5 p a g e - parto-rt.com · cancer registries (npcr) and the national cancer ... median survival...

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Introduction/Background

Non–small-cell lung cancer patients with malignant pleural effusion have a poor

overall median survival

(4.3 months). VEGF is a

key regulator of pleural

effusion production. It is

unknown if

pharmacological

inhibition of VEGF

signaling modifies the

disease course of non–

small-cell lung cancer

patients with recurrent

malignant pleural

effusion. We report the

final results of a single-

arm phase II clinical trial of the VEGF receptor inhibitor, vandetanib, combined

with intrapleural catheter placement in patients with non–small-cell lung cancer

and recurrent malignant pleural effusion, to determine whether vandetanib

reduces time to pleurodesis.

Patients and Methods

Non–small-cell lung cancer

patients with proven metastatic

disease to the pleural space using

pleural fluid cytology or pleural

biopsy who required intrapleural

catheter placement were eligible

for enrollment. On the same day

of the intrapleural catheter

insertion, the patients were

started on a daily oral dose of 300

mg vandetanib, for a maximum of

10 weeks. The primary end point

was time to pleurodesis, with

1. Vandetanib and Indwelling Pleural Catheter for Non–

Small-Cell Lung Cancer With Recurrent Malignant Pleural

Effusion

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response rate as the secondary end point. Exploratory analyses included

measurement of pleural fluid cytokines and angiogenic factors before and during

therapy.

Results

Twenty eligible patients were included in the trial. Eleven patients completed 10

weeks of treatment. Median time to pleurodesis was 35 days (95% confidence

interval, 15-not applicable). Median time to pleurodesis in the historical cohort

was 63 days (95% confidence interval, 45-86) when adjusted for Eastern

Cooperative Oncology Group performance status ≤ 2.

Conclusion

Vandetanib therapy was well tolerated; however, it did not significantly reduce

time to pleurodesis.

Background

In this study, we examined trends in

the radiotherapy dose prescribed and

the effect of dose escalation on

survival in patients with stage III lung

cancer.

Materials and Methods

Radiation dose prescription patterns

were analyzed for 38,848 patients in

the National Cancer Database with

clinical stage III disease who

underwent concurrent

chemoradiation between 2004 and 2011 to a dose between 57 and 80 Gy. Survival

information was available for patients diagnosed from 2004 to 2006 (n = 12,024).

Overall survival (OS) was estimated using Kaplan-Meier methods. Cox

proportional hazard regression was used to estimate hazard ratios (HRs).

Results

The percentage of patients treated to ≥ 64 Gy increased from 50% in 2004 to 62%

in 2011 (P < .001). The 5-year OS was 12% for patients treated between 57 and

59.3 Gy, 14% for patients treated at 59.4 to 62.9 Gy, 16% for patients treated at

63 to 66 Gy and 66.1 to 73.9 Gy, and 13% for patients treated at 74 to 80 Gy (P <

.0001). In multivariate analysis, the estimated HR (95% confidence interval) was

Clinical Lung Cancer, Volume 15, Issue 5, September 2014, Pages 379–386

2. The Effect of Radiotherapy Dose on Survival in Stage III

Non–Small-Cell Lung Cancer Patients Undergoing

Definitive Chemoradiotherapy

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1.3 (1.1-1.6) for 57 to 59.3 Gy, 1.0 (0.9-1.2) for 59.4 to 62.9 Gy, 0.9 (0.9-1.2) for

63 to 66 Gy, 0.9 (0.8-1.1) for 66.1 to 73.9 Gy, and 1.0 (referent) for the 74 to 80

Gy cohort. There was no significant difference in the HR for the dose groups >

59.4 Gy compared with the 74 to 80 Gy cohort.

Conclusion

There was no improvement in OS with radiotherapy dose escalation beyond 59.4

Gy for patients with unresectable clinical stage III lung cancer treated

with chemoradiation.

