who have never smoked was more closely associated with highly polluted areas. People who have never smoked with lung cancer had significantly higher exposure levels of multiple pollutants.

CONCLUSIONS

Newly diagnosed lung cancer appears to be more related to poor air quality among people who have never smoked than people who have smoked. Future studies are needed to examine the associations of specific pollutants with lung cancer incidence.

Myrtenol ameliorates inflammatory, oxidative, apoptotic, and hyperplasic effects of urethane-induced atypical adenomatous hyperplasia in the rat lung

Lung atypical adenomatous hyperplasia (AAH) is a forerunner of pulmonary adenocarcinoma. The drugs being utilized in the remediation of this type of hyperplasia have some adverse impacts. The present research focused on the potential anti-hyperplasia effect of myrtenol, an herbal terpenoid, on urethane-induced lung AAH in rats. Rats were injected with urethane (1.5 g/kg) thrice at 48 h intervals, and 20 weeks later, the animals were treated with 50 mg/kg myrtenol intraperitoneally once a day for 1 week. The ELISA method was used to measure inflammatory cytokines and oxidative parameters in the lung tissue and bronchoalveolar lavage fluid (BALF). The expression of NFκB and apoptotic/antiapoptotic factors (P53/Bcl-2) was evaluated by western blot and immunohistochemistry, respectively. H&E staining was performed for histopathological investigation. Histopathology confirmed the anti-hyperplasia effect of myrtenol, which was evidenced by the reduction of bronchoalveolar wall thickness and inflammation score. It also decreased hyperplasia progression by reducing Bcl-2, IL-10, p53, and Ki67. Compared with the urethane group, myrtenol normalized the activity of the oxidative stress markers malondialdehyde (MDA), total antioxidant capacity (TAC), glutathione peroxidase (GPX), and superoxide dismutase (SOD). Moreover, it showed an anti-inflammatory effect by decreasing lung and BALF IL-1β levels and NFκB expression. Myrtenol may have a promising effect on lung cancer treatment by counteracting lung hyperplasia via modulation of inflammation, oxidative stress, and apoptosis.

Classification of NSCLC subtypes using lung microbiome from resected tissue based on machine learning methods

Classification of adenocarcinoma (AC) and squamous cell carcinoma (SCC) poses significant challenges for cytopathologists, often necessitating clinical tests and biopsies that delay treatment initiation. To address this, we developed a machine learning-based approach utilizing resected lung-tissue microbiome of AC and SCC patients for subtype classification. Differentially enriched taxa were identified using LEfSe, revealing ten potential microbial markers. Linear discriminant analysis (LDA) was subsequently applied to enhance inter-class separability. Next, benchmarking was performed across six different supervised-classification algorithms viz. logistic-regression, naïve-bayes, random-forest, extreme-gradient-boost (XGBoost), k-nearest neighbor, and deep neural network. Noteworthy, XGBoost, with an accuracy of 76.25%, and AUROC (area-under-receiver-operating-characteristic) of 0.81 with 69% specificity and 76% sensitivity, outperform the other five classification algorithms using LDA-transformed features. Validation on an independent dataset confirmed its robustness with an AUROC of 0.71, with minimal false positives and negatives. This study is the first to classify AC and SCC subtypes using lung-tissue microbiome.

Natural Killer Cell-Secreted IFN-γ and TNF-α Mediated Differentiation in Lung Stem-like Tumors, Leading to the Susceptibility of the Tumors to Chemotherapeutic Drugs

We demonstrate that natural killer (NK) cells induce a higher cytotoxicity against lung cancer stem-like cells (hA549) compared to differentiated lung cancer cell lines (H292). The supernatants from split-anergized NK cells (IL-2 and anti-CD16 mAb-treated NK cells) induced differentiation in hA549. Differentiated lung cancer cell line (H292) and NK cells differentiated hA549 expressed reduced NK cell-mediated cytotoxicity but expressed higher sensitivity to chemotherapeutic drugs. This finding validated our previous reports demonstrating that the levels of tumor killing by NK cells and by chemotherapeutic drugs correlate directly and indirectly, respectively, with the stage and levels of tumor differentiation. We also demonstrate the role of IFN-γ and TNF-α in inducing tumor differentiation. NK cells' supernatants or IFN-γ and TNF-α-induced tumor differentiation was blocked when we used antibodies against IFN-γ and TNF-α. Therefore, IFN-γ and TNF-α released from NK cells play a significant role in differentiating tumors, resulting in increased susceptibility of tumors to chemotherapeutic drugs. We also observed the different effects of MHC-class I antibodies in CSCs vs. differentiated tumors. Treatment with anti-MHC-class I decreased NK cell-mediated cytotoxicity in hA549 tumors, whereas it increased NK cell-mediated cytotoxicity when differentiated tumors were treated with antibodies against MHC-class I.

Unraveling the Core Components and Critical Targets of Houttuynia cordata Thunb. in Treating Non-small Cell Lung Cancer through Network Pharmacology and Multi-omics Analysis

OBJECTIVE

This study aimed to preliminary explore the molecular mechanisms of Houttuynia cordata Thunb. (H. cordata; Saururaceae) in treating non-small cell lung cancer (NSCLC), with the goal of screening drug potential targets for clinical drug development.

METHODS

This study employed a multi-omics and multi-source data integration approach to identify potential therapeutic targets of H. cordata against NSCLC from the TCMSP database, GEO database, BioGPS database, Metascape database, and others. Meanwhile, target localization was performed, and its possible mechanisms of action were predicted. Furthermore, dynamics simulations and molecular docking were used for verification. Multi-omics analysis was used to confirm the selected key genes' efficacy in treating NSCLC.

RESULTS

A total of 31 potential therapeutic targets, 8 key genes, and 5 core components of H. cordata against NSCLC were screened out. These potential therapeutic targets played a therapeutic role mainly by regulating lipid and atherosclerosis, the TNF signaling pathway, the IL-17 signaling pathway, and others. Molecular docking indicated a stable combination between MMP9 and quercetin. Finally, through multi-omics analysis, it was found that the expression of some key genes was closely related not only to the progression and prognosis of NSCLC but also to the level of immune infiltration.

CONCLUSION

Through comprehensive network pharmacology and multi-omics analysis, this study predicts that the core components of H. cordata play a role in treating NSCLC by regulating lipid and atherosclerosis, as well as the TNF signaling pathway. Among them, the anti-NSCLC activity of isoramanone is reported for the first time.

