[Lung cancer in adults: Better prognosis of patients aged 45 and under related to good condition and lower TNM stage (a comparative and retrospective study)]

Trends and risk factors of lung cancer in China

China is faced with heavy burdens caused by lung cancer, which has climbed to the top of both cancer incidence and mortality spectrums. The age-standardized rates of incidence and mortality have shown a trend of gradual up-trends in the last decades, while the crude rates rise much quickly due to the aging of population. Although the improvement in health care has contributed to better survival of lung cancer, its prognosis is still challenging. Apart from the common risk factors such as tobacco use, air pollution, and occupational hazards, some specific factors like Chinese-style cooking also have posed great threats to human health. In light of such national conditions, specific interventions should be conducted to curb the burden of lung cancer including smoking cessation, improvement of air quality, early detection and effective treatment of lung cancer.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios may aid in identifying patients with non-small cell lung cancer and predicting Tumor-Node-Metastasis stages

The present study aimed to identify a high-risk population with non-small cell lung cancer (NSCLC) and to predict TNM stages using the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR). This retrospective study included preoperative data of 171 patients and 105 controls. Compared with healthy controls, patients with NSCLC had higher levels of NLR and PLR (NLR, 2.719±0.183 vs. 1.813±0.079, P<0.01; PLR, 135.800±4.778 vs. 112.000±5.651, P<0.01, respectively). The associations between Tumor-Node-Metastasis stages and the aforementioned parameters were detected (both P<0.01). NLR and PLR improved the rate of early diagnosis of NSCLC, particularly for stages III and IV with a higher area under curve value (0.752 and 0.759, respectively) compared with stage I and II NSCLC. In addition, PLR with a T stage-dependent increase may be a potential and independent predictive marker for T stage (P<0.05); the NLR exhibited an N stage-dependent increase (except for stage N3) and was identified as a marker for N stage (P<0.0001). It was subsequently concluded that NLR and PLR are useful biomarkers in the early diagnosis of NSCLC; that these two parameters were capable of indicating advanced stages, III and IV; and that PLR and NLR were independent predictors for T and N stages, respectively.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios may aid in identifying patients with non-small cell lung cancer and predicting Tumor-Node-Metastasis stages

The present study aimed to identify a high-risk population with non-small cell lung cancer (NSCLC) and to predict TNM stages using the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR). This retrospective study included preoperative data of 171 patients and 105 controls. Compared with healthy controls, patients with NSCLC had higher levels of NLR and PLR (NLR, 2.719±0.183 vs. 1.813±0.079, P<0.01; PLR, 135.800±4.778 vs. 112.000±5.651, P<0.01, respectively). The associations between Tumor-Node-Metastasis stages and the aforementioned parameters were detected (both P<0.01). NLR and PLR improved the rate of early diagnosis of NSCLC, particularly for stages III and IV with a higher area under curve value (0.752 and 0.759, respectively) compared with stage I and II NSCLC. In addition, PLR with a T stage-dependent increase may be a potential and independent predictive marker for T stage (P<0.05); the NLR exhibited an N stage-dependent increase (except for stage N3) and was identified as a marker for N stage (P<0.0001). It was subsequently concluded that NLR and PLR are useful biomarkers in the early diagnosis of NSCLC; that these two parameters were capable of indicating advanced stages, III and IV; and that PLR and NLR were independent predictors for T and N stages, respectively.

Mutant-allele fraction heterogeneity is associated with non-small cell lung cancer patient survival

Genetic intratumor heterogeneity is associated with tumor occurrence, development and overall outcome. The present study aims to explore the association between mutant-allele fraction (MAF) heterogeneity and patient overall survival in lung cancer. Somatic mutation data of 939 non-small cell lung cancer (NSCLC) cases were obtained from The Cancer Genome Atlas. Entropy-based mutation allele fraction (EMAF) score was used to describe the uncertainty of individual somatic mutation patterns and to further analyze the association with patient overall survival. Results indicated that association between EMAF and overall survival was significant in the discovery set [hazard ratio (H)R=1.62; 95% confidence interval (CI): 1.08–2.41; P=0.018] and replication set (HR=1.63; 95% CI: 1.11–2.37; P=0.011). In addition, EMAF was also significantly different in lung adenocarcinoma and squamous cell carcinoma. Furthermore, a significant difference was indicated in early-stage patients. Results from c-index analysis indicated that EMAF improved the model predictive performance on the 3-year survival beyond that of traditional clinical staging, particularly in early-stage patients. In conclusion, EMAF successfully reflected MAF heterogeneity among patients with NSCLC. Additionally, EMAF improved the predictive performance in early-stage patient prognosis beyond that of traditional clinical staging. In clinical application, EMAF appears to identify a subset of early-stage patients with a poor prognosis and therefore may help inform clinical decisions regarding the application of chemotherapy after surgery.