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Bade BC, Zhao J, Li F, Tanoue L, Lazowski H, Alfano CM, Silvestri GA, Irwin ML. Trends and predictors of Quality of Life in lung cancer survivors. Lung Cancer 2024; 191:107793. [PMID: 38640687 DOI: 10.1016/j.lungcan.2024.107793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 04/08/2024] [Accepted: 04/13/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Health-related quality of life (HR-QoL) is often impaired in lung cancer survivors. To inform personalized survivorship care, we identified associations between HR-QoL scores and patient-, tumor-, and treatment-factors over time. MATERIALS AND METHODS We evaluated HR-QoL scores provided at diagnosis, 6 months, 1 year, and 2 years from the Yale Lung Cancer Biorepository. HR-QoL was measured via the Functional Assessment of Cancer Therapy - Lung (FACT-L) instrument and available for a subset of patients (n = 513). Analyses were stratified by early-stage (I-II; n = 355) non-small cell lung cancer (NSCLC), advanced stage NSCLC (III-IV; n = 158), and small cell lung cancer (SCLC, n = 21). We used mixed effects modeling and multivariable analysis with covariate adjustment to examine changes in FACT-L from diagnosis to follow-up. Sensitivity analysis was performed including patients with early-stage disease and complete FACT-L scores at both baseline and year 2 (n = 91). RESULTS The average FACT-L scores at diagnosis in early-stage NSCLC, advanced stage NSCLC, and SCLC were 121.0 (standard deviation (SD) 11.4), 109.2 (18.7), and 98.7 (20.2) respectively. At all timepoints, HR-QoL was higher in patients with early-stage NSCLC (vs advanced-stage disease). In patients with early- and advanced-stage NSCLC, HR-QoL was higher at years 1 and 2 than at diagnosis, though the changes did not meet clinical significance. At NSCLC diagnosis, higher HR-QoL was associated with older age, better performance status, participating in physical activity, adenocarcinoma histology, and (in advanced stage NSCLC) anticipated treatment with chemotherapy. At NSCLC follow-up, HR-QoL was higher in patients with higher BMI and better performance status. DISCUSSION In patients with newly diagnosed NSCLC, HR-QoL scores are impacted by patient factors, tumor factors, and treatment factors. HR-QoL is higher in patients with early-stage disease. In patients surviving 2 years, HR-QoL was higher at follow-up, though the change did not meet clinical significance. To optimize HR-QoL, lung cancer survivorship teams should prioritize comorbidity management, physical activity, healthy weight maintenance, and treatment-related side effects.
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Affiliation(s)
- Brett C Bade
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Institute of Health System Science, Feinstein Institutes for Medical Research; Northwell Health Cancer Institute.
| | | | | | - Lynn Tanoue
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine; Yale Cancer Center, Yale School of Medicine
| | | | - Catherine M Alfano
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Institute of Health System Science, Feinstein Institutes for Medical Research; Northwell Health Cancer Institute
| | - Gerard A Silvestri
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Medical University of South Carolina
| | - Melinda L Irwin
- Yale Cancer Center, Yale School of Medicine; Department of Chronic Disease Epidemiology, Yale University School of Public Health
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Udelsman BV, Detterbeck F, Tanoue L, Mase V, Boffa D, Blasberg J, Dhanasopon A, Ely S, Mazzarelli LJ, Bader A, Woodard G. Impact of the COVID-19 Pandemic on Lung Cancer Screening Processes in a Northeast Tertiary Health Care Network. J Comput Assist Tomogr 2024; 48:222-225. [PMID: 37832536 DOI: 10.1097/rct.0000000000001549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
ABSTRACT The coronavirus disease 2019 (COVID-19) pandemic disrupted health care systems, including implementation of lung cancer screening programs. The impact and recovery from this disruption on screening processes is not well appreciated. Herein, the radiology database of a Northeast tertiary health care network was reviewed before and during the pandemic (2013-2022). In the 3 months before the pandemic, an average of 77.3 lung cancer screening with computed tomography scans (LCS-CT) were performed per month. The average dropped to 23.3 between April and June of 2020, whereas COVID-19 hospitalizations peaked at 1604. By July, average hospitalizations dropped to 50, and LCS-CTs rose to >110 per month for the remaining year. LCS-CTs did not decline during COVID-19 surges in December of 2021 and 2022. The LCS-CT performance grew by 4.5% in 2020, 69.6% in 2021, and 27.0% in 2022, exceeding projected growth by 722 examinations. This resiliency indicates a potentially smaller impact of COVID-19 on lung cancer diagnoses than initially feared.