Crosstalk between ROS-inflammatory gene expression axis in the progression of lung disorders

A significant number of deaths and disabilities worldwide are brought on by inflammatory lung diseases. Many inflammatory lung disorders, including chronic respiratory emphysema, resistant asthma, resistance to steroids, and coronavirus-infected lung infections, have severe variants for which there are no viable treatments; as a result, new treatment alternatives are needed. Here, we emphasize how oxidative imbalance contributes to the emergence of provocative lung problems that are challenging to treat. Endogenic antioxidant systems are not enough to avert free radical-mediated damage due to the induced overproduction of ROS. Pro-inflammatory mediators are then produced due to intracellular signaling events, which can harm the tissue and worsen the inflammatory response. Overproduction of ROS causes oxidative stress, which causes lung damage and various disease conditions. Invasive microorganisms or hazardous substances that are inhaled repeatedly can cause an excessive amount of ROS to be produced. By starting signal transduction pathways, increased ROS generation during inflammation may cause recurrent DNA damage and apoptosis and activate proto-oncogenes. This review provides information about new targets for conducting research in related domains or target factors to prevent, control, or treat such inflammatory oxidative stress-induced inflammatory lung disorders.

Lipid-Based Nanocarriers for Targeted Gene Delivery in Lung Cancer Therapy: Exploring a Novel Therapeutic Paradigm

Lung cancer is a significant cause of cancer-related death worldwide. It can be broadly categorised into small-cell lung cancer (SCLC) and Non-small cell lung cancer (NSCLC). Surgical intervention, radiation therapy, and the administration of chemotherapeutic medications are among the current treatment modalities. However, the application of chemotherapy may be limited in more advanced stages of metastasis due to the potential for adverse effects and a lack of cell selectivity. Although small-molecule anticancer treatments have demonstrated effectiveness, they still face several challenges. The challenges at hand in this context comprise insufficient solubility in water, limited bioavailability at specific sites, adverse effects, and the requirement for epidermal growth factor receptor inhibitors that are genetically tailored. Bio-macromolecular drugs, including small interfering RNA (siRNA) and messenger RNA (mRNA), are susceptible to degradation when exposed to the bodily fluids of humans, which can reduce stability and concentration. In this context, nanoscale delivery technologies are utilised. These agents offer encouraging prospects for the preservation and regulation of pharmaceutical substances, in addition to improving the solubility and stability of medications. Nanocarrier-based systems possess the notable advantage of facilitating accurate and sustained drug release, as opposed to traditional systemic methodologies. The primary focus of scientific investigation has been to augment the therapeutic efficacy of nanoparticles composed of lipids. Numerous nanoscale drug delivery techniques have been implemented to treat various respiratory ailments, such as lung cancer. These technologies have exhibited the potential to mitigate the limitations associated with conventional therapy. As an illustration, applying nanocarriers may enhance the solubility of small-molecule anticancer drugs and prevent the degradation of bio-macromolecular drugs. Furthermore, these devices can administer medications in a controlled and extended fashion, thereby augmenting the therapeutic intervention's effectiveness and reducing adverse reactions. However, despite these promising results, challenges remain that must be addressed. Multiple factors necessitate consideration when contemplating the application of nanoparticles in medical interventions. To begin with, the advancement of more efficient delivery methods is imperative. In addition, a comprehensive investigation into the potential toxicity of nanoparticles is required. Finally, additional research is needed to comprehend these treatments' enduring ramifications. Despite these challenges, the field of nanomedicine demonstrates considerable promise in enhancing the therapy of lung cancer and other respiratory diseases.

Functional status, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio as prognostic factors of one-year survival rate in elderly patients with advanced-stage non-small cell lung cancer

BACKGROUND AND AIM

Non-small cell lung cancer (NSCLC) is the most common lung cancer found in elderly patients. Aging and chronic inflammation are related to its pathogenesis. Functional status, lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio describe a chronic inflammation and correlate to the survival of older adults with advanced-stage (IIIB-IV) NSCLC. This study aims to determine functional status, lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio as prognostic factors to 1-year survival in elderly patients with NSCLC stage IIIB-IV.

METHODS

Survival analysis with a cohort retrospective study is conducted on elderly patients with NSCLC stage IIIB-IV in Dharmais National Cancer Center Hospital between January 2020 and June 2022. Medical records were collected, comprising complete blood count prior to chemotherapy or radiotherapy, assessment of functional status through the Barthel Index for Activities of Daily Living (ADL), and 1-year survival post-diagnosis. Factors potentially influencing outcomes included diabetes mellitus, anemia, chronic obstructive pulmonary disease, and chronic kidney disease. Statistical analyses were performed using SPSS 20.0, employing the log-rank method for bivariate analysis and Cox regression for multivariate analysis.

RESULTS

In a cohort of 108 patients, the majority were aged 60-69 years (74.1 %), male (66.7 %), diagnosed at stage IV (80.5 %), and with adenocarcinoma subtype (75.0 %). Significant correlations were observed between the lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio with the 1-year survival rate in elderly patients with stage IIIB-IV NSCLC (p = 0.015 and p = 0.001, respectively). Functional status did not show a significant correlation with 1-year survival overall (p = 0.540), but significant correlations were noted in patients receiving chemotherapy (p = 0.044) and radiotherapy (p = 0.009).

CONCLUSION

The lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio provide significant prognostic insights regarding 1-year survival in elderly patients diagnosed with stage IIIB-IV non-small cell lung cancer (NSCLC). In contrast, the functional status of these patients does not demonstrate a significant correlation with one-year survival.

Nanoformulations in the treatment of lung cancer: current status and clinical potential

OBJECTIVE

Recent developments in nanotechnology have regained hope in enabling the eradication of lung cancer, while overcoming the drawbacks of the classic therapeutics. Nevertheless, there are still formidable obstacles that hinder the translation of such platforms from the bench into the clinic. Herein, we shed light on the clinical potential of these formulations and discuss their future directions.

SIGNIFICANCE OF REVIEW

The current article sheds light on the recent advancements in the recruitment of nanoformulations against lung cancer, focusing on their unique features, merits, and demerits. Moreover, inorganic nanoparticles, including gold, silver, magnetic, and carbon nanotubes are highlighted as emerging drug delivery technologies. Furthermore, the clinical status of these formulations is discussed, with particular attention on the challenges that they encounter in their clinical translation. Lastly, the future perspectives in this promising area are inspired.

KEY FINDINGS

Nanoformulations have a promising potential in improving the physico-chemical properties, pharmacokinetics, delivery efficiency, and selectivity of lung cancer therapeutics. The key challenges that encounter their clinical translation include their structural intricacy, high production cost, scale-up issues, and unclear toxicity profiles. The application of biodegradable platforms improves the biosafety of lung cancer-targeted nanomedicine. Moreover, the design of novel targeting strategies that apply a lower number of components can promote their industrial scalability and deliver them to the market at affordable prices.

CONCLUSIONS

Nanomedicines have opened up new possibilities for treating lung cancer. Focusing on tackling the challenges that hinder their clinical translation will promote the future of this area of endeavor.

Lung cancer in patients with pulmonary fibrosis: characteristics features and prognosis

BACKGROUND AND AIM

Lung cancer is one of the significant comorbidities seen in patients with Idiopathic Pulmonary Fibrosis (IPF). However, there is limited data on non-IPF Pulmonary Fibrosis (PF) patients with lung cancer (LC). The present study aims to compare the characteristics and survival outcomes of patients diagnosed with LC in IPF and non-IPF PF.

