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Sponagel J, Devarakonda S, Rubin JB, Luo J, Ippolito JE. De novo serine biosynthesis from glucose predicts sex-specific response to antifolates in non-small cell lung cancer cell lines. iScience 2022; 25:105339. [PMID: 36325067 PMCID: PMC9619300 DOI: 10.1016/j.isci.2022.105339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 11/29/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related death. Intriguingly, males with non-small cell lung cancer (NSCLC) have a higher mortality rate than females. Here, we investigated the role of serine metabolism as a predictive marker for sensitivity to the antifolate pemetrexed in male and female NSCLC cell lines. Using [13C6] glucose tracing in NSCLC cell lines, we found that a subset of male cells generated significantly more serine from glucose than female cells. Higher serine biosynthesis was further correlated with increased sensitivity to pemetrexed in male cells only. Concordant sex differences in metabolic gene expression were evident in NSCLC and pan-cancer transcriptome datasets, suggesting a potential mechanism with wide-reaching applicability. These data were further validated by integrating antifolate drug cytotoxicity and metabolic pathway transcriptome data from pan-cancer cell lines. Together, these findings highlight the importance of considering sex differences in cancer metabolism to improve treatment for all patients.
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Affiliation(s)
- Jasmin Sponagel
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Siddhartha Devarakonda
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Joshua B. Rubin
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience Washington University School of Medicine, St Louis, MO 63110, USA
| | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
- Siteman Cancer Center Biostatistics Shared Resource, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Joseph E. Ippolito
- Department of Radiology Washington University School of Medicine, St Louis, MO 63110, USA
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St Louis, MO 63110, USA
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Araghi M, Fidler-Benaoudia M, Arnold M, Rutherford M, Bardot A, Ferlay J, Bucher O, De P, Engholm G, Gavin A, Kozie S, Little A, Møller B, St Jacques N, Tervonen H, Walsh P, Woods R, O'Connell DL, Baldwin D, Elwood M, Siesling S, Bray F, Soerjomataram I. International differences in lung cancer survival by sex, histological type and stage at diagnosis: an ICBP SURVMARK-2 Study. Thorax 2022; 77:378-390. [PMID: 34282033 DOI: 10.1136/thoraxjnl-2020-216555] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 06/07/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Lung cancer has a poor prognosis that varies internationally when assessed by the two major histological subgroups (non-small cell (NSCLC) and small cell (SCLC)). METHOD 236 114 NSCLC and 43 167 SCLC cases diagnosed during 2010-2014 in Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK were included in the analyses. One-year and 3-year age-standardised net survival (NS) was estimated by sex, histological type, stage and country. RESULTS One-year and 3-year NS was consistently higher for Canada and Norway, and lower for the UK, New Zealand and Ireland, irrespective of stage at diagnosis. Three-year NS for NSCLC ranged from 19.7% for the UK to 27.1% for Canada for men and was consistently higher for women (25.3% in the UK; 35.0% in Canada) partly because men were diagnosed at more advanced stages. International differences in survival for NSCLC were largest for regional stage and smallest at the advanced stage. For SCLC, 3-year NS also showed a clear female advantage with the highest being for Canada (13.8% for women; 9.1% for men) and Norway (12.8% for women; 9.7% for men). CONCLUSION Distribution of stage at diagnosis among lung cancer cases differed by sex, histological subtype and country, which may partly explain observed survival differences. Yet, survival differences were also observed within stages, suggesting that quality of treatment, healthcare system factors and prevalence of comorbid conditions may also influence survival. Other possible explanations include differences in data collection practice, as well as differences in histological verification, staging and coding across jurisdictions.
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Affiliation(s)
- Marzieh Araghi
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Miranda Fidler-Benaoudia
- Cancer Epidemiology and Prevention Research, Holy Cross Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Melina Arnold
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Mark Rutherford
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
- Health Sciences, University of Leicester, Leicester, UK
| | - Aude Bardot
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Jacques Ferlay
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Prithwish De
- Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Gerda Engholm
- Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Kobenhavn, Denmark
| | - Anna Gavin
- Queen's University Belfast, Northern Ireland Cancer Registry, Belfast, UK
| | - Serena Kozie
- Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada
| | - Alana Little
- Cancer Institute New South Wales, Eveleigh, New South Wales, Australia
| | - Bjørn Møller
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Nathalie St Jacques
- Cancer Care Program, Registry and Analytics, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Hanna Tervonen
- Cancer Institute New South Wales, Eveleigh, New South Wales, Australia
| | | | - Ryan Woods
- BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Dianne L O'Connell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Cancer Research Division, Sydney, New South Wales, Australia
| | - David Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Mark Elwood
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Sabine Siesling
- Department of Research and Development, IKNL, Utrecht, The Netherlands
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Isabelle Soerjomataram
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
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Yu XQ, Yap ML, Cheng ES, Ngo PJ, Vaneckova P, Karikios D, Canfell K, Weber MF. Evaluating prognostic factors for sex differences in lung cancer survival: findings from a large Australian cohort. J Thorac Oncol 2022; 17:688-699. [DOI: 10.1016/j.jtho.2022.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
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A Machine Learning-Based Investigation of Gender-Specific Prognosis of Lung Cancers. ACTA ACUST UNITED AC 2021; 57:medicina57020099. [PMID: 33499377 PMCID: PMC7911834 DOI: 10.3390/medicina57020099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 01/21/2023]
Abstract
Background and Objective: Primary lung cancer is a lethal and rapidly-developing cancer type and is one of the most leading causes of cancer deaths. Materials and Methods: Statistical methods such as Cox regression are usually used to detect the prognosis factors of a disease. This study investigated survival prediction using machine learning algorithms. The clinical data of 28,458 patients with primary lung cancers were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Results: This study indicated that the survival rate of women with primary lung cancer was often higher than that of men (p < 0.001). Seven popular machine learning algorithms were utilized to evaluate one-year, three-year, and five-year survival prediction The two classifiers extreme gradient boosting (XGB) and logistic regression (LR) achieved the best prediction accuracies. The importance variable of the trained XGB models suggested that surgical removal (feature “Surgery”) made the largest contribution to the one-year survival prediction models, while the metastatic status (feature “N” stage) of the regional lymph nodes was the most important contributor to three-year and five-year survival prediction. The female patients’ three-year prognosis model achieved a prediction accuracy of 0.8297 on the independent future samples, while the male model only achieved the accuracy 0.7329. Conclusions: This data suggested that male patients may have more complicated factors in lung cancer than females, and it is necessary to develop gender-specific diagnosis and prognosis models.