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Affiliation(s)
- Brooks V Udelsman
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Frank Detterbeck
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Lynn Tanoue
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Vincent Mase
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Daniel Boffa
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Justin Blasberg
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Andrew Dhanasopon
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Sora Ely
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | | | - Anna Bader
- Department of Radiology, Yale University School of Medicine, New Haven, CT
| | - Gavitt Woodard
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
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Woodard G, Tanoue L, Detterbeck F, Boffa D, Mase V, Blasberg J, Dhanasopon A, Gosangi B, Traube L, Bader A. PP01.12 Increasing Diagnosis of Ground Glass Nodules and Semi-Solid Lung Lesions on Chest CT Scans over the Past Decade. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Kunitomo Y, Bade B, Gunderson CG, Akgün KM, Brackett A, Tanoue L, Bastian LA. Evidence of Racial Disparities in the Lung Cancer Screening Process: a Systematic Review and Meta-Analysis. J Gen Intern Med 2022; 37:3731-3738. [PMID: 35838866 PMCID: PMC9585128 DOI: 10.1007/s11606-022-07613-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Annual lung cancer screening (LCS) with low-dose chest computed tomography for high-risk individuals reduces lung cancer mortality, with greater reduction observed in Black participants in clinical trials. While racial disparities in lung cancer mortality exist, less is known about disparities in LCS participation. We conducted a systematic review to explore LCS participation in Black compared with White patients in the USA. METHODS A systematic review was conducted through a search of published studies in MEDLINE, PubMed, EMBASE, Web of Science, and Cumulative Index to Nursing and Allied-Health Literature Database, from database inception through October 2020. We included studies that examined rates of LCS participation and compared rates by race. Studies were pooled using random-effects meta-analysis. RESULTS We screened 18,300 titles/abstracts; 229 studies were selected for full-text review, of which nine studies met inclusion criteria. Studies were categorized into 2 groups: studies that reported the screening rate among an LCS-eligible patient population, and studies that reported the screening rate among a patient population referred for LCS. Median LCS participation rates were 14.4% (range 1.7 to 62.6%) for eligible patient studies and 68.5% (range 62.6 to 88.8%) for referred patient studies. The meta-analyses showed screening rates were lower in the Black compared to White population among the LCS-eligible patient studies ([OR]=0.43, [95% CI: 0.25, 0.74]). However, screening rates were the same between Black and White patients in the referred patient studies (OR=0.94, [95% CI: 0.74, 1.19]). DISCUSSION Black LCS-eligible patients are being screened at a lower rate than White patients but have similar rates of participation once referred. Differences in referrals by providers may contribute to the racial disparity in LCS participation. More studies are needed to identify barriers to LCS referral and develop interventions to increase provider awareness of the importance of LCS in Black patients. Trial Registry PROSPERO; No.: CRD42020214213; URL: http://www.crd.york.ac.uk/PROSPERO.
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Affiliation(s)
- Yukiko Kunitomo
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Brett Bade
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Craig G Gunderson
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Kathleen M Akgün
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Alexandria Brackett
- Harvey Cushing/John Hay Whitney Medical Library, Yale University School of Medicine, New Haven, CT, USA
| | - Lynn Tanoue
- Yale University School of Medicine, New Haven, CT, USA
| | - Lori A Bastian
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.
- Yale University School of Medicine, New Haven, CT, USA.
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Wood DE, Kazerooni EA, Aberle D, Berman A, Brown LM, Eapen GA, Ettinger DS, Ferguson JS, Hou L, Kadaria D, Klippenstein D, Kumar R, Lackner RP, Leard LE, Lennes IT, Leung ANC, Mazzone P, Merritt RE, Midthun DE, Onaitis M, Pipavath S, Pratt C, Puri V, Raz D, Reddy C, Reid ME, Sandler KL, Sands J, Schabath MB, Studts JL, Tanoue L, Tong BC, Travis WD, Wei B, Westover K, Yang SC, McCullough B, Hughes M. NCCN Guidelines® Insights: Lung Cancer Screening, Version 1.2022. J Natl Compr Canc Netw 2022; 20:754-764. [PMID: 35830884 DOI: 10.6004/jnccn.2022.0036] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The NCCN Guidelines for Lung Cancer Screening recommend criteria for selecting individuals for screening and provide recommendations for evaluation and follow-up of lung nodules found during initial and subsequent screening. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines for Lung Cancer Screening.
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Affiliation(s)
- Douglas E Wood
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Abigail Berman
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | | | | | - Lifang Hou
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Dipen Kadaria
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | | | - Peter Mazzone
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Robert E Merritt
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Mark Onaitis
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Varun Puri
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Dan Raz
- City of Hope National Medical Center
| | | | | | | | - Jacob Sands
- Dana-Farber/Brigham and Women's Cancer Center
| | | | | | | | | | | | | | | | - Stephen C Yang
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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Kunitomo Y, Bade B, Gunderson CG, Akgün KM, Brackett A, Cain H, Tanoue L, Bastian LA. Racial Differences in Adherence to Lung Cancer Screening Follow-Up: A Systematic Review and Meta-Analysis. Chest 2021; 161:266-275. [PMID: 34390706 DOI: 10.1016/j.chest.2021.07.2172] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/17/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND In 2013 the United States Preventive Services Taskforce (USPSTF) instituted recommendations for annual lung cancer screening (LCS) with low dose chest computed tomography for high-risk individuals. LCS reduces lung cancer mortality, with greater reduction observed in Black participants in clinical trials. While racial disparities in lung cancer mortality have been well documented, less is known about disparities in LCS participation and adherence to follow-up in clinical practice. RESEARCH QUESTION What is the association between race and adherence to LCS follow-up? STUDY DESIGN & METHODS A systematic review was conducted through a search of published studies in MEDLINE, PubMed, EMBASE, Web of Science, and Cumulative Index to Nursing and Allied Health Literature Database, from database inception through October 2020. We included studies that examined rates of adherence to LCS follow-up and compared rates by race. Studies were pooled using random-effects meta-analysis. RESULTS We screened 18,300 titles/abstracts and 229 studies were selected for full-text review. Nine studies met inclusion criteria; seven were included in the meta-analysis. Median adherent follow-up rate was 37% (range 16-82%). Notable differences among the studies included the proportion of the Black population (range 4-47%) and the structure of the LCS programs. The meta-analyses showed lower adherence to LCS follow-up in the Black population (Odds Ratio [OR]=0.67, [95% CI: 0.55, 0.80]). This disparity persisted across all malignancy risk levels determined by initial screening results. INTERPRETATION There is lower adherence to LCS follow-up in Black compared to White patients despite the higher potential lung cancer mortality benefit. Literature specifically addressing race-related barriers to LCS adherence is still limited. To ensure equity in LCS benefits, greater outreach to eligible Black patients should be implemented through increased physician education and utilization of screening program coordinators to focus on this patient population.