Objectives

The aim of this review is to present the current role of two techniques of extensive

mediastinal dissection, in the staging of lung cancer.

Materials and methods

The authors performed a search for original papers published in English language,

peer-reviewed journals.

Results

According to the published

evidence, definitions of VAMLA

and TEMLA are given and the

main elements of the operative

technique are briefly presented.

Extensiveness and completeness of

mediastinal lymph node dissection

using these techniques, their

diagnostic yield as well as

complications and use of hospital

resources are discussed. The role of

VAMLA and TEMLA in the contemporary staging of lung cancer is presented in

context of other staging techniques and the current clinical practice guidelines.


3. Optimal mediastinal staging in non-small cell lung

cancer: What is the role of TEMLA and VAMLA?

Department of Thoracic Surgery, Jagiellonian University, John Paul II

Hospital, Cracow, Poland

non-small cell lung cancer

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Conclusion

On the basis of the evidence currently available, it may be concluded that

VAMLA and TEMLA have no contemporarily use in the routine mediastinal

staging of lung cancer. This is because of their invasiveness and – at least for

TEMLA – high risk of complications and mortality, which renders it

unacceptable as a diagnostic procedure, and also due to the development of

equally accurate, but far less invasive techniques, i.e. EBUS-NA and EUS-NA.

Objective

The examination of lung cancer by histology type is important for

monitoring population trends that have implications for etiology and

prevention, screening and clinical diagnosis, prognosis and

treatment. We provide a comprehensive description of recent

histologic lung cancer incidence rates and trends in the USA using combined

population-based registry data for the entire nation.


Histologic lung cancer

incidence data was

analyzed from CDC's

National Program of

Cancer Registries (NPCR)

and the National Cancer

Institute's Surveillance,

Epidemiology and End

Results (SEER) Program.

Standardized rates and

trends were calculated for

men and women by age,

race/ethnicity, and U.S.

Census region. Rate ratios were examined for differences in rates between men

and women, and annual percent change was calculated to quantify changes in

incidence rates over time.

Lung Cancer, Volume 86, Issue 1, Pages 1–4, October 2014

4. Patterns in lung cancer incidence rates and trends by

histologic type in the United States, 2004–2009

Division of Cancer Prevention and Control, National Center for Chronic

Disease Prevention and Health Promotion, Centers for Disease Control and

Prevention (CDC), CDC 4770 Buford Highway NE, F-76 Chamblee, GA 30341,

USA

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Results

Trend analysis demonstrate that overall rates have decreased, but incidence has

remained stable for women aged 50 or older. Adenocarcinoma and squamous cell

carcinoma were the two most common histologic subtypes. Adenocarcinoma

rates continued to increase in men and women, and squamous cell rates increased

in women only. All histologic subtype rates for white women exceeded rates for

black women. Histologic rates for black men exceeded those for white men,

except for small cell carcinoma. The incidence rate for Hispanics was nearly half

the rate for blacks and whites.

Conclusion

The continuing rise in incidence of lung adenocarcinoma, the rise of squamous

cell cancer in women, and differences by age, race, ethnicity and region points to

the need to better understand factors acting in addition to, or in synergy with,

cigarette smoking that may be contributing to observed differences in lung cancer

histology.

Background

Genetic alterations in malignant pleural mesothelioma (MPM) patients are not

well-understood.

Patients and methods


5. Identification of actionable mutations in malignant

pleural mesothelioma

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Surgical specimens and tumor biopsies from 42 patients with MPM were

collected from 2003 to 2012. The samples were analyzed for mutations

in EGFR, KRAS, BRAF, PIK3CA, NRAS, MEK1, AKT1, PTEN, and HER2 and

amplifications in EGFR, MET, PIK3CA, FGFR1, and FGFR2. In addition, 21

patients’ samples were analyzed using amplicon-based massively parallel

sequencing for actionable mutations in 48 cancer-related genes.