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Risk factors for skeletal-related events in non-small cell lung cancer patients treated with bone-modifying agents. Support Care Cancer 2021; 29:4081-4088. [PMID: 33404803 DOI: 10.1007/s00520-020-05880-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The risk factors for skeletal-related events (SREs) among non-small cell lung cancer (NSCLC) patients during treatment with bone-modifying agents (BMAs) are not yet well-understood. METHODS The medical records of 238 consecutive NSCLC patients treated with BMAs, including zoledronic acid and denosumab, at the Chiba University Hospital from 2012 to 2016 were reviewed in the present study. SREs were defined as either pathologic fractures, spinal cord compression, the need for bone irradiation or surgery, or hypercalcemia. The risk factors for earlier occurrence of the first SRE from the time of the first bone metastasis diagnosis after the initiation of BMA treatment were identified. RESULTS Of the 238 included patients, 92% (n = 220) had a performance status (PS) of 0-2 at diagnosis of bone metastasis. Forty-eight (20%) patients developed at least one SRE. The most common first SRE was the need for bone irradiation surgery (n = 27, 56%). Significant risk factors included poor PS (hazard ratio [HR]: 4.36; p = .024), male sex (HR: 2.17; p = .022), and the use of zoledronic acid (HR: 1.91; p = .032). The overall survival (OS) from the first bone metastasis diagnosis was 394 days (95% confidence interval [CI]: 331-465). The OS of patients with PS 3 and 4 at the diagnosis of bone metastasis (median: 36 days; 95% CI: 13-50) was significantly (p < 0.0001) shorter than that of patients with PS 0-2 (median: 411 days; 95% CI: 354-558) (HR: 4.53; 95% CI: 2.62-7.35). CONCLUSIONS Careful observation is needed for patients with the identified risk factors, which include poor PS and male sex, despite the BMA treatment.
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Shioyama Y, Onishi H, Takayama K, Matsuo Y, Takeda A, Yamashita H, Miyakawa A, Murakami N, Aoki M, Matsushita H, Matsumoto Y, Shibamoto Y. Clinical Outcomes of Stereotactic Body Radiotherapy for Patients With Stage I Small-Cell Lung Cancer: Analysis of a Subset of the Japanese Radiological Society Multi-Institutional SBRT Study Group Database. Technol Cancer Res Treat 2018; 17:1533033818783904. [PMID: 29983096 PMCID: PMC6048619 DOI: 10.1177/1533033818783904] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) is widely used as a curative treatment option for
stage I non-small-cell lung cancer, but for patients with stage I small-cell lung cancer,
the role of stereotactic body radiotherapy is unclear. In this study, we retrospectively
analyzed the outcomes of a subset of patients with stage I small-cell lung cancer treated
with stereotactic body radiotherapy in the database of the Japanese Radiological
Society-Multi-Institutional stereotactic body radiotherapy Study Group. The 43 patients
treated with stereotactic body radiotherapy for stage I small-cell lung cancer between
2004 and 2012 at 11 Japanese institutions were studied: median age = 77 years; 32 (74%)
males and 11 females; and 80% were medically inoperable. The clinical stage was IA in 31
and IB in 12. In all patients, the lung tumors were pathologically proven as small-cell
lung cancer. A total dose of 48 to 60 Gy was administered in 4 to 8 fractions. The median
biologically effective dose (α/β = 10 Gy) was 105.6 Gy. Chemotherapy and prophylactic
cranial irradiation were administered in only 8 patients, respectively. The median
follow-up time was 23.2 months. The 2-year overall survival, progression-free survival,
and distant metastasis-free survival rates were 72.3%, 44.6%, and 47.2%, respectively. The
2-year local control was 80.2%. Regarding the patterns of failure, distant metastasis,
lymph node metastasis, and local recurrence were observed in 47%, 28%, and 16% of
patients, respectively. No ≥grade 3 stereotactic body radiotherapy-related toxicities were
observed. Although stereotactic body radiotherapy was thus revealed to be effective for
the local control of stage I small-cell lung cancer, the incidence of distant metastases
was high. Further investigations of larger cohorts are needed, including analyses of the
effects of combined chemotherapy.
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Affiliation(s)
- Yoshiyuki Shioyama
- 1 Department of Radiation Oncology, Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Japan
| | - Hiroshi Onishi
- 2 Department of Radiology, Graduate School of Medicine, Yamanashi University, Yamanashi, Japan
| | - Kenji Takayama
- 3 Division of Radiation Oncology, Institute of Biomedical Research and Innovation, Kobe, Japan
| | - Yukinori Matsuo
- 4 Department of Radiation Oncology and Image-applied Therapy, Kyoto University, Kyoto, Japan
| | - Atsuya Takeda
- 5 Department of Radiology, Ofuna Chuo Hospital, Kamakura, Japan
| | - Hideomi Yamashita
- 6 Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akifumi Miyakawa
- 7 Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Naoya Murakami
- 8 Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiko Aoki
- 9 Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Haruo Matsushita
- 10 Department of Radiation Oncology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yasuo Matsumoto
- 11 Department of Radiation Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yuta Shibamoto
- 7 Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Seigneurin A, Delafosse P, Trétarre B, Woronoff AS, Velten M, Grosclaude P, Guizard AV, Lapôtre-Ledoux B, Bara S, Molinié F, Colonna M. Are comorbidities associated with long-term survival of lung cancer? A population-based cohort study from French cancer registries. BMC Cancer 2018; 18:1091. [PMID: 30419850 PMCID: PMC6233579 DOI: 10.1186/s12885-018-5000-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Survival rates of lung cancer remains poor and the impact of comorbidities on the prognosis is discussed. The objective of this study was to assess if the Charlson Comorbidity Index (CCI) was associated with 8-year survival rates by histological type. Methods A cohort study was conducted using randomly selected cases from 10 French cancer registries. Net survival rates were computed using the Pohar-Perme estimator of the net cumulative rate. Three Cox models were independently built for adenocarcinomas, squamous cell and small cell cancers to estimate prognostic factors including CCI grade. Results A total of 646 adenocarcinomas, 524 squamous cell and 233 small cell cancers were included in the analysis. The net 8-year survival rate ranged from 12.6% (95% CI: 9.8–15.4%) for adenocarcinomas and 13.4% (95% CI: 10.1–16.7%) for squamous cell carcinomas, to 3.7% (95% CI: 1.1–6.3%) for small cell cancers. Observed and net survival rates decreased for CCI grades ≥3 for all histological group considered. After adjustment for sex, age group, stage and diagnostic mode, CCI grades 1 (HR = 1.6 [95% CI: 1.1–2.3]), 2 (HR = 1.7 [95% CI: 1.1–2.7]) and ≥ 3 (HR = 2.7 [95% CI: 1.7–4.4]) were associated with lower survival rates only for small cell cancers. Conclusion After adjustment for age, sex, stage and diagnostic mode, the presence of comorbidity based on CCI grades 1–2 and ≥ 3 was associated with lower survival rates for small cell cancers whereas no differences were observed for adenocarcinomas and squamous cell cancers.
