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Wu J, Li R, Gan J, Zheng Q, Wang G, Tao W, Yang M, Li W, Ji G, Li W. Application of artificial intelligence in lung cancer screening: A real-world study in a Chinese physical examination population. Thorac Cancer 2024. [PMID: 39206529 DOI: 10.1111/1759-7714.15428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND With the rapid increase of chest computed tomography (CT) images, the workload faced by radiologists has increased dramatically. It is undeniable that the use of artificial intelligence (AI) image-assisted diagnosis system in clinical treatment is a major trend in medical development. Therefore, in order to explore the value and diagnostic accuracy of the current AI system in clinical application, we aim to compare the detection and differentiation of benign and malignant pulmonary nodules between AI system and physicians, so as to provide a theoretical basis for clinical application. METHODS Our study encompassed a cohort of 23 336 patients who underwent chest low-dose spiral CT screening for lung cancer at the Health Management Center of West China Hospital. We conducted a comparative analysis between AI-assisted reading and manual interpretation, focusing on the detection and differentiation of benign and malignant pulmonary nodules. RESULTS The AI-assisted reading exhibited a significantly higher screening positive rate and probability of diagnosing malignant pulmonary nodules compared with manual interpretation (p < 0.001). Moreover, AI scanning demonstrated a markedly superior detection rate of malignant pulmonary nodules compared with manual scanning (97.2% vs. 86.4%, p < 0.001). Additionally, the lung cancer detection rate was substantially higher in the AI reading group compared with the manual reading group (98.9% vs. 90.3%, p < 0.001). CONCLUSIONS Our findings underscore the superior screening positive rate and lung cancer detection rate achieved through AI-assisted reading compared with manual interpretation. Thus, AI exhibits considerable potential as an adjunctive tool in lung cancer screening within clinical practice settings.
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Affiliation(s)
- Jiaxuan Wu
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Chengdu, Sichuan, China
- Institute of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruicen Li
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiadi Gan
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Chengdu, Sichuan, China
- Institute of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qian Zheng
- West China Clinical Medical College, Sichuan University, Chengdu, China
| | - Guoqing Wang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenjuan Tao
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Yang
- National Clinical Research Center for Geriatrics (WCH), West China Hospital, Sichuan University, Chengdu, China
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Wenyu Li
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guiyi Ji
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Chengdu, Sichuan, China
- Institute of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Precision Medicine Center, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- The Research Units of West China, Chinese Academy of Medical Sciences, West China Hospital, Chengdu, Sichuan, China
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Wei W, Wang Y, Ouyang R, Wang T, Chen R, Yuan X, Wang F, Wu S, Hou H. Machine Learning for Early Discrimination Between Lung Cancer and Benign Nodules Using Routine Clinical and Laboratory Data. Ann Surg Oncol 2024:10.1245/s10434-024-15762-3. [PMID: 39014163 DOI: 10.1245/s10434-024-15762-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Lung cancer poses a global health threat necessitating early detection and precise staging for improved patient outcomes. This study focuses on developing and validating a machine learning-based risk model for early lung cancer screening and staging, using routine clinical data. METHODS Two medical center, observational, retrospective studies were conducted, involving 2312 lung cancer patients and 653 patients with benign nodules. Machine learning techniques, including differential analysis and feature selection, were employed to identify key factors for modeling. The study focused on variables such as nodule density, carcinoembryonic antigen (CEA), age, and lifestyle habits. The Logistic Regression model was utilized for early diagnoses, and the XGBoost model was utilized for staging based on selected features. RESULTS For early diagnoses, the Logistic Regression model achieved an area under the curve (AUC) of 0.716 (95% confidence interval [CI] 0.607-0.826), with 0.703 sensitivity and 0.654 specificity. The XGBoost model excelled in distinguishing late-stage from early-stage lung cancer, exhibiting an AUC of 0.913 (95% CI 0.862-0.963), with 0.909 sensitivity and 0.814 specificity. These findings highlight the model's potential for enhancing diagnostic accuracy and staging in lung cancer. CONCLUSION This study introduces a novel machine learning-based risk model for early lung cancer screening and staging, leveraging routine clinical information and laboratory data. The model shows promise in enhancing accuracy, mitigating overdiagnosis, and improving patient outcomes.
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Affiliation(s)
- Wei Wei
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Renren Ouyang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rujia Chen
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Yuan
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Shiji Wu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Hongyan Hou
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Wu J, Li R, Zhang H, Zheng Q, Tao W, Yang M, Zhu Y, Ji G, Li W. Screening for lung cancer using thin-slice low-dose computed tomography in southwestern China: a population-based real-world study. Thorac Cancer 2024; 15:1522-1532. [PMID: 38798230 PMCID: PMC11219290 DOI: 10.1111/1759-7714.15383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES Lung cancer is one of the most common malignant tumors threatening human life and health. At present, low-dose computed tomography (LDCT) screening for the high-risk population to achieve early diagnosis and treatment of lung cancer has become the first choice recommended by many authoritative international medical organizations. To further optimize the lung cancer screening method, we conducted a real-world study of LDCT lung cancer screening in a large sample of a healthy physical examination population, comparing differences in lung nodules and lung cancer detection between thin and thick-slice LDCT scanning. METHODS A total of 29 296 subjects who underwent low-dose thick-slice CT scanning (5 mm thickness) from January 2015 to December 2015 and 28 058 subjects who underwent low-dose thin-slice CT scanning (1 mm thickness) from January 2018 to December 2018 in West China Hospital were included. The positive detection rate, detection rate of lung cancer, pathological stage of lung cancer, and mortality rate of lung cancer were analyzed and compared between the two groups. RESULTS The positive rate of LDCT screening in the thin-slice scanning group was significantly higher than that in the thick-slice scanning group (20.1% vs. 14.4%, p < 0.001). In addition, the lung cancer detection rate in the thin-slice LDCT screening positive group was significantly higher than that in the thick-slice scanning group (78.0% vs. 52.9%, p < 0.001). CONCLUSIONS The screening positive rate of low-dose thin-slice CT scanning is higher and more early-stage lung cancer (IA1 stage) can be detected in the screen-positive group.
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Affiliation(s)
- Jiaxuan Wu
- Department of Pulmonary and Critical Care MedicineWest China Hospital, Sichuan UniversityChengduChina
- State Key Laboratory of Respiratory Health and MultimorbidityWest China HospitalChengduChina
- Institute of Respiratory Health and MultimorbidityWest China Hospital, Sichuan UniversityChengduChina
| | - Ruicen Li
- Health Management Center, General Practice Medical CenterWest China Hospital, Sichuan UniversityChengduChina
| | - Huohuo Zhang
- Department of Pulmonary and Critical Care MedicineWest China Hospital, Sichuan UniversityChengduChina
- State Key Laboratory of Respiratory Health and MultimorbidityWest China HospitalChengduChina
- Institute of Respiratory Health and MultimorbidityWest China Hospital, Sichuan UniversityChengduChina
| | - Qian Zheng
- West China Clinical Medical CollegeSichuan UniversityChengduChina
| | - Wenjuan Tao
- Institute of Hospital ManagementWest China Hospital, Sichuan UniversityChengduChina
| | - Ming Yang
- National Clinical Research Center for GeriatricsWest China Hospital, Sichuan UniversityChengduChina
- Center of Gerontology and GeriatricsWest China Hospital, Sichuan UniversityChengduChina
| | - Yuan Zhu
- Health Management Center, General Practice Medical CenterWest China Hospital, Sichuan UniversityChengduChina
| | - Guiyi Ji
- Health Management Center, General Practice Medical CenterWest China Hospital, Sichuan UniversityChengduChina
| | - Weimin Li
- Department of Pulmonary and Critical Care MedicineWest China Hospital, Sichuan UniversityChengduChina
- State Key Laboratory of Respiratory Health and MultimorbidityWest China HospitalChengduChina
- Institute of Respiratory Health and MultimorbidityWest China Hospital, Sichuan UniversityChengduChina
- Institute of Respiratory Health, Frontiers Science Center for Disease‐related Molecular NetworkWest China Hospital, Sichuan UniversityChengduChina
- Precision Medicine Center, Precision Medicine Key Laboratory of Sichuan ProvinceWest China Hospital, Sichuan UniversityChengduChina
- The Research Units of West China, Chinese Academy of Medical SciencesWest China HospitalChengduChina
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Deboever N, Antonoff M. Commentary: Unlocking knowledge: Navigating readability challenges in thoracic surgery patient education materials. J Thorac Cardiovasc Surg 2024; 167:1659-1660. [PMID: 38244855 DOI: 10.1016/j.jtcvs.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Affiliation(s)
- Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Mara Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
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Herbst AN, McCullough MB, Wiener RS, Barker AM, Maguire EM, Fix GM. Proactively tailoring implementation: the case of shared decision-making for lung cancer screening across the VA New England Healthcare Network. BMC Health Serv Res 2023; 23:1282. [PMID: 37993840 PMCID: PMC10664378 DOI: 10.1186/s12913-023-10245-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Shared Decision-Making to discuss how the benefits and harms of lung cancer screening align with patient values is required by the US Centers for Medicare and Medicaid and recommended by multiple organizations. Barriers at organizational, clinician, clinical encounter, and patient levels prevent SDM from meeting quality standards in routine practice. We developed an implementation plan, using the socio-ecological model, for Shared Decision-Making for lung cancer screening for the Department of Veterans Affairs (VA) New England Healthcare System. Because understanding the local context is critical to implementation success, we sought to proactively tailor our original implementation plan, to address barriers to achieving guideline-concordant lung cancer screening. METHODS We conducted a formative evaluation using an ethnographic approach to proactively identify barriers to Shared Decision-Making and tailor our implementation plan. Data consisted of qualitative interviews with leadership and clinicians from seven VA New England medical centers, regional meeting notes, and Shared Decision-Making scripts and documents used by providers. Tailoring was guided by the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). RESULTS We tailored the original implementation plan to address barriers we identified at the organizational, clinician, clinical encounter, and patient levels. Overall, we removed two implementation strategies, added five strategies, and modified the content of two strategies. For example, at the clinician level, we learned that past personal and clinical experiences predisposed clinicians to focus on the benefits of lung cancer screening. To address this barrier, we modified the content of our original implementation strategy Make Training Dynamic to prompt providers to self-reflect about their screening beliefs and values, encouraging them to discuss both the benefits and potential harms of lung cancer screening. CONCLUSIONS Formative evaluations can be used to proactively tailor implementation strategies to fit local contexts. We tailored our implementation plan to address unique barriers we identified, with the goal of improving implementation success. The FRAME-IS aided our team in thoughtfully addressing and modifying our original implementation plan. Others seeking to maximize the effectiveness of complex interventions may consider using a similar approach.
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Affiliation(s)
- Abigail N Herbst
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Megan B McCullough
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
- Department of Public Health, Zuckerberg School of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, US, USA
- The Pulmonary Center, Boston University Chobanian &, Avedisian School of Medicine, Boston, MA, USA
| | - Anna M Barker
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Elizabeth M Maguire
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Gemmae M Fix
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA.
- General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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Ren J, Wang Y, Liu C, Yang L, Men X, Qiu Z. Correlation analysis of clinical, pathological, imaging and genetic features of ground-glass nodule featured lung adenocarcinomas between high-risk and non-high-risk individuals. Eur J Med Res 2023; 28:478. [PMID: 37924162 PMCID: PMC10625210 DOI: 10.1186/s40001-023-01462-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/19/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Early stage lung adenocarcinomas manifested as ground-glass nodules (GGNs) are increasingly being detected, but screening and diagnosis for GGN-featured lung adenocarcinomas in different risk populations reach no agreement. OBJECTIVES To analyze the clinical, pathological, imaging and genetic features of GGN-featured lung adenocarcinomas on high-resolution computed tomography (HRCT) in different risk groups. METHODS Include patients with GGNs on HRCT surgically diagnosed as lung adenocarcinoma in the West China Hospital, Sichuan University from 2009 to 2021, and their clinical, pathological, imaging and gene sequencing data. RESULTS According to Chinese Expert Consensus on Screening and Management of Lung Cancer, 1,800 patients with GGN-featured lung adenocarcinoma, 545 males (incl. 269 smokers) and 1,255 females (incl. 16 smokers), were divided into high-risk (509) and non-high-risk (1,291) groups. Among them, 1,095 were detected via physical examination. The mean age at diagnosis was 54.78 (23-84) and the mean time from detection to diagnosis was 9.59 months. There were more males than females in the high-risk group [288 (56.58%) vs 221 (43.42%)], just the opposite in the non-high-risk group [1,034 (80.09%) vs 257 (19.91%)] (both P < 0.001). No statistical difference was found in GGN detection way (P > 0.05). The frequency of invasive adenocarcinoma was higher in the high-risk group, while those of precursor lesions and minimally invasive adenocarcinoma were higher in the non-high-risk group (all P < 0.001). The preoperative follow-up time in the non-high-risk group was shorter (P < 0.05). A total of 711 gene mutations were observed in 473 patients with a ratio of non-high-risk to high-risk of 494:217. The incidence of EGFR mutation was not statistically significant (P = 0.824), while those of TP53 and KRAS mutations were higher in the high-risk group (P < 0.05). CONCLUSIONS GGN-featured lung adenocarcinoma is dominated by non-high-risk female patients. Shorter preoperative follow-up in the non-high-risk group and no statistical difference in GGN detection way suggests the existing screening criteria for high-risk population may not suit GGN-featured lung cancer. In addition, the incidences of KRAS and TP53 mutations are higher in the high-risk group.
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Affiliation(s)
- Jing Ren
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- The Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yuan Wang
- Department of Pulmonary and Critical Care Medicine/Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Chunrong Liu
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lan Yang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xinlu Men
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Outpatient Department, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zhixin Qiu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Qi C, Xiong XZ. Value of peripheral blood circulating tumor cell detection in the diagnosis of thoracic diseases and the prediction of severity. Clin Exp Med 2023; 23:2331-2339. [PMID: 36929453 PMCID: PMC10543157 DOI: 10.1007/s10238-023-01022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/05/2023] [Indexed: 03/18/2023]
Abstract
Circulating tumor cell (CTC) detection, as a noninvasive liquid biopsy method, has been used in the diagnosis, prognostic indication, and monitoring of a variety of cancers. In this study, we aimed to investigate whether CTC detection could be used in the early diagnosis and prediction of severity of thoracic diseases. We enrolled 168 thoracic disease patients, all of whom underwent pathological biopsy. Carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) measurement was also performed in 146 patients. There were 131 cases of malignant thoracic diseases and 37 cases of benign lesions. We detected CTCs in a 5 ml peripheral blood sample with the CTCBiopsy® system and analyzed the value of CTC count for predicting disease severity. Of 131 patients with a diagnosis of thoracic malignancy, CTCs were found in blood samples from 122 patients. However, only 2 out of 37 patients with benign thoracic disease had no detectable CTCs. There was no significant correlation between CTC count and benign and malignant lesions (P = 0.986). However, among 131 patients who had been diagnosed with malignant lesions, 33 had lymph node metastasis or distant metastasis. The presence of CTCs was significantly correlated with metastasis (P = 0.016 OR = 1.14). The area under the receiver operating characteristic (ROC) curve was 0.625 (95% confidence interval (CI), 0.519 to 0.730 P = 0.032). In addition, with stage IA1 as the cutoff, all patients were further divided into an early-stage group and a late-stage group. CTC count was significantly correlated with disease progression (P = 0.031 OR = 1.11), with an area under the curve (AUC) of 0.599 (95% CI, 0.506-0.692 P = 0.47). The sensitivity and specificity of CTC detection for the diagnosis of disease stage were 72.3% and 45.5%, respectively. In addition, the cutoff of 2.5 CTCs was the same when predicting disease metastasis and staging. Furthermore, the combination of CTC count, demographic characteristics and tumor markers had better predictive significance for disease staging. CTC count can effectively indicate the stages and metastasis of thoracic diseases, but it cannot differentiate benign and malignant diseases.
