Society for Translational Medicine Expert Consensus on the preoperative assessment of circulatory and cardiac functions and criteria for the assessment of risk factors in patients with lung cancer

Cardiovascular Toxicity and Risk Mitigation with Lung Cancer Treatment

PURPOSE OF REVIEW

Patients with lung cancer often have concomitant cardiovascular comorbidities and receive potentially cardiotoxic therapies. As oncologic outcomes improve, the relative impact of cardiovascular disease on lung cancer survivors is expected to increase. This review summarizes cardiovascular toxicities observed after treatment for lung cancer, as well as recommended risk mitigation strategies.

RECENT FINDINGS

A variety of cardiovascular events may be observed after surgery, radiation therapy (RT), and systemic therapy. The risk of cardiovascular events after radiation therapy (RT) is higher than previously appreciated (23-32%), and RT dose to the heart is a modifiable risk factor. Targeted agents and immune checkpoint inhibitors have been associated with cardiovascular toxicities distinct from those of cytotoxic agents; these are rare but can be severe and require prompt intervention. Optimization of cardiovascular risk factors is important at all phases of cancer therapy and survivorship. Recommended practices for baseline risk assessment, preventive measures, and appropriate monitoring are discussed herein.

Impact of GTF2H1 and RAD54L2 polymorphisms on the risk of lung cancer in the Chinese Han population

Background

Repair pathway genes play an important role in the development of lung cancer. The study aimed to assess the correlation between single nucleotide polymorphisms (SNPs) in DNA repair gene (GTF2H1 and RAD54L2) and the risk of lung cancer.

Methods

Five SNPs in GTF2H1 and four SNPs in RAD54L2 in 506 patients with lung cancer and 510 age-and gender-matched healthy controls were genotyped via the Agena MassARRAY platform. The influence of GTF2H1 and RAD54L2 polymorphisms on lung cancer susceptibility was assessed using logistic regression analysis by calculating odds ratios (ORs) and their corresponding 95% confidence intervals (CIs).

Results

RAD54L2 rs9864693 GC genotype increased the risk of lung cancer (OR = 1.33, 95%CI: 1.01–1.77, p = 0.045). Stratified analysis found that associations of RAD54L2 rs11720298, RAD54L2 rs4687592, RAD54L2 rs9864693 and GTF2H1 rs4150667 with lung cancer risk were found in subjects aged ≤ 59 years. Precisely, a protective effect of RAD54L2 rs11720298 on the occurrence of lung cancer was observed in non-smokers and drinkers. GTF2H1 rs4150667 was associated with a decreased risk of lung cancer in subjects with BMI ≤ 24 kg/m2. RAD54L2 rs4687592 was associated with an increased risk of lung cancer in drinkers. In addition, GTF2H1 rs3802967 was associated with a reduced risk of lung squamous cell carcinoma.

Conclusion

Our study first revealed that RAD54L2 rs9864693 was associated with an increased risk of lung cancer in the Chinese Han population. This study may increase the understanding of the effect of RAD54L2 and GTF2H1 polymorphisms on lung cancer occurrence.

Impact of COL6A4P2 gene polymorphisms on the risk of lung cancer: A case-control study

Lung cancer (LC) is a malignant tumor that poses the greatest threat to human health and life. Most studies suggested that the occurrence of LC is associated with environmental and genetic factors. We aimed to explore the association between COL6A4P2 single nucleotide polymorphisms (SNPs) and CHD risk in the Chinese Southern Han population. Based on the 'case-control' experimental design (510 cases and 495 controls), we conducted an association study between five candidate COL6A4P2 SNPs and the corresponding LC risk. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated by logistic regression to analyze the LC susceptibility under different genetic models. The results showed that COL6A4P2 rs34445363 was significantly associated with LC risk under alleles model (OR = 1.26, 95%CI: 1.01-1.58, p = 0.038). In addition, rs34445363 was also significantly associated with LC risk under the log-additive model (OR = 1.26, 95%CI: 1.01-1.58, p = 0.041). The results of subgroup analysis showed that rs34445363 (OR = 1.42, 95%CI: 1.03-1.95, p = 0.033) and rs61733464 (OR = 0.72, 95%CI: 0.52-0.99, p = 0.048) were both significantly associated with LC risk in the log-additive model among participants who were ≤ 61 years old. We also found that the variation of rs34445363 (GA vs. GG, OR = 1.73, 95%CI: 1.04-2.86, p = 0.034) and rs77941834 (TA vs. TT, OR = 1.88, 95%CI: 1.06-3.34, p = 0.032) were associated with LC risk in the codominant model among female participants. Our study is the first to find that COL6A4P2 gene polymorphism is associated with LC risk in the Chinese Han population. Our study provides a basic reference for individualized LC prevention.

[Role of preoperative cardiology consultation in patients undergoing cancer surgery]

AIM

To evaluate the effects of preoperative cardiology consultation on the risk of perioperative cardiac complications in patients undergoing cancer surgery.

MATERIALS AND METHODS

74 patients with bronchial, lung, mediastinal and gastrointestinal cancer were referred to the cardiologist as a part of the preoperative management. Patients were assigned either to Group 1 (n=21), who required non - invasive testing or invasive coronary angiography (CAG), or to Group 2 (n=53), who did not have any indications to additional testing.

RESULTS

The median age was 65.8 years in Group 1 and 64.5 years in Group 2, p=0.408. Group 1 patients had higher RCRI than Group 2 patients (7.4±4.5 vs. 2.9±4.5, respectively, p=0.002). Four (19.05%) patients in Group 1 underwent minimally invasive examination without any further indications to CAG. 16 (76.2%) patients underwent CAG. Of them, 5 (23.8%) patients had severe coronary artery stenosis, and 4 (19.0%) patients had severe brachycephalic artery stenosis (≥50%). After CAG findings, one carotid artery and three coronary arteries (14.3%) were stented. Drug therapy was prescribed to one patient. One patient required stenting after the treatment of the underlying disease. Group 2 patients were more likely to achieve the endpoints - heart rhythm disturbances, decompensation of chronic heart failure, cardiac death (5.45% in Group 2 vs. 4.76% in Group 1, p>0.05). Multivariate analysis reported that angina pectoris was an independent factor to refer patients to the additional testing (p.