METHODS

The multicenter data records of IPF and non-IPF PF patients diagnosed with lung cancer between 2010- 2022 were analyzed in this descriptive, cross-sectional, and retrospective study.

RESULTS

Of the 251 patients involved in this study [164 IPF-LC, 87 non-IPF PF-LC], 89.6% were male, the mean age was 69±7.9 years and the smoking rate was 85.7%. Honeycomb pattern was more frequently observed in IPF-LC patients [62.8%,37.9%p<0.001], whereas ground-glass opacity [33.5%,59.8%p<0.001] and emphysema [37.8%,59.8%p<0.001] were more frequently seen in non-IPF PF-LC patients. The most commonly seen histological type was squamous cell carcinoma [42.7%,33.9%], followed by adenocarcinoma [28.2%; 32.2%]. [46.4%;47.2%] and their 5-year mortality rates were high [64.6%, 63.2%]. The median survival for both groups was 2±0.22 years [median 95% CI (1.55-2.44)]. The shortest survival time was observed in non-IPF PF-LC subgroup with unclassified PF [1±0.253 years median 95% CI (0.50-1.49) (p=0.030)].

CONCLUSIONS

The majority of IPF and non-IPF PF LC patients were male, elderly, and had a high smoking rate. Squamous cell carcinoma was the most frequently seen histological type and they had short survival periods and high mortality rates. The survival period of unclassified non-IPF PF-LC patients was found to be the shortest.

Mendelian randomization study of the relationship between blood and urine biomarkers and lung cancer

Introduction

Identifying suitable biomarkers is crucial for exploring the pathogenesis, early screening, and therapeutic monitoring of lung cancer. This study aims to analyze comprehensively the associations between lung cancer and biomarkers in blood and urine.

Methods

Bidirectional two-sample Mendelian randomization (MR) was used to evaluate the potential causal relationships between blood and urine biomarkers and lung cancer. We obtained Single nucleotide polymorphisms (SNPs) related to lung cancer from the 2021 Finnish database of genome-wide association studies, including small cell lung cancer (SCLC), total non-small cell lung cancer (NSCLC), lung adenocarcinoma (LAC), and lung squamous cell carcinoma (LSCC).Data on blood and urine biomarkers were derived from the UK Biobank cohort, comprising 376,807 participants.

Results

We found a potential inverse causal relationship between total bilirubin and SCLC (β=-0.285, P=0.015, FDR=0.12). Urate was inversely associated with NSCLC (β=-0.158, P=0.004, FDR=0.036*). Serum calcium showed a possible inverse relationship with lung squamous cell carcinoma (β=-0.256, P=0.046, FDR=0.138), while urinary creatinine was positively associated (β=1.233, P=0.024, FDR=0.216). Non-albumin proteins (β=-0.272, P=0.020, FDR=0.180) and total protein (β=-0.402, P=0.009, FDR=0.072) were inversely related to lung squamous cell carcinoma. The AST/ALT ratio was positively associated with lung adenocarcinoma (β=0.293, P=0.009, FDR=0.072). Our reverse Mendelian randomization study found a positive causal association between small cell lung cancer and serum creatinine (β=0.022, P=0.002, FDR=0.018*), while it was inversely associated with the estimated glomerular filtration rate(eGFR)(β=-0.022, P=0.003, FDR=0.027*). A positive causal relationship was also observed with cystatin C (β=0.026, P=0.005, FDR=0.045*) and glycated hemoglobin HbA1c (β=0.013, P=0.014, FDR=0.028*). A negative causal relationship was observed with Gamma_glutamyltransferase (β=-0.013, P=0.019, FDR=0.152). For non-small cell lung cancer, a negative causal relationship was found with albumin (β=-0.024, P=0.002, FDR=0.016*), while a potentially positive causal relationship was observed with cystatin C (β=0.022, P=0.006, FDR=0.054). Possible negative causal relationships were also observed with phosphate (β=-0.013, P=0.008, FDR=0.072) and urinary potassium (β=-0.011, P=0.012, FDR=0.108), while a potential positive causal relationship was observed with C-reactive protein (β=0.013, P=0.040, FDR=0.280).Regarding lung squamous cell carcinoma, an inverse causal relationship was found with eGFR (β=-0.022, P=9.58e-06, FDR=8.62×10-5*), while a positive causal relationship was observed with serum creatinine (β=0.021, P=1.16e-4, FDR=1.05×10-3*). Potential positive causal relationships were observed with Urate (β=0.012, P=0.020, FDR=0.180), urea (β=0.010, P=0.046, FDR=0.141), and glycated hemoglobin HbA1c (β=0.020, P=0.049, FDR P=0.098), whereas a potential negative causal relationship was observed with sex hormone-binding globulin(SHBG) (β=-0.020, P=0.036, FDR=0.108).Lastly, adenocarcinoma was found to have a positive causal association with alkaline phosphatase (β=0.015, P=0.006, FDR=0.033*).

Conclusion

Our study provides a robust theoretical basis for the early screening and therapeutic monitoring of lung cancer and contributes to understanding the pathogenesis of the disease.

The association between sleep quantity, insomnia and lung cancer risk - A systematic review and meta-analysis

PURPOSE

The effect of various sleep traits on the risk of lung cancer differs among pre-existing studies. This study aims to systematically review and synthesise the association between sleep duration and insomnia with the incidence of lung cancer.

METHODS

PubMed, Embase and The Cochrane Library were searched from inception to 23 April 2023 for observational studies examining the effect of sleep quantity or insomnia on lung cancer incidence. We pooled maximally-adjusted hazard ratios and odds ratios separately using random effects inverse variance weighted models. The risk of bias of observational studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

We included 11 observational studies with a pooled cohort of 5,049,141 patients. The mean age of the patients was 49.5 ± 17.7 years, and 51.4% were males. The risk of bias ranged from low-moderate. Individuals who slept for a shorter or longer duration than the reference range of sleep per night showed an increased risk of lung cancer by 11% (HR:1.11; 95%CI:1.00-1.23) and 16% (HR:1.16; 95%CI:1.06-1.27) respectively. Furthermore, individuals with insomnia symptoms had a 9% greater risk of lung cancer than those without symptoms (HR:1.09; 95%CI:1.05-1.13).

CONCLUSION

This study suggests that insufficient sleep, excessive sleep and insomnia may be associated with an increased risk of lung cancer. Physicians should be mindful of this association and encourage healthy sleep practises among patients. Given the observed heterogeneity among some pre-existing studies, future research with longer periods of follow-up, greater control for covariates and objective testing of sleep parameters may add value to this topic.

