[Lung cancer at a university hospital: epidemiological and histological characteristics of a recent and a historical series]

SIRT3 acts as a novel biomarker for the diagnosis of lung cancer: A retrospective study

Lung cancer (LC) is a prevalent malignancy worldwide with increased morbidity and mortality. Mitochondrial nicotinamide adenine dinucleotide-dependent deacetylase sirtuin-3 (SIRT3) has been reported to be involved in tumorigenesis. In this retrospective study, we measured the expression and diagnostic value of SIRT3 in LC patients.Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to measure serum SIRT3 mRNA level in 150 LC patients and 52 healthy volunteers. SIRT3 protein level was detected using western blot for 84 pairs of LC and adjacent normal tissues. The association of SIRT3 mRNA level with clinical parameters of LC patients was estimated via chi-square test. Receiver operating characteristic curve (ROC) was plotted to evaluate the diagnostic performance of serum SIRT3 in LC patients.SIRT3 mRNA and protein levels were significantly decreased in LC tissues and serum samples, compared with corresponding controls (P < .05). Moreover, the expression of SIRT3 mRNA was negatively associated with tumor size (P = .002), tumor node metastasis stage (P < .001), and metastasis (P < .001). ROC curve demonstrated that serum SIRT3 could distinguish LC patients from healthy individuals, with an area under the curve of 0.918. The optimal cutoff value was 3.12, reaching a sensitivity of 86.4%, and a specificity of 94%.SIRT3 expression is significantly down-regulated in LC serum and tissues. SIRT3 may be employed as a promising biomarker in the early diagnosis of LC.

Predicting delays in lung cancer diagnosis and staging

Background

Despite growing interest in increasing the efficiency and speed of the diagnosis, staging, and treatment of lung cancer (LC), the interval from signs and symptoms to diagnosis and treatment remains longer than recommended. The aim of this study was to analyze the factors that cause delays in the LC diagnosis/staging process and, consequently, delays in making therapeutic decisions.

Methods

We analyzed audit data from a prospective dataset of 1330 patients assessed at The Lung Cancer Rapid Diagnostic Unit from 26 June 2013 to 26 March 2016. The number and type of procedures and medical tests and the times of all procedures were recorded. Clinical and epidemiological variables and whether the diagnosis was performed on an inpatient or outpatient basis were also recorded.

Results

Malignancy was confirmed in 737 (55.4%) of the 1330 patients, with LC in 627 of these (85.2%). The mean interval to final diagnosis was 19.8 ± 13.9 days. Variables significantly related to a longer diagnostic time were the number of days until computed tomography (CT) was performed (odds ratio [OR], 95% confidence interval [CI] 1.347, 1.103–1.645; P = 0.003), until a histology sample was obtained (OR 1.243, 95% CI1.062–1.454; P = 0.007), and the total number of tests performed during the diagnostic and staging process (OR 1.823, 95% CI 1.046–3.177; P = 0.03).

Conclusions

A greater number of tests and more days to CT and histology led to longer delay times. Optimization of these factors should reduce delays in the LC diagnosis process.

[Epidemiological Evolution of Lung Cancer in the South of Spain from 1990 to 2010]

Background

Changes in lung cancer has been characterized by the increase of cases among women and the increase in adenocarcinomas among other histological subtypes.

Methods

Descriptive analysis of cases diagnosed with lung cancer in Hospital Virgen de las Nieves (Spain) from 1990 to 2010, based on five variables (age, sex, smoking, histology and pathological anatomy). The study establishes associations between these variables and compares the results with the literature.

Results

2, 026 patients were diagnosed with lung cancer in this period; 1, 838 were males (90.7%) and 188 women (9.3%); 1, 892 patients (93.4%) were smokers or ex-smokers and 134 (6.6%) had never smoked; the most frequent non-small cell histology types were squamous cell carcinoma and adenocarcinoma and it was the most frequent neoplasia in women and were associated with a lower tobacco consumption.

Conclusion

The large majority of lung cancer cases is associated with a history of smoking tobacco and there are histopathological differences according to gender and cumulative tobacco smoke load.