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Affiliation(s)
- Chang Qi
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
| | - Xian-Zhi Xiong
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China.
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Wiesel O, Sung SW, Katz A, Leibowitz R, Bar J, Kamer I, Berger I, Nir-Ziv I, Mark Danieli M. A Novel Urine Test Biosensor Platform for Early Lung Cancer Detection. BIOSENSORS 2023; 13:627. [PMID: 37366992 DOI: 10.3390/bios13060627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality worldwide. Early detection is essential to achieving a better outcome and prognosis. Volatile organic compounds (VOCs) reflect alterations in the pathophysiology and body metabolism processes, as shown in various types of cancers. The biosensor platform (BSP) urine test uses animals' unique, proficient, and accurate ability to scent lung cancer VOCs. The BSP is a testing platform for the binary (negative/positive) recognition of the signature VOCs of lung cancer by trained and qualified Long-Evans rats as biosensors (BSs). The results of the current double-blind study show high accuracy in lung cancer VOC recognition, with 93% sensitivity and 91% specificity. The BSP test is safe, rapid, objective and can be performed repetitively, enabling periodic cancer monitoring as well as an aid to existing diagnostic methods. The future implementation of such urine tests as routine screening and monitoring tools has the potential to significantly increase detection rate as well as curability rates with lower healthcare expenditure. This paper offers a first instructive clinical platform utilizing VOC's in urine for detection of lung cancer using the innovative BSP to deal with the pressing need for an early lung cancer detection test tool.
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Affiliation(s)
- Ory Wiesel
- Division of Thoracic and Esophageal Surgery the Cardiovascular Center, Tzafon Medical Center, Affiliated to Azrieli Faculty of Medicine, Bar-Ilan University, Poriya 1520800, Israel
| | - Sook-Whan Sung
- Department of Thoracic and Cardiovascular Surgery, Ewha Womens University Seoul Hospital, 260 Gonghang-daero, Gangseo-gu, Seoul 07804, Republic of Korea
| | - Amit Katz
- Head of Thoracic Surgery, Rambam Health Care Campus, P.O. Box 9602, Haifa 3109601, Israel
| | - Raya Leibowitz
- Oncology institute, Shamir Medical Center, Zerifin 703001, Israel
| | - Jair Bar
- Institute of Oncology, Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Iris Kamer
- Institute of Oncology, Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Itay Berger
- Early OM, 4 Meir Ariel St., Natanya 4253063, Israel
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Crothers K, Shahrir S, Kross EK, Kava CM, Cole A, Wenger D, Triplette M. Patient and Clinician Recommendations to Improve Communication and Understanding of Lung Cancer Screening Results. Chest 2023; 163:707-718. [PMID: 36209835 DOI: 10.1016/j.chest.2022.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/24/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patient understanding of chest low-dose CT (LDCT) scan results for lung cancer screening (LCS) may impact outcomes. RESEARCH QUESTION What are patient- and clinician-identified gaps in understanding and communication of LCS results and how might communication be improved through a patient-oriented tool? STUDY DESIGN AND METHODS We performed a mixed-methods study of participants recruited from a multisite LCS program to understand knowledge gaps after receiving LCS results and to guide development of a commonly asked questions (CAQ) after LCS information sheet. Initial patient surveys assessed understanding and reactions to LCS results (n = 190). We then conducted patient interviews and focus group discussions (n = 31) to understand experiences receiving LDCT scan results and reactions to results letters and the proposed CAQ; we also interviewed clinicians (n = 6) for feedback on these resources. We summarized survey responses and used thematic analysis to identify major themes in focus groups and interviews. RESULTS Of 190 survey respondents (43% response rate), although 88% agreed that they "understood" their LCS results, only 55% reported understanding what a lung nodule is. Approximately two-thirds thought it was "very important" to receive more information regarding lung nodules and incidental lung and heart disease. In interviews and focus groups, although patients believed that brief results letters for normal LDCT scan results generally were acceptable, most found letters explaining abnormal LDCT scan and incidental findings to be concerning and not a substitute for discussion with their clinician. Nearly all patients expressed that the CAQ sheet provided helpful information on nodules, results reporting and incidental findings, and helped them form questions to ask their clinicians. INTERPRETATION We identified patient-reported information needs regarding LCS results and developed a CAQ information sheet that was refined with patient and clinician input. The CAQ may represent a simple and feasible way to improve LCS results reporting and to augment clinician-patient discussions.
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Affiliation(s)
- Kristina Crothers
- VA Puget Sound Healthcare System, University of Washington, Seattle, WA; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washingon, Seattle, WA.
| | - Shahida Shahrir
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washingon, Seattle, WA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA
| | - Erin K Kross
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washingon, Seattle, WA; Cambia Palliative Care Center of Excellence, UW Medicine, Seattle, WA
| | - Christine M Kava
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA
| | - Allison Cole
- Department of Family Medicine, University of Washington, Seattle, WA
| | - David Wenger
- Division of Pulmonary and Critical Care, Evergreen Healthcare, Kirkland, WA
| | - Matthew Triplette
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washingon, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
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Ma S, Yu X, Jin X, Qiu F, Chen X, Wang R, Cao C. The usefulness of liquid-based cytology of bronchoalveolar lavage fluid combined with bronchial brush specimens in lung cancer diagnosis. J Int Med Res 2022; 50:3000605221132708. [PMID: 36345162 PMCID: PMC9647257 DOI: 10.1177/03000605221132708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective To explore the diagnostic value of liquid-based cytology (LBC) of
bronchoalveolar lavage fluid (BALF) combined with bronchial brushing
(BB). Methods One hundred patients with pulmonary masses or nodules found by chest computed
tomography (CT) or X-ray before bronchoscopy or other diagnostic biopsy
examinations were selected consecutively for this retrospective study. BALF
and BB were performed for all patients. After conventional smear via BB, we
mixed the BALF and BB samples in a prepared thin-layer bottle. Results The sensitivity of LBC of BALF combined with BB was noticeably higher than
that of BB alone in the total sample group (65.15% vs. 32.84%,
respectively). Similarly, in both the bronchoscopically visible group and
invisible group, a higher sensitivity for LBC of BALF with BB vs BB alone
(68.89% vs. 39.13%, respectively; 57.14% vs. 19.05%, respectively) was
observed. Additionally, the negative predictive value of LBC of BALF with BB
was higher than that with BB alone (58.56% vs. 42.31%; 61.29% vs. 44.73%;
53.47% vs. 37.83%; total sample vs visible vs invisible groups,
respectively). Conclusion Regardless of whether lesions or nodules are bronchoscopically visible or
invisible, LBC of BALF combined with BB may increase the diagnostic value
over BB alone in lung cancer diagnosis.
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Affiliation(s)
- Shanni Ma
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, Zhejiang, P. R. China
| | - Xuechan Yu
- Ningbo University School of Medicine, Ningbo, Zhejiang, P. R. China
| | - Xiaoyan Jin
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, Zhejiang, P. R. China
| | - Feng Qiu
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, Zhejiang, P. R. China
| | - Xueqin Chen
- Department of Traditional Medicine, Ningbo First Hospital, Ningbo, Zhejiang, P. R. China
| | - Ran Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P. R. China
| | - Chao Cao
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, Zhejiang, P. R. China
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11
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Qi C, Sun SW, Xiong XZ. From COPD to Lung Cancer: Mechanisms Linking, Diagnosis, Treatment, and Prognosis. Int J Chron Obstruct Pulmon Dis 2022; 17:2603-2621. [PMID: 36274992 PMCID: PMC9586171 DOI: 10.2147/copd.s380732] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open
Abstract
Many studies have proved that the pathogenesis of the chronic obstructive pulmonary disease (COPD) and lung cancer is related, and may cause and affect each other to a certain extent. In fact, the change of chronic airway obstruction will continue to have an impact on the screening, treatment, and prognosis of lung cancer.In this comprehensive review, we outlined the links and heterogeneity between COPD and lung cancer and finds that factors such as gene expression and genetic susceptibility, epigenetics, smoking, epithelial mesenchymal transformation (EMT), chronic inflammation, and oxidative stress injury may all play a role in the process. Although the relationship between these two diseases have been largely determined, the methods to prevent lung cancer in COPD patients are still limited. Early diagnosis is still the key to a better prognosis. Thus, it is necessary to establish more intuitive screening evaluation criteria and find suitable biomarkers for lung cancer screening in high-risk populations with COPD. Some studies have indicated that COPD may change the efficacy of anti-tumor therapy by affecting the response of lung cancer patients to immune checkpoint inhibitors (ICIs). And for lung cancer patients with COPD, the standardized management of COPD can improve the prognosis. The treatment of lung cancer patients with COPD is an individualized, comprehensive, and precise process. The development of new targets and new strategies of molecular targeted therapy may be the breakthrough for disease treatment in the future.
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Affiliation(s)
- Chang Qi
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Sheng-Wen Sun
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Xian-Zhi Xiong
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China,Correspondence: Xian-Zhi Xiong, Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, People’s Republic of China, Tel/Fax +86 27-85726705, Email
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12
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Kennedy K, Hulbert A, Pasquinelli M, Feldman LE. Impact of CT screening in lung cancer: Scientific evidence and literature review. Semin Oncol 2022; 49:S0093-7754(22)00053-7. [PMID: 36114033 DOI: 10.1053/j.seminoncol.2022.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022]
Abstract
The treatment of lung cancer has improved significantly in recent years however, lung cancer remains as a leading cause of cancer-related mortality worldwide. Lung cancer screening has been explored, over the past several decades, as a means of reducing lung cancer mortality, to identify asymptomatic disease when it is potentially curable. The National Lung Screening Trial (NLST) established that low-dose computed tomography (LDCT) scans of the chest can be instrumental in reducing lung cancer mortality but the criteria for screening implemented in this trial may not be equitably sensitive across racial and sex subpopulations. Furthermore, the high false detection rate reported in this trial has raised concerns regarding overdiagnosis with LDCT alone. The aim of this review is to summarize the history of lung cancer screening trials, limitations of lung cancer screening, the impact of alternative risk prediction models in reducing disparities, and the use of biomarkers in conjunction with imaging to improve diagnostic authenticity.
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Affiliation(s)
- Kathleen Kennedy
- Division of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Alicia Hulbert
- Department of Surgery, University of Illinois at Chicago, College of Medicine, Chicago, Illinois; Section of Hematology/Oncology, Medical Service, Jesse Brown VA Medical Center, Chicago, Illinois
| | - Mary Pasquinelli
- Division of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Lawrence E Feldman
- Division of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Section of Hematology/Oncology, Medical Service, Jesse Brown VA Medical Center, Chicago, Illinois.
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13
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Gao Q, Zeng Q, Wang Z, Li C, Xu Y, Cui P, Zhu X, Lu H, Wang G, Cai S, Wang J, Fan J. Start of an era: circulating cell-free DNA for early detection of cancers. Innovation (N Y) 2022; 3:100259. [PMID: 35647572 PMCID: PMC9133648 DOI: 10.1016/j.xinn.2022.100259] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022] Open
Abstract
Effective screening modalities are currently available for only a small subset of cancers, and they generally have suboptimal performance with complicated procedures. Therefore, there is an urgent need to develop simple, accurate, and non-invasive methods for early detection of cancers. Genetic and epigenetic alterations in plasma circulating cell-free DNA (cfDNA) have shown the potential to revolutionize methods of early detection of cancers and facilitate subsequent diagnosis to improve survival of patients. The medical interest in cfDNA assays has been inspired by emerging single- and multi-early detection of cancers studies. This review summarizes current technological and clinical advances, in the hopes of providing insights into the development and applications of cfDNA assays in various cancers and clinical scenarios. The key phases of clinical development of biomarkers are highlighted, and the future developments of cfDNA-based liquid biopsies in early detection of cancers are outlined. It is hoped that this study can boost the potential integration of cfDNA-based early detection of cancers into the current clinical workflow. Liquid biopsy, characterized by minimal invasiveness and user friendliness, can identify multiple cancers at the early stage and localize the tissue of origin The state-of-the-art technology facilitates the application of circulating cell-free DNA (cfDNA) assays in the early detection of cancers cfDNA assays are expected to be integrated into the clinical workflow after technological refinement and clinical trial validation The development and application strategies of cfDNA assays in various cancers and clinical scenarios can vary, and the harm-and-benefit should be balanced carefully
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Affiliation(s)
- Qiang Gao
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Fudan University, Shanghai 200032, China
- Key Laboratory of Medical Epigenetics and Metabolism, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Qiang Zeng
- Health Management Institute, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhijie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100006, China
| | | | - Yu Xu
- Burning Rock Biotech, Guangzhou 510320, China
| | - Peng Cui
- Burning Rock Biotech, Guangzhou 510320, China
| | - Xin Zhu
- Burning Rock Biotech, Guangzhou 510320, China
| | - Huafei Lu
- Burning Rock Biotech, Guangzhou 510320, China
| | | | - Shangli Cai
- Burning Rock Biotech, Guangzhou 510320, China
- Corresponding author
| | - Jie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100006, China
- Corresponding author
| | - Jia Fan
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Fudan University, Shanghai 200032, China
- Key Laboratory of Medical Epigenetics and Metabolism, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
- Corresponding author
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14
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Peng L, Deng HY, Liu ZK, Shang QW, Huang KL, Zheng QQ, Li W, Wang Y. Wedge Resection vs. Stereotactic Body Radiation Therapy for Clinical Stage I Non-small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Front Surg 2022; 9:850276. [PMID: 35372460 PMCID: PMC8967956 DOI: 10.3389/fsurg.2022.850276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/21/2022] [Indexed: 12/25/2022] Open
Abstract
BackgroundWhether wedge resection or stereotactic body radiation therapy (SBRT) has better effectiveness in treatment of clinical stage I non-small cell lung cancer (NSCLC) patients remains unclear. Here we conducted the first meta-analysis to directly compare the survival outcomes of clinical stage I NSCLCs treated with wedge resection and SBRT.MethodsWe systematically searched studies from PubMed, Embase, and Corchrane Library up to October 1, 2021. Data for analysis mainly included overall survival (OS) and disease-free survival (DFS), which were obtained directly from the text results or calculated from the Kaplan–Meier survival curve. We used the standard random-effect model test (DerSimonian and Laird method) to analyze the pooled hazard ratios (HRs) and 95% confidence intervals (CIs). The Q-test and I2-test were used to assess heterogeneity. The stability of pooled HRs was examined by sensitivity analysis.ResultsSix retrospective studies with a total of 11,813 clinical stage I NSCLCs who received wedge resection or SBRT were included. The results showed that patients receiving wedge resection had a significantly better OS (HR = 1.20, 95% CI = [1.07, 1.34], P = 0.002) than those with SBRT, but no significant difference of DFS (HR 1.53, 95% CI = [0.83–2.83], P = 0.17) was observed. There was no significant heterogeneity during our analysis, but there may be potential publication bias among these studies.ConclusionsOur meta-analysis showed that clinical stage I NSCLCs treated with wedge resection had superior OS than those treated with SBRT. However, more prospective clinical trials should be well-designed to evaluate the optimal treatment modality of early-stage NSCLCs.
