Tobacco Smoking and Lung Cancer: Perception-changing facts

Soybean-Derived Bioactive Components in Prevention and Intervention of Lung Cancer

Soybean (Glycine max) is one of Asia's most valuable oil crops, offering a rich source of dietary protein and bioactive compounds with diverse clinical applications. Key bioactive phytochemicals in soybean, including isoflavones, flavonoids, carotenoids, phytosterols, soyasaponins, fatty acids, and protein isolates, are known for their potential health benefits. These compounds exert functional properties by modulating critical metabolic pathways, such as the mitogen-activated protein kinase (MAPK), estrogen receptor (ER), and nuclear factor kappa-B (NF-κB) pathways. With a growing body of epidemiological and clinical evidence supporting the anticancer potential of soybean, this review systematically examines the role of soybean-derived bioactive components in the prevention and treatment of lung cancer. To our knowledge, this is the first review to focus specifically on the impact of soy-derived bioactive components on lung cancer progression and modulation, offering insights into their mechanisms and potential as dietary interventions.

Predictive performance of risk prediction models for lung cancer incidence in Western and Asian countries: a systematic review and meta-analysis

Numerous prediction models have been developed to identify high-risk individuals for lung cancer screening, with the aim of improving early detection and survival rates. However, no comprehensive review or meta-analysis has assessed the performance of these models across different sociocultural contexts. Therefore, this review systematically examines the performance of lung cancer risk prediction models in Western and Asian populations. PubMed and EMBASE were searched from inception through January 2023. Studies published in English that proposed a validated model on human populations with well-defined predictive performances were included. Two reviewers independently screened the titles and abstracts, and the Prediction Model Risk of Bias Assessment Tool (PROBAST) was used to assess study quality. A random-effects meta-analysis was performed, and a 95% confidence interval (CI) for model performance was reported. Between-study heterogeneity was adjusted for using the Hartung-Knapp-Sidik-Honkman test. A total of 54 studies were included, with 42 from Western countries and 12 from Asian countries. Most Western studies focused on ever-smokers (19/42; 45.2%) and the general population (17/42; 40.5%), and only two Asian studies developed models exclusively for never-smokers. Across both Western and Asian prediction models, the three most consistently included risk factors were age, sex, and family cancer history. In 45.2% (19/42) of Western and 50.0% (6/12) of Asian studies, models incorporated both traditional risk factors and biomarkers. In addition, 14.8% (8/54) of the studies directly compared biomarker-based models with those incorporating only traditional risk factors, demonstrating improved discrimination. Machine-learning algorithms were applied in eight Western models and two Asian models. External validation of PLCOM2012 (AUC = 0.748; 95% CI: 0.719-0.777) outperformed other prediction models, such as Bach (AUC = 0.710; 95% CI: 0.674-0.745) and Spitz models (AUC = 0.698; 95% CI: 0.640-0.755). Despite showing promising results, the majority of Asian risk models in our study lack external validation. Our review also highlights a significant gap in prediction models for never-smokers. Future research should focus on externally validating existing Asian models or incorporating relevant Asian risk factors into widely used Western models (PLCOM2012) to better account for unique risk profiles and lung cancer progression patterns in Asian populations.

Role of Nanoformulations in the Treatment of Lung Cancer

Lung cancer is the second deadliest disease in the world. A major portion of deaths related to cancer are due to lung cancer in both males and females. Interestingly, unbelievable advances have occurred in recent years through the use of nanotechnology and development in both the diagnosis and treatment of lung cancer. Due to their in vivo stability, the nanotechnology-based pharmacological system gained huge attractiveness, solubility, absorption from the intestine, pharmacological effectiveness, etc. of various anticancer agents. However, this field needs to be utilized more to get maximum results in the treatment of lung cancer, along with wider context medicines. In the present review, authors have tried to concentrate their attention on lung cancer`s difficulties along with the current pharmacological and diagnostic situation, and current advancements in approaches based on nanotechnology for the treatment and diagnosis of lung cancer. While nanotechnology offers these promising avenues for lung cancer diagnosis and treatment, it is important to acknowledge the need for careful evaluation of safety, efficacy, and regulatory approval. With continued research and development, nanotechnology holds tremendous potential to revolutionize the management of lung cancer and improve patient outcomes. The review also highlights the involvement of endocrine systems, especially estrogen in lung cancer proliferation. Some of the recent clinical trials and patents on nanoparticle-based formulations that have applications in the treatment and diagnosis of lung cancer are also discussed.

[Non-small cell lung cancer in adults under 40 years of age]

INTRODUCTION

Non-small cell lung cancers (NSCLC) are the most common lung cancers, withpeak incidence at 65years of age. These cancers rarely occur before the age of 40.

METHODS

Based on an illustrative clinical case, a systematic review of the literature was conducted to study the epidemiological, clinical, histological, and biological characteristics of NSCLC in adults under 40years of age. Two equations were developed to search for articles on Medline and Scopus.

RESULTS

Sixty-five articles were included in the review; 1.7% of patients were under 40years old, 50.7% were women, 66.7% presented adenocarcinoma, 51.9% were diagnosed at stage IV, 75% were non-smokers, 39.9% were exposed to other toxins, 33% had an EGFR mutation, 6.6% had a KRAS mutation, 25% had an ALK translocation, 73.7% were symptomatic, and over 75% had PS<2.

CONCLUSION

NSCLC in patients under 40years of age presents characteristics different from those in older patients. Various factors are implicated, one example being lower exposure to tobacco, and they can influence the distribution of histological subtypes and the frequency of mutations.

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

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

Effects of Conjugated Linoleic Acid (CLA) Supplementation and Exposure of Cigarette Smoke on Bcl-2, P53 Protein, and TNF-α Expression in the Epitels of Wistar Rats (Rattus Norvegicus) Bladder

OBJECTIVE

To determine the effect of Conjugated Linoleic Acid (CLA) supplementation on Bcl-2, P53 protein and TNF- α expression in the bladder of rats which is exposed to cigarette smoke.

Methods: The study is a true experimental in Wistar rats. Sample was divided into 4 groups: group A had a 0.5% CLA supplementation (125 mg) diet, group B had a 1% of CLA diet (250mg). 2 other was control groups group without CLA supplementation (group C) as positive control and without cigarette smoke exposure and group D as negative control. The study takes 60 days of exposure and then Bcl-2, P53 protein and TNF- α expression on bladder epithelial was evaluated by immunohistochemistry staining. Data analysis was then performed using the One-way ANOVA test.

Result: It showed that rats in group C has an average Bcl-2 expression of 25.8±7.33%, while Group B obtained an average Bcl-2 expression was 14.2±9.6% and had a significant difference when compared to group C (p=0.032). TNF-α expression in the four groups showed that TNF- α expression in group C was the highest with an average of 87.80±8.20. For TNF- α group B of 28.80±13.88 expression has a significant difference when compared to group C (p=0.000). Increase expression of wild-type p53 in group B compared to group A and decrease expression of wild type p53 in groups C and D compared to group B. Meanwhile, mutant type p53 expression showed no expression in all study groups.

Conclusion: Exposure of cigarette smoke can increase the expression of Bcl-2, P53 protein and TNF- α in the bladder mucosa and CLA supplementation can reduce Bcl-2, wild-type P53 protein and TNF- α expression.

Renewable risk assessment of heterogeneous streaming time-to-event cohorts

The analysis of streaming time-to-event cohorts has garnered significant research attention. Most existing methods require observed cohorts from a study sequence to be independent and identically sampled from a common model. This assumption may be easily violated in practice. Our methodology operates within the framework of online data updating, where risk estimates for each cohort of interest are continuously refreshed using the latest observations and historical summary statistics. At each streaming stage, we introduce parameters to quantify the potential discrepancy between batch-specific effects from adjacent cohorts. We then employ penalized estimation techniques to identify nonzero discrepancy parameters, allowing us to adaptively adjust risk estimates based on current data and historical trends. We illustrate our proposed method through extensive empirical simulations and a lung cancer data analysis.