Results

Genetic alterations were detected

in 4 patients (one KRAS mutation

and 3 PIK3CA amplifications).

Patients harboring genetic

alterations showed significantly

poorer survival than patients with

no genetic alterations. Moreover,

significance was maintained if the

patients only

harbored PIK3CA amplification. A

total 16 genetic mutations were

identified in the 9 patients’

samples (4 TP53 mutations,

3 APC mutations,

3 PIK3CA mutations, and

2 VHL mutations, etc.) by deep sequencing.

Conclusions

Genetic alterations that are potential targets for molecular targeted therapy were

detected in MPM. Amplicon-based massively parallel sequencing was shown to

have the advantage of more comprehensive genetic analysis. Further

investigation in a larger cohort is necessary to uncover more targetable genetic

alterations in MPM and to validate their clinical significance.


6. Retrospective evaluation of thromboembolic events in

patients with non-small cell lung cancer treated with

platinum-based chemotherapy

Department of Pulmonary Diseases, VU University Medical Center, de

Boelelaan 1117, 1081 HV Amsterdam, The Netherlands

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Abstract

Objectives

Thromboembolic events (TE) are

common in patients with cancer and are

potentially life-threatening. In lung

cancer, little is known about thrombosis

during chemotherapy treatment. The

aim of this study was to describe the

incidence of TE in patients with non-

small cell lung cancer (NSCLC),

occurring during treatment with

platinum-based chemotherapy.

Methods

We retrospectively selected patients with NSCLC treated with platinum-based

chemotherapy at the VU University Medical Center Amsterdam between 2000

and 2012. Patients who underwent recent surgery were excluded. All TE were

included that occurred from start of chemotherapy treatment until 30 days after

last administration.

Results

Among 784 included patients, 63

(8.0%) patients had 69 TE during

treatment. Forty-five venous TE

(VTE) and 24 arterial TE (ATE).

Six patients had multiple events

within treatment period, 3 of which

had simultaneous ATE and VTE. In

total, 613 patients were treated with

cisplatin, 119 patients received

carboplatin and 52 patients received both in first- or second-line treatment. In 8%

(55/665) of the patients exposed to cisplatin a TE had occurred vs. 5% (8/171) in

patients exposed to carboplatin (p = 0.42). The majority of TE occurred in the

first 2 cycles (70%). History of TE was related to occurrence of TE during

chemotherapy (p < 0.01). Median PFS was similar in patients with and without

TE (6.2 vs. 7.2 months, respectively; p = 0.10). Median OS was significantly

shorter in patients with TE (9.5 vs. 12.9 months, respectively; p = 0.03).

Conclusion

In our series, both ATE and VTE were a common finding during chemotherapy.

TE was a poor prognostic factor. No difference in TE incidence was found

between patients treated with cisplatin or carboplatin.


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Objectives

Population-based data on metastatic sites and

survival in site-specific metastases are lacking for lung cancer and for any cancer

because most cancer registries do not record metastases. This study uses a novel

population-based approach to identify metastases from both death certificates and

national inpatient data to describe metastatic pathways in lung cancer patients.


17,431 deceased lung cancer patients

diagnosed 2002–2010 were

identified from the nationwide

Swedish Cancer Registry, which is

based on compulsory reports. The

influence of age at diagnosis, sex, and

histological subtype on metastatic

spread was investigated. Survival in

metastatic lung cancer was assessed

by histology and metastatic site.

Results

The most frequent metastatic sites were the nervous system, bone, liver,

respiratory system, and adrenal gland. Liver (35%) and nervous system (47%)

metastases were common in patients with metastases from small cell lung cancer,

and bone (39%) and respiratory system (22%) metastases in adenocarcinoma.

Women (43% vs. 35%) and younger patients had more metastases to the nervous

system. Median survival after diagnosis was 13 months for non-metastatic and

five months for metastatic lung cancer. In this novel data, liver metastases

conferred the worst prognosis (three months), especially for large cell histology.

