The variation of cell type distribution in lung cancer: a study of 10,910 cases at a medical center in Taiwan between 1970 and 1993

Clinical profile of lung cancer in North India: A 10-year analysis of 1862 patients from a tertiary care center

Introduction:

Over the past few years, the demographic profile of lung cancer has changed. However, most reports are limited by small numbers, short follow-up period, and show an inconsistent pattern. A comprehensive evaluation of changing trends over a long period has not been done.

Materials and Methods:

Consecutive lung cancer patients were studied over a 10-year period from January 2008 to March 2018 at the All India Institute of Medical Sciences, New Delhi, and relevant clinical information, and survival outcomes were analyzed.

Results:

A total of 1862 patients were evaluated, with mean (SD) age of 59 (11.1) years, and comprising 82.9% males. Majority were smokers (76.2%) with median smoking index of 500 (interquartile range [IQR]: 300–800). Adenocarcinoma (ADC) was the most common type (34%), followed by squamous cell carcinoma (SCC – 28.6%) and small cell lung cancer (SCLC) (16.1%). Over the 10-year period, ADC increased from 9.5% to 35.9%, SCC from 25.4% to 30.6%, and non-small cell lung cancer -not otherwise specified (NSCLC-NOS) decreased from 49.2% to 21.4%. The proportion of females with lung cancer increased although smoking rates remained similar. Majority of NSCLC (95%) continued to be diagnosed at an advanced stage (3 or 4). Epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements were present in 25.3% and 11.5% ADC patients, respectively. The median overall survival was 8.8 months (IQR 3.7–19) for all patients and 12.57 (IQR 6.2–28.7) months among the 1013 patients who were initiated on specific treatment (chemotherapy, targeted therapy, radiotherapy, or surgery). Never-smokers were younger, more likely to be female and educated, had a higher prevalence of ADC and EGFR/ALK mutations, and had better survival.

Conclusion:

Among this large cohort, our center seems to follow the global trend with increasing incidence of ADC. EGFR mutation positivity was similar to existing reports, while higher ALK positivity was detected. A characteristic phenotype of never-smokers with lung cancer was elucidated which demonstrated better survival.

Cigarette Filter Ventilation and its Relationship to Increasing Rates of Lung Adenocarcinoma

The 2014 Surgeon General's Report on smoking and health concluded that changing cigarette designs have caused an increase in lung adenocarcinomas, implicating cigarette filter ventilation that lowers smoking machine tar yields. The Food and Drug Administration (FDA) now has the authority to regulate cigarette design if doing so would improve public health. To support a potential regulatory action, two weight-of-evidence reviews were applied for causally relating filter ventilation to lung adenocarcinoma. Published scientific literature (3284 citations) and internal tobacco company documents contributed to causation analysis evidence blocks and the identification of research gaps. Filter ventilation was adopted in the mid-1960s and was initially equated with making a cigarette safer. Since then, lung adenocarcinoma rates paradoxically increased relative to other lung cancer subtypes. Filter ventilation 1) alters tobacco combustion, increasing smoke toxicants; 2) allows for elasticity of use so that smokers inhale more smoke to maintain their nicotine intake; and 3) causes a false perception of lower health risk from "lighter" smoke. Seemingly not supportive of a causal relationship is that human exposure biomarker studies indicate no reduction in exposure, but these do not measure exposure in the lung or utilize known biomarkers of harm. Altered puffing and inhalation may make smoke available to lung cells prone to adenocarcinomas. The analysis strongly suggests that filter ventilation has contributed to the rise in lung adenocarcinomas among smokers. Thus, the FDA should consider regulating its use, up to and including a ban. Herein, we propose a research agenda to support such an effort.