Novel nanoparticle AuNCs conjugated with Desmoglein-3 antibody for FL/CT dual-mode targeted imaging and precise treatment of lung squamous cell carcinoma

Due to lack of effective, early and non-invasive diagnostic as well as treatment tools, the surgical treatment opportunities for lung squamous cell carcinoma (SCC) are limited, resulting in high mortality rates. Therefore, the combination of targeted recognition and precise treatment of lung SCC is of great significance. In this study, a multifunctional nanoparticle is designed and synthesized, which specifically identifies lung SCC cells for target imaging and therapy. Desmoglein-3 (Dsg-3), a transmembrane glycoprotein found in desmosomes, is highly expressed in lung SCC cells. Gold nanoclusters (AuNCs) conjugated with Dsg-3 antibodies to form Au-Dsg-3 through coupling reaction. The results showed that the fluorescence imaging (FI) intensity and computed tomography (CT) signal of Au-Dsg-3 significantly increased within 6 h in vitro and in vivo, achieving dual-modal imaging to detect lung SCC effectively. Besides, Au-Dsg-3 even integrates targeted photothermal therapy (PTT) characteristics in a single nanoparticle. When exposed to near-infrared radiation (NIR), the temperature of the tumor site increased rapidly and reached a high temperature of 53.3 °C after 600 s, causing tumor ablation and growth inhibition. In summary, Au-Dsg-3 provides a key platform for targeted biological imaging and collaborative PTT, which demonstrates good performance on lung SCC.

Prevalence of Electronic Cigarette Smoking Among Students of Shaqra University, Saudi Arabia

Background Electronic cigarettes are devices that use a flavored nicotine solution instead of burning tobacco leaves. Since their emergence, e-cigarettes have gained popularity in Saudi Arabia, particularly among young adults. Recently, many non-smoking youths have begun to use e-cigarettes as an alternative social behavior. Recent studies have confirmed that e-cigarettes have harmful effects on the respiratory system. Approximately 48.5 million Europeans have used an e-cigarette at least once while 7.5 million Europeans currently use e-cigarettes. This study aims to assess the prevalence of e-cigarette use and possible addictiveness among Shaqra University students. Methodology This is a cross-sectional study conducted at Shaqra University in 2021. A total of 290 students (18 years old and older) from Shaqra University were included in our study. The subjects were selected through simple random sampling. A self-administered online questionnaire related to e-cigarettes was used. Results Completed questionnaires were obtained from 290 students (average age of 20.2 ± 1.8 years). A total of 58 (20.1%) of the respondents were e-cigarette users. The obtained results showed that the mean age of e-cigarette smokers was 20.5 years, e-cigarette usage significantly differed between age groups (p < 0.001), and the highest prevalence of e-cigarette smoking was in Shaqra Governorate (i.e., 13.1%). Conclusion It's vital to acknowledge that the capacity for addiction to e-cigarettes is comparable to traditional smoking and other nicotine-containing items. It's essential to consistently observe students and smokers to better understand the effects of vaping patterns on this specific group.

Gene-Expression Patterns of Tumor and Peritumor Tissues of Smoking and Non-Smoking HPV-Negative Patients with Head and Neck Squamous Cell Carcinoma

We studied the gene-expression patterns in specimens of tumor and peritumor tissue biopsies of 26 patients with head and neck carcinomas depending on smoking status. Histological and immunohistochemical examinations verified that all tumors belonged to the "classical" subgroup of head and neck carcinomas, and the HPV-negative tumor status was confirmed. The expression of 28 tumor-associated genes determined by RT-PCR was independent of patients' sex or age, TNM status, degree of differentiation, or tissue localization. Moreover, in peritumor tissue, none of the 28 genes were differentially expressed between the groups of smoking and nonsmoking patients. During oncotransformation in both studied groups, there were similar processes typical for HNSCC progression: the expression levels of paired keratins 4 and 13 were reduced, while the expression levels of keratin 17 and CD44 were significantly increased. However, further investigation revealed some distinctive features: the expression of the genes EGFR and TP63 increased significantly only in the nonsmoking group, and the expression of IL6, CDKN2A, EGF, and PITX1 genes changed only in the smoking group. In addition, correlation analysis identified several clusters within which genes displayed correlations in their expression levels. The largest group included 10 genes: TIMP1, TIMP2, WEE1, YAP, HIF1A, PI3KCA, UTP14A, APIP, PTEN, and SLC26A6. The genetic signatures associated with smoking habits that we have found may serve as a prerequisite for the development of diagnostic panels/tests predicting responses to different therapeutic strategies for HNSCC.

Pre-clinical lung squamous cell carcinoma mouse models to identify novel biomarkers and therapeutic interventions

Primary lung carcinoma or lung cancer (LC) is classified into small-cell or non-small-cell (NSCLC) lung carcinoma. Lung squamous cell carcinoma (LSCC) is the second most common subtype of NSCLC responsible for 30% of all LCs, and its survival remains low with only 24% of patients living for five years or longer post-diagnosis primarily due to the advanced stage of tumors at the time of diagnosis. The pathogenesis of LSCC is still poorly understood and has hampered the development of effective diagnostics and therapies. This review highlights the known risk factors, genetic and epigenetic alterations, miRNA biomarkers linked to the development and diagnosis of LSCC and the lack of therapeutic strategies to target specifically LSCC. We will also discuss existing animal models of LSCC including carcinogen induced, transgenic and xenograft mouse models, and their advantages and limitations along with the chemopreventive studies and molecular studies conducted using them. The importance of developing new and improved mouse models will also be discussed that will provide further insights into the initiation and progression of LSCC, and enable the identification of new biomarkers and therapeutic targets.

Polo-like Kinase 4: A Multifaceted Marker Linking Tumor Aggressiveness and Unfavorable Prognosis, and Insights into Therapeutic Strategies

(1) Background: This study investigated whether polo-like kinase 4 (PLK4) is a suitable therapeutic target or biomarker for lung adenocarcinoma (LUAD). (2) Methods: We acquired LUAD data from The Cancer Genome Atlas (TCGA) database through the UCSC Xena data portal. Gene expression, clinical, survival, and mutation data from multiple samples were analyzed. Gene enrichment analysis, unsupervised clustering of PLK4-related pathways, and differential gene expression analyses were performed. Additionally, correlations, t-tests, survival analyses, and statistical analyses were performed. (3) Results: PLK4 expression was higher in LUAD tissues than in normal tissues and was associated with poor prognosis for both overall and progression-free survival in LUAD. PLK4 was highly correlated with cell-proliferation-related pathways using Gene Ontology (GO) biological process terms. PLK4 expression and pathways that were highly correlated with PLK4 expression levels were upregulated in patients with LUAD with the TP53 mutation. (4) Conclusions: PLK4 expression affects the survival of patients with LUAD and is a potential therapeutic target for LUAD with TP53 mutations.

Targeted EGFR Nanotherapy in Non-Small Cell Lung Cancer

Non-small cell lung cancer (NSCLC) remains a leading cause of cancer-related mortality worldwide. Despite advances in treatment, the prognosis remains poor, highlighting the need for novel therapeutic strategies. The present review explores the potential of targeted epidermal growth factor receptor (EGFR) nanotherapy as an alternative treatment for NSCLC, showing that EGFR-targeted nanoparticles are efficiently taken up by NSCLC cells, leading to a significant reduction in tumor growth in mouse models. Consequently, we suggest that targeted EGFR nanotherapy could be an innovative treatment strategy for NSCLC; however, further studies are needed to optimize the nanoparticles and evaluate their safety and efficacy in clinical settings and human trials.

Cancer incidence and mortality in Brunei Darussalam, 2011 to 2020

This study presents the trends of age-standardised incidence and mortality rates of common cancers in Brunei Darussalam from 2011 to 2020. All cancer cases diagnosed among Brunei Darussalam citizens and permanent residents in the period 2011 to 2020 were included in the study. De-identified data were provided by the CanReg5 based BDCR, Ministry of Health Brunei Darussalam. The annual age-standardised incidence and mortality rates per 100,000 persons were standardised by the direct method using the World Health Organization (WHO) world standard population distribution. Joinpoint regression analyses were used to study the incidence and mortality trends of cancer in Brunei Darussalam over the 2011-2020 period. Trends were expressed as average annual percent change (AAPC) over 2011 to 2020, or annual percent change (APC) for a given time period. There were a total of 6,495 new cancer cases diagnosed and 3,359 death cases recorded from 2011 to 2020, in Brunei Darussalam. The five common cancers for males were colorectal, lung and bronchus, prostate, liver, and non-Hodgkin lymphoma. Among females, the five most common cancers were breast, colorectal, lung and bronchus, corpus uteri and cervix uteri. The five leading cancer deaths for males were lung and bronchus, colorectal, liver, prostate, and stomach, while for females, the five leading cancer deaths were breast, lung and bronchus, colorectal, ovary, and cervix uteri. There was a significant increase in the incidence trend of corpus uteri (AAPC[Formula: see text]) and a significant decline in the incidence trend for cervical cancer (AAPC[Formula: see text]) from 2011 to 2020. There was a significant increase in the mortality trend of female breast cancer from 2011 to 2015 (APC[Formula: see text]), but the trend significantly declined from 2015 to 2020 (APC[Formula: see text]). We also found a significant decrease in mortality trends for stomach cancer (AAPC[Formula: see text]) from 2011 to 2020 for both genders combined. The burden of common cancers is expected to continue to grow with ageing population, effective public health interventions targeting high burden cancers and high-risk groups, and control of modifiable risk factors will continue to be the essential approaches in reducing cancer burden.