Bone metastases also featured poor survival, whereas survival in respiratory and

nervous system metastases was better.

Conclusion

Metastatic sites and survival in metastatic lung cancer is influenced by sex,

histological subtype, and age at diagnosis. Liver and bone metastases signal poor

survival, compared with nervous system metastases.

7. Metastatic sites and survival in lung cancer

Division of Molecular Genetic Epidemiology, German Cancer Research Centre

(DKFZ), 69120 Heidelberg, Germany


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Objectives

Hyponatremia is reported in about 15% of small cell lung cancer (SCLC).

Variable results of the prognostic significance of low plasmatic sodium (Napl)

have been reported. Our study was performed to investigate the prognostic role

of hyponatremia in SCLC patients treated in second-line with topotecan

chemotherapy.


Data were retrospectively collected

from a database including clinical

data from 631 patients enrolled in 6

prospective topotecan iv studies.

Final data were obtained from 564

patients in which data on baseline

Napl were available. Univariate and

multivariate analysis were carried out

to study the possible correlation

between Napl and second-line

clinical outcomes.

Results

Hyponatremia (Napl < 135 mequiv./l) was

present in 101 cases (17.9%). Napl was <125

mequiv./l in 16 patients (2.8%), 126–130

mequiv./l in 11 (2%), 130–134 mequiv./l in 74

(13.1%), while 463 patients (82.1%) showed

normal values. The median survival was 28.7

weeks in patients with normal Napl, and 21.1

weeks in patients with hyponatremia (p <

0.0001, HR = 1.67, 95%CI = 1.32–2.10). By

Cox multivariate analysis, hyponatremia was

associated with poorer prognosis (p = 0.0024, HR = 1.44, 95%CI = 1.13–1.82).

A not statistically significant trend of correlation between hyponatremia and

progression-free survival (p = 0.085, HR = 1.23, 95%CI 0.97–1.55) and response

rate (p = 0.5037, OR = 0.81, 95%CI 0.44–1.49) was observed.

8. Prognostic role of hyponatremia in 564 small cell lung

cancer patients treated with topotecan

Oncology Unit, University Hospital of Parma, Viale Antonio Gramsci, 14,

43126 Parma, Italy

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Conclusion

Hyponatremia is an independent prognostic factor for patients with SCLC treated

with topotecan in second-line setting. Further studies are needed to prospectically

confirm these results and to develop an optimal therapy for hyponatremic

patients.


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Background

The objective of this study was to evaluate the role of postoperative radiotherapy

(PORT) in the setting of adjuvant chemotherapy for pathological stage N2 (pN2)

non–small-cell lung cancer (NSCLC).

Materials and Methods

A retrospective review of 219 consecutive pN2 NSCLC patients who underwent

curative surgery followed by adjuvant chemotherapy was performed. Forty-one

patients additionally received PORT. Propensity scores for PORT receipt were

individually calculated and used for matching to compare the outcome between

patients who did (+) and did not (-) receive PORT. One hundred eleven patients

in the PORT (-) group and 38 patients in PORT (+) group were matched. Clinical

and pathologic characteristics were well-balanced.

Results

9. Role of Postoperative Radiotherapy After Curative

Resection and Adjuvant Chemotherapy for Patients With

Pathological Stage N2 Non–Small-Cell Lung Cancer: A

Propensity Score Matching Analysis

epartment of Radiation Oncology, Seoul National University College of

Medicine, Seoul, Republic of Korea

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The median follow-up duration was 48

months. In the matched patients, PORT

resulted in a significantly lower crude

locoregional relapse (43.2% vs.

23.7%; P = .032). Also, PORT was

associated with improved locoregional

control (LRC) rate (5-year LRC 63.7% vs.

48.6%; P = .036), but not distant

metastasis-free survival, disease-free

survival (DFS), and overall survival. An

exploratory subgroup analysis suggested a potential DFS benefit of PORT in

patients with multiple station mediastinal lymph node metastases (5-year DFS,

43.2% vs. 16.6%; P = .037) and squamous cell carcinoma histology (5-year DFS,

70.1% vs. 23.3%;P = .011).