Use of commercial WAMs for monitoring individual with lung cancer. A systematic review

This systematic review explored the feasibility and impact of interventions using commercial activity monitors to track physical activity and health-related outcomes during lung cancer treatment. Inclusion criteria focused on studies involving commercially available activity trackers that provided monitoring feedback to lung cancer patients. The devices selected were popular models, including Fitbit, Garmin, Apple, Samsung, and Polar. Studies assessing the reliability or validity of these trackers, as well as qualitative studies, protocols, non-English publications, and those featuring non-commercial devices, were excluded. Additionally, studies incorporating physical activity with other interventions (e.g., robotic surgery) were excluded if exercise outcomes could not be analysed independently. Searches were conducted across various electronic databases, including the Cochrane Database of Systematic Reviews, CINAHL Complete®, Science Citation Index, Google Scholar, Scopus, IEEE Xplore, and PubMed, covering the period from January 2000 to November 2023. The quality of the studies was assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) and the Risk of Bias in Randomised Trials (RoB 2.0) tools. Twelve studies met the inclusion criteria, utilising commercial wearable technology for monitoring lung cancer patients over an average of 6.3 ± 4.7 weeks. A key limitation of this review was the wide variation in how interventions were implemented across studies. Yet, the interventions significantly improved daily activity levels and intensity, quality of life, psychological impact, and physical function compared to usual care. These monitors show promise in predicting, monitoring, and detecting physical activity, motivating patients, and aiding in recovery. However, limitations exist, and further evidence is needed to confirm their efficacy as primary monitoring tools in lung cancer treatment.

Anti-cancer effect of sodium pentaborate in combination with cisplatin on lung cancer cell lines

BACKGROUND

Despite the development of novel therapeutic modalities, lung cancer persists as the leading cause of cancer-related mortality. Platinum-based treatments represent the most prominent treatment option, with cisplatin being the most frequently utilized chemotherapeutic agent. However, cisplatin has several serious side effects. A substantial body of evidence has emerged in recent years indicating that boron compounds exhibit anti-cancer properties when administered as monotherapy or in combination with chemotherapy agents. The objective of this study is to examine the anti-cancer effects of Cisplatin (Cis) and sodium pentaborate pentahydrate (NaB), both individually and in combination, on non-small cell lung cancer (NSCLC) cell line A-549 cells and small cell lung cancer (SCLC) cell line DMS-114 cells under in vitro conditions.

METHODS AND RESULTS

The effects of cisplatin and NAB on cell survival, apoptosis, the cell cycle, and the expression levels of apoptotic, anti-apoptotic, and tumor suppressor genes were determined by an MTS assay, an Annexin-V assay, a cell cycle analysis, and real-time PCR (qPCR). It was found that the IC-50 value of cisplatin, which was 10 µM when used alone, decreased to 2.5 µM when combined with a non-toxic dose of NaB on the A-549 cell line. BAX and TP53 gene expression levels were elevated by the Nab-Cisplatin combination in the A-549 cell line. The combination was observed to result in an approximately 19-fold increase in CDK2 gene expression in the A-549 cell line and an approximately 6-fold increase in the DMS-114 line, which resulted in S phase and/or G2 phase arrest on the cell cycle. Gene expression levels of Survivin and Ki-67 were decreased by the combination on both cell lines when compared with cisplatin alone. The findings demonstrate that NaB exerts an anti-cancer effect on the A-549 and DMS-114 cell lines. Moreover, when combined with cisplatin, it produces a synergistic anti-cancer effect on the A-549 cell line, whereby apoptosis is activated and cell proliferation is inhibited.

CONCLUSION

The combination of NaB and cisplatin represents a novel approach to the treatment of NSCLC. This is due to the fact that it reduces the IC-50 value of cisplatin and also results in a greater inhibition of cell division and a stronger induction of cell death when used in the context of a combined treatment. Further insight into the effects of the NaB-cisplatin combination will be gained from in vivo experiments and clinical studies.

In Silico Design of Peptide Inhibitors Targeting HER2 for Lung Cancer Therapy

BACKGROUND/OBJECTIVES

Human epidermal growth factor receptor 2 (HER2) is overexpressed in several malignancies, such as breast, gastric, ovarian, and lung cancers, where it promotes aggressive tumor proliferation and unfavorable prognosis. Targeting HER2 has thus emerged as a crucial therapeutic strategy, particularly for HER2-positive malignancies. The present study focusses on the design and optimization of peptide inhibitors targeting HER2, utilizing machine learning to identify and enhance peptide candidates with elevated binding affinities. The aim is to provide novel therapeutic options for malignancies linked to HER2 overexpression.

METHODS

This study started with the extraction and structural examination of the HER2 protein, succeeded by designing the peptide sequences derived from essential interaction residues. A machine learning technique (XGBRegressor model) was employed to predict binding affinities, identifying the top 20 peptide possibilities. The candidates underwent further screening via the FreeSASA methodology and binding free energy calculations, resulting in the selection of four primary candidates (pep-17, pep-7, pep-2, and pep-15). Density functional theory (DFT) calculations were utilized to evaluate molecular and reactivity characteristics, while molecular dynamics simulations were performed to investigate inhibitory mechanisms and selectivity effects. Advanced computational methods, such as QM/MM simulations, offered more understanding of peptide-protein interactions.

RESULTS

Among the four principal peptides, pep-7 exhibited the most elevated DFT values (-3386.93 kcal/mol) and the maximum dipole moment (10,761.58 Debye), whereas pep-17 had the lowest DFT value (-5788.49 kcal/mol) and the minimal dipole moment (2654.25 Debye). Molecular dynamics simulations indicated that pep-7 had a steady binding free energy of -12.88 kcal/mol and consistently bound inside the HER2 pocket during a 300 ns simulation. The QM/MM simulations showed that the overall total energy of the system, which combines both QM and MM contributions, remained around -79,000 ± 400 kcal/mol, suggesting that the entire protein-peptide complex was in a stable state, with pep-7 maintaining a strong, well-integrated binding.

CONCLUSIONS

Pep-7 emerged as the most promising therapeutic peptide, displaying strong binding stability, favorable binding free energy, and molecular stability in HER2-overexpressing cancer models. These findings suggest pep-7 as a viable therapeutic candidate for HER2-positive cancers, offering a potential novel treatment strategy against HER2-driven malignancies.

Berberine and Lung Cancer: From Pure Form to Its Nanoformulations

Lung cancer is the most fatal cancer worldwide. The etiology of lung cancer has yet to be fully characterized. Smoking and air pollution are several risk factors for lung cancer. Berberine, an isoquinoline alkaloid, is an antihyperglycemic, antidepressant, antioxidative, anti-inflammatory, and anticancer compound. Evidence substantiates that berberine has antitumor effects, exerting its effects by targeting a variety of cellular and molecular processes, such as apoptosis, autophagy, cell cycle arrest, migration, and metastasis. Although the beneficial effects of berberine have been reported, some limitations including low bioavailability and absorption as well as poor aqueous solubility have hindered its clinical application. Nanotechnology and nanodelivery bioformulation approaches may bypass these limitations. In addition, the combination of berberine with other therapies has been shown to result in greater treatment efficacy for lung cancer. Herein, we summarize cellular and molecular pathways that are affected by berberine, its clinical efficacy upon various combinations, and the potential for nanotechnology in lung cancer therapy.