Carotenoids for lung cancer chemoprevention and chemotherapy: Promises and controversies

BACKGROUND

Lung cancer is one of the leading causes of malignancy in the world. Several therapeutical and chemopreventive approaches have been practised to mitigate the disease. The use of phytopigments including carotenoids is a well-known approach. However, some of the prominent clinical trials interrogated the efficacy of carotenoids in lung cancer prevention.

METHODS

A elaborate literature survey have been performed investigating in vitro, in vivo, and clinical studies reported on the administration of carotenoids for chemoprevention and chemotherapy.

RESULTS

Tobacco consumption, genetic factors, dietary patterns, occupational carcinogens, lung diseases, infection, and sex disparities are some of the prominent factors leading to lung cancer. Significant evidence has been found underlining the efficiency of carotenoids in alleviating cancer. In vitro studies have proven that carotenoids act through PI3K/ AKT/mTOR, ERK-MAPK pathways and induce apoptosis through PPAR, IFNs, RAR, which are p53 intermediators in lung cancer signaling. Animal models and cell lines studies showed promising results, while the outcomes of clinical trials are contradictory and require further verification.

CONCLUSION

The carotenoids exert chemotherapeutic and chemopreventive effects on lung tumors which has been evidenced in numerous investigations. However, further analyses are necessary to the answer the uncertainties raised by several clinical trials.

The association between hormone therapy and the risk of lung cancer in postmenopausal women: a 16-year nationwide population-based study

OBJECTIVE

Although an association between hormone therapy (HT) and the risk of developing lung cancer has been reported, the results on the topic are inconsistent. Our study objective was to investigate whether postmenopausal women who undergo HT exhibit a risk of developing lung cancer.

METHODS

In this matched cohort study, we obtained the data of 38,104 postmenopausal women older than 45 years who were treated using HT between 2000 and 2015 from Taiwan's National Health Insurance Research Database, and 152,416 matched participants who were not treated using HT were enrolled as controls at a 1:4 ratio.

RESULTS

We used a Cox proportional hazards regression model to identify the risk of developing lung cancer during 16 years of follow-up, and the results indicate no significant difference in the proportion of postmenopausal women treated using HT ( P = 0.129) who developed lung cancer and that of those not treated using HT (0.866% [330 of 38,104] vs 0.950% [1,449 of 152,416]). After adjustment for age and other variables, the adjusted hazard ratio was 0.886 (95% CI, 0.666-1.305, P = 0.433), indicating no association between HT and lung cancer development in postmenopausal women. In a subgroup analysis, the risk of lung cancer was significantly lower in the women who were treated using HT when the HT cumulative dosage was ≥401 mg or when the therapy duration was ≥5 years compared with in those not treated using HT; the adjusted hazard ratios were 0.633 (95% CI, 0.475-0.930; P < 0.001) and 0.532 (95% CI, 0.330-0.934; P < 0.001), respectively, after adjustment.

CONCLUSIONS

Our results indicate that HT is not associated with the risk of lung cancer development in postmenopausal women; furthermore, a higher cumulative dosage and the long-term effects of HT reduce the risk of developing lung cancer.

The Importance of the Immune System and Molecular Cell Signaling Pathways in the Pathogenesis and Progression of Lung Cancer

Lung cancer is a disease that in recent years has become one of the greatest threats to modern society. Every year there are more and more new cases and the percentage of deaths caused by this type of cancer increases. Despite many studies, scientists are still looking for answers regarding the mechanisms of lung cancer development and progression, with particular emphasis on the role of the immune system. The aim of this literature review was to present the importance of disorders of the immune system and the accompanying changes at the level of cell signaling in the pathogenesis of lung cancer. The collected results showed that in the process of immunopathogenesis of almost all subtypes of lung cancer, changes in the tumor microenvironment, deregulation of immune checkpoints and abnormalities in cell signaling pathways are involved, which contribute to the multistage and multifaceted carcinogenesis of this type of cancer. We, therefore, suggest that in future studies, researchers should focus on a detailed analysis of tumor microenvironmental immune checkpoints, and to validate their validity, perform genetic polymorphism analyses in a wide range of patients and healthy individuals to determine the genetic susceptibility to lung cancer development. In addition, further research related to the analysis of the tumor microenvironment; immune system disorders, with a particular emphasis on immunological checkpoints and genetic differences may contribute to the development of new personalized therapies that improve the prognosis of patients.

Fitting additive risk models using auxiliary information

There has been a growing interest in incorporating auxiliary summary information from external studies into the analysis of internal individual-level data. In this paper, we propose an adaptive estimation procedure for an additive risk model to integrate auxiliary subgroup survival information via a penalized method of moments technique. Our approach can accommodate information from heterogeneous data. Parameters to quantify the magnitude of potential incomparability between internal data and external auxiliary information are introduced in our framework while nonzero components of these parameters suggest a violation of the homogeneity assumption. We further develop an efficient computational algorithm to solve the numerical optimization problem by profiling out the nuisance parameters. In an asymptotic sense, our method can be as efficient as if all the incomparable auxiliary information is accurately acknowledged and has been automatically excluded from consideration. The asymptotic normality of the proposed estimator of the regression coefficients is established, with an explicit formula for the asymptotic variance-covariance matrix that can be consistently estimated from the data. Simulation studies show that the proposed method yields a substantial gain in statistical efficiency over the conventional method using the internal data only, and reduces estimation biases when the given auxiliary survival information is incomparable. We illustrate the proposed method with a lung cancer survival study.

Comorbidities and perceived health status in persons with history of cancer in the USA

PURPOSE

Comorbidities can further challenge prognosis and general wellbeing of cancer patients. This study aimed to assess the association between comorbidities and perceived health status (PHS) of US persons with cancer.

METHODS

This cross-sectional study used 2019 Medical Expenditure Panel Survey (MEPS) data and included individuals who were alive throughout the year, aged 18 to 84 years, and had diagnosis for cancer. Using adjusted logistic regression models, we estimated the association of comorbidities (no, few [1/2], and more [3 or more] comorbidities) with PHS. Analyses accounted for the complex design of MEPS.

RESULTS

The dataset included 28,512 participants, 1739 of which were eligible for the study. Of these, 11.16% (95% CI 9.64, 12.59%); 41.73% (95% CI 39.21, 43.96%); and 47.10% (95% CI 44.86, 49.73%) reported having no, few, and more comorbidities, respectively. While breast (N = 356), prostate (N = 276), and melanoma (N = 273) were the most common cancers, hypertension (88.3%), hypercholesterolemia (49.5%), and arthritis (48%) were the most prevalent comorbidities. Adjusted logistic regression showed that, compared with those with no comorbidities, persons with few and more comorbidities had 1.58 (95% CI = 0.79, 3.15) and 2.27 (95% CI = 1.19, 4.32) times greater odds of poor PHS. Younger or male patients, those with less formal education, low-income, pain, functional limitation, or poor perception of mental health were more likely to regard their health as poor.

CONCLUSION

About 88% of persons with history of cancer in the USA aged 18-84 years reported at least one comorbidity. Having more comorbidities, along with several other variables, was associated with poor PHS. Comorbidities management must be given special consideration to improve the prognosis and general wellbeing of persons with cancer.