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Affiliation(s)
- A Seigneurin
- Isère Cancer Registry, CHU Grenoble, Grenoble, France. .,Grenoble Alpes University, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique Mathématiques et Applications Grenoble, Unité Mixte de Recherche 5525, Grenoble, France. .,Medical evaluation unit, CHU Grenoble Alpes, Grenoble, France.
| | - P Delafosse
- Isère Cancer Registry, CHU Grenoble, Grenoble, France
| | - B Trétarre
- Hérault Cancer Registry, Montpellier, France
| | - A S Woronoff
- Doubs Cancer Registry, CHU Besançon, Besançon, France
| | - M Velten
- Bas-Rhin Cancer Registry, Université de Strasbourg, Strasbourg, France
| | - P Grosclaude
- Tarn Cancer Registry, Institut Claudius Regaud, IUCT-O, Registre des cancer du Tarn, Toulouse, France.,, LEASP - UMR 1027 Inserm-Université Toulouse III, Toulouse, France
| | - A V Guizard
- Calvados Cancer Registry, CLCC François Baclesse, Caen, France
| | | | - S Bara
- Manche Cancer Registry, CH du Cotentin, Cherbourg en Cotentin, France
| | - F Molinié
- Loire-Atlantique and Vendée Cancer Registry, CHU Nantes, Nantes, France
| | - M Colonna
- Isère Cancer Registry, CHU Grenoble, Grenoble, France
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Patient, tumor, and healthcare factors associated with regional variability in lung cancer survival: a Spanish high-resolution population-based study. Clin Transl Oncol 2018; 21:621-629. [PMID: 30341474 DOI: 10.1007/s12094-018-1962-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/08/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE The third most frequently diagnosed cancer in Europe in 2018 was lung cancer; it is also the leading cause of cancer death in Europe. We studied patient and tumor characteristics, and patterns of healthcare provision explaining regional variability in lung cancer survival in southern Spain. METHODS A population-based cohort study included all 1196 incident first invasive primary lung cancer (C33-C34 according to ICD-10) cases diagnosed between 2010 and 2011 with follow-up until April 2015. Data were drawn from local population-based cancer registries and patients' hospital medical records from all public and private hospitals from two regions in southern Spain. RESULTS There was evidence of regional differences in lung cancer late diagnosis (58% stage IV in Granada vs. 65% in Huelva, p value < 0.001). Among patients with stage I, only 67% received surgery compared with 0.6% of patients with stage IV. Patients treated with a combination of radiotherapy, chemotherapy, and surgery had a 2-year mortality risk reduction of 94% compared with patients who did not receive any treatment (excess mortality risk 0.06; 95% CI 0.02-0.16). Geographical differences in survival were observed between the two regions: 35% vs. 26% at 1-year since diagnosis. CONCLUSIONS The observed geographic differences in survival between regions are due in part to the late cancer diagnosis which determines the use of less effective therapeutic options. Results from our study justify the need for promoting lung cancer early detection strategies and the harmonization of the best practice in lung cancer management and treatment.
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Poor prognosis patients with inoperable locally advanced NSCLC and large tumors benefit from palliative chemoradiotherapy: a subset analysis from a randomized clinical phase III trial. J Thorac Oncol 2015; 9:825-33. [PMID: 24807158 PMCID: PMC4132042 DOI: 10.1097/jto.0000000000000184] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Poor prognosis patients with bulky stage III locally advanced non–small-cell lung cancer may not be offered concurrent chemoradiotherapy (CRT). Following a phase III trial concerning the effect of palliative CRT in inoperable poor prognosis patients, this analysis was performed to explore how tumor size influenced survival and health-related quality of life (HRQOL). Methods: A total of 188 poor prognosis patients recruited in a randomized clinical trial received four courses intravenous carboplatin day 1 and oral vinorelbine day 1 and 8, at 3-week intervals. The experimental arm (N = 94) received radiotherapy with fractionation 42 Gy/15, starting at the second chemotherapy course. This subset study compares outcomes in patients with tumors larger than 7 cm (N = 108) versus tumors 7 cm or smaller (N = 76). Results: Among those with tumors larger than 7 cm, the median overall survival in the chemotherapy versus CRT arm was 9.7 and 13.4 months, respectively (p = 0.001). The 1-year survival was 33% and 56%, respectively (p = 0.01). Except for a temporary decline during treatment, HRQOL was maintained in the CRT arm, regardless of tumor size. Among those who did not receive CRT, patients with tumors larger than 7 cm experienced a gradual decline in the HRQOL. The CRT group had significantly more esophagitis and hospitalizations because of side effects regardless of tumor size. Conclusion: In patients with poor prognosis and inoperable locally advanced non–small-cell lung cancer, large tumor size should not be considered a negative predictive factor. Except for performance status 2, patients with tumors larger than 7 cm apparently benefit from CRT.
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Fischer-Valuck BW, Durci M, Katz SR, Wu HT, Syh J, Syh J, Patel B, Rosen LR. Influence of patient characteristics on survival following treatment with helical stereotactic body radiotherapy (SBRT) in stage I non-small-cell lung cancer. Thorac Cancer 2013; 4:27-34. [DOI: 10.1111/j.1759-7714.2012.00137.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Lung cancer prognosis in Spain: The role of histology, age and sex. Respir Med 2012; 106:1301-8. [DOI: 10.1016/j.rmed.2012.06.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 06/01/2012] [Accepted: 06/04/2012] [Indexed: 11/24/2022]
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Yu JL, Simmons C, Victor JC, Han D, Hogeveen S, Leighl N, Verma S. Impact of new chemotherapeutic and targeted agents on survival in stage IV non-small cell lung cancer. Oncologist 2011; 16:1307-15. [PMID: 21835896 DOI: 10.1634/theoncologist.2011-0079] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Significant advances in the systemic management of metastatic non-small cell lung cancer (NSCLC) have occurred over the past decade, with options now including multiple lines of chemotherapy, epidermal growth factor receptor inhibitors, and antiangiogenic agents. Improvements in overall survival have been demonstrated in randomized controlled trials comparing these newer agents with best supportive care or standard therapy. This study examined uptake of these therapies in general practice and their impact on survival. METHODS This retrospective cohort study compared demographic, treatment, and survival data among 987 patients diagnosed with stage IV NSCLC at two institutions in 1998, 2003, and 2008. Cohorts were selected based on intervals when doublet chemotherapy, second-line chemotherapy, and targeted agents were incorporated into the standard treatment regimen. RESULTS The proportion of patients receiving systemic therapy increased over time (20% in 1998, 42% in 2008). Overall survival improved significantly across cohorts (p < .001), with 2-year survival rates of 0.3% in 1998, 4% in 2003, and 15% in 2008. In a multivariate survival analysis, the 2003 and 2008 cohorts were independently associated with longer survival, as was the use of one or more lines of systemic therapy. Elderly patients (aged ≥70 years) were also more likely to receive systemic therapy over time, with longer overall survival (p < .001). CONCLUSION Over the past decade, there has been an increasing use of systemic therapy in stage IV NSCLC patients, including the elderly. This has been associated with significantly longer overall survival.