A systematic review on feature extraction methods and deep learning models for detection of cancerous lung nodules at an early stage -the recent trends and challenges

Lung cancer is one of the most common life-threatening worldwide cancers affecting both the male and the female populations. The appearance of nodules in the scan image is an early indication of the development of cancer cells in the lung. The Low Dose Computed Tomography screening technique is used for the early detection of cancer nodules. Therefore, with more Computed Tomography (CT) lung profiles, an automated lung nodule analysis system can be utilized through image processing techniques and neural network algorithms. A CT image of the lung consists of many elements such as blood vessels, ribs, nodules, sternum, bronchi and nodules. These nodules can be both benign and malignant, where the latter leads to lung cancer. Detecting them at an earlier stage can increase life expectancy by up to 5 to 10 years. To analyse only the nodules from the profile, the respected features are extracted using image processing techniques. Based on the review, textural features were the promising ones in medical image analysis and for solving computer vision problems. The importance of uncovering the hidden features allows Deep Learning algorithms (DL) to function better, especially in medical imaging, where accuracy has improved. The earlier detection of cancerous lung nodules is possible through the combination of multi-featured extraction and classification techniques using image data. This technique can be a breakthrough in the deep learning area by providing the appropriate features. One of the greatest challenges is the incorrect identification of malignant nodules results in a higher false positive rate during the prediction. The suitable features make the system more precise in prognosis. In this paper, the overview of lung cancer along with the publicly available datasets is discussed for the research purposes. They are mainly focused on the recent research that combines feature extraction and deep learning algorithms used to reduce the false positive rate in the automated detection of lung nodules. The primary objective of the paper is to provide the importance of textural features when combined with different deep-learning models. It gives insights into their advantages, disadvantages and limitations regarding possible research gaps. These papers compare the recent studies of deep learning models with and without feature extraction and conclude that DL models that include feature extraction are better than the others.

lncRNAs'p potential roles in the pathogenesis of cancer via interacting with signaling pathways; special focus on lncRNA-mediated signaling dysregulation in lung cancer

Lung cancer ranks among the most lethal types of cancer globally, with a high occurrence and fatality rate. The spread of cancer to other parts of the body, known as metastasis, is the primary cause of treatment failure and death in lung cancer cases. Current approaches for treating advanced lung cancer typically involve a combination of chemotherapy and targeted therapy. However, the majority of patients ultimately develop resistance to these treatments, leading to a worsened prognosis. In recent years, cancer biology research has predominantly focused on the role of protein-encoding genes in cancer development. Long non-coding RNAs (lncRNAs) are transcripts over 200 nucleotides in length that do not encode proteins but are crucial RNA molecules involved in numerous biological functions. While many functions of lncRNAs remain unknown, some have been linked to human diseases, including cancer. Studies have demonstrated that lncRNAs interact with other large molecules in the cell, such as proteins, DNA, and RNA, influencing various critical aspects of cancer. LncRNAs play a significant role in regulating gene expression and have a crucial function in the transcriptional regulation of cancer cells. They mediate various biological and clinical processes such as invasion, metastasis, apoptosis, and cell proliferation. Dysregulation of lncRNAs has been found to impact the process of carcinogenesis through advanced technologies like RNA sequencing and microarrays. Collectively, these long non-coding RNAs hold promise as potential biomarkers and therapeutic targets for human cancers. In this segment, we provide a comprehensive summary of the literature on the characteristics and formation of lncRNAs, along with an overview of their current known roles in lung cancer.

Clinical and Molecular Features of Malignant Pleural Effusion in Non-Small Cell Lung Cancer (NSCLC) of a Caucasian Population

Background and Objectives: The diversity of patients with malignant pleural effusion (MPE) due to non-small cell lung cancer (NSCLC) as well as the variability in mutations makes it essential to improve molecular characterization. Objective: Describe clinical, pathological, and molecular characteristics MPE in a Caucasian population. Materials andMethods: Retrospective study of patients with NSCLC diagnosis who had undergone a molecular study from 1 January 2018-31 December 2022. Univariate analysis was performed to compare patient characteristics between the group with and without MPE and molecular biomarkers. Results: A total of 400 patients were included; 53% presented any biomarker and 29% had MPE.PDL1, which was the most frequent. EGFR mutation was associated with women (OR:3.873) and lack of smoking (OR:5.105), but not with MPE. Patients with pleural effusion were older and had lower ECOG. There was no significant difference in the presence of any biomarker. We also did not find an association between the presence of specific mutations and MPE (22.4% vs. 18%, p = 0.2), or PDL1 expression (31.9% vs. 35.9%, p = 0.3). Being younger constituted a protective factor for the presence of MPE (OR:0.962; 95% CI 0.939-0.985, p = 0.002), as well as ECOG ≤ 1 (OR:0.539; 95% CI 0.322-0.902, p = 0.01). Conclusions: This is the first study that describes the clinical, pathological, and molecular characteristics of MPE patients due to NSCLC in a Caucasian population. Although overall we did not find significant differences in the molecular profile between patients with MPE and without effusion, EGFR mutation was associated with a tendency towards pleural progression.

Lung cancer survival trends and prognostic factors: A 26-year population-based study in Girona Province, Spain

BACKGROUND

Lung cancer (LC) is Europe's primary cause of cancer-related mortality largely due to its historically low survival rates. The aim of this study was to analyze 26-year survival trends in the province of Girona, Spain, and to identify key prognostic factors.

METHODS

Population-based study of LC cases collected between 1994 and 2019, with follow-up until December 31, 2021. Variables included date of diagnosis, sex, age, histology, and tumor stage (the latter since 2010). Diagnosis dates were categorized into three periods (1994-2002, 2003-2011, and 2012-2019). Multivariate flexible parametric models, incorporating age as a non-linear, time-varying covariate, were used to analyze net survival (NS) and trends. Annual absolute change in survival (AAC_S) was calculated using 3-year NS.

RESULTS

The analysis of 9,113 LC cases showed a NS improvement between the first and last period (7.1 months (95 %CI: 6.5;7.6) to 8.5 months (95 %CI: 7.9;9.1)). Squamous cell carcinoma (NSC-SCC) showed the greatest improvement with an AAC_S of 0.32 % (95 % CI: 0.21; 0.43), while survival for non-small cell lung cancer not otherwise specified declined (AAC_S of -0.19 % (95 %CI: -0.26; -0.12)). Prognostic analysis of the 3,642 cases (2010-2019) indicated a lower LC death risk for adenocarcinoma and NSC-SCC compared to LC not otherwise specified (HR 0.52 and 0.62, respectively). Increasing tumor stage correlated with higher LC mortality risk (1.8-, 4.0-, and 10.1-fold increase for stage II, III, and IV, respectively, compared to stage I).