Chitosan-alginate nanoparticles of cabazitaxel: Design, dual-receptor targeting and efficacy in lung cancer model

Cabazitaxel (CZT) loaded chitosan-alginate based (CSA) nanoparticles were developed with dual targeting functions of both folate receptor and epidermal growth factor receptor (EGFR) using ionic gelation technique. The chitosan-folate conjugate was synthesized, and characterized by using FTIR, NMR and Mass spectroscopy. The physicochemical parameters and morphology of all CSA nanoparticles were examined. The degree of conjugation of folic acid and cetuximab (CTXmab) was determined by UV-Visible spectroscopy and Bradford assay, respectively. Moreover, XPS analysis also supported the presence of the ligands on nanoparticles. The cellular-uptake study performed on A-549 cells demonstrated a significant enhancement in the uptake of dual-receptor targeted CSA nanoparticles than non-targeted and single-receptor targeted CSA nanoparticles. Further, CZT-loaded dual receptors targeted CSA nanoparticles also showed significantly lower IC50 values (~38 folds) than the CZT control against A-549 cells. Further, in-vivo histopathological evaluations of dual receptor-targeted CSA nanoparticles have demonstrated better safety in Wistar rats. Moreover, its treatment on the Benzo(a)pyrene (B(a)P) induced lung cancer mice model has showed the enhanced anticancer efficacy of CZT with a prolonged survival rate.

Prevalence and clinical characteristics of malignant lung nodules in tuberculosis endemic area in a single tertiary centre

BACKGROUND

Lung nodule management remains a challenge to clinicians, especially in endemic tuberculosis areas. Different guidelines are available with various recommendations; however, the suitability of these guidelines for the Asian population is still unclear. Our study described the prevalence of malignant lung nodules among nodules measuring 2-30 mm, the demographic and characteristics of lung nodules between benign and malignant groups, and the clinician's clinical practice in managing lung nodules.

METHOD

Retrospective review of lung nodules from the computed tomography archiving and communication system (PACS) database and clinical data from January 2019 to January 2022. The data was analysed by using chi square, mann whitney test and simple logistic regression.

RESULTS

There were 288 nodules measuring 2-30 mm identified; 49 nodules underwent biopsy. Twenty-seven (55%) biopsied nodules were malignant, (prevalence of 9.4%). Among the malignant lung nodules, 74% were adenocarcinoma (n = 20). The commonest benign nodules were granuloma n = 12 (55%). In nodules > 8 mm, the median age of malignant and benign was 72 ± 12 years and 66 ± 16 years, respectively (p = 0.024). There was a significant association of benign nodules (> 8 mm) in subjects with previous or concurrent tuberculosis (p = 0.008). Benign nodules are also associated with nodule size ≤ 8 mm, without spiculation (p < 0.001) and absence of emphysema (p = 0.007). The nodule size and the presence of spiculation are factors to make the clinicians proceed with tissue biopsy. Spiculated nodules and increased nodule size had 11 and 13 times higher chances of undergoing biopsy respectively (p < 0.001).) Previous history of tuberculosis had a 0.874 reduced risk of progression to malignant lung nodules (p = 0.013). These findings implied that these three factors are important risk factors for malignant lung nodules. There was no mortality association between benign and malignant. Using Brock's probability of malignancy, nodules ≤ 8 mm had a low probability of malignancy.

CONCLUSION

The prevalence of malignant lung nodules in our centre was comparatively lower than non-Asian countries. Older age, the presence of emphysema, and spiculation are associated with malignancy. Clinical judgment is of utmost importance in managing these patients. Fleishner guideline is still being used as a reference by our clinician.

Muscarinic Receptors Associated with Cancer

Simple Summary

Recently, cancer research has described the presence of the cholinergic machinery, specifically muscarinic receptors, in a wide variety of cancers due to their activation and signaling pathways associated with tumor progression and metastasis, providing a wide overview of their contribution to different cancer formation and development for new antitumor targets. This review focused on determining the molecular signatures associated with muscarinic receptors in breast and other cancers and the need for pharmacological, molecular, biochemical, technological, and clinical approaches to improve new therapeutic targets.

Abstract

Cancer has been considered the pathology of the century and factors such as the environment may play an important etiological role. The ability of muscarinic agonists to stimulate growth and muscarinic receptor antagonists to inhibit tumor growth has been demonstrated for breast, melanoma, lung, gastric, colon, pancreatic, ovarian, prostate, and brain cancer. This work aimed to study the correlation between epidermal growth factor receptors and cholinergic muscarinic receptors, the survival differences adjusted by the stage clinical factor, and the association between gene expression and immune infiltration level in breast, lung, stomach, colon, liver, prostate, and glioblastoma human cancers. Thus, targeting cholinergic muscarinic receptors appears to be an attractive therapeutic alternative due to the complex signaling pathways involved.

Role of Long Noncoding RNAs in Smoking-Induced Lung Cancer: An In Silico Study

The prevalence of lung cancer induced by cigarette smoking has increased over time. Long noncoding (lnc) RNAs, regulatory factors that play a role in human diseases, are commonly dysregulated in lung cancer. Cigarette smoking is closely related to changes in lncRNA expression, which can affect lung cancer. Herein, we assess the mechanism of lung cancer initiation induced by smoking. To calculate the impact of smoking on the survival of patients with lung cancer, we extracted data from The Cancer Genome Atlas and Gene Expression Omnibus databases and identified the differentially expressed genes in the lung cancer tissue compared to the normal lung tissue. Genes positively and negatively associated with smoking were identified. Gene Ontology, Kyoto Encyclopedia of Genes and Genomes, and Cytoscape analyses were performed to determine the function of the genes and the effects of smoking on the immune microenvironment. lncRNAs corresponding to smoking-associated genes were identified, and a smoking-related lncRNA model was constructed using univariate and multivariate Cox analyses. This model was used to assess the survival of and potential risk in patients who smoked. During screening, 562 differentially expressed genes were identified, and we elucidated that smoking affected the survival of patients 4.5 years after the diagnosis of lung cancer. Furthermore, genes negatively associated with smoking were closely associated with immunity. Twelve immune cell types were also found to infiltrate differentially in smokers and nonsmokers. Thus, the smoking-associated lncRNA model is a good predictor of survival and risk in smokers and may be used as an independent prognostic factor for lung cancer.

Limited-Stage Small-Cell Lung Cancer: Current Progress and the Next Frontier

Limited-stage (LS) small-cell lung cancer (SCLC) is defined as disease confined to a tolerable radiation portal without extrathoracic metastases. Despite clinical research over two decades, the prognosis of LS-SCLC patients remains poor. The current standard of care for LS-SCLC patients is concurrent platinum-based chemotherapy with thoracic radiotherapy (RT). Widespread heterogeneity on the optimal radiation dose and fractionation regimen among physicians highlights the logistical challenges of administering BID regimens. Prophylactic cranial irradiation (PCI) is recommended to patients following a good initial response to chemoradiation due to improved overall survival from historical trials and the propensity for LS-SCLC to recur with brain metastases. However, PCI utilization is being debated due to the greater availability of magnetic resonance imaging (MRI) and data in extensive-stage SCLC regarding close MRI surveillance in lieu of PCI while spurring novel RT techniques, such as hippocampal-avoidance PCI. Additionally, novel treatment combinations incorporating targeted small molecule therapies and immunotherapies with or following radiation for LS-SCLC have seen recent interest and some concepts are being investigated in clinical trials. Here, we review the landscape of progress, limitations, and challenges for LS-SCLC including current standard of care, novel radiation techniques, and the integration of novel therapeutic strategies for LS-SCLC.

Percutaneous coronary intervention in patients with cancer and readmissions within 90 days for acute myocardial infarction and bleeding in the USA

AIMS

The post-discharge outcomes of patients with cancer who undergo PCI are not well understood. This study evaluates the rates of readmissions within 90 days for acute myocardial infarction (AMI) and bleeding among patients with cancer who undergo percutaneous coronary intervention (PCI).

METHODS AND RESULTS

Patients treated with PCI in the years from 2010 to 2014 in the US Nationwide Readmission Database were evaluated for the influence of cancer on 90-day readmissions for AMI and bleeding. A total of 1 933 324 patients were included in the analysis (2.7% active cancer, 6.8% previous history of cancer). The 90-day readmission for AMI after PCI was higher in patients with active cancer (12.1% in lung, 10.8% in colon, 7.5% in breast, 7.0% in prostate, and 9.1% for all cancers) compared to 5.6% among patients with no cancer. The 90-day readmission for bleeding after PCI was higher in patients with active cancer (4.2% in colon, 1.5% in lung, 1.4% in prostate, 0.6% in breast, and 1.6% in all cancer) compared to 0.6% among patients with no cancer. The average time to AMI readmission ranged from 26.7 days for lung cancer to 30.5 days in colon cancer, while the average time to bleeding readmission had a higher range from 38.2 days in colon cancer to 42.7 days in breast cancer.