The usefulness of thoracic ultrasonography in diagnosis and staging of bronchogenic carcinoma

Aim

To evaluate (1) the usefulness of thoracic ultrasound in diagnosis and staging of bronchogenic carcinoma by comparing lesion detectability between thoracic- ultrasound and computed tomography and (2) the outcome of thoracic-ultrasound-guided biopsy in diagnosing bronchogenic carcinoma.

Methods

We conducted a cross-sectional study on 53 patients of confirmed bronchogenic carcinoma. All patients had been investigated by thoracic-ultrasound and chest-computed tomography; data regarding the presence of mass (its size, necrosis), lymph nodes invasion, peritumoural atelectasis, consolidations, pleural effusion, chest wall invasion, and paralysis of the diaphragm were recorded. Thoracic-ultrasound-guided biopsy was done for 41 patients.

Results

Thoracic-ultrasound had significantly higher detection rate of peritumoural atelectasis, paralysis of the diaphragm, and supraclavicular lymph nodes invasion, while it has significantly lower detection rate of pulmonary masses and mediastinal lymph nodes invasion than computed tomography. It has nonsignificant higher detection rate of pleural effusion, consolidations, chest wall invasion and necrosis within mass than computed tomography. Thoracic-ultrasound detects static air-bronchogram and/or fluid bronchogram in 53.3% of bronchogenic carcinoma-associated consolidation. Thoracic-ultrasound-guided biopsy revealed positive yield in 78.0% (32/41) of patients. All patients with negative thoracic-ultrasound biopsy had mass size >5 cm with necrosis within the mass. Self-limited complications occurred in 26.8% after thoracic-ultrasound-guided biopsy (haemoptysis 22.0%, pneumothorax 2.4% and subcutaneous emphysema 2.4%).

Conclusion

Thoracic-ultrasound has a significant complementary role to computed tomography in diagnosis and staging of bronchogenic carcinoma. Thoracic-ultrasound-guided biopsy revealed good positive yield (78%), its yield was negatively affected by mass size and necrosis. It is a simple, practical and accurate procedure without significant patients' risks.

Estimation of life expectancy of patients diagnosed with the most common cancers in the Valparaiso Region, Chile

Background

The 1000s of people who die from cancer each year have become one of the leading causes of death among the Chilean population, placing it as the second cause of death in the region of Valparaiso between 1997 and 2003. Statistics have provided different measures regarding the life expectancy of cancer patients which have resulted in being useful to establish courses of action for prevention and treatment plans to follow.

Methods

Data was extracted from the cancer module of the Epidemiology Assistance System (SADEPI for its initials in Spanish) which stores information about cancer cases in the provinces of Valparaiso and Petorca. The survival period is defined as the difference in days between the date of occurrence and the date of death of the patient by separating the data into quartiles.

Results

The more frequent cancers in the region of Valparaiso behave similarly to global behaviours of the disease. The majority of affected patients are around 65 years of age which progressively lowers its occurrence in younger adults under the age of 45.

Conclusions

Further efforts are required for early detection and timely access to treatment for cancer patients. Statistics are an important support in achieving this.

Inhibition of Calcium-Activated Chloride Channel ANO1/TMEM16A Suppresses Tumor Growth and Invasion in Human Lung Cancer

Lung cancer or pulmonary carcinoma is primarily derived from epithelial cells that are thin and line on the alveolar surfaces of the lung for gas exchange. ANO1/TMEM16A, initially identified from airway epithelial cells, is a member of Ca2+-activated Cl- channels (CaCCs) that function to regulate epithelial secretion and cell volume for maintenance of ion and tissue homeostasis. ANO1/TMEM16A has recently been shown to be highly expressed in several epithelium originated carcinomas. However, the role of ANO1 in lung cancer remains unknown. In this study, we show that inhibition of calcium-activated chloride channel ANO1/TMEM16A suppresses tumor growth and invasion in human lung cancer. ANO1 is upregulated in different human lung cancer cell lines. Knocking-down ANO1 by small hairpin RNAs inhibited proliferation, migration and invasion of GLC82 and NCI-H520 cancel cells evaluated by CCK-8, would-healing, transwell and 3D soft agar assays. ANO1 protein is overexpressed in 77.3% cases of human lung adenocarcinoma tissues detected by immunohistochemistry. Furthermore, the tumor growth in nude mice implanted with GLC82 cells was significantly suppressed by ANO1 silencing. Taken together, our findings provide evidence that ANO1 overexpression contributes to tumor growth and invasion of lung cancer; and suppressing ANO1 overexpression may have therapeutic potential in lung cancer therapy.