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Affiliation(s)
- Lei Peng
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Han-Yu Deng
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Han-Yu Deng
| | - Zhen-Kun Liu
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qian-Wen Shang
- Department of Clinical Lab, Chongqing University Cancer Hospital and Chongqing Cancer Hospital, Chongqing, China
| | - Kai-Li Huang
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qiang-Qiang Zheng
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wen Li
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
- Yun Wang
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15
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Balagurunathan Y, Beers A, McNitt-Gray M, Hadjiiski L, Napel S, Goldgof D, Perez G, Arbelaez P, Mehrtash A, Kapur T, Yang E, Moon JW, Bernardino G, Delgado-Gonzalo R, Farhangi MM, Amini AA, Ni R, Feng X, Bagari A, Vaidhya K, Veasey B, Safta W, Frigui H, Enguehard J, Gholipour A, Castillo LS, Daza LA, Pinsky P, Kalpathy-Cramer J, Farahani K. Lung Nodule Malignancy Prediction in Sequential CT Scans: Summary of ISBI 2018 Challenge. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:3748-3761. [PMID: 34264825 PMCID: PMC9531053 DOI: 10.1109/tmi.2021.3097665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Lung cancer is by far the leading cause of cancer death in the US. Recent studies have demonstrated the effectiveness of screening using low dose CT (LDCT) in reducing lung cancer related mortality. While lung nodules are detected with a high rate of sensitivity, this exam has a low specificity rate and it is still difficult to separate benign and malignant lesions. The ISBI 2018 Lung Nodule Malignancy Prediction Challenge, developed by a team from the Quantitative Imaging Network of the National Cancer Institute, was focused on the prediction of lung nodule malignancy from two sequential LDCT screening exams using automated (non-manual) algorithms. We curated a cohort of 100 subjects who participated in the National Lung Screening Trial and had established pathological diagnoses. Data from 30 subjects were randomly selected for training and the remaining was used for testing. Participants were evaluated based on the area under the receiver operating characteristic curve (AUC) of nodule-wise malignancy scores generated by their algorithms on the test set. The challenge had 17 participants, with 11 teams submitting reports with method description, mandated by the challenge rules. Participants used quantitative methods, resulting in a reporting test AUC ranging from 0.698 to 0.913. The top five contestants used deep learning approaches, reporting an AUC between 0.87 - 0.91. The team's predictor did not achieve significant differences from each other nor from a volume change estimate (p =.05 with Bonferroni-Holm's correction).
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Affiliation(s)
| | | | | | | | - Sandy Napel
- Dept. of Radiology, School of Medicine, Stanford University (SU), CA
| | | | - Gustavo Perez
- Biomedical computer vision lab (BCV), Universidad de los Andes, Colombia
| | - Pablo Arbelaez
- Biomedical computer vision lab (BCV), Universidad de los Andes, Colombia
| | - Alireza Mehrtash
- Robotics and Control Laboratory (RCL), Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC
- Surgical Planning Laboratory (SPL), Radiology Department, Brigham and Women’s Hospital, Boston, MA, 02130
| | - Tina Kapur
- Surgical Planning Laboratory (SPL), Radiology Department, Brigham and Women’s Hospital, Boston, MA, 02130
| | - Ehwa Yang
- Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jung Won Moon
- Human Medical Imaging & Intervention Center, Seoul 06524, Korea
| | - Gabriel Bernardino
- Centre Suisse d’Électronique et de Microtechnique, Neuchâtel, Switzerland
| | | | - M. Mehdi Farhangi
- Medical Imaging Laboratory, University of Louisville, Louisville, KY. USA
- Computer Engineering and Computer Science, University of Louisville
| | - Amir A. Amini
- Medical Imaging Laboratory, University of Louisville, Louisville, KY. USA
- Electrical and Computer Engineering Department, University of Louisville, Louisville, KY. USA
| | | | - Xue Feng
- Spingbok Inc
- Department of Biomedical Engineering, University of Virginia, Charlottesville
| | | | | | - Benjamin Veasey
- Medical Imaging Laboratory, University of Louisville, Louisville, KY. USA
- Electrical and Computer Engineering Department, University of Louisville, Louisville, KY. USA
| | - Wiem Safta
- Computer Engineering and Computer Science, University of Louisville
| | - Hichem Frigui
- Computer Engineering and Computer Science, University of Louisville
| | - Joseph Enguehard
- Department of Radiology, Boston Children’s Hospital, and Harvard Medical School
| | - Ali Gholipour
- Department of Radiology, Boston Children’s Hospital, and Harvard Medical School
| | | | - Laura Alexandra Daza
- Department of Biomedical Engineering, Universidad de los Andes, Bogota, Colombia
| | - Paul Pinsky
- Divsion of Cancer Prevention, National Cancer Institute (NCI), Washington DC
| | | | - Keyvan Farahani
- Center for Biomedical Informatics and Information Technology, National Cancer Institute (NCI), Washington DC
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16
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Samarelli AV, Masciale V, Aramini B, Coló GP, Tonelli R, Marchioni A, Bruzzi G, Gozzi F, Andrisani D, Castaniere I, Manicardi L, Moretti A, Tabbì L, Guaitoli G, Cerri S, Dominici M, Clini E. Molecular Mechanisms and Cellular Contribution from Lung Fibrosis to Lung Cancer Development. Int J Mol Sci 2021; 22:12179. [PMID: 34830058 PMCID: PMC8624248 DOI: 10.3390/ijms222212179] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 12/15/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrosing interstitial lung disease (ILD) of unknown aetiology, with a median survival of 2-4 years from the time of diagnosis. Although IPF has unknown aetiology by definition, there have been identified several risks factors increasing the probability of the onset and progression of the disease in IPF patients such as cigarette smoking and environmental risk factors associated with domestic and occupational exposure. Among them, cigarette smoking together with concomitant emphysema might predispose IPF patients to lung cancer (LC), mostly to non-small cell lung cancer (NSCLC), increasing the risk of lung cancer development. To this purpose, IPF and LC share several cellular and molecular processes driving the progression of both pathologies such as fibroblast transition proliferation and activation, endoplasmic reticulum stress, oxidative stress, and many genetic and epigenetic markers that predispose IPF patients to LC development. Nintedanib, a tyrosine-kinase inhibitor, was firstly developed as an anticancer drug and then recognized as an anti-fibrotic agent based on the common target molecular pathway. In this review our aim is to describe the updated studies on common cellular and molecular mechanisms between IPF and lung cancer, knowledge of which might help to find novel therapeutic targets for this disease combination.
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Affiliation(s)
- Anna Valeria Samarelli
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, 41100 Modena, Italy; (A.V.S.); (V.M.); (B.A.); (R.T.); (A.M.); (G.B.); (F.G.); (D.A.); (I.C.); (L.M.); (A.M.); (S.C.); (M.D.)
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena and Reggio Emilia, University of Modena Reggio Emilia, 41100 Modena, Italy;
| | - Valentina Masciale
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, 41100 Modena, Italy; (A.V.S.); (V.M.); (B.A.); (R.T.); (A.M.); (G.B.); (F.G.); (D.A.); (I.C.); (L.M.); (A.M.); (S.C.); (M.D.)
- Oncology Unit, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, 41100 Modena, Italy;
| | - Beatrice Aramini
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, 41100 Modena, Italy; (A.V.S.); (V.M.); (B.A.); (R.T.); (A.M.); (G.B.); (F.G.); (D.A.); (I.C.); (L.M.); (A.M.); (S.C.); (M.D.)
- Thoracic Surgery Unit, Department of Diagnostic and Specialty Medicine—DIMES of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni—L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121 Forlì, Italy
| | - Georgina Pamela Coló
- Laboratorio de Biología del Cáncer INIBIBB-UNS-CONICET-CCT, Bahía Blanca 8000, Argentina;
| | - Roberto Tonelli
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, 41100 Modena, Italy; (A.V.S.); (V.M.); (B.A.); (R.T.); (A.M.); (G.B.); (F.G.); (D.A.); (I.C.); (L.M.); (A.M.); (S.C.); (M.D.)
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena and Reggio Emilia, University of Modena Reggio Emilia, 41100 Modena, Italy;
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41100 Modena, Italy
| | - Alessandro Marchioni
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, 41100 Modena, Italy; (A.V.S.); (V.M.); (B.A.); (R.T.); (A.M.); (G.B.); (F.G.); (D.A.); (I.C.); (L.M.); (A.M.); (S.C.); (M.D.)
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena and Reggio Emilia, University of Modena Reggio Emilia, 41100 Modena, Italy;
| | - Giulia Bruzzi
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, 41100 Modena, Italy; (A.V.S.); (V.M.); (B.A.); (R.T.); (A.M.); (G.B.); (F.G.); (D.A.); (I.C.); (L.M.); (A.M.); (S.C.); (M.D.)
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena and Reggio Emilia, University of Modena Reggio Emilia, 41100 Modena, Italy;
| | - Filippo Gozzi
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, 41100 Modena, Italy; (A.V.S.); (V.M.); (B.A.); (R.T.); (A.M.); (G.B.); (F.G.); (D.A.); (I.C.); (L.M.); (A.M.); (S.C.); (M.D.)
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena and Reggio Emilia, University of Modena Reggio Emilia, 41100 Modena, Italy;
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41100 Modena, Italy
| | - Dario Andrisani
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, 41100 Modena, Italy; (A.V.S.); (V.M.); (B.A.); (R.T.); (A.M.); (G.B.); (F.G.); (D.A.); (I.C.); (L.M.); (A.M.); (S.C.); (M.D.)
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena and Reggio Emilia, University of Modena Reggio Emilia, 41100 Modena, Italy;
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41100 Modena, Italy
| | - Ivana Castaniere
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, 41100 Modena, Italy; (A.V.S.); (V.M.); (B.A.); (R.T.); (A.M.); (G.B.); (F.G.); (D.A.); (I.C.); (L.M.); (A.M.); (S.C.); (M.D.)
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena and Reggio Emilia, University of Modena Reggio Emilia, 41100 Modena, Italy;
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41100 Modena, Italy
| | - Linda Manicardi
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, 41100 Modena, Italy; (A.V.S.); (V.M.); (B.A.); (R.T.); (A.M.); (G.B.); (F.G.); (D.A.); (I.C.); (L.M.); (A.M.); (S.C.); (M.D.)
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena and Reggio Emilia, University of Modena Reggio Emilia, 41100 Modena, Italy;
| | - Antonio Moretti
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, 41100 Modena, Italy; (A.V.S.); (V.M.); (B.A.); (R.T.); (A.M.); (G.B.); (F.G.); (D.A.); (I.C.); (L.M.); (A.M.); (S.C.); (M.D.)
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena and Reggio Emilia, University of Modena Reggio Emilia, 41100 Modena, Italy;
| | - Luca Tabbì
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena and Reggio Emilia, University of Modena Reggio Emilia, 41100 Modena, Italy;
| | - Giorgia Guaitoli
- Oncology Unit, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, 41100 Modena, Italy;
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41100 Modena, Italy
| | - Stefania Cerri
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, 41100 Modena, Italy; (A.V.S.); (V.M.); (B.A.); (R.T.); (A.M.); (G.B.); (F.G.); (D.A.); (I.C.); (L.M.); (A.M.); (S.C.); (M.D.)
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena and Reggio Emilia, University of Modena Reggio Emilia, 41100 Modena, Italy;
| | - Massimo Dominici
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, 41100 Modena, Italy; (A.V.S.); (V.M.); (B.A.); (R.T.); (A.M.); (G.B.); (F.G.); (D.A.); (I.C.); (L.M.); (A.M.); (S.C.); (M.D.)
- Oncology Unit, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, 41100 Modena, Italy;
| | - Enrico Clini
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, 41100 Modena, Italy; (A.V.S.); (V.M.); (B.A.); (R.T.); (A.M.); (G.B.); (F.G.); (D.A.); (I.C.); (L.M.); (A.M.); (S.C.); (M.D.)
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena and Reggio Emilia, University of Modena Reggio Emilia, 41100 Modena, Italy;
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17
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Patient Identification of Lung Cancer Screening Follow-up Recommendations and the Association with Adherence. Ann Am Thorac Soc 2021; 19:799-806. [PMID: 34727513 DOI: 10.1513/annalsats.202107-887oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Adherence to follow-up lung cancer screening (LCS) in real-world settings is suboptimal. Patient understanding of screening results and anticipated follow-up may be crucial to adherence. OBJECTIVE To determine patient-factors associated with identification of follow-up recommendations as a measure of patient understanding of screening results after LCS , and to determine whether misidentification of follow-up is associated with lower adherence to recommendations. METHODS We performed a prospective study of patients in the University of Washington/Seattle Cancer Care Alliance LCS registry who underwent an initial LCS exam between June 2017- September 2019. We mailed potential participants a survey following initial LCS exam, with additional data abstracted from the electronic health record and LCS registry. Participants were asked to identify the timing and next step for their follow-up, with answers corresponding to Lung-RADS recommendations. We examined associations between incorrect identification of recommended follow-up and patient-level characteristics, self-perceived benefit/harm of LCS, LCS knowledge, Lung-RADS score, and patient-reported method of LCS results communication (letter, telephone or in-person). We used multivariable logistic regression to evaluate associations with incorrect identification of recommendations and assessed incorrect identification of recommendations as a potential mechanism for poor adherence in a separate regression model. RESULTS One-hundred eighty-eight participants completed the survey (response rate 44%); 47% misidentified their follow-up recommendation. Those with lung-RADS scores ≥3 had higher odds of incorrectly identifying follow-up recommendations compared to those with scores <3, as did those with lower educational attainment. However, there was no significant association between incorrect identification of follow-up and ultimate adherence to follow-up. CONCLUSION Understanding of LCS follow-up appears to be poor, especially among those with lower education levels and positive findings. Among survey responders, incorrect identification of follow-up was not associated with poor adherence, suggesting other factors, such as provider interventions, may be driving adherence behavior. These results can inform efforts to target improved patient education regarding follow-up for LCS. Primary sources of funding. American Lung Association and American Thoracic Society.