CONCLUSIONS

Following PCI, patients with cancer have increased risk for readmissions for AMI or bleeding, with the magnitude of risk depending on both cancer type and the presence of metastasis.

The Impact of Comorbidity on Survival in Patients With Head and Neck Squamous Cell Carcinoma: A Nationwide Case-Control Study Spanning 35 Years

Background

Comorbidity is presumed to impact survival of head and neck squamous cell cancer (HNSCC) patients. However, the prevalence and prognostic impact of comorbidity in these patients is not yet well established. The aim of this study is to outline the comorbidity burden of HNSCC patients and investigate the relation to overall survival and cancer-specific mortality.

Methods

The comorbidity burden of patients registered with HNSCC in the Danish Cancer Registry between 1980 and 2014 was evaluated based on the Charlson Comorbidity Index (CCI). Patients' risks of comorbid conditions compared to age- and gender-matched controls were estimated by odds ratios (OR). The impact of comorbidity on overall survival and cancer-specific mortality was evaluated by Cox regression and Kaplan-Meier survival analysis.

Results

A total of 25,388 HNSCC patients were included (72.5% male; mean age 63.2 years at diagnosis; median follow-up 3.0 years). CCI at diagnosis was significantly higher in patients compared to controls (p < 0.001). The most common comorbid conditions among the patients were additional non-metastatic malignancy (10.9%) and cerebrovascular disease (7.7%). Compared to controls, patients had higher odds of metastatic malignancy (OR: 4.65; 95% CI: 4.21-5.15; p < 0.001), mild liver disease (OR: 6.95; 95% CI: 6.42-7.53; p < 0.001), and moderate-severe liver disease (OR: 7.28; 95% CI: 6.14-8.65; p < 0.001). The multivariate Cox analysis revealed increasing hazard ratios with increasing CCI and in coherence the Kaplan-Meier curves showed poorer overall survival and increased cancer-specific mortality in patients with higher CCI.

Conclusion

HNSCC patients' comorbidity burden was significantly greater compared to the general population and increased comorbidity was correlated with increased cancer-related mortality.

Current clinical trials and patent update on lung cancer: a retrospective review

Several clinical trials using different interventions are currently being sponsored to combat lung cancer at its different stages. The purpose of this study was to provide a portfolio of those trials. All active, open and recruiting clinical trials registered at ClinicalTrials.gov up to March 2018 were included. Information related to 6092 registered lung cancer trials was downloaded. Phase II trials were in the majority, comprising nearly 48.7% of total clinical trials with industry the major sponsor (41.3%) followed by NIH (12.3%). Multicenter studies were the norm accounting for 47.9% and the main study location was the USA (50.9%). Common interventions were radiation (26%), surgery (22%) and EGFR inhibitors (17%). Patent information includes major patent filing office and sponsors. The data analysis provides a comprehensive description of lung cancer trials.

Discordance between Fluorescence In Situ Hybridization and Immunohistochemistry Analysis of Anaplastic Lymphoma Kinase Rearrangement in Indian Patients with Non-Small Cell Lung Cancer

Aims  This study aims to evaluate the incidence of anaplastic lymphoma kinase (ALK) mutation in nonsmall cell lung cancer (NSCLC) incorporating fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) methods and to look for any discordance. Methods  We evaluated 101 samples obtained from an enriched cohort of NSCLCs patients from the Army Hospital Research and Referral, New Delhi, India, between November 2016 and November 2018. IHC was performed using the highly-sensitive D5F3 rabbit monoclonal primary antibody. FISH was performed with dual-color, break-apart probe (ZytoLight SPEC) on formalin-fixed, and paraffin-embedded tissue. Discordance between IHC and FISH for ALK rearrangements was evaluated. Pearson correlation coefficient ( r ) was performed to identify any association of ALK presence (by IHC and FISH) with smoking brain metastasis, programmed death-ligand (PD-L1) expression, pleural effusion, and histopathological subtype. Results  A total of 7.92% (8/101) cases tested by IHC and 9.9% (10/101) cases tested by FISH were positive for ALK rearrangement. Of 93 ALK IHC-negative cases, 4 were ALK FISH-positive, whereas of 91 ALK FISH-negative cases, 4 were ALK IHC-positive cases. The correlation analysis demonstrated no or very weak correlation in ALK mutations by IHC or FISH with smoking, brain metastasis, PD-L1 expression, pleural effusion, and histopathological examination, except a weak positive correlation ( r = 0.33) observed between brain metastasis and ALK rearrangement identified by FISH. Conclusions  Our study demonstrated a somewhat similar incidence of ALK FISH-positive cases and ALK IHC-positive cases, though the incidence was numerically higher for ALK-FISH method.

Pulmonary function and factors associated with current smoking among the hill tribe populations in northern Thailand: a cross-sectional study

BACKGROUND

Smoking is considered one of the major poor health behaviors leading to several health problems. Individuals with a poor education and economic status are vulnerable to smoking, particularly the hill tribe people in Thailand. This study aimed to estimate the prevalence of current smoking, assess pulmonary function, and identify factors associated with current smoking among individuals aged 20 years and older of the hill tribes in northern Thailand.

METHOD

A cross-sectional study was conducted to gather information from the hill tribe people living in 42 hill tribe villages. A validated questionnaire, spirometry, and pulse oximetry were used as the research tools. Face-to-face interviews were conducted to collect data from the participants in a private room after obtaining informed consent voluntarily. Chi-squared test and logistic regression were used to detect the associations between the variables at the significance level of α = 0.05.

RESULTS

In total, 2216 participants were recruited into the study: 54.6% were women, 80.3% were aged 31-59 years, and 86.1% were married. The prevalence of smoking was 36.3%; 20.6% were current smokers (36.7% among men and 7.0% among women), and 15.7% were ever smokers. Half of the participants (50.1%) had smoked for ≤9 years, 80.1% smoked ≤10 pieces per day, 64.2% smoked traditional tobacco, 42.8% had low-to-moderate levels of knowledge of the harms of smoking, and 68.4% had low-to-moderate levels of attitudes toward the harms of smoking. Only sex was statistically significant among the different smoking behaviors (p-value< 0.001), and the participants' pulmonary function was not significantly different. After controlling for age, sex, religion, and education, three variables were found to be associated with current smoking among the hill tribe people in Thailand: men were more likely to smoke than women (AOR = 7.52, 95% CI = 5.53-10.24); those who used amphetamines were more likely to smoke than those who did not (AOR = 2.92, 95% CI = 1.69-5.03); those who had poor attitudes toward the harms of smoking were more likely to smoke than those who had a positive attitude toward the harms of smoking (AOR = 2.47, 95% CI = 1.53-3.97).

CONCLUSION

Translating essential health messages into the hill tribe language and improving the channel to deliver this information to the target populations, particularly men, are crucial strategies for improving their knowledge and attitudes toward the harms of smoking and making them quit smoking.

Randomized phase II trial of carboplatin + nab-paclitaxel versus cisplatin + gemcitabine for chemotherapy-naïve squamous cell carcinoma: North Japan lung cancer study group 1302

BACKGROUND

A subset analysis of the CA031 trial showed significant improvement in the overall response rate after administration of carboplatin plus weekly albumin-bound paclitaxel compared to carboplatin plus paclitaxel for squamous cell carcinoma of the lung (SQ). We conducted this phase II study to compare carboplatin plus weekly albumin-bound paclitaxel (CnP) to cisplatin plus gemcitabine (CG), a standard regimen for SQ.

METHODS

Chemotherapy-naïve patients with SQ were randomly assigned to receive cisplatin (80 mg/m²) on day 1 plus gemcitabine (1000 mg/m²) on days 1 and 8 every 3 weeks or carboplatin (area under the curve: 6 mg/mL/min) on day 1 plus nab-paclitaxel (75 mg/m²) on days 1, 8, and 15 every 3 weeks. The primary endpoint was overall response rate. The secondary endpoints were progression-free survival, overall survival, disease control rate, and toxicity.