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Affiliation(s)
- Yukiko Kunitomo
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System West Haven, Connecticut, United States; Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Yale School of Medicine, New Haven, Connecticut, United States
| | - Brett Bade
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System West Haven, Connecticut, United States; Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Yale School of Medicine, New Haven, Connecticut, United States
| | - Craig G Gunderson
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System West Haven, Connecticut, United States; Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Yale School of Medicine, New Haven, Connecticut, United States
| | - Kathleen M Akgün
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System West Haven, Connecticut, United States; Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Yale School of Medicine, New Haven, Connecticut, United States
| | - Alexandria Brackett
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, Connecticut, United States
| | - Hilary Cain
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Yale School of Medicine, New Haven, Connecticut, United States
| | - Lynn Tanoue
- Yale School of Medicine, New Haven, Connecticut, United States
| | - Lori A Bastian
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System West Haven, Connecticut, United States; Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Yale School of Medicine, New Haven, Connecticut, United States.
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Kunitomo Y, Young G, Datta R, Korn LL, Tanoue L, Gautam S. A 62-Year-Old Woman With Lung Cancer, Ulcerating Rash, and Rapidly Progressive Hypoxemia. Chest 2021; 158:e191-e196. [PMID: 33036118 PMCID: PMC7533682 DOI: 10.1016/j.chest.2020.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/08/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022] Open
Abstract
CASE PRESENTATION A 62-year-old nonsmoking woman with no medical history initially presented with a 3-month history of rash. A painful, erythematous exanthem had progressed from her forehead, cheeks, and upper chest to her eyes (heliotrope rash) and hands, primarily involving the extensor surface finger joints with prominent digital ulceration.
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Affiliation(s)
- Yukiko Kunitomo
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Grant Young
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Rupak Datta
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Lisa L Korn
- Section of Rheumatology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Lynn Tanoue
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Samir Gautam
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
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Bade BC, Gan G, Li F, Lu L, Tanoue L, Silvestri GA, Irwin ML. "Randomized trial of physical activity on quality of life and lung cancer biomarkers in patients with advanced stage lung cancer: a pilot study". BMC Cancer 2021; 21:352. [PMID: 33794808 PMCID: PMC8015735 DOI: 10.1186/s12885-021-08084-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lung cancer survivors need more options to improve quality of life (QoL). It is unclear to what extent patients with advanced stage disease are willing to participate in home-based physical activity (PA) and if these interventions improve QoL. The goal of our study was to determine interest in participating in our 3-month home-based walking regimen in patients with advanced stage lung cancer. We used a randomized design to evaluate for potential benefit in PA and patient-reported outcomes. METHODS We performed an open-label, 1:1 randomized trial in 40 patients with stage III/IV non-small cell lung cancer (NSCLC) evaluating enrollment rate, PA, QoL, dyspnea, depression, and biomarkers. Compared to usual care (UC), the intervention group (IG) received an accelerometer, in-person teaching session, and gain-framed text messages for 12 weeks. RESULTS We enrolled 56% (40/71) of eligible patients. Participants were on average 65 years and enrolled 1.9 years from diagnosis. Most patients were women (75%), and receiving treatment (85%) for stage IV (73%) adenocarcinoma (83%). A minority of patients were employed part-time or full time (38%). Both groups reported low baseline PA (IG mean 37 (Standard deviation (SD) 46) vs UC 59 (SD 56) minutes/week; p = 0.25). The IG increased PA more than UC (mean change IG + 123 (SD 212) vs UC + 35 (SD 103) minutes/week; p = 0.051)). Step count in the IG was not statistically different between baseline (4707 step/day), week 6 (5605; p = 0.16), and week 12 (4606 steps/day; p = 0.87). The intervention improved EORTC role functioning domain (17 points; p = 0.022) with borderline improvement in dyspnea (- 13 points; p = 0.051) compared to UC. In patients with two blood samples (25%), we observed a significant increase in soluble PD-1 (219.8 (SD 54.5) pg/mL; p < 0.001). CONCLUSIONS Our pilot trial using a 3-month, home-based, mobile health intervention enrolled over half of eligible patients with stage III and IV NSCLC. The intervention increased PA, and may improve several aspects of QoL. We also identified potential biomarker changes relevant to lung cancer biology. Future research should use a larger sample to examine the effect of exercise on cancer biomarkers, which may mediate the association between PA and QoL. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov ( NCT03352245 ).