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18
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Implementing Shared Decision-Making for Lung Cancer Screening across a Veterans Health Administration Hospital Network. Ann Am Thorac Soc 2021; 19:476-483. [PMID: 34678137 DOI: 10.1513/annalsats.202105-620sd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Shared-decision making (SDM) for lung cancer screening (LCS) is recommended by multiple organizations, reflecting a larger movement towards patient-centered care. Yet SDM for LCS does not routinely occur due to barriers at multiple levels. Moreover, how best to implement SDM into routine clinical practice remains unknown. There is a need for a novel approach to overcome multi-level barriers and ensure high-quality SDM for LCS is integrated into routine practice. We present the protocol for our US Department of Veteran Affairs (VA) funded study. Our protocol is designed to implement and evaluate a multi-level, tailored approach to SDM for LCS in routine clinical practice within the VA New England Health Care Network, comprising eight medical centers. In this prospective, pragmatic hybrid implementation-effectiveness study, we will first conduct a formative evaluation of barriers to SDM for LCS at each level of the socioecological model, which will inform our tailored implementation plan. We will then sequentially introduce components of our tailored, multi-level approach to implementing SDM for LCS across VA New England. Finally, using mixed methods, we will evaluate the implementation and its impact on Effectiveness (primary outcome, defined as patient-centeredness of SDM), as well as implementation outcomes informed by the RE-AIM implementation science framework (i.e., Reach to patients, Adoption by providers, Implementation fidelity). Tailored implementation will address identified challenges to achieving policy recommendations for SDM for LCS in VA New England, inform nationwide implementation of SDM for LCS, and address stakeholder interests in promoting more patient-centered interactions across the VA.
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19
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Xia C, Liu M, Li X, Zhang H, Li X, Wu D, Ren D, Hua Y, Dong M, Liu H, Chen J. Prediction Model for Lung Cancer in High-Risk Nodules Being Considered for Resection: Development and Validation in a Chinese Population. Front Oncol 2021; 11:700179. [PMID: 34631529 PMCID: PMC8500307 DOI: 10.3389/fonc.2021.700179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/06/2021] [Indexed: 01/10/2023] Open
Abstract
Background Determining benign and malignant nodules before surgery is very difficult when managing patients with pulmonary nodules, which further makes it difficult to choose an appropriate treatment. This study aimed to develop a lung cancer risk prediction model for predicting the nature of the nodule in patients’ lungs and deciding whether to perform a surgical intervention. Methods This retrospective study included patients with pulmonary nodules who underwent lobectomy or sublobectomy at Tianjin Medical University General Hospital between 2017 and 2020. All subjects were further divided into training and validation sets. Multivariable logistic regression models with backward selection based on the Akaike information criterion were used to identify independent predictors and develop prediction models. Results To build and validate the model, 503 and 260 malignant and benign nodules were used. Covariates predicting lung cancer in the current model included female sex, age, smoking history, nodule type (pure ground-glass and part-solid), nodule diameter, lobulation, margin (smooth, or spiculated), calcification, intranodular vascularity, pleural indentation, and carcinoembryonic antigen. The final model of this study showed excellent discrimination and calibration with a concordance index (C-index) of 0.914 (0.890–0.939). In an independent sample used for validation, the C-index for the current model was 0.876 (0.825–0.927) compared with 0.644 (0.559–0.728) and 0.681 (0.605–0.757) for the Mayo and Brock models. The decision curve analysis showed that the current model had higher discriminatory power for malignancy than the Mayo and the Brock models. Conclusions The current model can be used in estimating the probability of lung cancer in nodules requiring surgical intervention. It may reduce unnecessary procedures for benign nodules and prompt diagnosis and treatment of malignant nodules.
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Affiliation(s)
- Chunqiu Xia
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Minghui Liu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Li
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongbing Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Xuanguang Li
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Di Wu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Dian Ren
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu Hua
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Dong
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongyu Liu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China.,Department of Thoracic Surgery, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
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20
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Zhang Y, Shen JQ, Shao L, Chen Y, Lei L, Wang JL. Non-small-cell lung cancer with epidermal growth factor receptor L861Q-L833F compound mutation benefits from both afatinib and osimertinib: A case report. World J Clin Cases 2021; 9:8220-8225. [PMID: 34621884 PMCID: PMC8462190 DOI: 10.12998/wjcc.v9.i27.8220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/17/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have been adopted as the standard of care for non-small cell lung cancer (NSCLC) patients harboring EGFR sensitizing mutations. Besides the two common mutations exon 19 deletion and L858R, which together comprise approximately 85% of EGFR mutations in NSCLC, rare EGFR mutations also exist, including point mutations, deletions, and insertions spanning EGFR exons 18-25. However, the responsiveness of uncommon EGFR mutations to EGFR TKIs remains elusive and attracts increasing interest. CASE SUMMARY Herein, we report a 55-year-old male patient with stage IV NSCLC harboring a rare EGFR L833F-L861Q compound mutation in cis. The patient achieved a partial response to first-line treatment with afatinib and a progression-free survival of 10 mo. After afatinib failure, the patient received multiple line treatments with chemotherapy. Upon disease progression, the heavily pretreated patient was treated with osimertinib and bevacizumab, and both lung lesion and brain metastases were stable for more than 3 mo. He had an overall survival of 25 mo. CONCLUSION Our case revealed that both afatinib and the osimertinib + bevacizumab combination demonstrated clinical efficacy in NSCLC harboring an EGFR L833F-L861Q compound mutation. The results provide more therapeutic options for patients with rare compound mutations.
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Affiliation(s)
- Yao Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Institute of Thoracic Oncology, Fudan University, Shanghai 200032, China
| | - Ji-Qiao Shen
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Institute of Thoracic Oncology, Fudan University, Shanghai 200032, China
| | - Lin Shao
- Burning Rock Biotech, Guangzhou 510300, Guangdong Province, China
| | - Yan Chen
- Burning Rock Biotech, Guangzhou 510300, Guangdong Province, China
| | - Lei Lei
- Burning Rock Biotech, Guangzhou 510300, Guangdong Province, China
| | - Jia-Lei Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Institute of Thoracic Oncology, Fudan University, Shanghai 200032, China
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21
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Al-Shamsi HO, Jaffar H, Mahboub B, Khan F, Albastaki U, Hammad S, Zaabi AA. Early Diagnosis of Lung Cancer in the United Arab Emirates: Challenges and Strategic Recommendations. Clin Pract 2021; 11:671-678. [PMID: 34563011 PMCID: PMC8482116 DOI: 10.3390/clinpract11030082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 12/25/2022] Open
Abstract
In the United Arab Emirates (UAE), lung cancer (LC) was the third leading cause of deaths due to cancer in 2017. Around 80% of the patients in the UAE are diagnosed at a late stage, rendering the treatment less effective in improving survival outcomes. Lack of awareness of disease symptomatology, deficient screening initiatives, misdiagnosis, and delayed referral to the specialist are contributing factors for delayed diagnosis. Effective screening at a primary care setting can be crucial for early diagnosis, referral to specialists, and enhancing patient outcomes. It is important to establish screening and referral guidelines through which each suspected case can be identified and provided timely intervention. Although the international screening and referral pathway framework are comprehensive, several regional barriers need to be addressed before they can be adapted at the national level. A group of LC experts from the UAE deliberated on issues like delayed diagnosis of LC and strategic recommendations for overcoming the challenges. The discussion was based on the review of the published evidence, international and regional guidelines for screening and early diagnosis of LC. Herein, we present a guideline, endorsed by the esteemed panel of experts, for aiding early diagnosis and optimizing the management of LC in the UAE.
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Affiliation(s)
- Humaid O. Al-Shamsi
- Department of Oncology, Burjeel Cancer Institute, Burjeel Medical City, Abu Dhabi 111499, United Arab Emirates
- Innovation and Research Center, Burjeel Cancer Institute, Burjeel Medical City, Abu Dhabi 111499, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah 999041, United Arab Emirates
- Emirates Oncology Society, Dubai 22107, United Arab Emirates
| | - Hassan Jaffar
- Sheikh Khalifa Specialty Hospital, Ras Alkhaima 999041, United Arab Emirates;
| | - Bassam Mahboub
- Rashid Hospital, Dubai 111499, United Arab Emirates; (B.M.); (U.A.)
| | - Faraz Khan
- American Hospital, Dubai 111499, United Arab Emirates;
| | - Usama Albastaki
- Rashid Hospital, Dubai 111499, United Arab Emirates; (B.M.); (U.A.)
| | - Sayed Hammad
- Dubai Hospital, Dubai 111499, United Arab Emirates;
| | - Ashraf Al Zaabi
- Zayed Military Hospital, Abu Dhabi 111499, United Arab Emirates;
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22
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Schenk EL, Patil T, Pacheco J, Bunn PA. 2020 Innovation-Based Optimism for Lung Cancer Outcomes. Oncologist 2021; 26:e454-e472. [PMID: 33179378 PMCID: PMC7930417 DOI: 10.1002/onco.13590] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/05/2020] [Indexed: 12/13/2022] Open
Abstract
Lung cancer is the leading cause of cancer death in both males and females in the U.S. and worldwide. Owing to advances in prevention, screening/early detection, and therapy, lung cancer mortality rates are decreasing and survival rates are increasing. These innovations are based on scientific discoveries in imaging, diagnostics, genomics, molecular therapy, and immunotherapy. Outcomes have improved in all histologies and stages. This review provides information on the clinical implications of these innovations that are practical for the practicing physicians, especially oncologists of all specialities who diagnose and treat patients with lung cancer. IMPLICATIONS FOR PRACTICE: Lung cancer survival rates have improved because of new prevention, screening, and therapy methods. This work provides a review of current standards for each of these areas, including targeted and immunotherapies. Treatment recommendations are provided for all stages of lung cancer.
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Affiliation(s)
- Erin L. Schenk
- Division of Medical Oncology, University of Colorado Cancer CenterAuroraColoradoUSA
| | - Tejas Patil
- Division of Medical Oncology, University of Colorado Cancer CenterAuroraColoradoUSA
| | - Jose Pacheco
- Division of Medical Oncology, University of Colorado Cancer CenterAuroraColoradoUSA
| | - Paul A. Bunn
- Division of Medical Oncology, University of Colorado Cancer CenterAuroraColoradoUSA
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23
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Dyer DS, Zelarney PT, Carr LL, Kern EO. Improvement in Follow-up Imaging With a Patient Tracking System and Computerized Registry for Lung Nodule Management. J Am Coll Radiol 2021; 18:937-946. [PMID: 33607066 DOI: 10.1016/j.jacr.2021.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Despite established guidelines, radiologists' recommendations and timely follow-up of incidental lung nodules remain variable. To improve follow-up of nodules, a system using standardized language (tracker phrases) recommending time-based follow-up in chest CT reports, coupled with a computerized registry, was created. MATERIALS AND METHODS Data were obtained from the electronic health record and a facility-built electronic lung nodule registry. We evaluated two randomly selected patient cohorts with incidental nodules on chest CT reports: before intervention (September 2008 to March 2011) and after intervention (August 2011 to December 2016). Multivariable logistic regression was used to compare the cohorts for the main outcome of timely follow-up, defined as a subsequent report within 13 months of the initial report. RESULTS In all, 410 patients were included in the pretracker cohort versus 626 in the tracker cohort. Before system inception, 30% of CT reports lacked an explicit time-based recommendation for nodule follow-up. The proportion of patients with timely follow-up increased from 46% to 55%, and the proportion of those with no documented follow-up or follow-up beyond 24 months decreased from 48% to 31%. The likelihood of timely follow-up increased 41%, adjusted for high risk for lung cancer and age 65 years or older. After system inception, reports missing a tracker phrase for nodule recommendation averaged 6%, without significant interyear variation. CONCLUSIONS Standardized language added to CT reports combined with a computerized registry designed to identify and track patients with incidental lung nodules was associated with improved likelihood of follow-up imaging.
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Affiliation(s)
- Debra S Dyer
- Chair, Department of Radiology, National Jewish Health, Denver, Colorado.
| | | | - Laurie L Carr
- Past President, Medical Executive Committee; Division of Oncology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Elizabeth O Kern
- Chief, Division of Medical, Behavioral and Community Health, Department of Medicine; Past Chair, Institutional Review Board; Chair, Ethics Resource Committee, National Jewish Health, Denver, Colorado
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24
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Nishi SPE, Lowenstein LM, Mendoza TR, Lopez Olivo MA, Crocker LC, Sepucha K, Niu J, Volk RJ. Shared Decision-Making for Lung Cancer Screening: How Well Are We "Sharing"? Chest 2021; 160:330-340. [PMID: 33556362 DOI: 10.1016/j.chest.2021.01.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Lung cancer screening (LCS) reduces lung cancer mortality, but it also carries a range of risks. Shared decision-making (SDM) is a process of engaging patients in their health care decisions and is a vital component of LCS. RESEARCH QUESTION What is the quality of SDM among patients recently assessed for LCS? STUDY DESIGN AND METHODS Cross-sectional study of screened patients recruited from two academic tertiary care centers in the South Central Region of the United States. Self-reported surveys assessed patient demographics, values related to outcomes of LCS, knowledge, SDM components including receipt of educational materials, and decisional conflict. RESULTS Recently screened patients (n = 266) possessed varied LCS knowledge, answering an average of 41.4% of questions correctly. Patients valued finding cancer early over concerns about harms. Patients indicated that LCS benefits were presented to them by a health care provider far more often than harms (68.3% vs 20.8%, respectively), and 30.7% reported they received educational materials about LCS during the screening process. One-third of patients had some decisional conflict (33.6%) related to their screening decisions, whereas most patients (86.6%) noted that they were involved in the screening decision as much as they wanted. In multivariate models, non-White race and having less education were related to lower knowledge scores. Non-White patients and former smokers were more likely to be conflicted about the screening decision. Most patients (n = 227 [85.3%]) indicated that a health care provider had discussed smoking cessation or abstinence with them. INTERPRETATION Among recently screened patients, the quality of decision-making about LCS is highly variable. The low use of educational materials including decision aids and imbalance of conveying benefit vs risk information to patients is concerning. A structured approach using decision aids may assist with providing a balanced presentation of information and may improve the quality of SDM.