Whole blood microRNA expression may not be useful for screening non-small cell lung cancer

At least seven studies have suggested that microRNA levels in whole blood can be diagnostic for lung cancer. We conducted a large bi-institutional study to validate this. Qiagen^® PAXgene^™ Blood miRNA System was used to collect blood and extract RNA from it for 85 pathologic stage I-IV non-small cell lung cancer (NSCLC) cases and 76 clinically-relevant controls who had a benign pulmonary mass, or a high risk of developing lung cancer because of a history of cigarette smoking or age >60 years. Cases and controls were similar for age, gender, race, and blood hemoglobin and leukocyte but not platelet levels (0.23 and 0.26 million/μl, respectively; t test P = 0.01). Exiqon^® MiRCURY^™ microarrays were used to quantify microRNAs in RNA isolates. Quantification was also performed using Taqman^™ microRNA reverse transcription (RT)-PCR assays for five microRNAs whose lung cancer-diagnostic potential had been suggested in seven published studies. Of the 1,941 human mature microRNAs detectable with the microarray platform, 598 (31%) were identified as expressed and reliably quantified among the study's subjects. However, none of the microRNAs was differentially expressed between cases and controls (P >0.05 at false discovery rate <5% in test using empirical Bayes-moderated t statistics). In classification analyses with leave-one-out internal cross-validation, cases and controls could be identified by microRNA expression with 47% and 50% accuracy with support vector machines and top-scoring pair methods, respectively. Cases and controls did not differ for RT-PCR-based measurements of any of the five microRNAs whose biomarker potential had been suggested by seven previous studies. Additionally, no difference for microRNA expression was noticed in microarray-based microRNA profiles of whole blood of 12 stage IA-IIIB NSCLC cases before and three-four weeks after tumor resection. These findings show that whole blood microRNA expression profiles lack diagnostic value for high-risk screening of NSCLC, though such value may exist for selective sub-groups of NSCLC and control populations.

Sex disparities in the association of lung adenocarcinoma with colorectal cancer

Background: Most cancers share common risk factors. It might provide evidence of shared risk factors with cancers by investigating cross-country and cross-township comparisons.

Methods: The data were obtained from International Association of Cancer Registries/World Health Organization and the National Cancer Registration Program of Taiwan. Age standardized incidence rates were calculated among gastric cancer, colorectal cancer and lung adenocarcinoma in 19 countries from 1995 to 1998. The Pearson correlations were also compared among 3 types of cancers for both sexes.

Results: The incidence rates of gastric and colorectal cancer throughout different countries show male dominance with a male-to-female sex ratio of around 2 and 1.5, respectively. Significant cross-country correlations in colorectal cancer (r=0.918, p<0.001), gastric cancer (r=0.985, p<0.001) and lung adenocarcinoma (r=0.685, p=0.001) were observed between men and women. There was a significant international correlation between colorectal cancer and lung adenocarcinoma in men (r=0.526, p=0.021), but not in women. In cross-township comparisons of Taiwan, there were significant correlations in colorectal cancer (r=0.451, p<0.001), gastric cancer (r=0.486, p<0.001), and lung adenocarcinoma (r=0.217, p<0.001) between men and women. There were links of lung adenocarcinoma and gastric cancer (r=0.122, p=0.024) and colorectal cancer (r=0.128, p=0.018) in women, and lung adenocarcinoma and colorectal cancer in men (r=0.276, p<0.001).

Conclusions: There were associations between lung adenocarcinoma and colorectal cancer between and in both sexes in Taiwan, but not in cross-country comparisons. The results suggest that some factor, like genes, may be important as determinants for the association between lung adenocarcinoma and colorectal cancer.

Changes in the demographics and prognoses of patients with resected non-small cell lung cancer: a 20-year experience at a single institution in Korea

The demographics and prognosis of non-small cell lung cancer patients have changed during the last few decades. We conducted this study to assess the change in demographics and prognosis in resected non-small cell lung cancer patients during a 20-yr single-institution study in Korea. We retrospectively reviewed the medical records of 2,076 non-small cell lung cancer patients who underwent pulmonary resection between 1990 and 2009. Their clinical characteristics and survival were analyzed over a five-year period. With time, the proportions of female, adenocarcinoma, stage IA, and lobectomy patients increased, whereas the proportions of male, squamous cell carcinoma, stage IIIA, and pneumonectomy patients decreased. These demographic changes caused improved prognosis. The five-year survival rate of all patients was 53.9%. The five-year survival rate increased from 31.9% in 1990-1994, to 43.6% in 1995-1999, 51.3% in 2000-2004, and 69.7% in 2005-2009 (P < 0.001). In conclusion, among patients with resected non-small cell lung cancer, the proportions of female, adenocarcinoma, stage IA, and lobectomy patients have increased, and the five-year survival rate has gradually improved during the last 20 yr in Korea.