RESULTS

Between June 2013 and October 2018, 71 patients were enrolled and assigned to either the CG arm (n = 35) or the CnP arm (n = 36) of the study. The overall response rate was 43% [95% confidence interval (CI) 27.3-58.5] in the CG arm and 47% (95% CI 31.7-62.7) in the CnP arm. Although drug combination efficacies did not differ, there were differences in toxicity: hematologic toxicities (leukopenia, neutropenia, and thrombocytopenia) were found mostly in the CG arm, whereas anemia and sensory neuropathy were more common in the CnP arm.

CONCLUSIONS

CnP had similar response as CG despite being a carboplatin-based regimen and toxicities differed between arms. Regarding ORR, CnP was comparable to CG for SQ.

Health inequality: a longitudinal study on geographic variations in lung cancer incidence and mortality in Taiwan

Background

This study is aimed toward an analysis of the variations in lung cancer incidence and mortality, adjusted by population factors (age, gender, and year), between administrative areas.

Methods

This is a retrospective study, using 2005–2014 data in each administrative area from the Taiwan Cancer Registry database organized by the Health Promotion Administration. The yearly age-standardized (overall) and crude (stratified by gender and age) incidence/mortality (and their growth rates) for each administrative area were collected and calculated. We used a mixed model to analyze the repeated measurements of yearly incidence and mortality rates and used general linear regression to analyze their growth rates.

Results

It was found that male and elderly populations had significantly higher lung cancer incidence and mortality in Taiwan. After adjusting for gender, age, and calendar year, there were no significant variations in incidence among the administrative areas, while the mortality in Yilan County was significantly higher than that in Taipei City (the capital city of Taiwan). On the other hand, the incidence in the female and younger population and mortality growth rates were higher. The incidence growth rate in Keelung City was significantly lower than that in Taipei City, while there were no significant variations in mortality growth rate among administrative areas.

Conclusions

This study found an inequality in the lung cancer burden among cities in Taiwan, which can serve as the basis for future resource allocations for lung cancer prevention and treatment in Taiwan.

Mortality from Selected Cancers among Brazilian Mechanics

Introduction:

Mechanics are exposed to known human carcinogens. This study aimed to compare mortality from selected cancers between male mechanics and the general population of the South and Southeast regions of Brazil.

Methods:

Data on deaths, occurred between 2006-2017, among male mechanics and the general population, were obtained from the Mortality Information System. Occupations were classified using the Brazilian Classification of Occupations. Mortality Odds Ratio (MOR) and confidence intervals (95%) for selected cancers among mechanics, stratified by age (30-49, 50-69 years), race, and education compared to the general population, were estimated using logistic regression models.

Results:

In general, mechanics showed higher mortality from oropharynx, hypopharynx, larynx, lung and bladder cancers, but lower mortality for all leukemias. Oropharynx and larynx cancer mortality risk was slightly higher among older mechanics, while hypopharynx cancer mortality was more noticeable among the youngest. Lower mortality from all leukemias was observed only among younger mechanics. Mortality by oropharynx and larynx cancers were higher among white mechanics. They were also the only ones to experience higher mortality by hypopharynx cancer, while lung cancer mortality were increased only among non-white ones. Mechanics of all educational levels were more likely to die by the oropharynx cancer. Those with 1-7 and 8 or more years of schooling also showed excess of death by the cancers of larynx and all leukemias. Significantly higher mortality by pancreas cancer was only observed among mechanics with no education, while those with 1-7 years of schooling showed higher risk to die by lung and bladder cancers. Those with 8 or more years of schooling show increased mortality risk for hypopharynx cancer. Increased mortality risk for myeloid leukemia was only observed when stratified by region of residence.

Conclusion:

Results of our study suggest a positive association between mechanic occupation and some specific cancers.

ATR-FTIR spectroscopy as adjunct method to the microscopic examination of hematoxylin and eosin-stained tissues in diagnosing lung cancer

Lung cancer remains the leading cause of cancer-related death worldwide. Since prognosis and treatment outcomes rely on fast and accurate diagnosis, there is a need for more cost-effective, sensitive, and specific method for lung cancer detection. Thus, this study aimed to determine the ability of ATR-FTIR in discriminating malignant from benign lung tissues and evaluate its concordance with H&E staining. Three (3) 5μm-thick sections were cut from formalin fixed paraffin embedded (FFPE) cell or tissue blocks from patients with lung lesions. The outer sections were H&E-stained and sent to two (2) pathologists to confirm the histopathologic diagnosis. The inner section was deparaffinized by standard xylene method and then subjected to ATR-FTIR analysis. Distinct spectral profiles that distinguished (p<0.05) one sample from another, called the "fingerprint region", were observed in five (5) peak patterns representing the amides, lipids, and nucleic acids. Principal component analysis and hierarchical cluster analysis evidently clustered the benign from malignant tissues. ATR-FTIR showed 97.73% sensitivity, 92.45% specificity, 94.85% accuracy, 91.49% positive predictive value and 98.00% negative predictive value in discriminating benign from malignant lung tissue. Further, strong agreement was observed between histopathologic readings and ATR-FTIR analysis. This study shows the potential of ATR-FTIR spectroscopy as a potential adjunct method to the gold standard, the microscopic examination of hematoxylin and eosin (H&E)-stained tissues, in diagnosing lung cancer.

Nanoparticulate Gels for Cutaneous Administration of Caffeic Acid

Caffeic acid is a natural antioxidant, largely distributed in plant tissues and food sources, possessing anti-inflammatory, antimicrobial, and anticarcinogenic properties. The object of this investigation was the development of a formulation for caffeic acid cutaneous administration. To this aim, caffeic acid has been loaded in solid lipid nanoparticles by hot homogenization and ultrasonication, obtaining aqueous dispersions with high drug encapsulation efficiency and 200 nm mean dimension, as assessed by photon correlation spectroscopy. With the aim to improve the consistence of the aqueous nanodispersions, different types of polymers have been considered. Particularly, poloxamer 407 and hyaluronic acid gels containing caffeic acid have been produced and characterized by X-ray and rheological analyses. A Franz cell study enabled to select poloxamer 407, being able to better control caffeic acid diffusion. Thus, a nanoparticulate gel has been produced by addition of poloxamer 407 to nanoparticle dispersions. Notably, caffeic acid diffusion from nanoparticulate gel was eight-fold slower with respect to the aqueous solution. In addition, the spreadability of nanoparticulate gel was suitable for cutaneous administration. Finally, the antioxidant effect of caffeic acid loaded in nanoparticulate gel has been demonstrated by ex-vivo evaluation on human skin explants exposed to cigarette smoke, suggesting a protective role exerted by the nanoparticles.

Cardiovascular mortality and morbidity following radical radiotherapy for lung cancer: Is cardiovascular death under-reported?

BACKGROUND

Lung cancer is the most common malignancy worldwide. Radical radiotherapy is an essential treatment in the management of early and locally advanced lung cancer. Cardiac events are known to occur following radical radiotherapy for lung cancer. This study examines the burden of cardiac events post radiotherapy, and estimates the accuracy of death certification in patients who received radical radiotherapy for lung cancer.

METHODS

We conducted a retrospective observational cohort study for all patients receiving radical radiotherapy for non-small cell lung cancer (NSCLC) at a large cancer centre between 01/01/2010 to 31/12/2016. Baseline cardiovascular disease and cancer status and treatment data were collected, along with hospital admission data and documented cause of death from the national registry for a median follow-up period of 34 months.

RESULTS

Of 1224 patients included in the analysis, 378 (30.9%) patients had cardiovascular disease at baseline, including 140 (11.4%) with prior myocardial infarction. In the 846 patients without known cardiovascular disease, 451 (53.3%) had a QRISK2 predicted 10-year cardiovascular risk >20% over 10 years. During follow-up, 215 hospitalisations occurred (Incidence rate 6.2 per hundred patient years) which were classified as primarily cardiac, and 622 patients died (18 per 100 patient-years). However, death certificates stated a primary cardiac cause of death in only 33 cases (5.3% of deaths). Notably, 29% of patients dying out of hospital and certified as cancer death did not have documented cancer relapse prior to death, and 61% had no community palliative care input prior to death, implying these events may have been sudden and unexpected.