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Affiliation(s)
- Brett C Bade
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, P.O. Box 208057 300 Cedar Street TAC - 441 South, New Haven, CT, 06520-8057, USA.
| | - Geliang Gan
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, USA
| | - Fangyong Li
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, USA
| | - Lingeng Lu
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, USA
| | - Lynn Tanoue
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, P.O. Box 208057 300 Cedar Street TAC - 441 South, New Haven, CT, 06520-8057, USA
| | - Gerard A Silvestri
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Medical University of South Carolina, New Haven, USA
| | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, USA
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Ye Q, Wu J, Lu Y, Naganawa M, Gallezot JD, Ma T, Liu Y, Tanoue L, Detterbeck F, Blasberg J, Chen MK, Casey M, Carson RE, Liu C. Improved discrimination between benign and malignant LDCT screening-detected lung nodules with dynamic over static 18F-FDG PET as a function of injected dose. Phys Med Biol 2018; 63:175015. [PMID: 30095083 PMCID: PMC6158045 DOI: 10.1088/1361-6560/aad97f] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer mortality rate can be significantly reduced by up to 20% through routine low-dose computed tomography (LDCT) screening, which, however, has high sensitivity but low specificity, resulting in a high rate of false-positive nodules. Combining PET with CT may provide more accurate diagnosis for indeterminate screening-detected nodules. In this work, we investigated low-dose dynamic 18F-FDG PET in discrimination between benign and malignant nodules using a virtual clinical trial based on patient study with ground truth. Six patients with initial LDCT screening-detected lung nodules received 90 min single-bed PET scans following a 10 mCi FDG injection. Low-dose static and dynamic images were generated from under-sampled list-mode data at various count levels (100%, 50%, 10%, 5%, and 1%). A virtual clinical trial was performed by adding nodule population variability, measurement noise, and static PET acquisition start time variability to the time activity curves (TACs) of the patient data. We used receiver operating characteristic (ROC) analysis to estimate the classification capability of standardized uptake value (SUV) and net uptake constant K i from their simulated benign and malignant distributions. Various scan durations and start times (t *) were investigated in dynamic Patlak analysis to optimize simplified acquisition protocols with a population-based input function (PBIF). The area under curve (AUC) of ROC analysis was higher with increased scan duration and earlier t *. Highly similar results were obtained using PBIF to those using image-derived input function (IDIF). The AUC value for K i using optimized t * and scan duration with 10% dose was higher than that for SUV with 100% dose. Our results suggest that dynamic PET with as little as 1 mCi FDG could provide discrimination between benign and malignant lung nodules with higher than 90% sensitivity and specificity for patients similar to the pilot and simulated population in this study, with LDCT screening-detected indeterminate lung nodules.
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Affiliation(s)
- Qing Ye
- Department of Radiology and Biomedical Imaging, Yale University, USA
- Department of Engineering Physics, Tsinghua University, China
- Key Laboratory of Particle & Radiation Imaging, Ministry of Education (Tsinghua University), China
| | - Jing Wu
- Department of Radiology and Biomedical Imaging, Yale University, USA
| | - Yihuan Lu
- Department of Radiology and Biomedical Imaging, Yale University, USA
| | - Mika Naganawa
- Department of Radiology and Biomedical Imaging, Yale University, USA
| | | | - Tianyu Ma
- Department of Engineering Physics, Tsinghua University, China
- Key Laboratory of Particle & Radiation Imaging, Ministry of Education (Tsinghua University), China
| | - Yaqiang Liu
- Department of Engineering Physics, Tsinghua University, China
- Key Laboratory of Particle & Radiation Imaging, Ministry of Education (Tsinghua University), China
| | - Lynn Tanoue
- Yale Lung Screening and Nodule Program, Department of Internal Medicine, Yale University, USA
| | - Frank Detterbeck
- Thoracic Oncology Program, Yale Cancer Center, Yale University, USA
| | - Justin Blasberg
- Thoracic Oncology Program, Yale Cancer Center, Yale University, USA
| | - Ming-Kai Chen
- Department of Radiology and Biomedical Imaging, Yale University, USA
| | - Michael Casey
- Molecular Imaging, Siemens Medical Solutions USA, Inc., USA
| | - Richard E. Carson
- Department of Radiology and Biomedical Imaging, Yale University, USA
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, USA
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Cartmel B, Jones B, Fucito L, Tanoue L, Sather P, Toll B. Lung Cancer Screening at Smilow Cancer Hospital and Yale Cancer Center. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Rothberg BG, Das R, Jackson L, Lazowski H, Bai Y, O'Neill D, Roberts S, Rothberg J, Herbst R, Kim A, Boffa D, Rimm D, Detterbeck F, Tanoue L. P1.05-017 The Prognostic Impact of EGFR, KRAS and TP53 Somatic Mutations in Curatively Resected Early-Stage Lung Adenocarcinomas. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Reid AE, Tanoue L, Detterbeck F, Michaud GC, McCorkle R. The Role of the Advanced Practitioner in a Comprehensive Lung Cancer Screening and Pulmonary Nodule Program. J Adv Pract Oncol 2015; 5:440-6. [PMID: 26328217 PMCID: PMC4530114 DOI: 10.6004/jadpro.2014.5.6.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Amanda E Reid
- 1University of Texas MD Anderson Cancer Center, Houston, Texas; 2Yale University School of Medicine, New Haven, Connecticut; 3Yale University School of Nursing, New Haven, Connecticut
| | - Lynn Tanoue
- 1University of Texas MD Anderson Cancer Center, Houston, Texas; 2Yale University School of Medicine, New Haven, Connecticut; 3Yale University School of Nursing, New Haven, Connecticut
| | - Frank Detterbeck
- 1University of Texas MD Anderson Cancer Center, Houston, Texas; 2Yale University School of Medicine, New Haven, Connecticut; 3Yale University School of Nursing, New Haven, Connecticut
| | - Gaetane Celine Michaud
- 1University of Texas MD Anderson Cancer Center, Houston, Texas; 2Yale University School of Medicine, New Haven, Connecticut; 3Yale University School of Nursing, New Haven, Connecticut
| | - Ruth McCorkle