Aryl hydrocarbon receptor protects lung adenocarcinoma cells against cigarette sidestream smoke particulates-induced oxidative stress

Environmental cigarette smoke has been suggested to promote lung adenocarcinoma progression through aryl hydrocarbon receptor (AhR)-signaled metabolism. However, whether AhR facilitates metabolic activation or detoxification in exposed adenocarcinoma cells remains ambiguous. To address this question, we have modified the expression level of AhR in two human lung adenocarcinoma cell lines and examined their response to an extract of cigarette sidestream smoke particulates (CSSP). We found that overexpression of AhR in the CL1-5 cell line reduced CSSP-induced ROS production and oxidative DNA damage, whereas knockdown of AhR expression increased ROS level in CSSP-exposed H1355 cells. Oxidative stress sensor Nrf2 and its target gene NQO1 were insensitive to AhR expression level and CSSP treatment in human lung adenocarcinoma cells. In contrast, induction of AhR expression concurrently increased mRNA expression of xenobiotic-metabolizing genes CYP1B1, UGT1A8, and UGT1A10 in a ligand-independent manner. It appeared that AhR accelerated xenobiotic clearing and diminished associated oxidative stress by coordinate regulation of a set of phase I and II metabolizing genes. However, the AhR-signaled protection could not shield cells from constant oxidative stress. Prolonged exposure to high concentrations of CSSP induced G0/G1 cell cycle arrest via the p53-p21-Rb1 signaling pathway. Despite no effect on DNA repair rate, AhR facilitated the recovery of cells from growth arrest when CSSP exposure ended. AhR-overexpressing lung adenocarcinoma cells exhibited an increased anchorage-dependent and independent proliferation when recovery from exposure. In summary, our data demonstrated that AhR protected lung adenocarcinoma cells against CSSP-induced oxidative stress and promoted post-exposure clonogenicity.

Lung cancer in never smokers--a different disease

Although most lung cancers are a result of smoking, approximately 25% of lung cancer cases worldwide are not attributable to tobacco use, accounting for over 300,000 deaths each year. Striking differences in the epidemiological, clinical and molecular characteristics of lung cancers arising in never smokers versus smokers have been identified, suggesting that they are separate entities. This Review summarizes our current knowledge of this unique and poorly understood disease.

Lung cancer in Asian women-the environment and genes*

The mortality rate of lung cancer in Asian women has increased significantly in the past few decades. Environmental factors include tobacco smoke (active and environmental), other indoor pollutions (cooking oil vapours, coal burning, fungus spores), diet, and infections. Active tobacco smoking is not the major factor. The relative risk of lung cancer among non-smoking women ever exposed to environmental smoke from their husbands was 1.20 from a meta-analysis. Cooking oil vapours associated with high temperature wok cooking and indoor coal burning for heating and cooking in unvented homes, particularly in rural areas, are risk factors for Chinese women. Chronic benign respiratory diseases due to the fungus Microsporum canis probably accounts for the high incidence of lung cancer in northern Thai women at Sarapee. Diets rich in fruits, leafy green vegetables, and vitamin A are protective, while cured meat (Chinese sausage, pressed duck and cured pork), deep-fried cooking, and chili increased the risk. Tuberculosis is associated with lung cancer. Also, a Taiwanese study showed that the odds ratio of papillomavirus (HPV) 16/18 infection in non-smoking female lung cancer patients was 10.1, strongly suggesting a causative role. Genetic factors have also been studied in Chinese women, including human leucocyte antigens, K-ras oncogene activation, p53 mutation, polymorphisms of phase I activating enzymes (cytochrome P450, N-acetyltransferase slow acetylator status), and phase II detoxifying enzymes (glutathione-S-transferases, N-acetyltransferase rapid acetylator status). New molecular screening technology would facilitate identification of molecular targets for future studies. The interaction between environmental and genetic factors should also be further elucidated.