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Affiliation(s)
- Shawn P E Nishi
- Department of Internal Medicine, Division of Pulmonary Critical Care and Sleep Medicine, The University of Texas Medical Branch, Galveston, TX.
| | - Lisa M Lowenstein
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tito R Mendoza
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Maria A Lopez Olivo
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Laura C Crocker
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jiangong Niu
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert J Volk
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX
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25
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Huang J, Yue N, Wu J, Shi N, Wang Q, Cui T, Zheng M, Sun S, Jin H. Screening rate and influential factors of lung cancer with low-dose computed tomography in Asian population: a systematic review and meta-analysis. J Public Health (Oxf) 2020; 44:246-254. [PMID: 33348356 DOI: 10.1093/pubmed/fdaa225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/02/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There are currently no studies synthesizing the screening rate and influential factors of low-dose computed tomography (LDCT)-screened lung cancer in Asian population. METHODS A systematic review was conducted, using both English and Chinese language databases on March, 2019. The pooled screening rate and estimated odds ratios (ORs) of influential factors were analyzed using random effects models. Subgroup and meta-regression analyses were also employed to explore the heterogeneity. RESULTS The pooled LDCT lung cancer screening rate was 1.12% (95% confidence interval (CI): 0.94%, 1.32%), and increased with age. Adenocarcinoma and stage I lung cancer had higher screening rates. Analysis of influential factors in the general population showed that female and elder age (≥50 years) were significantly influencing LDCT lung cancer screening rate (for female, OR = 1.32, 95% CI: 1.15-1.52; for adults ≥ 50 years, OR = 1.94, 95% CI: 1.52-2.49). Meta-regression analysis indicated that the heterogeneity maybe significantly correlated with the sample size, risk population and source of population. CONCLUSIONS Unlike European and American populations, female and adults > 50 years rather than smoking adults were positively associated with screening rate in Asian populations. It is important to further study the benefits of lung cancer screening with LDCT in Asian populations.
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Affiliation(s)
- Jinxin Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Na Yue
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Jingwei Wu
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA 19122, USA
| | - Naiyang Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Qiang Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Tingting Cui
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Mengyun Zheng
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Siqing Sun
- Zhongda Hospital Southeast University, Nanjing 210009, China
| | - Hui Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
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26
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Cao C, Yu X, Zhu T, Jiang Q, Li Y, Li X. Diagnostic role of liquid-based cytology of bronchial lavage fluid in addition to bronchial brushing specimens in lung cancer. TUMORI JOURNAL 2020; 107:325-328. [PMID: 32972322 DOI: 10.1177/0300891620960218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Liquid-based cytology (LBC) tests, including the liquid-based thin layer method, have demonstrated the highest potential for reducing false-negatives and improving sample quality. METHOD This study aimed to evaluate the diagnostic role of LBC of bronchial brushing specimens in lung cancer. A total of 249 patients were analyzed in our study, involving 155 patients with combined bronchial brushing and bronchoalveolar lavage (BAL) and 94 patients with BAL alone. RESULTS The sensitivity in the combined bronchial brushing and BAL group was 61.4% in the diagnosis of lung cancer, which is much higher than with BAL alone. Rates of positive predictive values and negative predictive values in the combined group compared with the BALF alone group were 98.6% vs 100% and 47.6% vs 37.4%, respectively. Sensitivity in the BALF alone group was 12.5% in bronchoscopically invisible pulmonary lesions and as high as 52.1% in the combined group. CONCLUSION The results from our study demonstrated that LBC of brushing samples could be used as an important complement of bronchoscopy and could have the potential to be widely applied.
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Affiliation(s)
- Chao Cao
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, China
| | - Xuechan Yu
- Medical School of Ningbo University, Ningbo, China
| | - Tingting Zhu
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, China
| | - Qingwen Jiang
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, China.,Medical School of Ningbo University, Ningbo, China
| | - Yiting Li
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, China.,Medical School of Ningbo University, Ningbo, China
| | - Xinjian Li
- Department of Thoracic Surgery, Ningbo First Hospital, Ningbo, China
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Patient vs Clinician Perspectives on Communication About Results of Lung Cancer Screening: A Qualitative Study. Chest 2020; 158:1240-1249. [PMID: 32387521 PMCID: PMC7478230 DOI: 10.1016/j.chest.2020.03.081] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/13/2020] [Accepted: 03/24/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In the incidental pulmonary nodule and breast cancer screening settings, high-quality patient-centered communication can improve adherence to evaluation and mitigate patient distress. Although guidelines emphasize shared decision-making before lung cancer screening, little is known about patient-clinician communication after lung cancer screening. RESEARCH QUESTION How do patients and clinicians perceive communication and results notification after lung cancer screening, and are there approaches that may mitigate or exacerbate distress? STUDY DESIGN AND METHODS We conducted interviews and focus groups with 49 patients who underwent lung cancer screening in the prior year and 36 clinicians who communicate screening results (primary care providers, pulmonologists, nurses), recruited from lung cancer screening programs at 4 hospitals. We analyzed transcripts using conventional content analysis. RESULTS Clinicians and patients diverged in their impressions of the quality of communication after lung cancer screening. Clinicians recognized the potential for patient distress and tailored their approach to disclosure based on how clinically concerning they perceived results to be. Disclosure of normal or low-risk findings usually occurred by letter; clinicians believed this process was efficient and well received by patients. Yet many patients were dissatisfied: several could not recall receiving results at all, and others reported that receiving results by letter left them confused and concerned, with little opportunity to ask questions. By contrast, patients with larger nodules typically received results during an immediate phone call or clinic visit, and both patients and clinicians agreed that these conversations represented high-quality communication that met patient needs. Regardless of their cancer risk, patients who learned their results in a conversation appreciated the opportunity to discuss both the meaning of the nodule and the evaluation plan, and to have their concerns addressed, preempting distress. INTERPRETATION Tension exists between clinicians' interest in efficiency of results notification by letter in low-risk cases and patients' need to understand and be reassured about screening results, their implications, and the plan for subsequent screening or nodule evaluation-even when clinicians did not perceive results as concerning. Brief conversations to discuss lung cancer screening results may improve patient understanding and satisfaction while reducing distress.
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Paul R, Schabath M, Gillies R, Hall L, Goldgof D. Convolutional Neural Network ensembles for accurate lung nodule malignancy prediction 2 years in the future. Comput Biol Med 2020; 122:103882. [PMID: 32658721 DOI: 10.1016/j.compbiomed.2020.103882] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 01/03/2023]
Abstract
Convolutional Neural Networks (CNNs) have been utilized for to distinguish between benign lung nodules and those that will become malignant. The objective of this study was to use an ensemble of CNNs to predict which baseline nodules would be diagnosed as lung cancer in a second follow up screening after more than one year. Low-dose helical computed tomography images and data were utilized from the National Lung Screening Trial (NLST). The malignant nodules and nodule positive controls were divided into training and test cohorts. T0 nodules were used to predict lung cancer incidence at T1 or T2. To increase the sample size, image augmentation was performed using rotations, flipping, and elastic deformation. Three CNN architectures were designed for malignancy prediction, and each architecture was trained using seven different seeds to create the initial weights. This enabled variability in the CNN models which were combined to generate a robust, more accurate ensemble model. Augmenting images using only rotation and flipping and training with images from T0 yielded the best accuracy to predict lung cancer incidence at T2 from a separate test cohort (Accuracy = 90.29%; AUC = 0.96) based on an ensemble 21 models. Images augmented by rotation and flipping enabled effective learning by increasing the relatively small sample size. Ensemble learning with deep neural networks is a compelling approach that accurately predicted lung cancer incidence at the second screening after the baseline screen mostly 2 years later.
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Affiliation(s)
- Rahul Paul
- Department of Computer Science & Engineering, University of South Florida, Tampa, FL, USA.
| | - Matthew Schabath
- Department of Cancer Epidemiology, H. L. Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Robert Gillies
- Department of Cancer Imaging and Metabolism, H. L. Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Lawrence Hall
- Department of Computer Science & Engineering, University of South Florida, Tampa, FL, USA
| | - Dmitry Goldgof
- Department of Computer Science & Engineering, University of South Florida, Tampa, FL, USA
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Duan S, Cao H, Liu H, Miao L, Wang J, Zhou X, Wang W, Hu P, Qu L, Wu Y. Development of a machine learning-based multimode diagnosis system for lung cancer. Aging (Albany NY) 2020; 12:9840-9854. [PMID: 32445550 PMCID: PMC7288961 DOI: 10.18632/aging.103249] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
As an emerging technology, artificial intelligence has been applied to identify various physical disorders. Here, we developed a three-layer diagnosis system for lung cancer, in which three machine learning approaches including decision tree C5.0, artificial neural network (ANN) and support vector machine (SVM) were involved. The area under the curve (AUC) was employed to evaluate their decision powers. In the first layer, the AUCs of C5.0, ANN and SVM were 0.676, 0.736 and 0.640, ANN was better than C5.0 and SVM. In the second layer, ANN was similar with SVM but superior to C5.0 supported by the AUCs of 0.804, 0.889 and 0.825. Much higher AUCs of 0.908, 0.910 and 0.849 were identified in the third layer, where the highest sensitivity of 94.12% was found in C5.0. These data proposed a three-layer diagnosis system for lung cancer: ANN was used as a broad-spectrum screening subsystem basing on 14 epidemiological data and clinical symptoms, which was firstly adopted to screen high-risk groups; then, combining with additional 5 tumor biomarkers, ANN was used as an auxiliary diagnosis subsystem to determine the suspected lung cancer patients; C5.0 was finally employed to confirm lung cancer patients basing on 22 CT nodule-based radiomic features.
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Affiliation(s)
- Shuyin Duan
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Huimin Cao
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Hong Liu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
| | - Lijun Miao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
| | - Jing Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
| | - Xiaolei Zhou
- Henan Provincial Chest Hospital, Zhengzhou 450001, China
| | - Wei Wang
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Pingzhao Hu
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E 3N4, Canada
| | - Lingbo Qu
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China.,Henan Joint International Research Laboratory of Green Construction of Functional Molecules and Their Bioanalytical Applications, Zhengzhou 450001, China
| | - Yongjun Wu
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China.,The Key Laboratory of Nanomedicine and Health Inspection of Zhengzhou, Zhengzhou 450001, China
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Lung Cancer Incidence and Mortality with Extended Follow-up during Screening. J Thorac Oncol 2020; 14:1692-1694. [PMID: 31558228 DOI: 10.1016/j.jtho.2019.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 10/25/2022]
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Paul R, Schabath MB, Gillies R, Hall LO, Goldgof DB. Hybrid models for lung nodule malignancy prediction utilizing convolutional neural network ensembles and clinical data. J Med Imaging (Bellingham) 2020; 7:024502. [PMID: 32280729 PMCID: PMC7134617 DOI: 10.1117/1.jmi.7.2.024502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/09/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose: Due to the high incidence and mortality rates of lung cancer worldwide, early detection of a precancerous lesion is essential. Low-dose computed tomography is a commonly used technique for screening, diagnosis, and prognosis of non-small-cell lung cancer. Recently, convolutional neural networks (CNN) had shown great potential in lung nodule classification. Clinical information (family history, gender, and smoking history) together with nodule size provide information about lung cancer risk. Large nodules have greater risk than small nodules. Approach: A subset of cases from the National Lung Screening Trial was chosen as a dataset in our study. We divided the nodules into large and small nodules based on different clinical guideline thresholds and then analyzed the groups individually. Similarly, we also analyzed clinical features by dividing them into groups. CNNs were designed and trained over each of these groups individually. To our knowledge, this is the first study to incorporate nodule size and clinical features for classification using CNN. We further made a hybrid model using an ensemble with the CNN models of clinical and size information to enhance malignancy prediction. Results: From our study, we obtained 0.9 AUC and 83.12% accuracy, which was a significant improvement over our previous best results. Conclusions: In conclusion, we found that dividing the nodules by size and clinical information for building predictive models resulted in improved malignancy predictions. Our analysis also showed that appropriately integrating clinical information and size groups could further improve risk prediction.
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Affiliation(s)
- Rahul Paul
- University of South Florida, Department of Computer Science and Engineering, Tampa, Florida, United States
| | - Matthew B. Schabath
- H. L. Moffitt Cancer Center and Research Institute, Department of Cancer Epidemiology, Tampa, Florida, United States
| | - Robert Gillies
- H. L. Moffitt Cancer Center and Research Institute, Department of Cancer Physiology, Tampa, Florida, United States
| | - Lawrence O. Hall
- University of South Florida, Department of Computer Science and Engineering, Tampa, Florida, United States
| | - Dmitry B. Goldgof
- University of South Florida, Department of Computer Science and Engineering, Tampa, Florida, United States
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González Maldonado S, Delorme S, Hüsing A, Motsch E, Kauczor HU, Heussel CP, Kaaks R. Evaluation of Prediction Models for Identifying Malignancy in Pulmonary Nodules Detected via Low-Dose Computed Tomography. JAMA Netw Open 2020; 3:e1921221. [PMID: 32058555 DOI: 10.1001/jamanetworkopen.2019.21221] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Malignancy prediction models based on participant-related characteristics and imaging parameters from low-dose computed tomography (CT) may improve decision-making regarding nodule management and diagnosis in lung cancer screening. OBJECTIVE To externally validate 5 malignancy prediction models that were developed in screening settings, compared with 3 models that were developed in clinical settings, in terms of discrimination and absolute risk calibration among participants in the German Lung Cancer Screening Intervention trial. DESIGN, SETTING, AND PARTICIPANTS In this population-based diagnostic study, malignancy probabilities were estimated by applying 8 prediction models to data from 1159 participants in the intervention arm of the Lung Cancer Screening Intervention trial, a randomized clinical trial conducted from October 23, 2007, to April 30, 2016, with ongoing follow-up. This analysis considers end points up to 1 year after individuals' last screening visit. Inclusion criteria for participants were at least 1 noncalcified pulmonary nodule detected on any of 5 annual screening visits, receiving a lung cancer diagnosis within the active screening phase of the Lung Cancer Screening Intervention trial, and an unequivocal identification of the malignant nodules. Data analysis was performed from February 1, 2019, through December 5, 2019. INTERVENTIONS Five annual rounds of low-dose multislice CT. MAIN OUTCOMES AND MEASURES Discrimination ability and calibration of malignancy probabilities estimated by 5 models developed in data from screening studies (4 Pan-Canadian Early Detection of Lung Cancer Study [PanCan] models using a parsimonious approach including nodule spiculation [PanCan-1b] or a comprehensive approach including nodule spiculation [PanCan-2b], and PanCan-2b replacing the nodule diameter variable with mean diameter [PanCan-MD] or volume [PanCan-VOL], as well as a model developed by the UK Lung Cancer Screening trial) and 3 models developed in clinical settings (US Department of Veterans Affairs, Mayo Clinic, and Peking University People's Hospital). RESULTS A total of 1159 participants (median [range] age, 57.63 [50.34-71.89] years; 763 [65.8%] men) with 3903 pulmonary nodules were included in this study. For nodules detected in the prevalence round of CT, the PanCan models showed excellent discrimination (PanCan-1b: area under the curve [AUC], 0.93 [95% CI, 0.87-0.99]; PanCan-2b: AUC, 0.94 [95% CI, 0.89-0.99]; PanCan-MD: AUC, 0.94 [95% CI, 0.91-0.98]; PanCan-VOL: AUC, 0.94 [95% CI, 0.90-0.98]), and all of the screening models except PanCan-MD and PanCan-VOL showed acceptable calibration (PanCan-1b: Spiegelhalter z = -1.081; P = .28; PanCan-2b: Spiegelhalter z = 0.436; P = .67; PanCan-MD: Spiegelhalter z = 3.888; P < .001; PanCan-VOL: Spiegelhalter z = 1.978; P = .05; UK Lung Cancer Screening trial: Spiegelhalter z = -1.076; P = .28), whereas the other models showed worse discrimination and calibration, from an AUC of 0.58 (95% CI, 0.46-0.70) for the UK Lung Cancer Screening trial model to an AUC of 0.89 (95% CI, 0.82-0.97) for the Mayo Clinic model. CONCLUSIONS AND RELEVANCE This diagnostic study found that PanCan models showed excellent discrimination and calibration in prevalence screenings, confirming their ability to improve nodule management in screening settings, although calibration to nodules detected in follow-up scans should be improved. The models developed by the Mayo Clinic, Peking University People's Hospital, Department of Veterans Affairs, and UK Lung Cancer Screening Trial did not perform as well.