- 1University of Texas MD Anderson Cancer Center, Houston, Texas; 2Yale University School of Medicine, New Haven, Connecticut; 3Yale University School of Nursing, New Haven, Connecticut
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Erb C, Soulos P, Tanoue L, Gross C. Surveillance Practice Patterns After Curative Intent Therapy for Stage I Non-small Cell Lung Cancer in the Medicare Population. Chest 2014. [DOI: 10.1378/chest.1992085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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14
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Dy R, Tanoue L. Targeted Testing for Latent Tuberculosis: How Much Do We Know? Chest 2014. [DOI: 10.1378/chest.1988066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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15
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16
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Reid A, Detterbeck F, Michaud G, Guillod P, Tanoue L. Physicians' Assessment of Lung Cancer Risk and the Influence of Prediction Models on Decisions Relating to Lung Screening. Chest 2013. [DOI: 10.1378/chest.1662734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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17
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Vest MT, Herrin J, Soulos PR, Decker RH, Tanoue L, Michaud G, Kim AW, Detterbeck F, Morgensztern D, Gross CP. Use of new treatment modalities for non-small cell lung cancer care in the Medicare population. Chest 2013. [PMID: 23187634 DOI: 10.1378/chest.12-1149] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many older patients with early stage non-small cell lung cancer (NSCLC) do not receive curative therapy. New surgical techniques and radiation therapy modalities, such as video-assisted thoracoscopic surgery (VATS), potentially allow more patients to receive treatment. The adoption of these techniques and their impact on access to cancer care among Medicare beneficiaries with stage I NSCLC are unknown. METHODS We used the Surveillance, Epidemiology and End Results-Medicare database to identify patients with stage I NSCLC diagnosed between 1998 and 2007. We assessed temporal trends and created hierarchical generalized linear models of the relationship between patient, clinical, and regional factors and type of treatment. RESULTS The sample comprised 13,458 patients with a mean age of 75.7 years. The proportion of patients not receiving any local treatment increased from 14.6% in 1998 to 18.3% in 2007. The overall use of surgical resection declined from 75.2% to 67.3% ( P , .001), although the proportion of patients undergoing VATS increased from 11.3% to 32.0%. Similarly, although the use of new radiation modalities increased from 0% to 5.2%, the overall use of radiation remained stable. The oldest patients were less likely to receive surgical vs no treatment (OR, 0.12; 95% CI, 0.09-0.16) and more likely to receive radiation vs surgery (OR, 13.61; 95% CI, 9.75-19.0). CONCLUSION From 1998 to 2007, the overall proportion of older patients with stage I NSCLC receiving curative local therapy decreased, despite the dissemination of newer, less-invasive forms of surgery and radiation.
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Affiliation(s)
- Michael T Vest
- Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, New Haven, CT
| | - Jeph Herrin
- Department of Internal Medicine, Section of Cardiology, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT; Health Research and Educational Trust, Chicago, IL
| | - Pamela R Soulos
- Department of Internal Medicine, Section of General Internal Medicine, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Roy H Decker
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT; Department of Therapeutic Radiology, New Haven, CT
| | - Lynn Tanoue
- Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, New Haven, CT
| | - Gaetane Michaud
- Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, New Haven, CT
| | - Anthony W Kim
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT; Department of Surgery, Section of Thoracic Surgery, New Haven, CT
| | - Frank Detterbeck
- Department of Surgery, Section of Thoracic Surgery, New Haven, CT
| | - Daniel Morgensztern
- Department of Internal Medicine, Section of Medical Oncology, New Haven, CT; Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Cary P Gross
- Department of Internal Medicine, Section of General Internal Medicine, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT.
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18
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Anagnostou VK, Dimou AT, Botsis T, Killiam EJ, Gustavson MD, Homer RJ, Boffa D, Zolota V, Dougenis D, Tanoue L, Gettinger SN, Detterbeck FC, Syrigos KN, Bepler G, Rimm DL. Molecular classification of nonsmall cell lung cancer using a 4-protein quantitative assay. Cancer 2011; 118:1607-18. [PMID: 22009766 DOI: 10.1002/cncr.26450] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 04/08/2011] [Accepted: 05/17/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND The importance of definitive histological subclassification has increased as drug trials have shown benefit associated with histology in nonsmall-cell lung cancer (NSCLC). The acuity of this problem is further exacerbated by the use of minimally invasive cytology samples. Here we describe the development and validation of a 4-protein classifier that differentiates primary lung adenocarcinomas (AC) from squamous cell carcinomas (SCC). METHODS Quantitative immunofluorescence (AQUA) was employed to measure proteins differentially expressed between AC and SCC followed by logistic regression analysis. An objective 4-protein classifier was generated to define likelihood of AC in a training set of 343 patients followed by validation in 2 independent cohorts (n = 197 and n = 235). The assay was then tested on 11 cytology specimens. RESULTS Statistical modeling selected thyroid transcription factor 1 (TTF1), CK5, CK13, and epidermal growth factor receptor (EGFR) to generate a weighted classifier and to identify the optimal cutpoint for differentiating AC from SCC. Using the pathologist's final diagnosis as the criterion standard, the molecular test showed a sensitivity of 96% and specificity of 93%. Blinded analysis of the validation sets yielded sensitivity and specificity of 96% and 97%, respectively. Our assay classified the cytology specimens with a specificity of 100% and sensitivity of 87.5%. CONCLUSIONS Molecular classification of NSCLC using an objective quantitative test can be highly accurate and could be translated into a diagnostic platform for broad clinical application.