CONCLUSIONS

LC survival has notably improved, particularly for NSC-SCC. Survival is influenced by sex, age, date of diagnosis, tumor histology and especially by stage, underscoring comprehensive data collection's importance.

Association between renal dysfunction and outcomes of lung cancer: A systematic review and meta‑analysis

Renal insufficiency and/or chronic kidney disease are common comorbidities in patients with lung cancer, potentially affecting their prognosis. The aim of the present study was to assess the existing evidence on the association between renal insufficiency (RI)/chronic kidney disease (CKD) and the overall survival (OS) and disease-free survival (DFS) of patients with lung cancer (LC). Comprehensive electronic searches in the PubMed, Embase and Scopus databases were performed for observational cohort and case-control studies and randomized controlled trials that investigated the association between RI/CKD and the OS and/or DFS of patients with LC. Random-effect models were used, and the combined effect sizes were reported as either standardized mean differences or relative risks, along with 95% confidence intervals (CI). A total of 10 studies were included. The duration of follow-up in the included studies ranged from 12 months to 5 years. Compared with patients with normal renal function, patients with LC with RI/CKD had worse OS rates [hazard ratio (HR), 1.38; 95% CI, 1.16-1.63] but similar DFS rates (HR, 1.12; 95% CI, 0.75-1.67) at follow-up. Subgroup analysis demonstrated a significant association between poor OS and RI/CKD in patients with stage I/II LC [HR, 1.76; 95% CI, 1.30-2.37] but not in patients with stage III/IV LC [HR, 1.18; 95% CI, 0.91, 1.54]. Furthermore, irrespective of the treatment modality i.e., surgery [HR, 1.78; 95% CI, 1.40-2.27] or medical management [HR, 1.37; 95% CI, 1.25-1.50], RI/CKD was notably associated with a poor OS at follow-up. The findings of the present study underscore the adverse impact of RI/CKD on the long-term survival of patients with LC.

Updated Efficacy and Safety of Lorlatinib in a Phase 2 Study in Chinese Patients With Previously Treated Advanced ALK-Positive Non-small Cell Lung Cancer

OBJECTIVES

Lorlatinib, a brain-penetrant, third-generation anaplastic lymphoma kinase (ALK) inhibitor, demonstrated robust overall and intracranial antitumor activity in patients with advanced ALK-positive non-small cell lung cancer (NSCLC) previously treated with an ALK inhibitor in a global phase 1/2 study (NCT01970865) and a multicenter phase 2 study conducted in China (NCT03909971). We report updated 3-year follow-up data from the phase 2 study.

MATERIALS AND METHODS

Chinese patients with locally advanced or metastatic ALK-positive NSCLC that progressed after crizotinib as the only prior ALK inhibitor (cohort 1) or after 1 non-crizotinib ALK inhibitor (cohort 2), were enrolled in the study. All patients received lorlatinib 100 mg once daily.

RESULTS

At data cutoff, of 109 enrolled patients, the median duration of follow-up for progression-free survival (PFS) was 35.8 months in cohort 1 (n = 67) and 33.1 months in cohort 2 (n = 42). Median PFS (95% CI) per independent central review was 26.3 months (16.6-35.9) and 5.6 months (2.9-12.4), respectively. The median duration of follow-up for overall survival (OS) was 36.4 months and 37.5 months, respectively. Median OS (95% CI) was not reached (NR; NR-NR) and 21.9 months (11.9-NR), respectively. Median intracranial time to progression (95% CI) was NR (NR-NR) and NR (9.7 months-NR), respectively. No new safety signals emerged with long-term treatment.

CONCLUSION

The long-term data confirm robust overall and intracranial clinical activity of lorlatinib, with no new safety signals emerging. These results support using lorlatinib in Chinese patients with previously treated ALK-positive NSCLC with or without brain metastases.

CLINICALTRIALS

gov NCT03909971.

DeepGR: a deep-learning prognostic model based on glycolytic radiomics for non-small cell lung cancer

Background

Glycolysis proved to have a prognostic value in lung cancer; however, to identify glycolysis-related genomic markers is expensive and challenging. This study aimed at identifying glycolysis-related computed tomography (CT) radiomics features to develop a deep-learning prognostic model for non-small cell lung cancer (NSCLC).

Methods

The study included 274 NSCLC patients from cohorts of The Second Affiliated Hospital of Soochow University (SZ; n=64), the Cancer Genome Atlas (TCGA)-NSCLC dataset (n=74), and the Gene Expression Omnibus dataset (n=136). Initially, the glycolysis enrichment scores were evaluated using a single-sample gene set enrichment analysis, and the cut-off values were optimized to investigate the prognostic potential of glycolysis genes. Radiomic features were then extracted using LIFEx software. The least absolute reduction and selection operator (LASSO) algorithm was employed to determine the glycolytic CT radiomics features. A deep-learning prognostic model was constructed by integrating CT radiomics and clinical features. The biological functions of the model were analyzed by incorporating RNA sequencing data.

Results

Kaplan-Meier curves indicated that elevated glycolysis levels were associated with poorer survival outcomes. The LASSO algorithm identified 11 radiomic features that were then selected for inclusion in the deep-learning model. They have shown significant discrimination capability in assessing glycolysis status, achieving an area under the curve value of 0.8442. The glycolysis-based radiomics deep-learning model was named the DeepGR model. This model was able to effectively predict the clinical outcomes of NSCLC patients with AUCs of 0.8760 and 0.8259 in the SZ and TCGA cohorts, respectively. High-risk DeepGR scores were strongly associated with poor overall survival, resting memory CD4+ T cells, and a high response to programmed cell death protein 1 immunotherapy.

Conclusions

The DeepGR model effectively predicted the prognosis of NSCLC patients.

Role of Notch1 Signaling Pathway in Small Cell Lung Carcinoma

Lung cancer is the leading cause of cancer-related death around the globe. It is generally divided into small-cell and non-small-cell lung carcinomas. Small-cell lung cancer (SCLC) is a malignant tumor characterized by rapid growth, high metastatic potential, and a frequent rate of relapse after chemotherapy. All the features may worse aggressiveness of this cancer and increase the possibility of unsuccessful therapeutic attempts. Notch1 signaling is a crucial molecular pathway in the regulation of many cellular functions, including cell-cell communication and gene regulation. Moreover, it was proposed previously that Notch1 might be oncogenic in various types of cancer, but the question arises as to why many SCLC cell lines do not express this pathway. This review aims to explore the role of this complex pathway in SCLC in both vitro and vivo studies and whether it has a tumor-promoting or suppressive effect. After an extensive literature review, it was found that the expression of Notch1 signaling in SCLC reduces its proliferative ability while promoting increased cell apoptosis. Furthermore, it reduces cell motility, invasion, and metastatic ability and enhances cell-cell adhesion by inhibiting epithelial-mesenchymal transition (EMT). Furthermore, it contributes to cell chemo-resistance by altering multidrug resistance-associated protein-1 (MRP-1), demonstrating an overall tumor-suppressive effect. Given these findings, induction of Notch1 using histone deacetylase inhibitor (HDACi) may be a potential future therapeutic strategy for SCLC management. Nevertheless, the effect of such a sophisticated signaling pathway in tumor carcinogenesis can't be generalized to all human cancers, and further studies are needed to better tailor therapeutic plans based on the specific cellular context.