Conclusions

Even in the setting of adjuvant chemotherapy, PORT significantly increased LRC

for patients with curatively resected pN2 NSCLC. Some subgroups appear to

benefit from PORT in terms of DFS and LRC. Individualized strategies based on

risk factors might be considered.

Importance Screening for lung cancer has the potential to reduce mortality, but

in addition to detecting aggressive tumors, screening will also detect indolent

tumors that otherwise may not cause clinical symptoms. These overdiagnosis

cases represent an important potential harm of screening because they incur

additional cost, anxiety, and morbidity associated with cancer treatment.

Objective To estimate overdiagnosis in the National Lung Screening Trial

(NLST).

Design, Setting, and Participants We used data from the NLST, a randomized

trial comparing screening using low-dose computed tomography (LDCT) vs chest

radiography (CXR) among 53 452 persons at high risk for lung cancer observed


10. over diagnosis in Low-Dose Computed Tomography

Screening for Lung Cancer

Department of Radiology, Duke University Medical Center, Durham, North

Carolina

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for 6.4 years, to estimate the excess number of lung cancers in the LDCT arm of

the NLST compared with the CXR arm.

Main Outcomes and Measures We calculated 2 measures of overdiagnosis: the

probability that a lung cancer detected by screening with LDCT is an

overdiagnosis (PS), defined as the excess lung cancers detected by LDCT divided

by all lung cancers detected by screening in the LDCT arm; and the number of

cases that were considered overdiagnosis relative to the number of persons

needed to screen to prevent 1 death from lung cancer.

Results During follow-up, 1089 lung cancers were reported in the LDCT arm

and 969 in the CXR arm of the NLST. The probability is 18.5% (95% CI, 5.4%-

30.6%) that any lung cancer detected by screening with LDCT was an

overdiagnosis, 22.5% (95% CI, 9.7%-34.3%) that a non–small cell lung cancer

detected by LDCT was an overdiagnosis, and 78.9% (95% CI, 62.2%-93.5%) that

a bronchioalveolar lung cancer

detected by LDCT was an

overdiagnosis. The number of

cases of overdiagnosis found

among the 320 participants who

would need to be screened in the

NLST to prevent 1 death from

lung cancer was 1.38.

Conclusions and

Relevance More than 18% of all

lung cancers detected by LDCT

in the NLST seem to be indolent,

and overdiagnosis should be

considered when describing the risks of LDCT screening for lung cancer.

JAMA Intern Med. 2014;174(2):269-274.

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Hispolon is isolated from P. igniarius and exhibits antitumor activity. Here, we

explored the effects of hispolon on the lung cancer A549 and H661 cells. Cells

were incubated with various concentrations of hispolon (0, 5, 10, 20, 40, 80 or

160 μM) for 12, 24, 48 or 72 h. Cell viability was examined by MTT assay. Cell

cycle and apoptosis assay were

assessed by flow cytometry. Hispolon

decreased cell viability in a dose- and

time-dependent manner. The cell

cycle distribution showed that

hispolon enhanced the accumulations

of the cells in G0/G1 phase.

Mechanically, hispolon decreased the

expression of G1-S transition-related

proteins: Cyclin D1, cyclin E, CDK2,

CDK4 and CDK6, but increased the

expression of CDK inhibitor

p21CIP1 and p27 Kip1. Moreover,

hispolon induced cell apoptosis

through activation of the

mitochondrial pathway, evidenced by

the loss of mitochondrial membrane

potential, the release of cytochrome c

into cytosol, and the cleavage of

caspase-9, caspase-3 and poly (ADP-

ribose) polymerase (PARP) in

hispolon-treated cells. Additionally,

hispolon enhanced the expression of

p53, specific silencing of which

almost completely reversed hispolon-

mediated antitumor activity. Moreover, hispolon treatment was more effective on

H661 cells than on A549 cells in inhibiting cell viability and inducing cell

apoptosis. Our results indicate that hispolon inhibits the cell viability, induces

G0/G1 cell cycle arrest and apoptosis in lung cancer cells and p53 plays a critical

role in hispolon-mediated antitumor activity.