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Affiliation(s)
- Valsamo K Anagnostou
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
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19
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Anagnostou VK, Botsis T, Killiam E, Zolota V, Dougenis D, Tanoue L, Detterbeck FC, Syrigos KN, Bepler G, Rimm D. Molecular classification of non-small cell lung cancer using a four protein quantitative assay. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.10528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Anagnostou VK, Lowery FJ, Zolota V, Tzelepi V, Gopinath A, Liceaga C, Panagopoulos N, Frangia K, Tanoue L, Boffa D, Gettinger S, Detterbeck F, Homer RJ, Dougenis D, Rimm DL, Syrigos KN. High expression of BCL-2 predicts favorable outcome in non-small cell lung cancer patients with non squamous histology. BMC Cancer 2010; 10:186. [PMID: 20459695 PMCID: PMC2875218 DOI: 10.1186/1471-2407-10-186] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 05/09/2010] [Indexed: 01/16/2023] Open
Abstract
Background Bcl-2 promotes cell survival by inhibiting adapters needed for the activation and cleavage of caspases thus blocking the proteolytic cascade that ultimately dismantles the cell. Bcl-2 has been investigated as a prognostic factor in non small cell lung cancer (NSCLC) patients with conflicting results. Methods Here, we quantitatively assessed Bcl-2 expression in two large and independent cohorts to investigate the impact of Bcl-2 on survival. AQUA®, a fluorescent-based method for analysis of in situ protein expression, was used to measure Bcl-2 protein levels and classify tumors by Bcl-2 expression in a cohort of 180 NSCLC patients. An independent cohort of 354 NSCLC patients was used to validate Bcl-2 classification and evaluate outcome. Results Fifty % and 52% of the cases were classified as high expressers in training and validation cohorts respectively. Squamous cell carcinomas were more likely to be high expressers compared to adenocarcinomas (63% vs. 45%, p = 0.002); Bcl-2 was not associated with other clinical or pathological characteristics. Survival analysis showed that patients with high BCL-2 expression had a longer median survival compared to low expressers (22 vs. 17.5 months, log rank p = 0.014) especially in the subset of non-squamous tumors (25 vs. 13.8 months, log rank p = 0.04). Multivariate analysis revealed an independent lower risk for all patients with Bcl-2 expressing tumors (HR = 0.53, 95% CI 0.37-0.75, p = 0.0003) and for patients with non-squamous tumors (HR = 0.5, 95% CI 0.31-0.81, p = 0.005). Conclusions Bcl-2 expression defines a subgroup of patients with a favorable outcome and may be useful for prognostic stratification of NSCLC patients.
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Affiliation(s)
- Valsamo K Anagnostou
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
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Anagnostou VK, Kolokytha P, Dimou A, Killiam EJ, Zolota V, Dougenis D, Frangia K, Tanoue L, Detterbeck FC, Syrigos KN, Bepler G, Rimm DL. Abstract 4643: A novel 3-biomarker quantitative protein assay predicts survival in stage I lung squamous cell carcinomas. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-4643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Primary lung squamous cell carcinomas (SCC) form a distinct group in terms of molecular characteristics. There is no single assay that predicts outcome and selects optimal treatment for early stage SCC, especially for stage I where there is a 33-60% risk of disease-related death within 5 years after “curative” surgical treatment. The current staging system fails to select early stage SCC patients likely to recur and die of their disease after surgery. Emerging data using gene-expression profiling has shown that lung SCCs can be classified into high and low risk groups by signatures associated with down-regulation of epidermal development genes. However, the development of such molecular tools has been limited by lack of reproducibility and independent validation. Here we develop and validate a 3-protein classifier that stratifies early stage SCC by risk.
Quantitative immunofluorescence (AQUA®) was employed to measure proteins known to be part of SCC gene risk signatures; Cytokeratins 5 (CK5), 8 (CK8), 13 (CK13), 14 (CK14), 15 (CK15), 16 (CK16), 17 (CK17), 18 (CK18) and 19 (CK19) were analyzed in a multivariate Cox proportional hazards regression model following stepwise selection with backward elimination resulting in a 3-protein weighted classifier. A risk score was calculated combining binarized quantitative measurements of CK13, CK14 and CK17 in a training set of 160 SCC patients. X-tile software was employed to identify the optimal cut off risk score and classify patients into high and risk groups; this cut point was applied to an independent cohort of 76 SCC patients.
Weighted expression of CK13, CK14 and CK17 was used to build a model to classify patients in high and low risk groups. Survival analysis showed that patients in the low risk group had a longer median overall survival compared to the high risk group (46 vs. 28 months, log rank p=0.004). Multivariate analysis revealed an independent increased risk of death for all SCC patients with high scores (HR=1.76, 95% CI 1.28-2.5, p=0.001). Then the 3-biomarker classifier was tested on an independent cohort of 76 SCC patients which showed a 30.1 vs. 55 month median survival for high and low risk patients respectively (log rank p=0.001). Multivariate analysis in this cohort adjusting for age, gender and stage verified the significant prognostic role of the classifier (HR=1.88, 95% CI 1.22-2.9, p=0.004). The independent prognostic value of our model was especially valuable in stage I patients (HR=1.91, 95% CI 1.15-3.17, p=0.013) and even more compelling for stage I patients that were treated with surgery only (HR=2.92, 95% CI 1.31-6. 25, p=0.009).