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Affiliation(s)
- Joanne L Yu
- Sunnybrook Odette Cancer Centre, T Wing 2nd Floor, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5
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Nakamura H, Ando K, Shinmyo T, Morita K, Mochizuki A, Kurimoto N, Tatsunami S. Female gender is an independent prognostic factor in non-small-cell lung cancer: a meta-analysis. Ann Thorac Cardiovasc Surg 2011; 17:469-80. [PMID: 21881356 DOI: 10.5761/atcs.oa.10.01637] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE It is not clear whether women with non-small-cell lung cancer (NSCLC) live significantly longer than men. Thus, we conducted a meta-analysis of published studies to quantitatively compare NSCLC survival data between genders. MATERIALS AND METHODS A MEDLINE Web search for computer-archived bibliographic data regarding overall survival differences between genders was performed. DerSimonian-Laird random effects analysis was used to estimate the pooled hazard ratio (HR). RESULTS We selected 39 articles as appropriate data sources, involving 86 800 patients including 32 701 women and 54 099 men. Combined HRs for women vs. men in studies using univariate and multivariate analyses respectively were 0.79 (p <0.0001) and 0.78 (p <0.0001). Pooled HRs for 3 study subgroups having (1) fewer than 30% stage I cases, (2) fewer than 50% adenocarcinoma cases, and (3) statistical adjustment for smoking status all indicated the survival advantage of women. CONCLUSION This meta-analysis of published data concerning NSCLC patients indicated significantly better survival for women.
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Affiliation(s)
- Haruhiko Nakamura
- Departments of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Sex differences in outcome with bevacizumab therapy: analysis of patients with advanced-stage non-small cell lung cancer treated with or without bevacizumab in combination with paclitaxel and carboplatin in the Eastern Cooperative Oncology Group Trial 4599. J Thorac Oncol 2011; 6:103-8. [PMID: 21079521 DOI: 10.1097/jto.0b013e3181fa8efd] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION E4599 compared carboplatin and paclitaxel with (PCB) or without (PC) bevacizumab in patients with advanced-stage non-small cell lung cancer. Bevacizumab improved overall survival. However, an unplanned subset analysis did not show a survival benefit for females treated with bevacizumab. METHODS Known prognostic factors and toxicities were compared by sex. Proportional hazards models of survival with multiple factor combinations were used to adjust for treatment effect. RESULTS The analysis includes 850 patients. The median survival was 8.7 months (PC) versus 11.7 months (PCB) for males (p = 0.001) and 13.1 months (PC) versus 13.3 months (PCB) for females (p = 0.87). Progression-free survival and response rate on the PCB arm were 6.3 months and 29% for males and 6.2 months and 41% for females (p > 0.05). Progression-free survival and response rate on the PC arm were 4.3 months and 16% for males and 5.3 months and 14% for females (p > 0.05). No significant demographic differences were seen between the two arms for males, whereas fewer females on the PCB arm had liver metastasis (PCB 11.7% versus PC 23.2%, p = 0.003). Adverse events with a sex difference on the PCB arm included severe hypertension (males: 4.2%, females: 9.9%, p = 0.02), constipation (males: 1.4%, females: 4.7%, p = 0.05), and abdominal pain (males: 0.9%, females: 5.2%, p = 0.01). In the proportional hazards model adjusting for the other factors, the test for a sex by treatment interaction was not significant (p = 0.09). CONCLUSIONS Multiple factors may contribute to the apparent sex-specific differences in efficacy of bevacizumab noted in this study.
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Outcome and treatment strategy in female lung cancer: a single institution experience. Adv Med Sci 2011; 55:273-80. [PMID: 21097446 DOI: 10.2478/v10039-010-0044-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the survival rate of female lung cancer treated at the Institute of Oncology of the Vilnius University, Lithuania during the period between 1996-2005. MATERIALS AND METHODS During the period between 1996-2005, 471 women diagnosed with lung cancer were treated at the Department of Thoracic Surgery and Oncology of the Institute of Oncology, Vilnius University. Data on morphology, stage and treatment was collected from the medical records. All lung cancer cases by histology were classified in two groups: non-small cell lung cancer (includes squamous cell carcinoma, large cell carcinoma, adenocarcinoma and other less common types) and small cell lung cancer. The vital status of the study group was assessed as of December 31, 2007, by passive follow-up, using data from the population registry. It was found that 411 (87.3%) of the patients had died. Survival was estimated according to the Kaplan-Meier method. RESULTS The median survival of female lung cancer diagnosed during 1996-2005 in Lithuania show to be 8.7 months (8.4 (95% CI 7.2-10.8) months with non-small cell lung cancer and 9.3 (95% CI 6.3-13.0) months with small-cell lung cancer). Survival was more than 20 months in resectable non-small cell lung cancer (stages I, II, IIIA). Non-small cell lung cancer survival in advanced stages was less than 7 months. Small-cell lung cancer patients median survival at limited and extended stages of the disease were 9.5 (95% CI 2.9-18.4) compared to 9.2 (95% CI 6.2-13.7) months. Non-small cell lung cancer patients most frequently were treated by surgery (27.0%), surgery and chemotherapy or radiotherapy (19.6%). Small cell lung cancer patient treatment included chemo and radiotherapy (27.0%), chemotherapy (19.0%), radiotherapy (17.5%), surgery (27.9%). CONCLUSIONS The single center study of female lung cancer diagnosed during 1996-2005 in Lithuania show a significantly better chance of survival in resectable non-small cell lung cancer. Advanced stages of the disease at the time of diagnosis and choice of treatment options of female lung cancer in the country still remains an issue.