Pattern of use of radiotherapy for lung cancer: a descriptive study

BACKGROUND

Lung cancer remains one of the most prevalent forms of cancer. Radiotherapy, with or without other therapeutic modalities, is an effective treatment. Our objective was to report on the use of radiotherapy for lung cancer, its variability in our region, and to compare our results with the previous study done in 2004 (VARA-I) in our region and with other published data.

METHODS

We reviewed the clinical records and radiotherapy treatment sheets of all patients undergoing radiotherapy for lung cancer during 2007 in the 12 public hospitals in Andalusia, an autonomous region of Spain. Data were gathered on hospital, patient type and histological type, radiotherapy treatment characteristics, and tumor stage.

RESULTS

610 patients underwent initial radiotherapy. 37% of cases had stage III squamous cell lung cancer and were treated with radical therapy. 81% of patients with non-small and small cell lung cancer were treated with concomitant chemo-radiotherapy and the administered total dose was ≥60 Gy and ≥45 Gy respectively. The most common regimen for patients treated with palliative intent (44.6%) was 30 Gy. The total irradiation rate was 19.6% with significant differences among provinces (range, 8.5-25.6%; p<0.001). These differences were significantly correlated with the geographical distribution of radiation oncologists (r=0.78; p=0.02). Our results were similar to other published data and previous study VARA-I.

CONCLUSIONS

Our results shows no differences according to the other published data and data gathered in the study VARA-I. There is still wide variability in the application of radiotherapy for lung cancer in our setting that significantly correlates with the geographical distribution of radiation oncologists.

Lung cancer at a University Hospital in Saudi Arabia: A four-year prospective study of clinical, pathological, radiological, bronchoscopic, and biochemical parameters

OBJECTIVES AND BACKGROUND

Lung cancer accounts for 4% of all newly diagnosed cancers in Saudi Arabia. The pattern of presentation is unknown. The objectives of this study were to assess the clinical, radiological, pathological, biochemical and bronchoscopic abnormalities in lung cancer patients and to compare our findings with those reported in the literature.

METHODS

A total of 114 patients with proven lung cancer were selected for the study. A questionnaire concerning patients' demographic data was obtained; the abnormalities and the cell types of lung cancer were recorded prospectively in each subject.

RESULTS

A total of 114 patients with lung cancer were studied. Mean age ± SD was (59.8 ± 10.8) years, and (71.1%) were smokers and 95.1% of them were male, (90.1%) smoked >20 pack/yr (96.2%) for 20 years or more. Cough (76.3%) and clubbing (40.4%) were the most common symptom and physical abnormality respectively. The right lung (64.9%) was more commonly affected than the left (37.7%). Metastases were present in (49.1%) at presentation. The right and left upper bronchi (24% vs. 16%) were the mostly affected. Hypercalcemia was more common in squamous cell, while hyponatremia was more common in adenocarcinoma, and small cell. Squamous cell carcinoma was the most common cell type (51.8%) and significantly associated with smoking (P ≤ 0.001)

CONCLUSION

Squamous cell carcinoma was the most common cell type, and significantly associated with smoking. The incidence of metastasis was high at presentation. The right lung and right upper bronchus were often affected. Hypercalcemia and hyponatremia were the most common biochemical abnormalities.

Smoking habits in elderly lung cancer patients: still no changes in epidemiology? A single-center experience

PURPOSE

Our goal was to describe the clinical, histological, and epidemiological characteristics of lung cancer diagnoses in people ≥70 years of age.