Exosomal microRNA as a key regulator of PI3K/AKT pathways in human tumors

MicroRNAs (miRNAs) are conserved non-protein-coding RNAs that are naturally present in organisms and can control gene expression by suppressing the translation of mRNA or causing the degradation of mRNA. MicroRNAs are highly concentrated in the PI3K/AKT pathway, and abnormal activation of the PI3K/AKT pathway plays a role in cancer progression. The AKT/PI3K pathway is critical for cellular functions and can be stimulated by cytokines and in normal situations. It is involved in regulating various intracellular signal transduction, including development, differentiation, transcriptional regulation, protein, and synthesis. There is a growing body of evidence indicating that miRNAs, which are abundant in exosomes released by different cells, can control cellular biological activities via modulating the PI3K/AKT pathway, hence influencing cancer progression and drug resistance. This article provides an overview of the latest research progress regarding the function and medical use of the PI3K/AKT pathway and exosomal miRNA/AKT/PI3K axis in the behaviors of cancer cells.

ERK5 mediates pro-tumorigenic phenotype in non-small lung cancer cells induced by PGE2

Lung cancer is the leading cause of cancer-related deaths worldwide, with non-small cell lung cancer (NSCLC) constituting approximately 84 % of all lung cancer cases. The role of inflammation in the initiation and progression of NSCLC tumors has been the focus of extensive research. Among the various inflammatory mediators, prostaglandin E2 (PGE2) plays a pivotal role in promoting the aggressiveness of epithelial tumors through multiple mechanisms, including the stimulation of growth, evasion of apoptosis, invasion, and induction of angiogenesis. The Extracellular signal-Regulated Kinase 5 (ERK5), the last discovered member among conventional mitogen-activated protein kinases (MAPK), is implicated in cancer-associated inflammation. In this study, we explored whether ERK5 is involved in the process of tumorigenesis induced by PGE2. Using A549 and PC9 NSCLC cell lines, we found that PGE2 triggers the activation of ERK5 via the EP1 receptor. Moreover, both genetic and pharmacological inhibition of ERK5 reduced PGE2-induced proliferation, migration, invasion and stemness of A549 and PC9 cells, indicating that ERK5 plays a critical role in PGE2-induced tumorigenesis. In summary, our study underscores the pivotal role of the PGE2/EP1/ERK5 axis in driving the malignancy of NSCLC cells in vitro. Targeting this axis holds promise as a potential avenue for developing novel therapeutic strategies aimed at controlling the advancement of NSCLC.

A prospective study of a training program for bronchial sleeve resection using operable 3-dimensional models

Objective

To develop a training program for bronchial sleeve reconstruction using our previously developed 3-dimensional (3D) operable airway model and evaluate its effectiveness in surgical trainees.

Methods

Eight trainees and 4 faculty surgeons were enrolled. Their right upper lobe sleeve reconstruction procedures were scored by 2 senior surgeons in a blinded fashion on a 5-point Likert scale on the following: airway wall tear, reapplied ligatures, reapplied needles, needle entry and exit, anastomotic bite, and caliber adjustment (full score: 30). The trainees were randomized into training and control groups (n = 4 in each group). The training group underwent 6 cycles of training guided by video-based instructions. The control group underwent regular clinical training. All trainees were reevaluated.

Results

Before training, the median score of faculty surgeons was better than that of trainees (27.0 [range, 21.0-28.0] vs 17.5 [range, 9.5, 26.5]; P = .05), suggesting the validity of the scoring method. The initial scores and anastomosis times were similar in the control and training groups. After training, the scores tended to be higher in the training than in the control group (median, 28.2 [range, 27.0-29.0] vs 20.8 [range, 15.0-28.0]; P = .11). The anastomosis time tended to be shorter in the training group (median, 20.0 [18.9, 21.6] minutes vs 24.6 [range 17.8-30.9] minutes; P = .69). The reduction in anastomosis time was significantly greater in the training group (median, -9.4 [range, -4.5 to -13.1] vs 0.0 [range, 5.3 to -6.0]; P = .05).

Conclusions

The training program for bronchial sleeve resection using 3D airway models with video-based instructions improved the trainees' skills.

Epstein-Barr Virus BARF1 Is Expressed in Lung Cancer and Is Associated with Cancer Progression

BACKGROUND

Epstein-Barr virus (EBV) is involved in the development of lymphomas, nasopharyngeal carcinomas (NPC), and a subgroup of gastric carcinomas (GC), and has also been detected in lung carcinomas, even though the role of the virus in this malignancy has not yet been established. BamH1-A Rightward Frame 1 (BARF1), a suggested exclusive epithelial EBV oncoprotein, is detected in both EBV-associated GCs (EBVaGC) and NPC. The expression and role of BARF1 in lung cancer is unknown.

METHODS

A total of 158 lung carcinomas including 80 adenocarcinomas (AdCs) and 78 squamous cell carcinomas (SQCs) from Chilean patients were analyzed for EBV presence via polymerase chain reaction (PCR), Immunohistochemistry (IHC), or chromogenic in situ hybridization (CISH). The expression of BARF1 was evaluated using Reverse Transcription Real-Time PCR (RT-qPCR). Additionally, A549 and BEAS-2B lung epithelial cells were transfected with a construct for ectopic BARF1 expression. Cell proliferation, migration, invasion, and epithelial-mesenchymal transition (EMT) were evaluated.

RESULTS

We found that EBV was present in 37 out of 158 (23%) lung carcinomas using PCR. Considering EBV-positive specimens using PCR, IHC for Epstein-Barr nuclear antigen 1 (EBNA1) detected EBV in 24 out of 30 (80%) cases, while EBERs were detected using CISH in 13 out of 16 (81%) cases. Overall, 13 out of 158 (8%) lung carcinomas were shown to be EBV-positive using PCR/IHC/CISH. BARF1 transcripts were detected in 6 out of 13 (46%) EBV-positive lung carcinomas using RT qPCR. Finally, lung cells ectopically expressing BARF1 showed increased migration, invasion, and EMT.

CONCLUSIONS

EBV is frequently found in lung carcinomas from Chile with the expression of BARF1 in a significant subset of cases, suggesting that this viral protein may be involved in EBV-associated lung cancer progression.

A case report of the diagnosis and treatment of immune checkpoint inhibitor-related encephalitis induced by camrelizumab

Background

Camrelizumab has been widely used in the treatment of various cancers, it is important to determine the side-effect of this drug and the corresponding treatment strategy.