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Affiliation(s)
- Sandra González Maldonado
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Stefan Delorme
- Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Anika Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Erna Motsch
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Claus-Peter Heussel
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik-Heidelberg GmbH, Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
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Volk RJ, Lowenstein LM, Leal VB, Escoto KH, Cantor SB, Munden RF, Rabius VA, Bailey L, Cinciripini PM, Lin H, Housten AJ, Luckett PG, Esparza A, Godoy MC, Bevers TB. Effect of a Patient Decision Aid on Lung Cancer Screening Decision-Making by Persons Who Smoke: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e1920362. [PMID: 32003822 PMCID: PMC7042872 DOI: 10.1001/jamanetworkopen.2019.20362] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Lung cancer screening with low-dose computed tomography lowers lung cancer mortality but has potential harms. Current guidelines support patients receiving information about the benefits and harms of lung cancer screening during decision-making. OBJECTIVE To examine the effect of a patient decision aid (PDA) about lung cancer screening compared with a standard educational material (EDU) on decision-making outcomes among smokers. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted using 13 state tobacco quitlines. Current and recent tobacco quitline clients who met age and smoking history eligibility for lung cancer screening were enrolled from March 30, 2015, to September 12, 2016, and followed up for 6 months until May 5, 2017. Data analysis was conducted between May 5, 2017, and September 30, 2018. INTERVENTIONS Participants were randomized to the PDA video Lung Cancer Screening: Is It Right for Me? (n = 259) or to EDU (n = 257). MAIN OUTCOMES AND MEASURES The primary outcomes were preparation for decision-making and decisional conflict measured at 1 week. Secondary outcomes included knowledge, intentions, and completion of screening within 6 months of receiving the intervention measured by patient report. RESULTS Of 516 quit line clients enrolled, 370 (71.7%) were younger than 65 years, 320 (62.0%) were female, 138 (26.7%) identified as black, 47 (9.1%) did not have health insurance, and 226 (43.8%) had a high school or lower educational level. Of participants using the PDA, 153 of 227 (67.4%) were well prepared to make a screening decision compared with 108 of 224 participants (48.2%) using EDU (odds ratio [OR], 2.31; 95% CI, 1.56-3.44; P < .001). Feeling informed about their screening choice was reported by 117 of 234 participants (50.0%) using a PDA compared with 66 of 233 participants (28.3%) using EDU (OR, 2.56; 95% CI, 1.72-3.79; P < .001); 159 of 234 participants (68.0%) using a PDA compared with 110 of 232 (47.4%) participants using EDU reported being clear about their values related to the harms and benefits of screening (OR, 2.37; 95% CI, 1.60-3.51; P < .001). Participants using a PDA were more knowledgeable about lung cancer screening than participants using EDU at each follow-up assessment. Intentions to be screened and screening behaviors did not differ between groups. CONCLUSIONS AND RELEVANCE In this study, a PDA delivered to clients of tobacco quit lines improved informed decision-making about lung cancer screening. Many smokers eligible for lung cancer screening can be reached through tobacco quit lines. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02286713.
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Affiliation(s)
- Robert J. Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Lisa M. Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Viola B. Leal
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Kamisha H. Escoto
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Scott B. Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Reginald F. Munden
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Vance A. Rabius
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston
| | - Linda Bailey
- North American Quitline Consortium, Phoenix, Arizona
| | - Paul M. Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston
| | - Heather Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Ashley J. Housten
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | | | - Angelina Esparza
- Houston Department for Health and Human Services, Houston, Texas
| | - Myrna C. Godoy
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston
| | - Therese B. Bevers
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston
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Ye DM, Xu G, Ma W, Li Y, Luo W, Xiao Y, Liu Y, Zhang Z. Significant function and research progress of biomarkers in gastric cancer. Oncol Lett 2020; 19:17-29. [PMID: 31897111 PMCID: PMC6924079 DOI: 10.3892/ol.2019.11078] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/26/2019] [Indexed: 12/24/2022] Open
Abstract
Gastric cancer is one of the most common gastrointestinal tumor types, and the incidence and mortality rates are higher in men compared with women. Various studies have revealed that gastric cancer is a spectrum of tumor types, which have biological and genetic diversity. It has proven to be difficult to improve the overall survival and disease-free survival of patients with gastric cancer through the use of traditional surgery and chemoradiation, as gastric cancer is usually identified at an advanced stage. In consequence, the outcome is frequently poor. Thus, novel biomarkers and anticancer targets are required to improve the outcome. As the identification of biomarkers has increased due to advances in research and the greater availability of bioinformatics and functional genomics, the potential therapeutic regimens available have also increased concurrently. These advances have also improved the ability to predict responses to chemotherapy, targeted therapy and immunotherapy, whilst other biomarkers predict post-treatment survival and recurrence based on their expression. This review focuses closely on the important functions of biomarkers in the timely diagnosis and treatment of gastric cancer, in addition to the advances in the study of certain novel markers in gastric cancer.
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Affiliation(s)
- Dong Mei Ye
- Key Laboratory of Cancer Cellular and Molecular Pathology, Cancer Research Institute of Hengyang Medical College, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Gaosheng Xu
- Department of Surgery, Yueyang Maternal and Child Health Hospital, Yueyang, Hunan 414000, P.R. China
| | - Wei Ma
- Department of Surgery, Yueyang Maternal and Child Health Hospital, Yueyang, Hunan 414000, P.R. China
| | - Yuxuan Li
- Key Laboratory of Cancer Cellular and Molecular Pathology, Cancer Research Institute of Hengyang Medical College, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Weiru Luo
- Hengyang Medical College, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Yiyang Xiao
- Hengyang Medical College, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Yong Liu
- Department of Pathology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Zhiwei Zhang
- Key Laboratory of Cancer Cellular and Molecular Pathology, Cancer Research Institute of Hengyang Medical College, University of South China, Hengyang, Hunan 421001, P.R. China
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Wood DE, Kazerooni EA, Baum SL, Eapen GA, Ettinger DS, Hou L, Jackman DM, Klippenstein D, Kumar R, Lackner RP, Leard LE, Lennes IT, Leung ANC, Makani SS, Massion PP, Mazzone P, Merritt RE, Meyers BF, Midthun DE, Pipavath S, Pratt C, Reddy C, Reid ME, Rotter AJ, Sachs PB, Schabath MB, Schiebler ML, Tong BC, Travis WD, Wei B, Yang SC, Gregory KM, Hughes M. Lung Cancer Screening, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 16:412-441. [PMID: 29632061 DOI: 10.6004/jnccn.2018.0020] [Citation(s) in RCA: 383] [Impact Index Per Article: 76.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. Early detection of lung cancer is an important opportunity for decreasing mortality. Data support using low-dose computed tomography (LDCT) of the chest to screen select patients who are at high risk for lung cancer. Lung screening is covered under the Affordable Care Act for individuals with high-risk factors. The Centers for Medicare & Medicaid Services (CMS) covers annual screening LDCT for appropriate Medicare beneficiaries at high risk for lung cancer if they also receive counseling and participate in shared decision-making before screening. The complete version of the NCCN Guidelines for Lung Cancer Screening provides recommendations for initial and subsequent LDCT screening and provides more detail about LDCT screening. This manuscript focuses on identifying patients at high risk for lung cancer who are candidates for LDCT of the chest and on evaluating initial screening findings.
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Yoo H, Jeong BH, Chung MJ, Lee KS, Kwon OJ, Chung MP. Risk factors and clinical characteristics of lung cancer in idiopathic pulmonary fibrosis: a retrospective cohort study. BMC Pulm Med 2019; 19:149. [PMID: 31412851 PMCID: PMC6693185 DOI: 10.1186/s12890-019-0905-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/25/2019] [Indexed: 12/31/2022] Open
Abstract
Background Lung cancer is a common comorbidity of idiopathic pulmonary fibrosis (IPF) and has poor outcomes. The incidence and clinical factors related to development of lung cancer in idiopathic pulmonary fibrosis (IPF) are unclear. The aim of this study was to elucidate the cumulative incidence, risk factors, and clinical characteristics of lung cancer in IPF. Methods In this retrospective study, we analyzed clinical data for 938 patients who were diagnosed with IPF without lung cancer between 1998 and 2013. Demographic, physiologic, radiographic, and histologic characteristics were reviewed. Cumulative incidence of lung cancer and survival were estimated by the Kaplan-Meier method. Risk factors of lung cancer development were determined by Cox proportional hazard analysis. Results Among 938 IPF patients without lung cancer at initial diagnosis, lung cancer developed in 135 (14.5%) during the follow-up period. The cumulative incidences of lung cancer were 1.1% at 1 year, 8.7% at 3, 15.9% at 5, and 31.1% at 10 years. Risk factors of lung cancer were male gender, current smoking at IPF diagnosis, and rapid annual decline of 10% or more in forced vital capacity (FVC). Patients who developed lung cancer were mostly elderly men with smoking history. Squamous cell carcinoma followed by adenocarcinoma was the most common histologic type. Lung cancer was frequently located in areas abutting or within fibrosis. Survival was significantly worse in patients with lung cancer compared to patients with IPF alone. Conclusion Lung cancer frequently developed in patients with IPF and was common in current-smoking men with rapid decline of FVC. Electronic supplementary material The online version of this article (10.1186/s12890-019-0905-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hongseok Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnamgu, Seoul, Republic of Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnamgu, Seoul, Republic of Korea
| | - Myung Jin Chung
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Soo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnamgu, Seoul, Republic of Korea
| | - Man Pyo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnamgu, Seoul, Republic of Korea.
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Tolwin Y, Gillis R, Agmon IN, Shrem NS, Rosenbaum E, Peled N. Increased Incidence of Lung Cancer Among Patients With Superficial Transitional Cell Carcinoma: A Potential Risk Cohort for Lung Cancer Screening. Clin Lung Cancer 2019; 20:429-434. [PMID: 31303453 DOI: 10.1016/j.cllc.2019.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/27/2019] [Accepted: 06/07/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Smoking is a major risk factor for lung cancer (LC) and transitional cell carcinoma of the bladder (TCC). Current recommendations for LC screening do not include TCC as a risk factor for determining screening eligibility. In this study we aimed to evaluate whether TCC patients constitute a population who might benefit from LC screening. PATIENTS AND METHODS The Surveillance, Epidemiology, and End Results 18 database was used to determine the incidence, standardized incidence ratio (SIR), and the average time to diagnosis of LC in patients with localized TCC of the bladder (American Joint Committee on Cancer, sixth edition, stages 0-1). RESULTS On the basis of 91,606 patients with localized TCC, The SIR for LC in men was 1.89 (95% confidence interval [CI], 1.8-1.97), significantly different from the risk for all solid tumors. The SIR for LC in women was 2.43 (95% CI, 2.22-2.65), significantly higher than for men. The 5-year incidence of LC was 3.2%, and the 10-year incidence was 5.94%. The average time to diagnosis of LC was 3.4 years, with >80% of LC cases occurring within 5 years of TCC diagnosis. CONCLUSION Patients with localized TCC have a higher incidence of LC than the general population. The risk is significantly increased among women compared with men. Considering this increased risk, patients with early stage TCC might stand to benefit from LC screening. Additional differences were noted between male and female TCC patients, which bear further study.
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Affiliation(s)
| | - Roni Gillis
- The Legacy Heritage Center and Dr Larry Norton Institute, Soroka Medical Center, Beer Sheva, Israel; Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Inbar Nardi Agmon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Davidoff Cancer Center, Rabin Medical Center, Petach Tiqwa, Israel
| | - Noa Shani Shrem
- The Legacy Heritage Center and Dr Larry Norton Institute, Soroka Medical Center, Beer Sheva, Israel; Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eli Rosenbaum
- Davidoff Cancer Center, Rabin Medical Center, Petach Tiqwa, Israel
| | - Nir Peled
- The Legacy Heritage Center and Dr Larry Norton Institute, Soroka Medical Center, Beer Sheva, Israel; Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Quantitative Imaging features Improve Discrimination of Malignancy in Pulmonary nodules. Sci Rep 2019; 9:8528. [PMID: 31189944 PMCID: PMC6561979 DOI: 10.1038/s41598-019-44562-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 05/17/2019] [Indexed: 12/26/2022] Open
Abstract
Pulmonary nodules are frequently detected radiological abnormalities in lung cancer screening. Nodules of the highest- and lowest-risk for cancer are often easily diagnosed by a trained radiologist there is still a high rate of indeterminate pulmonary nodules (IPN) of unknown risk. Here, we test the hypothesis that computer extracted quantitative features (“radiomics”) can provide improved risk-assessment in the diagnostic setting. Nodules were segmented in 3D and 219 quantitative features are extracted from these volumes. Using these features novel malignancy risk predictors are formed with various stratifications based on size, shape and texture feature categories. We used images and data from the National Lung Screening Trial (NLST), curated a subset of 479 participants (244 for training and 235 for testing) that included incident lung cancers and nodule-positive controls. After removing redundant and non-reproducible features, optimal linear classifiers with area under the receiver operator characteristics (AUROC) curves were used with an exhaustive search approach to find a discriminant set of image features, which were validated in an independent test dataset. We identified several strong predictive models, using size and shape features the highest AUROC was 0.80. Using non-size based features the highest AUROC was 0.85. Combining features from all the categories, the highest AUROC were 0.83.