MATERIALS AND METHODS

Information on patients diagnosed with lung cancer from January 2006 to February 2008 was prospectively collected from the outpatient oncology department at a regional hospital. A total of 83 patients (97.6% men; mean age 77 years) were studied. There was a higher ratio of men to women than that reported in younger populations. Mean age was higher than that reported for randomized studies: 65.1% were ≥75 years old. Patients >80 years constituted 28.9% of the study population. Most patients (96.4%) had a history of smoking; they were predominantly former smokers (72.5% vs. 27.5%).

RESULTS

The most common histological types were squamous cell (61.3%) and small cell (14.5%) carcinoma. Metastasis was present in 36.1% of patients. Stage was significantly associated with survival (logrank p < 0.001). There was no association between age and survival. Squamous cell lung cancer was associated with a better survival (p = 0.003).

CONCLUSIONS

Elderly lung cancer patients who attended clinical practice were older than those included in prospective studies. The predominance of men and squamous cell carcinoma is associated with a smoking history. The epidemiological and histological patterns of younger patients have changed, possibly in relation to changes in smoking habits. The translation of these changes to elderly patients will be evidenced in the future. Only prospective epidemiologic studies will determine whether smoking habits are changing epidemiology in elderly lung cancer patients.

[Clinical care characteristics and factors associated with in-hospital mortality for lung cancer in Spain]

BACKGROUND AND OBJECTIVE

Lung cancer causes high morbimortality in Spain and is currently experiencing a significant increase in women. The aim of this study was to describe differential clinical and health care characteristics by sex, as well as factors associated with and geographic differences of in-hospital mortality.

MATERIAL AND METHOD

Descriptive study of episodes registered in the National Hospital Discharge Minimum Basic Data Set for admission type and gender in 2005. Two logistic regression models by sex were built in order to explain the individual influence of variables on in-hospital mortality. Using predictive values of the models, standardized mortality rates were calculated to study the variation between Spanish regions.

RESULTS

Women presented a lower mean age, smoking habit and in-hospital mortality than men. However, women presented more adenocarcinomas, greater care in high volume centers, more surgery in readmissions and were subjected to chemotherapy more often in new admissions than men. Adenocarcinoma in men and no specific location in women were associated with higher mortality. Smoking habit and lung diagnosis procedures in men, and middle lobe location and bronchoscopy in women were associated with lower mortality. The geographical mortality pattern detected was similar in both sexes only in some regions of Spain.

CONCLUSIONS

Differential clinical characteristics, health care and overall results appear to exist depending on individuals' gender. Recognition of these differences are crucial in order to improve the effectiveness and equity of our health care system.

Dissimilarity in gene expression profiles of lung adenocarcinoma in Japanese men and women

BACKGROUND

Although clinical differences in lung cancer between men and women have been noted, few studies have examined the sex dissimilarity using gene expression analysis.

OBJECTIVE

The purpose of this study was to determine the different molecular carcinogenic mechanisms involved in lung cancers in Japanese men and women.

METHODS

Patients who received surgery for stage I lung adenocarcinoma were included. RNA was extracted from cancerous and normal tissue, and gene expression was then examined with oligonucleotide microarray analysis. A quantitative polymerase chain reaction assay was performed.

RESULTS

In a microarray analysis of tissue from 13 men and 6 women, 12 genes were under-expressed and 24 genes were overexpressed in lung adenocarcinoma in women compared with men. Genes related to cell cycle were present in underexpressed genes, and genes related to apoptosis, ubiquitination, and metabolism were observed in overexpressed genes. Of interest among the selected genes were WAP four-disulfide core domain 2 (WFDC2) and major histocompatibility complex, class II, DM alpha (HLA-DMA); these genes were classified into 2 groups by hierarchical clustering analysis. Expression of WFDC2 in nonsmokers was significantly higher than that in smokers (P=0.023). However, there was no significant difference in HLA-DMA expression between smokers and nonsmokers.

CONCLUSION

Thirty-six genes that characterize lung adenocarcinoma by sex were selected. This information may contribute to the development of novel diagnostic techniques and treatment modalities that consider sex differences in lung adenocarcinoma.