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Sterlacci W, Tzankov A, Veits L, Oberaigner W, Schmid T, Hilbe W, Fiegl M. The Prognostic Impact of Sex on Surgically Resected Non–Small Cell Lung Cancer Depends on Clinicopathologic Characteristics. Am J Clin Pathol 2011; 135:611-8. [DOI: 10.1309/ajcpqf24nywnmvmg] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Matsuo Y, Shibuya K, Nagata Y, Takayama K, Norihisa Y, Mizowaki T, Narabayashi M, Sakanaka K, Hiraoka M. Prognostic Factors in Stereotactic Body Radiotherapy for Non–Small-Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2011; 79:1104-11. [DOI: 10.1016/j.ijrobp.2009.12.022] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 10/30/2009] [Accepted: 12/08/2009] [Indexed: 12/25/2022]
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Sex differences in lung cancer susceptibility: A review. ACTA ACUST UNITED AC 2010; 7:381-401. [DOI: 10.1016/j.genm.2010.10.002] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2010] [Indexed: 12/31/2022]
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Jacobs-Lawson JM, Schumacher MM, Hughes T, Arnold S. Gender differences in psychosocial responses to lung cancer. ACTA ACUST UNITED AC 2010; 7:137-48. [DOI: 10.1016/j.genm.2010.03.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2009] [Indexed: 10/19/2022]
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Wheatley-Price P, Blackhall F, Lee SM, Ma C, Ashcroft L, Jitlal M, Qian W, Hackshaw A, Rudd R, Booton R, Danson S, Lorigan P, Thatcher N, Shepherd FA. The influence of sex and histology on outcomes in non-small-cell lung cancer: a pooled analysis of five randomized trials. Ann Oncol 2010; 21:2023-2028. [PMID: 20332134 DOI: 10.1093/annonc/mdq067] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Some non-small-cell lung cancer (NSCLC) surgical series have indicated that the positive prognostic effect of female sex is limited to patients with adenocarcinoma. We carried out a retrospective analysis to investigate the role of sex and histology on efficacy, toxicity, and dose delivery after chemotherapy. PATIENT AND METHODS Individual patient data were pooled from five randomized, phase III, advanced NSCLC chemotherapy trials. Primary outcomes were response rate, overall survival (OS), toxicity, and dose delivery. A secondary analysis examined survival by sex in histological subgroups. RESULTS Of 2349 patients, 34% were women. Women had a higher response rate to chemotherapy (42% versus 40%, P = 0.01) and longer survival than men (median OS 9.6 versus 8.6 months, P = 0.002). The difference in OS remained after adjusting for age, stage, performance status, and histology (hazard ratio 0.83, 95% confidence interval 0.74-0.92, P = 0.0005). Upon further examination, longer survival in women was only seen in patients with adenocarcinoma (test for interaction P = 0.006). There were no differences in hematological toxicity or transfusions. Women experienced more grade 3-4 emesis than men (P < 0.0001) and more dose delays (P = 0.02) or dose reductions (P < 0.0001). CONCLUSION The positive prognostic effect among women is confirmed in patients receiving platinum-based chemotherapy but appears confined to those with adenocarcinoma histology.
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Affiliation(s)
- P Wheatley-Price
- Princess Margaret Hospital/University Health Network, Toronto, Ontario, Canada.
| | | | - S-M Lee
- University College Hospital, London
| | - C Ma
- Princess Margaret Hospital/University Health Network, Toronto, Ontario, Canada
| | | | - M Jitlal
- Cancer Research UK and University College London Cancer Trials Centre, London
| | - W Qian
- Medical Research Council Clinical Trials Unit, London
| | - A Hackshaw
- Cancer Research UK and University College London Cancer Trials Centre, London
| | - R Rudd
- St Bartholomew's Hospital, London
| | | | - S Danson
- Weston Park Hospital, Sheffield, UK
| | | | | | - F A Shepherd
- Princess Margaret Hospital/University Health Network, Toronto, Ontario, Canada
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Farjadfar A, Mojtahedi Z, Ghayumi MA, Erfani N, Haghshenas MR, Ghaderi A. Interleukin-18 promoter polymorphism is associated with lung cancer: a case-control study. Acta Oncol 2010; 48:971-6. [PMID: 19642044 DOI: 10.1080/02841860902878145] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Interleukin-18 (IL-18) is a multifunctional cytokine that augments IFN-gamma production and affects tumor immune response. In the present case-control study, we tested whether IL-18 promoter polymorphism contributes to lung cancer susceptibility in Iranian patients. MATERIAL AND METHODS The study groups were 73 patients with lung cancer, including 53 with squamous carcinoma (SC) and 20 with small cell lung carcinoma (SCLC), and 97 healthy regional aged-matched individuals. The frequency of IL-18 promoter single nucleotide polymorphisms (SNPs) at positions -656 (G/T), -607 (C/A), and -137 (G/C) was determined by polymerase chain reaction analyses. RESULTS There were significant differences in the IL-18 -607 allele and genotype distributions between the 73 lung cancer patients and controls. A significantly higher A allele frequency at position -607, which is associated with lower IL-18 production, was observed in lung cancer patients (48.6% vs. 35%; OR = 1.75; 95% CI 1.13-2.72). Also, patients with the -607 CA and the AA genotypes had a 2.60-fold (95% CI 1.26-5.36) and 3.15-fold (95% CI 1.16-8.55) increase in risk of lung cancer. Subdivision of the patients according to histological type revealed that SC was significantly associated with IL-18 -607 SNPs. Although the percentages of -607 alleles and genotypes in SCLC patients were similar to the results in SC patients, the differences compared to control individuals did not reach statistical significance. Analysis with Arlequin software identified eight haplotypes from three SNPs analyzed here. The distributions of IL-18 gene haplotypes were not significantly different between patients and controls after Bonferroni correction. DISCUSSION This is the first report to investigate the association between IL-18 polymorphism and lung cancer. Our results suggest that IL-18 polymorphism contributes to the lung cancer risk, particularly among SC patients. Further studies with larger numbers of patients are required to determine the possible association between IL-18 polymorphisms and different histological types of lung cancer.
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Abstract
Lung cancer remains the leading cause of cancer death in men and women. Since the 1970s, there has been evidence for improved survival of women with lung cancer compared to men. Multiple analyses have demonstrated a survival advantage in women regardless of stage, histology, or treatment. The etiology for the improved prognosis is not yet fully elucidated, but is likely related to underlying biologic differences, including hormonal interactions. More recently, gender differences in response to newer agents such as epidermal growth factor receptor inhibitors and anti-angiogenesis agents have been identified. Further exploration of tumor molecular, biologic, hormonal, and pharmacogenomic interactions may provide additional insight into the observed survival benefit for women and, ultimately, permit exploitation of these differences in our treatment selection for both women and men.
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Affiliation(s)
- Danielle Shafer
- Department of Medicine, Division of Hematology/Oncology, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA.
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Abstract
Lung cancer has reached epidemic proportions in women, and is now the most common cause of cancer death among both men and women in the United States. While smoking rates have declined marginally in women, the rising impact of lung cancer in women may imply that women are at higher risk from carcinogens secondary to underlying factors related to sex. These factors include differences in female physiology such as bronchial responsiveness and airway size, sex-based differences in nicotine metabolism via the cytochrome p450 system driven by hormones, and differences in DNA repair capacity, as well as the evolution of cigarettes. These hypotheses will be explored in depth in this article.