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Yang X, Dong X, Wang J, Li W, Gu Z, Gao D, Zhong N, Guan Y. Computed Tomography-Based Radiomics Signature: A Potential Indicator of Epidermal Growth Factor Receptor Mutation in Pulmonary Adenocarcinoma Appearing as a Subsolid Nodule. Oncologist 2019; 24:e1156-e1164. [PMID: 30936378 DOI: 10.1634/theoncologist.2018-0706] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/28/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Lung adenocarcinoma (LADC) with epidermal growth factor receptor (EGFR) mutation is considered a subgroup of lung cancer sensitive to EGFR-targeted tyrosine kinase inhibitors. We aimed to develop and validate a computed tomography (CT)-based radiomics signature for prediction of EGFR mutation status in LADC appearing as a subsolid nodule. MATERIALS AND METHODS A total of 467 eligible patients were divided into training and validation cohorts (n = 306 and 161, respectively). Radiomics features were extracted from unenhanced CT images by using Pyradiomics. A CT-based radiomics signature for distinguishing EGFR mutation status was constructed using the random forest (RF) method in the training cohort and then tested in the validation cohort. A combination of the radiomics signature with a clinical factors model was also constructed using the RF method. The performance of the model was evaluated using the area under the curve (AUC) of a receiver operating characteristic curve. RESULTS In this study, 64.2% (300/467) of the patients showed EGFR mutations. L858R mutation of exon 21 was the most common mutation type (185/301). We identified a CT-based radiomics signature that successfully discriminated between EGFR positive and EGFR negative in the training cohort (AUC = 0.831) and the validation cohort (AUC = 0.789). The radiomics signature combined with the clinical factors model was not superior to the simple radiomics signature in the two cohorts (p > .05). CONCLUSION As a noninvasive method, the CT-based radiomics signature can be used to predict the EGFR mutation status of LADC appearing as a subsolid nodule. IMPLICATIONS FOR PRACTICE Lung adenocarcinoma (LADC) with epidermal growth factor receptor (EGFR) mutation is considered a subgroup of lung cancer that is sensitive to EGFR-targeted tyrosine kinase inhibitors. However, some patients with inoperable subsolid LADC are unable to undergo tissue sampling by biopsy for molecular analysis in clinical practice. A computed tomography-based radiomics signature may serve as a noninvasive biomarker to predict the EGFR mutation status of subsolid LADCs when mutational profiling is not available or possible.
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Affiliation(s)
- Xinguan Yang
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Diseases, Guangzhou, People's Republic of China
- Department of Radiology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People's Republic of China
| | - Xiao Dong
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Diseases, Guangzhou, People's Republic of China
| | - Jiao Wang
- 12 Sigma Technologies, San Diego, California, USA
| | - Weiwei Li
- 12 Sigma Technologies, San Diego, California, USA
| | - Zhuoran Gu
- 12 Sigma Technologies, San Diego, California, USA
| | - Dashan Gao
- 12 Sigma Technologies, San Diego, California, USA
| | - Nanshan Zhong
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Diseases, Guangzhou, People's Republic of China
| | - Yubao Guan
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Diseases, Guangzhou, People's Republic of China
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40
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Coureau G, Delva F. [Lung cancer screening among the smoker population]. Bull Cancer 2019; 106:693-702. [PMID: 30777302 DOI: 10.1016/j.bulcan.2018.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 12/12/2022]
Abstract
CONTEXT Lung cancer is the most common cancer in men and the leading cause of cancer death worldwide. This cancer, often diagnosed at an advanced stage, mainly affects smokers and survival could increase with early detection. Screening by chest x-ray has not shown its effectiveness, then several randomized trials have been carried out about screening by thoracic low-dose computed tomography in smokers. METHODS A systematic review of these trials was conducted according to the PRISMA criteria as well as a point of the difficulties of setting up screening following these trials. RESULTS Among five trials that published mortality results, only the US one, the National Lung Screening Trial (NLST) was showed a 20% decrease in lung cancer mortality in smokers screened by low-dose computed tomography compared to chest x-ray. However, besides the lack of power of the other trials, a great heterogeneity of the methods makes the synthesis of the results difficult. While many expert groups are in favor of testing, only the United States has implemented a screening program, whose adherence remains low. CONCLUSION Many persistent questions about the eligible population, the organization, the side effects, and finally the cost-benefit, need additional research around these issues.
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Affiliation(s)
- Gaëlle Coureau
- Université Bordeaux, Epicene, centre Inserm U1219, 33000 Bordeaux, France; CHU de Bordeaux, service d'information médicale, 33000 Bordeaux, France.
| | - Fleur Delva
- Université Bordeaux, Epicene, centre Inserm U1219, 33000 Bordeaux, France; CHU de Bordeaux, service de médecine du travail et de pathologies professionnelles, 33000 Bordeaux, France
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Tian Y, Li M, Song W, Jiang R, Li YQ. Effects of probiotics on chemotherapy in patients with lung cancer. Oncol Lett 2019; 17:2836-2848. [PMID: 30854059 PMCID: PMC6365978 DOI: 10.3892/ol.2019.9906] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 11/21/2018] [Indexed: 12/13/2022] Open
Abstract
Chemotherapy damages the intestinal mucosa, causing adverse gastrointestinal reactions. Clostridium butyricum (C. butyricum) reduces the incidence of diarrhea in digestive diseases, including inflammatory bowel disease. Therefore, the aim of the present study was to investigate the role of C. butyricum in patients undergoing chemotherapy. A total of 41 participants with lung cancer were enrolled, and divided into the C. butyricum (CB) or placebo group using 1:1 randomization to obtain 20 CB and 21 placebo participants. On the first and last day of the 3-week intervention, blood and stool samples were collected and analyzed. To analyze stool flora, 16S ribosomal RNA sequencing was performed. The incidence of chemotherapy-induced diarrhea was lower in the CB group compared with the placebo group. The lymphocyte count and platelet/lymphocyte ratio (PLR) was markedly altered between the two groups. Neutrophil/lymphocyte ratio (NLR) and PLR decreased within the CB group. At week 3, the lymphocyte/monocyte ratio (LMR) was higher in the CB group compared with the placebo group. Alterations in lymphocyte subsets and immunoglobulin levels were not significantly different. Albumin (ALB) level and weight did not differ significantly between the two groups. At 3 weeks the total flora diversity did not decrease in either group. Phyla in the CB group varied slightly, while the proportion of Firmicutes in the placebo group decreased significantly. No statistically significant difference was observed between the two groups, though the genera producing short-chain fatty acids tended to increase, and the pathogenic genera tended to decrease in the CB group, which was almost the opposite of the observation in the placebo group. Operational taxonomy unit analysis revealed a notable increase in beneficial flora, including the Clostridium and Lactobacillus genera of the CB group, compared with the placebo group. The present study highlighted that C. butyricum reduced chemotherapy-induced diarrhea in patients with lung cancer, reduced the systemic inflammatory response system and encouraged homeostatic maintenance.
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Affiliation(s)
- Yang Tian
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250012, P.R. China
| | - Ming Li
- Department of Gastroenterology, Shandong University, Qilu Hospital, Jinan, Shandong 250012, P.R. China
| | - Wei Song
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250012, P.R. China
| | - Rui Jiang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250012, P.R. China
| | - Yan Qing Li
- Department of Gastroenterology, Shandong University, Qilu Hospital, Jinan, Shandong 250012, P.R. China
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Cherezov D, Hawkins SH, Goldgof DB, Hall LO, Liu Y, Li Q, Balagurunathan Y, Gillies RJ, Schabath MB. Delta radiomic features improve prediction for lung cancer incidence: A nested case-control analysis of the National Lung Screening Trial. Cancer Med 2018; 7:6340-6356. [PMID: 30507033 PMCID: PMC6308046 DOI: 10.1002/cam4.1852] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 12/19/2022] Open
Abstract
Background Current guidelines for lung cancer screening increased a positive scan threshold to a 6 mm longest diameter. We extracted radiomic features from baseline and follow‐up screens and performed size‐specific analyses to predict lung cancer incidence using three nodule size classes (<6 mm [small], 6‐16 mm [intermediate], and ≥16 mm [large]). Methods We extracted 219 features from baseline (T0) nodules and 219 delta features which are the change from T0 to first follow‐up (T1). Nodules were identified for 160 incidence cases diagnosed with lung cancer at T1 or second follow‐up screen (T2) and for 307 nodule‐positive controls that had three consecutive positive screens not diagnosed as lung cancer. The cases and controls were split into training and test cohorts; classifier models were used to identify the most predictive features. Results The final models revealed modest improvements for baseline and delta features when compared to only baseline features. The AUROCs for small‐ and intermediate‐sized nodules were 0.83 (95% CI 0.76‐0.90) and 0.76 (95% CI 0.71‐0.81) for baseline‐only radiomic features, respectively, and 0.84 (95% CI 0.77‐0.90) and 0.84 (95% CI 0.80‐0.88) for baseline and delta features, respectively. When intermediate and large nodules were combined, the AUROC for baseline‐only features was 0.80 (95% CI 0.76‐0.84) compared with 0.86 (95% CI 0.83‐0.89) for baseline and delta features. Conclusions We found modest improvements in predicting lung cancer incidence by combining baseline and delta radiomics. Radiomics could be used to improve current size‐based screening guidelines.
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Affiliation(s)
- Dmitry Cherezov
- Department of Computer Sciences and Engineering, University of South Florida, Tampa, Florida
| | - Samuel H Hawkins
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Dmitry B Goldgof
- Department of Computer Sciences and Engineering, University of South Florida, Tampa, Florida
| | - Lawrence O Hall
- Department of Computer Sciences and Engineering, University of South Florida, Tampa, Florida
| | - Ying Liu
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Qian Li
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Yoganand Balagurunathan
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Robert J Gillies
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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Park IK, Hyun K, Kim ER, Park S, Kang CH, Kim YT. The prognostic effect of the epidermal growth factor receptor gene mutation on recurrence dynamics of lung adenocarcinoma. Eur J Cardiothorac Surg 2018; 54:1022-1027. [PMID: 29878144 DOI: 10.1093/ejcts/ezy220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/09/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The prognostic effects of epidermal growth factor receptor (EGFR) gene mutation on lung adenocarcinoma recurrence have not been well established. The relationship between EGFR gene mutation and recurrence dynamics of lung adenocarcinoma was investigated. METHODS A total of 527 patients with complete resection for adenocarcinoma were reviewed retrospectively. EGFR gene mutation was analysed by polymerase chain reaction followed by bidirectional direct sequencing in recurred patients. Patients were divided into the EGFR gene mutation group (M) or the wild-type EGFR gene group (W). Recurrence types and disease-free intervals (DFIs) of the 2 groups were compared. DFIs were calculated by the Kaplan-Meier method and compared using the log-rank test and Cox proportional hazard model. RESULTS EGFR gene sequencing was performed in 115 recurrent adenocarcinoma patients. Sixty-six patients had EGFR mutations and 49 patients had wild-type EGFR. The median DFI of the 2 groups were significantly different (M: 20.3 months, W: 15.1 months, P = 0.012). EGFR gene mutation was the only prognostic factor for DFI [hazard ratio (HR) = 0.639, 95% confidence interval (CI) = 0.428-0.954, P = 0.029]. The proportion of loco-regional recurrences and distant metastases of both groups were similar (P = 0.50). In subgroup analysis, EGFR gene mutation (HR = 0.534, 95% CI = 0.339-0.839, P = 0.007) was a significant prognostic factor for DFI of distant metastases. CONCLUSIONS Lung adenocarcinoma with EGFR gene mutations had longer DFI than those with wild-type EGFR gene, especially with regard to distant metastasis. EGFR gene mutation was a prognostic factor for lung adenocarcinoma.
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Affiliation(s)
- In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Eung Re Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea.,Seoul National University Cancer Research Institute, Seoul, Korea
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Chung JM, Simmerman EL, Sadek RF, Wojtowicz S, Dillard TA, Albo D, Thomson NB, Schroeder C. Financial Analysis of Free Lung Cancer Screening Program Shows Profitability Using Broader NCCN Guidelines. Ann Thorac Surg 2018; 107:885-890. [PMID: 30419190 DOI: 10.1016/j.athoracsur.2018.09.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 09/11/2018] [Accepted: 09/24/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Lung cancer screening with low-dose computed tomography (LDCT) chest scans in high-risk populations has been established as an effective measure of preventive medicine by the National Lung Screening Trial. However, the sustainability of funding a program is still controversial. We present a 2.5-year profitability analysis of our screening program by using the broader National Comprehensive Cancer Network criteria. METHODS Retrospective chart review was performed on the initial 2.5-year data set of a free LDCT chest scan program that targeted the underserved Southeastern United States. Patients were selected by the National Comprehensive Cancer Network high-risk criteria, screening twice as many patients compared with Centers for Medicare and Medicaid Services criteria. LDCT scans were performed during the off-service hours of our positron emission tomography CT scanner. Analysis of fiscal years 2015 to 2017 was done to evaluate indirect cost, direct cost, and adjusted net margin per case after factoring downstream revenue from positive scans and other findings. RESULTS A total of 705 scans were performed with 418 patients referred for subsequent procedures or specialist evaluations. The mean overhead cost over total cost was 42.3%. The adjusted net margin per case was -$212 in the first year but turned positive to $177 in the third fiscal year. The total break-even point of adjusted net margin was between 6% and 7% of indirect cost as a function of charges. Of the 60 new patients introduced to the hospital system, a gross margin per case of $211 was found. CONCLUSIONS Free lung cancer screening can demonstrate profitability from downstream revenue with a lag time of 2 years.
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Affiliation(s)
- Jane M Chung
- Department of Surgery, Augusta University Medical Center, Augusta, Georgia
| | - Erika L Simmerman
- Department of Surgery, Augusta University Medical Center, Augusta, Georgia
| | - Ramses F Sadek
- Georgia Cancer Center Biostatistics Core, Augusta University Medical Center, Augusta, Georgia
| | - Suzanne Wojtowicz
- Department of Financial Planning and Analysis in Financial Management, Augusta University Medical Center, Augusta, Georgia
| | - Thomas A Dillard
- Department of Pulmonary and Critical Care, Augusta University Medical Center, Augusta, Georgia
| | - Daniel Albo
- Department of Surgery, Augusta University Medical Center, Augusta, Georgia; Georgia Cancer Center, Augusta University Medical Center, Augusta, Georgia
| | - Norman B Thomson
- Department of Radiology, Augusta University Medical Center, Augusta, Georgia
| | - Carsten Schroeder
- Department of Surgery, Augusta University Medical Center, Augusta, Georgia; Georgia Cancer Center, Augusta University Medical Center, Augusta, Georgia.