We developed and validated a quantitative biomarker-based independent prognostic model that accurately stratifies SCC patients for risk of disease specific death. Our classifier could be used to determine which stage I SCC patients can be treated with surgery alone and which would benefit from adjuvant chemotherapy.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4643.
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Affiliation(s)
| | | | - Anastasios Dimou
- 1Dept of Pathology, Yale University School of Medicine, New Haven, CT
| | | | | | | | | | - Lynn Tanoue
- 5Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, CT
| | | | | | - Gerold Bepler
- 8Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL
| | - David L. Rimm
- 1Dept of Pathology, Yale University School of Medicine, New Haven, CT
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Anagnostou VK, Bepler G, Syrigos KN, Tanoue L, Gettinger S, Homer RJ, Boffa D, Detterbeck F, Rimm DL. High Expression of Mammalian Target of Rapamycin Is Associated with Better Outcome for Patients with Early Stage Lung Adenocarcinoma. Clin Cancer Res 2009; 15:4157-64. [DOI: 10.1158/1078-0432.ccr-09-0099] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Anagnostou V, Lowery F, Syrigos K, Frangia K, Zolota V, Panagopoulos N, Dougenis D, Tanoue L, Detterbeck F, Homer R, Rimm D. Association of expression of bcl-2 with outcome in non-small cell lung cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e22039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22039 Background: BCL-2 promotes cell survival by inhibiting adapters needed for the activation and cleavage of caspases thus blocking the proteolytic cascade that ultimately dismantles the cell. It is preferentially expressed in squamous cell carcinomas of the lung and has been investigated as a potential prognostic parameter in lung cancer patients with conflicting results. Here, we quantitatively assessed BCL-2 protein expression in two large and independent data sets to investigate the impact of BCL-2 on patient survival. Methods: AQUA, a fluorescent-based method for analysis of in situ protein expression, was used to measure BCL-2 protein levels and classify tumor by BCL-2 expression in a cohort of 180 lung cancer patients from Yale New Haven Hospital (training set). An independent cohort of 360 lung cancer patients from Sotiria General Hospital and Patras University Hospital in Greece was used to validate BCL-2 classification and evaluate outcome (validation set). Results: Tumors expressed BCL-2 in 57% and 53% of the cases in training and validation cohorts respectively and squamous cell carcinomas expressed higher levels of BCL-2 expression compared to adenocarcinomas (mean AQUA score 42 and 26 respectively, p=0.007); BCL-2 was not associated with other standard clinical or pathological characteristics. Survival analysis showed that patients with high BCL-2 expression had a longer median overall survival compared to the low expressers (20 vs 15 months, log rank p=0.016). Multivariate analysis revealed an independent lower risk of death for lung cancer patients with BCL-2 expressing tumors (HR=0.58, 95% CI 0.39–0.86, p=0.006). Conclusions: BCL-2 expression defines a subgroup of patients with a favorable outcome and may be useful for prognostic stratification of lung cancer patients as well as incorporation of BCL-2 into clinical decisions. [Table: see text]
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Affiliation(s)
- V. Anagnostou
- Yale University School of Medicine, New Haven, CT; Yale University School of Medicine, New Haven, CT; Yale Cancer Center, Yale University School of Medicine, New Haven, CT; Sotiria General Hospital, Athens, Greece; University of Patras, Patras, Greece
| | - F. Lowery
- Yale University School of Medicine, New Haven, CT; Yale University School of Medicine, New Haven, CT; Yale Cancer Center, Yale University School of Medicine, New Haven, CT; Sotiria General Hospital, Athens, Greece; University of Patras, Patras, Greece
| | - K. Syrigos
- Yale University School of Medicine, New Haven, CT; Yale University School of Medicine, New Haven, CT; Yale Cancer Center, Yale University School of Medicine, New Haven, CT; Sotiria General Hospital, Athens, Greece; University of Patras, Patras, Greece
| | - K. Frangia
- Yale University School of Medicine, New Haven, CT; Yale University School of Medicine, New Haven, CT; Yale Cancer Center, Yale University School of Medicine, New Haven, CT; Sotiria General Hospital, Athens, Greece; University of Patras, Patras, Greece
| | - V. Zolota
- Yale University School of Medicine, New Haven, CT; Yale University School of Medicine, New Haven, CT; Yale Cancer Center, Yale University School of Medicine, New Haven, CT; Sotiria General Hospital, Athens, Greece; University of Patras, Patras, Greece
| | - N. Panagopoulos
- Yale University School of Medicine, New Haven, CT; Yale University School of Medicine, New Haven, CT; Yale Cancer Center, Yale University School of Medicine, New Haven, CT; Sotiria General Hospital, Athens, Greece; University of Patras, Patras, Greece
| | - D. Dougenis
- Yale University School of Medicine, New Haven, CT; Yale University School of Medicine, New Haven, CT; Yale Cancer Center, Yale University School of Medicine, New Haven, CT; Sotiria General Hospital, Athens, Greece; University of Patras, Patras, Greece
| | - L. Tanoue
- Yale University School of Medicine, New Haven, CT; Yale University School of Medicine, New Haven, CT; Yale Cancer Center, Yale University School of Medicine, New Haven, CT; Sotiria General Hospital, Athens, Greece; University of Patras, Patras, Greece
| | - F. Detterbeck
- Yale University School of Medicine, New Haven, CT; Yale University School of Medicine, New Haven, CT; Yale Cancer Center, Yale University School of Medicine, New Haven, CT; Sotiria General Hospital, Athens, Greece; University of Patras, Patras, Greece
| | - R. Homer