Lung cancer in North-West Italy: demographic and clinical trends in a hospital-based population of 1277 patients

This study intends to assess which demographic and/or clinical characteristics of lung cancer - if any - have changed during the last two decades in an Alpine area of North-West Italy. The study was carried out on 1277 consecutive lung cancer patients seen from January 1989 to October 2002 in a single institution. A set of 33 anthropometric, clinical, physical, laboratory, radiological and pathological variables was prospectively recorded for all patients. The date of diagnosis was used to divide the study population in quartiles of diagnostic age (period I: January 1989 to May 1992, 319 patients; period II: June 1992 to September 1995, 319 patients; period III: October 1995 to May 1999, 320 patients; period IV: June 1999 to October 2002, 319 patients). Patients were carefully followed up, and their subsequent clinical course recorded. The following variables showed a significant increasing trend over the years: patients' age, female sex, rate of ex-smokers, level of education, co-morbidity (both the number and the severity of previous pulmonary and extrapulmonary diseases), weight loss, liver enzymes and blood creatinine, carcinoembryonic antigen levels and the rate of adenocarcinomas. On the other hand, performance status, stage of disease, metastatic pattern, treatment modalities and survival expectancy did not change. Therefore, no diagnostic or therapeutic improvements occurring during the last 14 years had a visible impact on patients. It may be that the 'changing face' of lung cancer masked their effects.

A multicenter phase II study of the efficacy and safety of docetaxel plus cisplatin in Asian chemonaïve patients with metastatic or locally advanced non-small cell lung cancer

AIMS

To evaluate the efficacy and safety of docetaxel-cisplatin in patients with metastatic or locally advanced non-small cell lung cancer (NSCLC).

METHODS

Chemotherapy-naïve patients with histologically confirmed TNM stage III or IV NSCLC were recruited from 12 Asian trial centers. Patients received docetaxel (75 mg/m2) and cisplatin (75 mg/m2) every 3 weeks for 6 cycles.

RESULTS

130 of 146 patients were evaluable for efficacy (60% stage IV). Three complete and 58 partial responses were observed (overall response rate: 46.9%; 95% CI: 38.3-55.5%). Median time to progression was 6.9 months and median survival was 14.0 months; 1-year survival was 59.5%. Grade 3/4 neutropenia, thrombocytopenia and anemia occurred in 69.2%, 6.2% and 18.5% of patients, respectively. Grade 3/4 vomiting was observed in 13.7% and grade 3/4 neurosensory effects were observed in 2.7% of patients. There was one case of treatment-related death due to sepsis.

CONCLUSION

Docetaxel-cisplatin is an effective and well-tolerated treatment in Asian patients with NSCLC.

Lung cancer in elderly patients

Lung cancer is one of the most common causes of death in elderly patients in the United States. Treatment advances have improved survival in selected patients. The available treatments carry the risk of morbidity and mortality but the benefit in most patients far outweighs the risks, given the dismal prognosis of untreated disease. Elderly patients with lung cancer need careful attention during pretreatment assessment. Advanced age alone, however, should not contraindicate aggressive treatment. In the high-risk groups it is important to involve a team of physicians including surgeons, radiation oncologists, medical oncologists, and pulmonologists, who are familiar with current treatment options and their risks.

Cutaneous metastasis from small cell lung carcinoma. Case report

We report a rare case of cutaneous metastatic small cell lung carcinoma of the upper lip in a 73-year-old man, which was excised and the defect repaired with a single advancement flap from the cheek. The prognosis of such lesions is poor, and the incidence of other metastases elsewhere is high. The aim of treatment was to give him optimal quality of life for the short time left. The patient died of his primary disease four months later.

Trends of lung cancer incidence by histologic type: a population-based study in Osaka, Japan

We investigated trends of lung cancer incidence from 1974 to 1993 by histologic type, using data from the population-based cancer registry in Osaka, Japan. Since the proportion of cases with histologic types identified was not sufficiently high, sex- and age-specific incidence rates by histologic types were estimated assuming that the distribution of histologic types was the same across the same sex and age group regardless of reporting status. Cumulative risk from 0 to 74 years old for total lung cancer increased 1.3-fold from the period 1974-77 to 1986-89 and then plateaued in the period 1990-93 for both males and females. When divided into histologic types, cumulative risk for incidence of squamous cell carcinoma was almost constant during the study period for both males and females. During the same period, adenocarcinoma increased up to 1.4-fold for both males and females. This increase seemed to have reached a plateau recently for males, but not for females. Small cell carcinoma increased monotonously up to 1.6- to 1.7-fold for both males and females. Large cell carcinoma showed over 2-fold increase for both males and females; however, the estimates fluctuated due to the small number of cases. This study provides further evidence of a relative increase of adenocarcinoma compared to squamous cell carcinoma. Recent trends of tapering increase of lung cancer incidence should be confirmed by further observation.