CONCLUSION

There is a high prevalence of baseline cardiovascular disease in people undergoing radiotherapy for NSCLC, accompanied by significant rates of post-radiotherapy cardiovascular hospitalisation. However, only a small proportion of deaths are attributed to cardiovascular disease, together with the large amount of sudden deaths observed, this suggests that cardiovascular death is greatly under-reported in official statistics.

Association of TERT, OGG1, and CHRNA5 Polymorphisms and the Predisposition to Lung Cancer in Eastern Algeria

Lung cancer remains the most common cancer in the world. The genetic polymorphisms (rs2853669 in TERT, rs1052133 in OGG1, and rs16969968 in CHRNA5 genes) were shown to be strongly associated with the risk of lung cancer. Our study's aim is to elucidate whether these polymorphisms predispose Eastern Algerian population to non-small-cell lung cancer (NSCLC). To date, no study has considered this association in the Algerian population. This study included 211 healthy individuals and 144 NSCLC cases. Genotyping was performed using TaqMan probes and Sanger sequencing, and the data were analyzed using multivariate logistic regression adjusted for covariates. The minor allele frequencies (MAFs) of TERT rs2853669, CHRNA5 rs16969968, and OGG1 rs1052133 polymorphisms in controls were C: 20%, A: 31%, and G: 29%, respectively. Of the three polymorphisms, none shows a significant association, but stratified analysis rs16969968 showed that persons carrying the AA genotype are significantly associated with adenocarcinoma risk (pAdj = 0.03, ORAdj = 2.55). Smokers with an AA allele have a larger risk of lung cancer than smokers with GG or GA genotype (pAdj = 0.03, ORAdj = 3.91), which is not the case of nonsmokers. Our study suggests that CHRNA5 rs16969968 polymorphism is associated with a significant increase of lung adenocarcinoma risk and with a nicotinic addiction.

Hormone receptor expression correlates with EGFR gene mutation in lung cancer in patients with simultaneous primary breast cancer

Background

The coexistence of double primaries of lung cancer (LC) and breast cancer (BC) are not uncommon in women, but there has been limited research conducted of their molecular association. To decipher the internal pathogenesis of LC in patients with concurrent BC and LC, this study explored the clinical factors and relationship between hormone receptor (HR) expression and epidermal growth factor receptor (EGFR) gene mutation.

Methods

The clinicopathological characteristics of 400 female patients clinically diagnosed with double primary LC and BC at Fudan University Shanghai Cancer Center were collected. Pathological discrimination was performed to further confirm the double primaries in patients with available tissues. LC samples were then examined to detect EGFR gene mutation status by PCR-based assays and HR expression by immunohistochemistry (IHC). As a control cohort, the characteristics of 114 consecutive patients with LC only were compared with the double-primary patient group.

Results

A total of 169 patients were pathologically confirmed with simultaneous LC and BC between January 2010 and October 2018. The dominant LC subtype was adenocarcinoma (ADC) (95.1%), and invasive ductal carcinoma (IDC) was the main BC subtype (71.0%). Synchronous and metachronous double primary BC-LC cases accounted for 39.1% and 60.9% of the patients, respectively. The absence of family cancer history was associated with a shorter interval between the two primary cancer diagnoses. Among 64 patients with EGFR mutations, 34.4% had HR-positive LC tissue, compared with 0/24 (0%) of those with EGFR wild-type LC (P<0.001). All of the patients with positive HR expression harbored an activating EGFR mutation (n=22); however, no correlation was observed in the control cohort.

Conclusions

Double primary BC-LC patients have distinctive clinicopathological features compared to those with LC only. The expression of HRs is significantly correlated with EGFR mutation status of LC tissues.

Clinicopathological characteristics and treatment outcome in small cell lung cancer: A single institutional experience from India

Background and Objectives

Small cell lung cancer (SCLC) constitutes 14%-20% of all lung cancers. Clinical data on SCLC are scarce in literature. To report clinical features and treatment outcome of SCLC treated at our center.

Materials and Methods

This is a single institutional data review of SCLC patients treated between June 2011 and December 2018. Patients were staged as either localized or extensive disease after appropriate staging work-up. Patients with localized disease were treated with concurrent chemoradiation with platinum-based chemotherapy. Those with extensive disease were treated with platinum based palliative chemotherapy. Clinicopathological characteristics, treatment details, and outcome were recorded in this study. Patients who received at least one cycle of chemotherapy were included for survival analysis as intent-to-treat analysis.

Results

A total of 181 were patients registered with a median age of 62 years (range: 35-86 years) and male: female ratio of 166:15. Eighty-seven percent (n = 157) of patients had smoking history and 15% (n = 28) of patients had symptom of superior vena cava obstruction at baseline. Twenty-seven (15%) patients had localized disease at presentation. One hundred and twenty (66%) patients took systemic chemotherapy. Chemotherapy regimen was carboplatin only in 9 (7%), etoposide-carboplatin in 54 (45%), and cisplatin-etoposide in 57 (48%). Patients received median cycle number of 6 (range: 1-6). Of the evaluable 87 (73%) patients, initial response was complete response in 4, partial response in 57, stable disease in 20, and progressive disease in 6. Twenty patients received second-line chemotherapy at time of disease progression. After a median follow-up of 8.8 months (range: 0.3-46.1), median progression-free survival (PFS) of the whole population was 9.3 months.

Conclusions

Small cell carcinoma in our series had a high incidence of advanced stage (85%) and 13% of patients were nonsmoker. Only 66% of patients received palliative chemotherapy and achieved high disease control rate (>75%) in the evaluable patients with median PFS of 9.3 months.

Nicotinic-nAChR signaling mediates drug resistance in lung cancer

Lung cancer is the leading cause of cancer death worldwide. Cigarette smoking is the most common risk factor for lung carcinoma; other risks include genetic factors and exposure to radon gas, asbestos, secondhand smoke, and air pollution. Nicotine, the primary addictive constituent of cigarettes, contributes to cancer progression through activation of nicotinic acetylcholine receptors (nAChRs), which are membrane ligand-gated ion channels. Activation of nicotine/nAChR signaling is associated with lung cancer risk and drug resistance. We focused on nAChR pathways activated by nicotine and its downstream signaling involved in regulating apoptotic factors of mitochondria and drug resistance in lung cancer. Increasing evidence suggests that several sirtuins play a critical role in multiple aspects of cancer drug resistance. Thus, understanding the consequences of crosstalk between nicotine/nAChRs and sirtuin signaling pathways in the regulation of drug resistance could be a critical implication for cancer therapy.

Nicotine in E-cigarette smoke: cancer culprit?

Tobacco smoke's harmful effects are well-known; the harmful effects of tobacco smoke have been well-investigated. Nicotine in tobacco smoke contributes to the pathogenesis of various conditions, such as lung cancer, coronary artery disease and asthma. A decade ago, a seemingly safer alternative to tobacco cigarettes was introduced- the E-cigarette. However, studies have found that E-cigarette smoke (ECS) not only induces DNA damage but also reduces DNA repair activity via BER and NER pathways. Further research conducted with cells damaged by Ultra-Violet (UV) light or hydrogen peroxide (H₂O₂) indicates that ECS can function as a comutagen; nicotine can amplify mutagenic activity by merging with other mutagens. The downstream metabolites derived from nicotine found in ECS put E-cigarette smokers at a higher risk for developing lung or bladder cancers or heart disease than their non-smoking counterparts. Overall, these findings are instrumental in our understanding of the harmful effects of ECS.

The influence of hormone replacement therapy on lung cancer incidence and mortality

OBJECTIVE

Data regarding the effects of hormone replacement therapy (HRT) on non-small cell lung cancer (NSCLC) are mixed. We hypothesized HRT would have a protective benefit with reduced NSCLC incidence among women in a large, prospective cohort.

METHODS

We used data from the multicenter randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (1993-2001). Participants were women aged 50 to 74 years followed prospectively for up to 13 years for cancer screening. The influence of HRT on the primary outcome of NSCLC incidence and secondary outcomes of all-cause and disease-specific mortality were assessed with Kaplan-Meier analysis and Cox proportional hazard models adjusting for covariates.

RESULTS

In the overall cohort of 75,587 women, 1147 women developed NSCLC after a median follow-up of 11.5 years. HRT use was characterized as 49.4% current users, 17.0% former users, and 33.6% never users. Increased age, smoking, comorbidities, and family history were associated with increased risk of NSCLC. On multivariable analysis, current HRT use was associated with reduced risk of NSCLC compared with never users (hazard ratio, 0.80; 95% confidence interval, 0.70-0.93; P = .009). HRT or oral contraception use was not associated with significant differences in all-cause mortality or disease-specific mortality.