- Yale University School of Medicine, New Haven, CT; Yale University School of Medicine, New Haven, CT; Yale Cancer Center, Yale University School of Medicine, New Haven, CT; Sotiria General Hospital, Athens, Greece; University of Patras, Patras, Greece
| | - D. Rimm
- Yale University School of Medicine, New Haven, CT; Yale University School of Medicine, New Haven, CT; Yale Cancer Center, Yale University School of Medicine, New Haven, CT; Sotiria General Hospital, Athens, Greece; University of Patras, Patras, Greece
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Hajizadeh N, Rosenzweig J, Tanoue L. RESPIRATORY DISTRESS AFTER SMOKING A CIGARETTE. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.731a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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26
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Friedman LN, Nash ER, Bryant J, Henry S, Shi J, D'Amato J, Khaled GH, Russi MB, O'Connor PG, Edberg SC, Pisani MA, Cain HC, Tanoue L, Weissman DN. High rate of negative results of tuberculin and QuantiFERON tests among individuals with a history of positive skin test results. Infect Control Hosp Epidemiol 2006; 27:436-41. [PMID: 16671022 DOI: 10.1086/503690] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Accepted: 09/08/2005] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate individuals at high risk for tuberculosis exposure who had a history of a positive tuberculin skin test (TST) result in order to determine the prevalence of unsuspected negative TST results. To confirm these findings with the QuantiFERON-TB test (QFT), an in vitro whole-blood assay that measures tuberculin-induced secretion of interferon-gamma. METHODS This survey was conducted from November 2001 through December 2003 at 3 sites where TST screening is regularly done. Detailed histories and reviews of medical records were performed. TSTs were placed and read by 2 experienced healthcare workers, and blood was drawn for QFT. Any subject with a negative result of an initial TST during the study (induration diameter, <10 mm) underwent a second TST and a second QFT. The TST-negative group comprised individuals for whom both TSTs had an induration diameter of <10 mm. The confirmed-negative group comprised individuals for whom both TSTs yielded no detectable induration and results of both QFTs were negative. RESULTS A total of 67 immunocompetent subjects with positive results of a previous TST were enrolled in the study. Of 56 subjects who completed the TST protocol, 25 (44.6%; 95% confidence interval [CI], 31.6%-57.6%) were TST negative (P<.001). Of 31 subjects who completed the TST protocol and the QFT protocol, 8 (25.8%; 95% CI, 10.4%-41.2%) were confirmed negative (P<.005). CONCLUSIONS A significant proportion of subjects with positive results of a previous TST were TST negative in this study, and a subset of these were confirmed negative. These individuals' TST status may have reverted or may never have been positive. It will be important in future studies to determine whether such individuals lack immunity to tuberculosis and whether they should be considered for reentry into tuberculosis screening programs.
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Affiliation(s)
- Lloyd N Friedman
- Pulmonary and Critical Care Section, Department of Medicine, Yale University School of Medicine, New Haven, CT 06520-8057, USA.
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Abstract
Examining case studies from patients with interstitial lung diseases (ILDs) is important in order to evaluate current diagnosis and treatment options. Two cases will be discussed; the first case examines a patient with usual interstitial pneumonia, and the second case examines a patient with subacute ILD and elements to suggest a forme fruste presentation of an unclassifiable connective tissue disease. Each case highlights components of the differential diagnosis, as well as reviews the treatments and prognoses of these patients. The cases provide clinical pearls that are designed to enhance the reader's understanding of ILDs.
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Affiliation(s)
- Paul W Noble
- Pulmonary and Critical Care Section, Yale University School of Medicine, Yale University School of Medicine, 333 Cedar St, PO Box 208057, New Haven, CT 06520-8057, USA.
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Carley WW, Tanoue L, Merker M, Gillis CN. Isolation of rabbit pulmonary microvascular endothelial cells and characterization of their angiotensin converting enzyme activity. Pulm Pharmacol 1990; 3:35-40. [PMID: 1966901 DOI: 10.1016/0952-0600(90)90007-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An in vitro model using cultured rabbit pulmonary endothelial cells of microvascular origin was developed to define the luminal surface membrane characteristics of microvascular endothelium. Endothelial cells were isolated from peripheral lung segments and sorted after preferential uptake of a fluorescent derivative, diiodoindocarbo cyanine acetylated-LDL. Cells were further characterized by demonstrating angiotensin converting enzyme (ACE) on their surface by means of indirect immunofluorescence. ACE activity and its pharmacologic modification were then studied as functional assays of cell activity. Hydrolysis of Benz-phe-ala-pro (BPAP), a synthetic substrate for ACE was saturable over a concentration range of 1 to 100 microns. Thus, BPAP hydrolysis in cultured microvascular endothelial cells behaves overall in a manner similar to that seen in large resistance vessels except that a portion of the hydrolysis is not inhibited by captopril, an ACE-specific inhibitor, indicating the presence of another protease capable of BPAP hydrolysis. Accordingly, this system can be used to compare ACE and other protease kinetics in microvessel cells with those of large vessel endothelium or perfused lungs.
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Affiliation(s)
- W W Carley
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510
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