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Affiliation(s)
- Kavitha Ramchandran
- Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Abstract
BACKGROUND Previous research suggests that disparities in non-small-cell lung cancer (NSCLC) survival can be explained in part by disparities in the receipt of cancer treatment. Few studies, however, have considered race and sex disparities in the timing and appropriateness of treatment across stages of diagnosis. OBJECTIVE To evaluate the relationship of sex and race with the receipt of timely and clinically appropriate NSCLC treatment for each stage of diagnosis. METHOD Surveillance Epidemiology and End Result data linked to Medicare claims for beneficiaries diagnosed with NSCLC between 1995 and 1999 were used to evaluate the relationship between race and sex with timely and appropriate NSCLC treatment while controlling for other demographic characteristics, comorbidities, socioeconomic status, and provider supply (N = 22,145). RESULTS Overall adjusted rates of timely and appropriate treatment are 37.2%, 58.1%, and 29.2% for Medicare beneficiaries diagnosed with stage I or II, III, and IV NSCLC, respectively. Among stage I or II patients, women were 25% less likely to receive timely surgical resection relative to men, and blacks were 66% less likely to receive timely and appropriate treatment than whites. Black men were least likely to receive resection (22.2% compared with 43.7% for white men). Blacks were 34% less likely to receive timely surgery, chemotherapy, or radiation for stage III disease and were 51% less likely to receive chemotherapy in a timely fashion for stage IV disease relative to whites. CONCLUSION Significant variations in appropriate timely treatment were found within and across stages of diagnosis, confirming that sex and race differences in NSCLC treatment exist.
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McGovern SL, Liao Z, Bucci MK, McAleer MF, Jeter MD, Chang JY, O'Reilly MS, Cox JD, Allen PK, Komaki R. Is sex associated with the outcome of patients treated with radiation for nonsmall cell lung cancer? Cancer 2009; 115:3233-42. [DOI: 10.1002/cncr.24361] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Arrieta O, Saavedra-Perez D, Kuri R, Aviles-Salas A, Martinez L, Mendoza-Posada D, Castillo P, Astorga A, Guzman E, De la Garza J. Brain metastasis development and poor survival associated with carcinoembryonic antigen (CEA) level in advanced non-small cell lung cancer: a prospective analysis. BMC Cancer 2009; 9:119. [PMID: 19386089 PMCID: PMC2679041 DOI: 10.1186/1471-2407-9-119] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Accepted: 04/22/2009] [Indexed: 11/25/2022] Open
Abstract
Background Central nervous system is a common site of metastasis in NSCLC and confers worse prognosis and quality of life. The aim of this prospective study was to evaluate the prognostic significance of clinical-pathological factors (CPF), serum CEA levels, and EGFR and HER2 tissue-expression in brain metastasis (BM) and overall survival (OS) in patients with advanced NSCLC. Methods In a prospective manner, we studied 293 patients with NSCLC in IIIB-IV clinical stage. They received standard chemotherapy. CEA was measured prior to treatment; EGFR and HER2 were evaluated by immunohistochemistry. BM development was confirmed by MRI in symptomatic patients. Results BM developed in 27, and 32% of patients at 1 and 2 years of diagnosis with adenocarcinoma (RR 5.2; 95% CI, 1.002–29; p = 0.05) and CEA ≥ 40 ng/mL (RR 11.4; 95% CI, 1.7–74; p < 0.01) as independent associated factors. EGFR and HER2 were not statistically significant. Masculine gender (RR 1.4; 95% CI, 1.002–1.9; p = 0.048), poor performance status (RR 1.8; 95% CI, 1.5–2.3; p = 0.002), advanced clinical stage (RR 1.44; 95% CI, 1.02–2; p = 0.04), CEA ≥ 40 ng/mL (RR 1.5; 95% CI, 1.09–2.2; p = 0.014) and EGFR expression (RR 1.6; 95% CI, 1.4–1.9; p = 0.012) were independent associated factors to worse OS. Conclusion High CEA serum level is a risk factor for BM development and is associated with poor prognosis in patients with advanced NSCLC. Surface expression of CEA in tumor cells could be the physiopathological mechanism for invasion to CNS.
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Affiliation(s)
- Oscar Arrieta
- Department of Medical Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico.
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Borgmann K, Dikomey E, Petersen C, Feyer P, Hoeller U. Sex-specific aspects of tumor therapy. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2009; 48:115-124. [PMID: 19242712 DOI: 10.1007/s00411-009-0216-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 02/07/2009] [Indexed: 05/27/2023]
Abstract
There is increasing evidence that sex-specific differences in toxicity profiles and outcome after radiotherapy are accumulating in medical oncology, and that treatment strategies may require some modification. Furthermore, sex-specific differences in the sensitivity to genotoxic and therapeutical agents are also of general concern for risk estimation. This review is focussed on the specific influence of sex on these endpoints covering both a clinical and a biological point of view. In this paper, the literature was systematically reviewed with respect to sex-specific differences in tumor and normal tissue sensitivity after exposure to ionizing radiation, as well as to the relevant underlying molecular and cellular mechanisms. Although a number of data on sex-specific differences are available and remarkable differences on clinical, molecular, and cellular levels have been reported, a firm conclusion on any existing sex-specific differences is not yet possible. Future studies are required and should be focussed on this aspect of individual radiosensitivity.
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Affiliation(s)
- Kerstin Borgmann
- Laboratory of Radiobiology Experimental Radiooncology, Clinic of Radiotherapy and Radiooncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
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Shugarman LR, Bird CE, Schuster CR, Lynn J. Age and gender differences in medicare expenditures and service utilization at the end of life for lung cancer decedents. Womens Health Issues 2008; 18:199-209. [PMID: 18457755 PMCID: PMC2440649 DOI: 10.1016/j.whi.2008.02.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 02/15/2008] [Accepted: 02/27/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE Gender and age differences in medical care are well documented. We examined age and gender differences in Medicare expenditures for lung cancer decedents in the last year of life (LYOL) through a cross-sectional study of Medicare administrative and claims data. METHODS Participants were aged Medicare beneficiaries (>or=68) with lung cancer, who were covered by Parts A and B for 36 months before death (1996-1999; n = 13,120). Regression techniques were used to estimate age and gender differences in mean Medicare utilization and expenditures in the LYOL overall and by type of service, conditional on use: inpatient, outpatient, physician, skilled nursing facility (SNF), home health, and hospice, controlling for demographic, clinical, geographic, and supply characteristics. RESULTS Women were more likely than men to use inpatient, SNF, home health, and hospice services. Women's average expenditures were approximately dollars 1,900 greater than men's, with differences attributed to higher average expenditures for SNF, home health, and hospice. Older cohorts used fewer inpatient and outpatient services and used more SNF and hospice services in their LYOL. Average Medicare expenditures were significantly lower in older cohorts (dollars 8,487 less for those age >or=85 at death than for those 68-74). Adjusting for age explains most of the gender differences in average Medicare expenditures. Remaining gender differences vary across age cohorts, with larger gender differences in social-supportive service expenditures among those 68-74 and 75-84 and outpatient and physician services among those 75-84 and >or=85. DISCUSSION AND CONCLUSIONS Our findings suggest that gender disparities in expenditures are generally small at the end of life for lung cancer decedents, particularly among the older cohorts. As expected, the bigger observed differences are by age although the direction of the association is not consistent across types of service. Higher expenditures for women on social-supportive services may reflect fewer informal supports for older women compared with men.