CONCLUSIONS

These data represent among the largest prospective cohorts suggesting HRT use may have a protective effect on the development of NSCLC among women; the physiological basis of this effect merits further study; however, the results may influence discussion surrounding HRT use in women.

Mimicking cigarette smoke exposure to assess cutaneous toxicity

Cigarette smoke stands among the most toxic environmental pollutants and is composed of thousands of chemicals including polycyclic aromatic hydrocarbons (PAHs). Despite restrict cigarette smoking ban in indoor or some outdoor locations, the risk of non-smokers to be exposed to environmental cigarette smoke is not yet eliminated. Beside the well-known effects of cigarette smoke to the respiratory and cardiovascular systems, a growing literature has shown during the last 3 decades its noxious effects also on cutaneous tissues. Being the largest organ as well as the interface between the outer environment and the body, human skin acts as a natural shield which is continuously exposed to harmful exogenous agents. Thus, a prolonged and/or repetitive exposure to significant levels of toxic smoke pollutants may have detrimental effects on the cutaneous tissue by disrupting the epidermal barrier function and by exacerbating inflammatory skin disorders (i.e. psoriasis, atopic dermatitis). With the development of very complex skin tissue models and sophisticated cigarette smoke exposure systems it has become important to better understand the toxicity pathways induced by smoke pollutants in more realistic laboratory conditions to find solutions for counteracting their effects. This review provides an update on the skin models currently available to study cigarette smoke exposure and the known pathways involved in cutaneous toxicity. In addition, the article will briefly cover the inflammatory skin pathologies potentially induced and/or exacerbated by cigarette smoke exposure.

E-cigarette use among medical students at Qassim University: Knowledge, perception, and prevalence

Background:

The popularity of e-cigarettes is increasing rapidly worldwide and advertisements for such products are becoming ubiquitous in the media. Health concerns and smoking cessation are the most commonly reported reasons for traditional tobacco smokers to shift to e-cigarettes. As a result, the global market for e-cigarettes is on the rise. However, they are still a potential cause for many diseases.

Methods:

This is a cross-sectional study carried out at Qassim University in Buraydah, Saudi Arabia. A prevalidated questionnaire was distributed to medical students in April 2018 to evaluate the experience, knowledge, and awareness of e-cigarettes among the participants.

Results:

About one in ten students confirmed having smoked an e-cigarette. There was no significant relationship between e-cigarette users and demographic factors, such as gender, academic level, or age. However, the study showed a significant association between e-cigarette smoking and having an e-cigarette smoker among family members or friends. Most students 71.9% were not sure whether e-cigarettes were approved by the Food and Drug Administration (FDA) for smoking cessation. Only 23.3% of those surveyed believed that e-cigarettes can help in smoking cessation, whereas only 11% said that they would recommend it for a patient. On the contrary, 49.6% agreed that e-cigarettes are addictive. In response to another question, 92% reported receiving no education in medical school about e-cigarettes.

Conclusion:

Our study showed that medical students lacked knowledge about e-cigarettes. Therefore, more studies are needed to raise awareness about e-cigarettes, especially since the habit of using e-cigarettes is invading our society.

Electrochemical biosensors for the detection of lung cancer biomarkers: A review

Cancer is one of the most widespread challenges and important diseases, which has the highest mortality rate. Lung cancer is the most common type of cancer, so that about 25% of all cancer deaths are related to the lung cancer. The lung cancer is classified as two different types with different treatment methodology: the small cell lung carcinoma and nonsmall cell lung carcinoma are two categories of the lung cancer. Since the lung cancer is often in the latent period in its early stages, therefore, early diagnosis of lung cancer has many challenges. Hence, there is a need for sensitive and reliable tools for preclinical diagnosis of lung cancer. Therefore, many detection methods have been employed for early detection of lung cancer. As lung cancer tumors growth in the body, the cancerous cells release numerous DNA, proteins, and metabolites as special biomarkers of the lung cancer. The levels of these biomarkers show the stages of the lung cancer. Therefore, detection of the biomarkers can be used for screening and clinical diagnosis of the lung cancer. There are numerous biomarkers for the lung cancer such as EGFR, CEA, CYFRA 21-1, ENO1, NSE, CA 19-9, CA 125 and VEGF. Nowadays, electrochemical methods are very attractive and useful in the lung cancer detections. So, in this paper, the recent advances and improvements (2010-2018) in the electrochemical detection of the lung cancer biomarkers have been reviewed.

Comorbidity in HPV+ and HPV- oropharyngeal cancer patients: A population-based, case-control study

OBJECTIVES

Comorbid conditions impact outcome for patients treated for oropharyngeal squamous cell carcinoma (OPSCC) and serve as competing risk factors for death. The purpose of this study was to examine differences in comorbidities in patients with OPSCC and known HPV-DNA.

MATERIAL AND METHODS

We included patients diagnosed with OPSCC in Eastern Denmark in 2000-2014. Patients were linked to the Danish National Patient Register to identify comorbidities based on the Charlson Comorbidity Index (CCI) at time of diagnosis and following cancer treatment. Patients were age-and sex-matched in a 1:10 ratio with a reference group and stratified according to HPV-status.

RESULTS

In total 1,499 patients (55.0% HPV+) and 14,990 controls were included. Significantly more HPV+ patients had no comorbidities compared to HPV- patients at time of diagnosis (RR: 1.5 (1.3;1.6), n = HPV+: 522, HPV-: 302) and following treatment (RR 1.5 (1.4;1.6), n = HPV+: 342, HPV-: 142). Most prevalent comorbidity was malignancy not including OPSCCs. HPV+ patients had an increased risk of having AIDS before their OPSCC diagnosis compared to the reference population (OR: 4.8 (1.8;12.9)). HPV- patients had increased risk of multiple comorbidities including cerebrovascular disease (OR: 1.9 (1.4;2.5)), peripheral vascular disease (OR: 1.7 (1.9;3.7)), dementia (OR: 2.9 (1.4;5.8)), ulcer disease (OR: 2.6 (1.9;3.5)), liver disease, mild (OR: 9.5 (7.0;13.0)) and severe (OR: 13.9 (5.8;22.8)).

CONCLUSION

This study showed that HPV- patients had more comorbidities than HPV+ patients at the diagnosis time and following treatment. Irrespective of HPV-status, OPSCC patients had a significant increased risk of (secondary) malignancy compared to the reference population.

Association of EGFR mutations and HMGB1 genetic polymorphisms in lung adenocarcinoma patients

High-mobility group protein box 1 (HMGB1) is overexpressed and reported to be a prognostic factor in patients with non-small-cell lung cancer (NSCLC). Epidermal growth factor receptor (EGFR) mutants play an important role in NSCLC progression. The aim of this study was to explore potential associations between genetic polymorphisms of HMGB1 and EGFR mutations in a cohort that included 280 patients with NSCLC, some of whom were smokers and others who never smoked. Four tagged single-nucleotide polymorphisms (SNPs) of HMGB1 were detected by a TaqMan-based real-time polymerase chain reaction (PCR) in patients. We found that after adjusting for other covariates, NSCLC patients who smoked and who respectively had CG, CT, and TC heterozygotes of HMGB1 rs2249825, rs1045411, and rs1360485, were at lower risk of developing mutant EGFR, compared to those patients with wild-type homozygotes. Moreover, significant inverse associations between the CG and CG + GG genotypes of HMGB1 rs2249825 and the EGFR hotspot mutation, an exon 19 in-frame deletion, were also observed among NSCLC patients. Within patients harboring mutant EGFR, HMGB1 rs1360485 C (TC + CC) allele carriers were at higher risk of developing poorly differentiated cancer types (odds ratio=5.493, 95% confidence interval: 1.130~26.696, p=0.019), compared to patients with TT homozygotes. Furthermore, we found that HMGB1 rs1360485 polymorphisms seemed to be related to susceptibility to developing poorly differentiated cancer linked to tobacco consumption in EGFR mutant patients. In conclusion, our results suggested that HMGB1 variants are significantly inversely associated with EGFR mutations among NSCLC patients who smoked. HMGB1 variants and tobacco consumption might contribute to the pathological development of NSCLC.