11. The Anticancer Effects of Hispolon on Lung

Cancer Cells

Department of respiratory and cwritical care medicine, the first affiliated

hospital of Zhengzhou University

Biochem Biophys Res Commun. 2014 Sep 27. pii: S0006-291X(14)01726-4. doi: 10.1016/j.bbrc.2014.09.098.

P. igniarius

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BACKGROUND:

Lung cancer, particularly non-

small-cell lung cancer (NSCLC)

is the leading cause

of cancer mortality.

Chemotherapy combined

dendritic cells co-cultured with

cytokine-induced killer cells

(DC-CIK) immunotherapy has

been applied in advanced

NSCLC patients' treatment, but

couldn't provide consistent

beneficial results. Therefore, it is

necessary to evaluate the

efficiency and safety of

combination therapy to promote

the application.

METHODS:

A literature search for randomized controlled trials of NSCLC was conducted in

PubMed database. Before meta-analysis was performed, studies were evaluated

heterogeneity. Pooled risk ratios (RRs) were estimated and 95% confidence

intervals (CIs) were calculated using a fixed-effect model. Sensitivity analysis

was also performed.

RESULTS:

Six eligible trials were enrolled. Efficiency and safety of chemotherapy followed

by DC-CIK immunotherapy (experimental group) and chemotherapy alone

(control group) were compared. 1-year overall survival (OS) (P = 0.02) and

progression free survival (PFS) (P = 0.005) in the experimental group were

significantly increased compared with the control. Disease control rate (DCR)

12. Effectiveness and Safety of Chemotherapy Combined

with Dendritic Cells Co-Cultured with Cytokine-Induced

Killer Cells in the Treatment of Advanced Non-Small-

Cell Lung Cancer: A Systematic Review and Meta-Analysis

First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,

Tianjin, China; Tianjin University of Traditional Chinese Medicine, Tianjin,

China.

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(P = 0.006) rose significantly in experimental group. However, no significant

differences between the two groups were observed in 2-year OS (P = 0.21), 2-year

PFS (P = 0.10), overall response rate (ORR) (P = 0.76) and partial response (PR)

(P = 0.22). Temporary fever, anemia, leukopenia and nausea were the four major

adverse events (AEs) treated by chemotherapy. The incidence of anemia,

leukopenia and nausea in the experimental group was obviously lower than the

control group. Temporary fever rate was higher in experimental group than that

in the control, but could be alleviated by taking sufficient rest.

CONCLUSIONS:

Chemotherapy combined with DC-CIK immunotherapy showed superiority in

DCR, 1-year OS and PFS, and no more AEs appeared, however, there was no

significant improvement in ORR, PR, 2-year OS and PFS. As a whole, the

combination therapy is safer but modest in efficacy for advanced NSCLC

patients.

PLoS One. 2014 Sep 30;9(9):e108958. doi: 10.1371/journal.pone.0108958. eCollection 2014.

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PURPOSE:

Dual-energy (DE) radiographic imaging improves tissue

discrimination by separating soft from hard tissues in the

acquired images. This study was to establish a mathematic

model of DE imaging based on intrinsic properties of tissues and quantitatively

evaluate the feasibility of applying the DE imaging technique to tumor

localization in radiotherapy.