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Affiliation(s)
- S Novello
- SSD Oncologia Polmonare Ospedale San Luigi Gonzaga- Università di Torino, Turin
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Hanagiri T, Sugio K, Uramoto H, So T, Ichiki Y, Sugaya M, Ono K, Yasuda M, Nozoe T, Yasumoto K. Gender Difference as a Prognostic Factor in Patients Undergoing Resection of Non-Small Cell Lung Cancer. Surg Today 2007; 37:546-51. [PMID: 17593472 DOI: 10.1007/s00595-006-3453-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 11/30/2006] [Indexed: 12/18/2022]
Abstract
PURPOSE We studied the effects of gender difference on the incidence of lung cancer and its mortality rate, which is a subject of much discussion. METHODS We examined gender difference in the clinical features of 491 men and 222 women who underwent resection of primary non-small cell lung cancer (NSCLC) between 1994 and 2004. RESULTS The histological types of cancer were adenocarcinoma in 249 (51%) of the men and 182 (82%) of the women, and squamous cell carcinoma in 182 (37%) of the men and 27 (12%) of the women. The incidence of adenocarcinoma was significantly higher in the women. The proportion of stage IA disease was significantly higher in the women than in the men (45% vs 29%, respectively). The 5-year overall survival rates were 50% in the men and 63% in the women. In a multivariate analysis, gender difference was an independent prognostic factor; however, when death as a result of unrelated disease was excluded, there was no significant difference in prognosis. CONCLUSION Although the higher incidences of adenocarcinoma and stage IA cancer contributed to the good results of surgery in women, the low incidence of death attributed to diseases other than lung cancer was a major reason for their better prognosis.
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Affiliation(s)
- Takeshi Hanagiri
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Yahatanishi, Kitakyushu, 807-8555, Japan
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Affiliation(s)
- Anna Ceribelli
- Division of Medical Oncology A, Regina Elena National Cancer Institute, Rome, Italy.
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Foeglé J, Hédelin G, Lebitasy MP, Purohit A, Velten M, Quoix E. Specific Features of Non-small Cell Lung Cancer in Women: A Retrospective Study of 1738 Cases Diagnosed in Bas-Rhin between 1982 and 1997. J Thorac Oncol 2007; 2:466-74. [PMID: 17545840 DOI: 10.1097/01.jto.0000275340.39960.25] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The literature suggests that lung cancer may represent a different disease in women compared with men and that gender specificities have been reported mostly in clinical trials patients. METHODS We conducted a retrospective, population-based study of a sample of 1738 patients diagnosed with a non-small cell lung cancer (NSCLC) in the department of Bas-Rhin (northeastern France) between 1982 and 1997. Our study aimed to describe symptoms at presentation, stage, histological distribution, treatment modalities, and survival, according to sex. RESULTS Tobacco exposure differed significantly according to sex: 28.9% of women were nonsmokers versus 1.4% of the men. More NSCLC were metastatic at diagnosis in women than in men (41.1% versus 29.9%). Adenocarcinoma predominated in women (54.4%), whereas squamous cell carcinoma predominated in men (65.9%). Invasive procedures, such as transthoracic needle biopsy, contributed more frequently to histological diagnosis in women. Men and women underwent the same procedures for disease staging, excepted for the abdominal computed tomography scan, which was performed more frequently in women. Treatment also differed: in resectable disease, fewer pneumonectomies were performed in women; in locally advanced disease, the mean doses of thoracic irradiation were significantly lower in women (48.0 grays versus 55.5 grays); in metastatic-stage disease, fewer women received platin-based chemotherapy, but this difference was not significant. Sex was not a significant prognostic factor in our study, contrary to most North American studies, where women seem to have had better survival rates. CONCLUSIONS This study emphasizes gender differences in smoking exposure, presentation (stage, histological subtype), and diagnostic and therapeutic management of NSCLC.
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Affiliation(s)
- Jacinthe Foeglé
- Laboratoire d'épidémiologie et de santé publique, Université Louis Pasteur, Strasbourg, France
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Wisnivesky JP, Halm EA. Sex differences in lung cancer survival: do tumors behave differently in elderly women? J Clin Oncol 2007; 25:1705-12. [PMID: 17470862 DOI: 10.1200/jco.2006.08.1455] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Women with lung cancer appear to have better survival. Whether this results from better response to treatment, different tumor biology, or a longer life expectancy is not well understood. This study sought to assess sex differences in the natural history of lung cancer after controlling for unrelated causes of death and type of treatment. METHODS This study included 18,967 elderly patients with stage I and II non-small-cell lung cancer diagnosed between 1991 and 1999 from the Surveillance, Epidemiology, and End Results registry linked to Medicare records. Patients were grouped into three categories according to the treatment received: surgery, radiation or chemotherapy but no surgery, and untreated cases. We used stratified and multivariate analyses to evaluate sex differences in survival using three methods to control for competing risks: lung cancer-specific survival, overall survival adjusting for comorbidities, and relative survival. Sensitivity analysis was used to test whether potential differences in smoking could account for the observed association of sex with survival. RESULTS Women in all treatment groups had better lung cancer-specific, overall, and relative survival than did men (P < .0001). Stratified and multivariate analyses showed that women had better survival than did men after controlling for confounders. Sensitivity analyses showed that potential sex differences in smoking did not explain our findings. CONCLUSION In this national, population-based sample, elderly women with early lung cancer had better risk-adjusted survival regardless of the type of treatment. That sex differences were observed among untreated patients suggests that lung cancer in women may have a different natural history.
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Affiliation(s)
- Juan P Wisnivesky
- Division of General Internal Medicine and Pulmonary, Critical Care, Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Caldarella A, Crocetti E, Comin CE, Janni A, Pegna AL, Paci E. Gender differences in non-small cell lung cancer: a population-based study. Eur J Surg Oncol 2007; 33:763-8. [PMID: 17306497 DOI: 10.1016/j.ejso.2007.01.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Accepted: 01/02/2007] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND A retrospective study including all patients with non-small cell lung cancer carcinoma in a population-based registry was performed to characterize gender differences in lung cancer and to analyze the factors influencing prognosis in women. METHODS We retrieved through the Tuscan Cancer Registry (RTT) archive 2,523 lung tumor cases diagnosed during the period 1996-1998 in the provinces of Florence and Prato, central Italy. We compared the prognosis within 464 non-small lung cancer women and 1,798 men in a population-based case series. The influence of the following variables on postoperative survival were analyzed: age, cell type, pathologic T and N status, site of tumor and type of surgical resection. RESULTS The age at diagnosis was similar in women and in men. Women were significantly more likely to have adenocarcinoma but less likely to have squamous cell carcinoma compared with men. Fewer pneumonectomies were performed in women than in men. Nevertheless, prognosis was similar in both sexes and type of surgical resection was significant prognostic factor. CONCLUSIONS Lung cancer was more frequent in men than in women, but overall survival is similar. Differences in lung cancer histology and rate of pneumonectomies were found between men and women.