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Zhou Q, Fan Y, Wang Y, Qiao Y, Wang G, Huang Y, Wang X, Wu N, Zhang G, Zheng X, Bu H, Li Y, Wei S, Chen L, Hu C, Shi Y, Sun Y. [China National Lung Cancer Screening Guideline with Low-dose Computed
Tomography (2018 version)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018. [PMID: 29526173 PMCID: PMC5973012 DOI: 10.3779/j.issn.1009-3419.2018.02.01] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death in China. The results from a randomized controlled trial using annual low-dose computed tomography (LDCT) in specific high-risk groups demonstrated a 20% reduction in lung cancer mortality. The aim of tihs study is to establish the China National lung cancer screening guidelines for clinical practice. METHODS The China lung cancer early detection and treatment expert group (CLCEDTEG) established the China National Lung Cancer Screening Guideline with multidisciplinary representation including 4 thoracic surgeons, 4 thoracic radiologists, 2 medical oncologists, 2 pulmonologists, 2 pathologist, and 2 epidemiologist. Members have engaged in interdisciplinary collaborations regarding lung cancer screening and clinical care of patients with at risk for lung cancer. The expert group reviewed the literature, including screening trials in the United States and Europe and China, and discussed local best clinical practices in the China. A consensus-based guidelines, China National Lung Cancer Screening Guideline (CNLCSG), was recommended by CLCEDTEG appointed by the National Health and Family Planning Commission, based on results of the National Lung Screening Trial, systematic review of evidence related to LDCT screening, and protocol of lung cancer screening program conducted in rural China. RESULTS Annual lung cancer screening with LDCT is recommended for high risk individuals aged 50-74 years who have at least a 20 pack-year smoking history and who currently smoke or have quit within the past five years. Individualized decision making should be conducted before LDCT screening. LDCT screening also represents an opportunity to educate patients as to the health risks of smoking; thus, education should be integrated into the screening process in order to assist smoking cessation. CONCLUSIONS A lung cancer screening guideline is recommended for the high-risk population in China. Additional research , including LDCT combined with biomarkers, is needed to optimize the approach to low-dose CT screening in the future.
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Affiliation(s)
- Qinghua Zhou
- Lung Cancer Center/Lung Cancer Institute, West China University, Sichuan University, Chengdu 610041, China.,Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China.,China National Expert Group of Early Diagnosis and Treatment of Lung Cancer, Chengdu 610041, China
| | - Yaguang Fan
- Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China.,China National Expert Group of Early Diagnosis and Treatment of Lung Cancer, Chengdu 610041, China
| | - Ying Wang
- Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Youlin Qiao
- China National Expert Group of Early Diagnosis and Treatment of Lung Cancer, Chengdu 610041, China.,Cancer Hospital, Chinese Academy of Medical Sciences/China National Cancer Center, Beijing 100021, China
| | - Guiqi Wang
- China National Expert Group of Early Diagnosis and Treatment of Lung Cancer, Chengdu 610041, China.,Cancer Hospital, Chinese Academy of Medical Sciences/China National Cancer Center, Beijing 100021, China
| | - Yunchao Huang
- China National Expert Group of Early Diagnosis and Treatment of Lung Cancer, Chengdu 610041, China.,Cancer Hospital of Yunnan Province, Kunming 650105, China
| | - Xinyun Wang
- Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China.,China National Expert Group of Early Diagnosis and Treatment of Lung Cancer, Chengdu 610041, China
| | - Ning Wu
- China National Expert Group of Early Diagnosis and Treatment of Lung Cancer, Chengdu 610041, China.,Cancer Hospital, Chinese Academy of Medical Sciences/China National Cancer Center, Beijing 100021, China
| | | | | | - Hong Bu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yin Li
- Cancer Hospital of Henan Province, Zhengzhou 450008, China
| | - Sen Wei
- Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Liang'an Chen
- General Hospital of People's Liberation Army, Beijing 100853, China
| | - Chengping Hu
- Xiangya Hospital, Central South University, Changsa 410008, China
| | - Yuankai Shi
- Cancer Hospital, Chinese Academy of Medical Sciences/China National Cancer Center, Beijing 100021, China
| | - Yan Sun
- Cancer Hospital, Chinese Academy of Medical Sciences/China National Cancer Center, Beijing 100021, China
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Lowenstein LM, Escoto KH, Leal VB, Bailey L, Bevers TB, Cantor SB, Cinciripini PM, Jacobs LE, Esparza A, Godoy MC, Housten AJ, Lin H, Luckett P, Munden RF, Rabius V, Volk RJ. Randomized trial of a patient-centered decision aid for promoting informed decisions about lung cancer screening: Implementation of a PCORI study protocol and lessons learned. Contemp Clin Trials 2018; 72:26-34. [PMID: 30010085 PMCID: PMC6219628 DOI: 10.1016/j.cct.2018.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/01/2018] [Accepted: 07/12/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE We describe the methods, stakeholder engagement, and lessons learned from a study comparing a video decision aid to standard educational materials on lung cancer screening decisions. METHODS The study followed rigorous methodology standards from the Patient-Centered Outcomes Research Institute. The importance of patient-centeredness and patient/stakeholder engagement are reflected across the study's conceptualization, execution, interpretation, and dissemination efforts. Advisory groups of current and former smokers, quitline service providers, clinicians, and patient advocates were formed for the project. The study used both retrospective and prospective recruitment strategies. Randomization of patients occurred within state-based quitlines, with aggressive tracking of participants. We collected data at baseline and 1-week, 3-month and 6-months after receiving the intervention. The patient-centered outcomes included whether patients' receiving the decision aid a) felt better prepared to make a decision, b) felt more informed about the screening decision, c) had more clarity on their values regarding the benefits and harms of lung cancer screening, and d) were more knowledgeable about lung cancer screening than patients receiving the standard education materials. Exploratory outcomes included making an appointment with a health care provider to discuss screening, scheduling and completing lung cancer screening. RESULTS We have enrolled and randomized 516 quitline patients and learned many lessons about executing the trial based on significant patient and stakeholder engagement. CONCLUSIONS Conducting patient-centered outcomes research requires new ways of thinking and continuously checking-in with patients/stakeholders. The engagement of quitline service providers and patient advisors has been key to successful recruitment and dissemination planning. PCORI- CER-1306-03385 ClinicalTrials.gov NCT ID: NCT02286713.
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Affiliation(s)
- Lisa M Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kamisha H Escoto
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Viola B Leal
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Linda Bailey
- North American Quitline Consortium, Phoenix, AZ, United States
| | - Therese B Bevers
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Scott B Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lianne E Jacobs
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Myrna C Godoy
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ashley J Housten
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Heather Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pamela Luckett
- Information & Quality Healthcare, Ridgeland, MS, United States
| | - Reginald F Munden
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Vance Rabius
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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Smith RA, Andrews KS, Brooks D, Fedewa SA, Manassaram-Baptiste D, Saslow D, Brawley OW, Wender RC. Cancer screening in the United States, 2018: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin 2018; 68:297-316. [PMID: 29846940 DOI: 10.3322/caac.21446] [Citation(s) in RCA: 330] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 02/06/2023] Open
Abstract
Each year, the American Cancer Society publishes a summary of its guidelines for early cancer detection, data and trends in cancer screening rates from the National Health Interview Survey, and select issues related to cancer screening. In this 2018 update, we also summarize the new American Cancer Society colorectal cancer screening guideline and include a clarification in the language of the 2013 lung cancer screening guideline. CA Cancer J Clin 2018;68:297-316. © 2018 American Cancer Society.
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Affiliation(s)
- Robert A Smith
- Vice President, Cancer Screening, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Kimberly S Andrews
- Director, Guidelines Process, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Durado Brooks
- Vice President, Cancer Control Interventions, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Strategic Director for Risk Factors & Screening Surveillance, Department of Epidemiology and Research Surveillance, American Cancer Society, Atlanta, GA
| | | | - Debbie Saslow
- Senior Director, HPV Related and Women's Cancers, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Otis W Brawley
- Chief Medical Officer, American Cancer Society, Atlanta, GA
| | - Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
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48
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Wiener RS, Koppelman E, Bolton R, Lasser KE, Borrelli B, Au DH, Slatore CG, Clark JA, Kathuria H. Patient and Clinician Perspectives on Shared Decision-making in Early Adopting Lung Cancer Screening Programs: a Qualitative Study. J Gen Intern Med 2018; 33:1035-1042. [PMID: 29468601 PMCID: PMC6025674 DOI: 10.1007/s11606-018-4350-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/29/2017] [Accepted: 01/18/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Guidelines recommend, and Medicare requires, shared decision-making between patients and clinicians before referring individuals at high risk of lung cancer for chest CT screening. However, little is known about the extent to which shared decision-making about lung cancer screening is achieved in real-world settings. OBJECTIVE To characterize patient and clinician impressions of early experiences with communication and decision-making about lung cancer screening and perceived barriers to achieving shared decision-making. DESIGN Qualitative study entailing semi-structured interviews and focus groups. PARTICIPANTS We enrolled 36 clinicians who refer patients for lung cancer screening and 49 patients who had undergone lung cancer screening in the prior year. Participants were recruited from lung cancer screening programs at four hospitals (three Veterans Health Administration, one urban safety net). APPROACH Using content analysis, we analyzed transcripts to characterize communication and decision-making about lung cancer screening. Our analysis focused on the recommended components of shared decision-making (information sharing, deliberation, and decision aid use) and barriers to achieving shared decision-making. KEY RESULTS Clinicians varied in the information shared with patients, and did not consistently incorporate decision aids. Clinicians believed they explained the rationale and gave some (often purposely limited) information about the trade-offs of lung cancer screening. By contrast, some patients reported receiving little information about screening or its trade-offs and did not realize the CT was intended as a screening test for lung cancer. Clinicians and patients alike did not perceive that significant deliberation typically occurred. Clinicians perceived insufficient time, competing priorities, difficulty accessing decision aids, limited patient comprehension, and anticipated patient emotions as barriers to realizing shared decision-making. CONCLUSIONS Due to multiple perceived barriers, patient-clinician conversations about lung cancer screening may fall short of guideline-recommended shared decision-making supported by a decision aid. Consequently, patients may be left uncertain about lung cancer screening's rationale, trade-offs, and process.
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Affiliation(s)
- Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, ENRM VA Hospital, Bedford, MA, USA. .,The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.
| | - Elisa Koppelman
- Center for Healthcare Organization & Implementation Research, ENRM VA Hospital, Bedford, MA, USA.,Boston University School of Public Health, Boston, MA, USA
| | - Rendelle Bolton
- Center for Healthcare Organization & Implementation Research, ENRM VA Hospital, Bedford, MA, USA.,The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Karen E Lasser
- Boston University School of Public Health, Boston, MA, USA.,Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Belinda Borrelli
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - David H Au
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.,Division of Pulmonary Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.,Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jack A Clark
- Center for Healthcare Organization & Implementation Research, ENRM VA Hospital, Bedford, MA, USA.,Boston University School of Public Health, Boston, MA, USA
| | - Hasmeena Kathuria
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
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49
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Chao YK, Wen CT, Fang HY, Hsieh MJ. A single-center experience of 100 image-guided video-assisted thoracoscopic surgery procedures. J Thorac Dis 2018; 10:S1624-S1630. [PMID: 30034827 DOI: 10.21037/jtd.2018.04.44] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The advent of image-guided video-assisted thoracoscopic surgery (iVATS) has allowed the simultaneous localization and removal of small lung nodules. The aim of this study is to detail, in a retrospective review, one institution's experience using iVATS in this clinical setting, with a special attention to efficacy, safety, and procedural details. Methods This study was a retrospective analysis of prospectively collected data. Between October 2016 and January 2018, a total of 95 patients with 100 small lung nodules underwent iVATS. All procedures were performed in a hybrid operating room (HOR) in which a cone-beam computed tomography (CT) apparatus and a laser navigation system were present. Results The mean size of the 100 lung nodules was 7.94 mm, with their mean depth from the visceral pleura being 10 mm. A total of 98 nodules were successfully localized; of them, 94 were resected through a marker-guided procedure. There were four resection failures [wire dislodgement (n=2) or dye spillage (n=2)]). A significant inverse association was found between localization time (mean: 21.19 min) and the surgeon's experience (Pearson's r=-0.632; P<0.001). The mean length of hospital stay was 4.87 days and there were no perioperative deaths. Conclusions In the current context of an increase in early diagnosis of lung cancer by screening programs, iVATS performed in a HOR offers a safe and efficient option for simultaneous localization and removal of small pulmonary nodules.
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Affiliation(s)
- Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan
| | - Chih-Tsung Wen
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan
| | - Hsin-Yueh Fang
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan
| | - Ming-Ju Hsieh
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan
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50
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Nakano K, Sugiyama K, Satoh H, Shiromori S, Sugitate K, Arifuku H, Yoshida N, Watanabe H, Tokita S, Wakayama T, Tatewaki M, Souma R, Koyama K, Hirata H, Fukushima Y. Risk factors for disseminated intravascular coagulation in patients with lung cancer. Thorac Cancer 2018; 9:931-938. [PMID: 29851300 PMCID: PMC6068435 DOI: 10.1111/1759-7714.12766] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The mortality rate from disseminated intravascular coagulation (DIC) is higher in patients with lung cancer than in non-lung cancer patients. Moreover, the prevalence of DIC varies among the pathologic types of lung cancer. This study analyzed the relationship between coagulation factors and the pathologic types of lung cancer. METHODS Twenty-six patients with progressive, inoperable stage IIB or higher lung cancer (20 men, 6 women; mean age 71 years; 11 Adeno, 10 squamous cell carcinoma, and 5 small cell carcinoma) and five healthy volunteers without respiratory disease (3 men, 2 women; mean age 72 years) were enrolled in the study. Blood samples were collected at lung cancer diagnosis, before treatment. RESULTS White blood cell count, platelet count, serum C-reactive protein, fibrin/fibrinogen degradation products, fibrinogen, thrombin-antithrombin complex, and D-dimer levels differed significantly between lung cancer patients and the control group, but not among the pathologic types of lung cancer. Thrombomodulin levels were significantly higher in patients with Adeno and squamous cell carcinoma than in those with small cell carcinoma (P < 0.05 and P < 0.01, respectively). Antithrombin levels were significantly lower in patients with squamous cell carcinoma than in those with Adeno (P < 0.05). CONCLUSION Coagulation disorders may develop secondary to chronic inflammation in patients with progressive lung cancer. DIC in lung cancer may be attributed to changes in anticoagulation factors, such as thrombomodulin and antithrombin, but not in other coagulation factors.
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Affiliation(s)
- Kentaro Nakano
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Kumiya Sugiyama
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hideyuki Satoh
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Sadaaki Shiromori
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Kei Sugitate
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hajime Arifuku
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Naruo Yoshida
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hiroyoshi Watanabe
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Shingo Tokita
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Tomoshige Wakayama
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Masamitsu Tatewaki
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Ryosuke Souma
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Kenya Koyama
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hirokuni Hirata
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yasutsugu Fukushima
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
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