METHODS:

We investigated the dependence

of DE image quality on the

radiological equivalent path

length (EPL) of tissues with two

phantoms using a stereoscopic

x-ray imaging unit. 10 lung

cancer patients who underwent

radiotherapy each with gold

markers implanted in the tumor

were enrolled in the study

approved by the hospital's Ethics Committee. The displacements of the centroids

of the delineated gross tumor volumes (GTVs) in the digitally reconstructed

radiograph (DRR) and in the bone-canceled DE image were compared with the

averaged displacements of the centroids of gold markers to evaluate the feasibility

of using DE imaging for tumor localization.

RESULTS:

The results of the phantom study indicated that the contrast-to-noise ratio (CNR)

was linearly dependent on the difference of EPL and a mathematical model was

established. The objects and backgrounds corresponding to ΔEPL less than 0.08

are visually indistinguishable in the bone-canceled DE image. The analysis of

patient data showed that the tumor contrast in the bone-canceled images was

improved significantly as compared with that in the original radiographic images

and the accuracy of tumor localization using the DE imaging technique was

comparable with that of using fiducial makers.

CONCLUSION:

It is feasible to apply the technique for tumor localization in radiotherapy.

13. Feasibility Study of Dual Energy Radiographic Imaging

for Target Localization in Radiotherapy for Lung Tumors.

Department of Biomedical Engineering, Tianjin University, Tianjin, China.

PLoS One. 2014 Sep 30;9(9):e108823. doi: 10.1371/journal.pone.0108823. eCollection 2014.

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OBJECTIVES:

Higher risk of lung cancer has been noted in patients with type 2 diabetes mellitus

(DM). Some observational studies have shown a reduced risk of lung cancer in

DM patients taking metformin, but a dose-response relationship has never been

reported. The aim of this study is to exam the association between the dose of

metformin and the incidence oflung cancer in a Chinese population.

MATERIALS AND METHODS:

The dataset used for this nationwide population-based study is a cohort of 1

million subjects randomly sampled from individuals enrolled in the Taiwan

National Health Insurance system. We enrolled all subjects with newly diagnosed

type 2 DM between 1997 and 2007. Subjects with a diagnosis of neoplasm before

DM diagnosis, those using metformin before DM diagnosis, those with polycystic

ovary syndrome, and those with a DM diagnosis before their 15 years of age were

excluded. The demographic data and duration, cumulative dose and intensity of

metformin use were compared between patients developing lung cancer and those

without lung cancer.

RESULTS:

Totally, 47,356 subjects were identified. After adjusting for age, gender, and

modified Charlson Comorbidity Index score, the utilization of metformin was an

independent protecting factor, and the risk of developing lung cancer decreased

progressively with either the higher cumulative dose or the higher intensity of

metformin use.

CONCLUSIONS:

14. Metformin decreases lung cancer risk in diabetic

patients in a dose-dependent manner.

Division of Pulmonary and Critical Care Medicine, Department of Internal

Medicine, Kaohsiung Medical University Hospital, Taiwan.

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This study revealed that the use of metformin decreased the risk of lung cancer in

a dose-dependent manner in patients with type 2 DM. The chemo-preventive

effect of metformin deserves further study.

Objectives

Increasing evidence suggests that an elevated

peripheral monocyte count at presentation predicts a poor prognosis in various

types of malignancy, including malignant lymphoma. In lung adenocarcinoma,

tumor-associated macrophages (TAMs) were reported to be associated with a

poor prognosis. However, it is unknown if an elevated peripheral monocyte count

is associated with a poor prognosis in lung adenocarcinoma. This study assessed

the prognostic impact of the preoperative peripheral monocyte count in lung

adenocarcinoma.


We retrospectively analyzed

302 consecutive patients

with lung adenocarcinoma

who received curative

resection at Kitano Hospital.

The receiver operating

characteristic (ROC) curve

for the peripheral monocyte

count was used to determine

the cut-off value. The

relations between peripheral

monocyte counts and

clinicopathological factors

were assessed. We also evaluated the impacts of possible prognostic factors

including the preoperative peripheral monocyte count on survival, using the two-

tailed log-rank test and Cox proportional hazards model. In addition,

immunohistochemical staining for CD68 was performed to evaluate the

monocytes in primary tumors.