Case Description

The current case report describes the clinic, diagnosis, treatment and prognosis of camrelizumab-related encephalitis. Camrelizumab was administrated to a 67-year-old man with squamous cell carcinoma (SCC), a form of non-small cell lung cancer (NSCLC). One month after the treatment, the patient showed typical encephalitis symptoms including systemic fatigue, numbness of extremities and walking instability. Furthermore, the total protein in cerebrospinal fluid (CSF) was significantly elevated (1,399 vs. normal range 120-600 mg/L). Importantly, magnetic resonance imaging showed there was no brain metastasis. The patient did not get better after two days of intravenous injection of thioctic acid (1.2 g) and cobamamide (1.5 mg) once daily. Therefore, this patient was diagnosed as camrelizumab-related encephalitis. Then, we put him on one-month regimen: oral taper corticoids (methylprednisolone, MP) at 500 mg (days 1-4), 120 mg (days 5-10) and 60 mg (days 11-15); MP was replaced with oral prednisone acetate at 30 mg (days 16-30). After the treatment, the total protein in CSF was decreased to 873 mg/L, and all of encephalitis-related symptom was completely lost. About one year after the onset of encephalitis, the patient showed no recurrence of neurological symptoms.

Conclusions

The present case proves the efficacy and safety of corticoids in the treatment of camrelizumab-related adverse effects.

Lung Microbiome in Lung Cancer: A New Horizon in Cancer Study

Lung cancer is the second most prevalent cancer worldwide and a leading cause of cancer-related deaths. Recent technological advancements have revealed that the lung microbiome, previously thought to be sterile, is host to various microorganisms. The association between the lung microbiome and lung cancer initiation, progression, and metastasis is complex and contradictory. However, disruption in the homeostasis of microbiome compositions correlated with the increased risk of lung cancer. This review summarizes current knowledge about the most recent developments and trends in lung cancer-related microbiota or microbial components. This article aims to provide information on this rapidly evolving field while giving context to the general role of the lung microbiome in lung cancer. In addition, this review briefly discussed the causative association of lung microbiome with lung cancer. We will review the mechanisms by which lung microbiota influence carcinogenesis, focusing on microbiota dysbiosis. Moreover, we will also discuss the host-microbiome interaction as it plays a crucial role in stimulating and regulating the immune response. Finally, we will provide information on the diagnostic role of the microbiome in lung cancer. This article aims to offer an overview of the lung microbiome as a predictive and diagnostic biomarker in lung cancer.

Lymphangioleiomyomatosis as a potent lung cancer risk factor: Insights from a Japanese large cohort study

BACKGROUND AND OBJECTIVE

Lymphangioleiomyomatosis (LAM) is a rare neoplastic disease associated with the functional tumour suppressor genes TSC1 and TSC2 and causes structural destruction in the lungs, which could potentially increase the risk of lung cancer. However, this relationship remains unclear because of the rarity of the disease.

METHODS

We investigated the relative risk of developing lung cancer among patients diagnosed with LAM between 2001 and 2022 at a single high-volume centre in Japan, using data from the Japanese Cancer Registry as the reference population. Next-generation sequencing (NGS) was performed in cases where tumour samples were available.

RESULTS

Among 642 patients diagnosed with LAM (sporadic LAM, n = 557; tuberous sclerosis complex-LAM, n = 80; unclassified, n = 5), 13 (2.2%) were diagnosed with lung cancer during a median follow-up period of 5.13 years. All patients were female, 61.5% were never smokers, and the median age at lung cancer diagnosis was 53 years. Eight patients developed lung cancer after LAM diagnosis. The estimated incidence of lung cancer was 301.4 cases per 100,000 person-years, and the standardized incidence ratio was 13.6 (95% confidence interval, 6.2-21.0; p = 0.0008). Actionable genetic alterations were identified in 38.5% of the patients (EGFR: 3, ALK: 1 and ERBB2: 1). No findings suggested loss of TSC gene function in the two patients analysed by NGS.

CONCLUSION

Our study revealed that patients diagnosed with LAM had a significantly increased risk of lung cancer. Further research is warranted to clarify the carcinogenesis of lung cancer in patients with LAM.

Histopathological Patterns of Lung Cancer in Iran: A Single-Center Study

BACKGROUND

Lung cancer (LC) is one of the leading causes of cancer-related deaths worldwide. In Iran, it is the second most common cause of cancer-related deaths for men and the third most common for women. This study aimed to examine the clinicopathological characteristics of Iranian patients with LC.

METHODS

Clinicopathological data of 1382 patients with primary LC diagnosed over 11 years (2012‒2023) at the "National Institute of Tuberculosis and Lung Disease" (NRITLD), Tehran, Iran, were retrospectively reviewed.

RESULTS

Adenocarcinoma was the most common type of cancer found in the patients (42.44%). The median age was 59.69 years (mean: 60.41 years) ranging 24-88 years. The mean male-to-female ratio was 3.65. Additionally, 65.84% of patients were smokers. The majority of patients (82.69 %) were diagnosed at an advanced stage (stage IV) of cancer.

CONCLUSION

Although some of our findings are consistent with those of previous LC studies, there are some discrepancies, especially concerning the smoking status and median age of the Iranian patients. Therefore, additional clinical and epidemiological studies are needed to determine the impact of non-smoking factors, such as environmental exposure and genetic predisposition, on the development of LC.

Deciphering NF-kappaB pathways in smoking-related lung carcinogenesis

One of the main causes of death worldwide is lung cancer, which is largely caused by cigarette smoking. The crucial transcription factor NF-κB, which controls inflammatory responses and various cellular processes, is a constitutively present cytoplasmic protein strictly regulated by inhibitors like IκB proteins. Upon activation by external stimuli, it undergoes phosphorylation, translocates into the nucleus, and modulates the expression of specific genes. The incontrovertible association between pulmonary malignancy and tobacco consumption underscores and highlights a public health concern. Polycyclic aromatic hydrocarbons and nitrosamines, potent carcinogenic compounds present in the aerosol emitted from combusted tobacco, elicit profound deleterious effects upon inhalation, resulting in severe perturbation of pulmonary tissue integrity. The pathogenesis of smoking-induced lung cancer encompasses an intricate process wherein NF-κB activation plays a pivotal role, triggered by exposure to cigarette smoke through diverse signaling pathways, including those associated with oxidative stress and pro-inflammatory cytokines. Unraveling the participation of NF-κB in smoking-induced lung cancer provides pivotal insights into molecular processes, wherein intricate crosstalk between NF-κB and pathways such as MAPK and PI3K-Akt amplifies the inflammatory response, fostering an environment conducive to the formation of lung cancer. This study reviews the critical function of NF-κB in the complex molecular pathways linked to the initiation and advancement of lung carcinogenesis as well as potential treatment targets. See also the graphical abstract(Fig. 1).