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Affiliation(s)
- A Caldarella
- Clinical Epidemiology, Center for Study and Cancer Prevention, Via di San Salvi 12, 50135 Florence, Italy.
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Singer JW. Non-small cell lung cancer: does estrogen affect outcome? WOMENS HEALTH 2007; 3:1-3. [PMID: 19803858 DOI: 10.2217/17455057.3.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Belani CP, Marts S, Schiller J, Socinski MA. Women and lung cancer: Epidemiology, tumor biology, and emerging trends in clinical research. Lung Cancer 2007; 55:15-23. [PMID: 17084482 DOI: 10.1016/j.lungcan.2006.09.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 09/14/2006] [Accepted: 09/18/2006] [Indexed: 11/24/2022]
Abstract
Lung cancer is the leading cause of cancer-related death in both men and women. Environmental carcinogens, particularly tobacco smoke, play a dominant role in the development of lung cancer, although 10-15% of all patients diagnosed are non-smokers. In addition, emerging data demonstrate sex-specific differences in lung cancer susceptibility and prognosis. This implies that the development of lung cancer is modulated by complex interactions between genetic, hormonal, behavioral, and environmental factors. A better understanding of the differences between men and women and their impact on the prevention, diagnosis, and treatment of lung cancer requires continued basic and clinical research. Recent data on the epidemiological aspects of lung cancer in women, lung tumor biology, and emerging trends in clinical research were presented at a thought leaders' roundtable hosted by the Society for Women's Health Research. The panel concluded that as the patient population in lung cancer is changing from mostly male smokers to include women and non-smokers, an urgent need exists to increase awareness and research funding to improve lung cancer care, particularly in women. To further improve survival in this disease, both clinical characteristics and tumor biology should be considered in the development of new treatment options.
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Affiliation(s)
- Chandra P Belani
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, United States
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Bossard N, Velten M, Remontet L, Belot A, Maarouf N, Bouvier AM, Guizard AV, Tretarre B, Launoy G, Colonna M, Danzon A, Molinie F, Troussard X, Bourdon-Raverdy N, Carli PM, Jaffré A, Bessaguet C, Sauleau E, Schvartz C, Arveux P, Maynadié M, Grosclaude P, Estève J, Faivre J. Survival of cancer patients in France: a population-based study from The Association of the French Cancer Registries (FRANCIM). Eur J Cancer 2006; 43:149-60. [PMID: 17084622 DOI: 10.1016/j.ejca.2006.07.021] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 07/26/2006] [Accepted: 07/27/2006] [Indexed: 10/23/2022]
Abstract
We present the main results of the first population-based cancers survival study gathering all French registry data. Survival data on 205,562 cancer cases diagnosed between 01/01/1989 and 31/12/1997 were analysed. Relative survival was estimated using an excess rate model. The evolution of the excess mortality rate over the follow-up period was graphed. The analysis emphasised the effect of age at diagnosis and its variation with time after diagnosis. For breast and prostate cancers, the age-standardised five-year relative survivals were 84% and 77%, respectively. The corresponding results in men and women were 56% versus 58% for colorectal cancer and 12% versus 16% for lung cancer. For some cancer sites, the excess mortality rate decreased to low values by five years after diagnosis. For most cancer sites, age at diagnosis was a negative prognostic factor but this effect was often limited to the first year after diagnosis.
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Affiliation(s)
- N Bossard
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, F-69003, France.
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Wakelee HA, Bernardo P, Johnson DH, Schiller JH. Changes in the natural history of nonsmall cell lung cancer (NSCLC)--comparison of outcomes and characteristics in patients with advanced NSCLC entered in Eastern Cooperative Oncology Group trials before and after 1990. Cancer 2006; 106:2208-17. [PMID: 16604529 DOI: 10.1002/cncr.21869] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Demographic factors and treatment regimens were evaluated in relation to differences in outcome between patients with advanced nonsmall cell lung cancer (NSCLC) who were diagnosed and treated on Eastern Cooperative Oncology Group Phase II and III trials from 1981 to 1990 and from 1991 to 2000. METHODS In this retrospective analysis, 6 advanced NSCLC trials were identified between 1981 and 1990, and 3 trials were identified after 1990. Patient characteristics (n = 3398 patients) and other clinical outcomes were analyzed, including progression-free survival (PFS) and overall survival (OS). RESULTS Patients who entered on trials after 1990 more likely were women, received a cisplatin-containing regimen, had a performance status of 0 or 1, had Stage IIIB (vs. Stage IV) disease, had tumors with adenocarcinoma histology, had weight loss < or = 10%, and had pulmonary-only metastases (although more total metastases and brain metastases) compared with patients who were diagnosed before 1990. OS was longer post-1990 than pre-1990 (8.2 months vs. 5.8 months pre-1990), and PFS was longer post-1990 (3.5 months vs. 2.6 months pre-1990; P<.001 for both). In addition, the median interval from the date of disease progression to death increased by nearly 62% in the later decade. CONCLUSIONS Improved survival in more recent NSCLC trials was explained in part by the enrollment of patients with more favorable prognostic factors. A change in the natural history of the disease was reflected by some of these changes, including increased numbers of women with the disease and changes in the patterns of metastases. Changes in eligibility criteria also accounted for some improvements in prognostic factors and improved second line therapies in the later decade. Thus, the survival improvements are likely to be multifactorial, with improved therapies also playing a major role.
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Affiliation(s)
- Heather A Wakelee
- Department of Medicine, Division of Medical Oncology, Stanford Cancer Center, Stanford University, Stanford, California 94305-5826, USA.
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Albain KS, Belani CP, Bonomi P, O'Byrne KJ, Schiller JH, Socinski M. PIONEER: A Phase III Randomized Trial of Paclitaxel Poliglumex Versus Paclitaxel in Chemotherapy-Naive Women with Advanced-Stage Non-Small-Cell Lung Cancer and Performance Status of 2. Clin Lung Cancer 2006; 7:417-9. [PMID: 16800969 DOI: 10.3816/clc.2006.n.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kathy S Albain
- Loyola University, Chicago Medical Center, Maywood, IL 60153, USA.
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