Results

Lung Cancer. 2014 Sep 22. pii: S0169-5002(14)00399-7. doi: 10.1016/j.lungcan.2014.09.012.

15. Prognostic impact of preoperative monocyte counts in

patients with resected lung adenocarcinoma

Respiratory Disease Center, Tazuke Kofukai Medical Research Institute, Kitano

Hospital, Osaka, Japan

lung adenocarcinoma

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A peripheral monocyte count of 430 mm−3 was the optimal cut-off value for

prognosis. An elevated peripheral monocyte count was significantly associated

with sex, performance status, smoking history, chronic obstructive pulmonary

disease and interstitial lung disease. The two-tailed log-rank test demonstrated

that patients with an elevated peripheral monocyte count experienced a poorer

recurrence-free survival (RFS) and overall survival (OS) (P = 0.0063, P < 0.0001,

respectively). In the multivariate analysis an elevated peripheral monocyte count

was shown to be an independent prognostic factor for the RFS and OS (HR:

1.765; 95% CI: 1.071–2.910; P = 0.0258, HR: 4.339; 95% CI: 2.032–9.263; P =

0.0001, respectively). Furthermore, numbers of the monocytes in primary tumors

significantly correlated with peripheral monocyte counts (r = 0.627, P < 0.0001).

Conclusion

The preoperative peripheral monocyte count is an important prognostic factor for

patients with lung adenocarcinoma after curative resection.

Introduction

Apart from the association with tobacco consumption, other

factors of importance for prevention and early diagnosis of

lung cancer have received little attention. We present a case–

control study focusing on professional exposure to carcinogens and social status.

Methods

A written questionnaire was completed by 551 consecutive patients with lung

cancer and 494 patients with large bowel cancer. The groups were balanced

Lung Cancer, Volume 85, Issue 3, Pages 457–464, September 2014

16. Pollution in the working place and social status: Co-

factors in lung cancer carcinogenesis

Institute of Oncology Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia

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regarding gender and age distribution. The questionnaire included data on place

of birth, education, smoking history, diet and alcohol intake, body weight and

height, occupation, housing conditions and family income. According to standard

epidemiological criteria, professional exposure to carcinogens was classified as

professions with exposure to confirmed lung cancer carcinogens, professions

with exposure to suspected lung cancer carcinogens and other professions.

Results

As expected, there were significant differences between the two groups regarding

smoking status. While there were no significant differences in educational levels,

more immigrants were among patients with lung cancer (17.9% vs 11.6%,p =

0.005). On average, lung cancer patients had a lower body mass index (BMI) at

24.77, as compared to 26.14 for large bowel cancer (p = 0.000). Lung cancer

patients had lower income and poorer housing conditions; the bivariate difference

was significant both for income levels (p = 0.046) and type of residence (p =

0.009). The proportion of patients working in professions with exposures to

known carcinogens was 33.5% for lung cancer, and 17.1% for large bowel cancer

(p = 0.000). In the multivariate analysis, smoking (p = 0.000), BMI (p = 0.000)

and type of occupation (p = 0.001) were significant factors.

Conclusions

While there is no doubt about smoking in lung cancer carcinogenesis,

professional exposure to carcinogens and belonging to lower socio-economic

strata also play an important role.

Background

The criterion of two target lesions per organ in the RECIST 1.1 is

an arbitrary one, not being supported by any objective evidence.

We compared tumor responses, respectively, using the RECIST 1.1 (measuring

two target lesions per organ) and modified RECIST 1.1 (measuring the single

largest lesion in each organ) in patients with advanced non-small cell lung cancer

(NSCLC).

Lung Cancer, Volume 85, Issue 3, Pages 346–350, September 2014

17. Tumor response assessment by measuring the single

largest lesion per organ in patients with advanced non-small

cell lung cancer

Department of Internal Medicine, Kangnam Sacred-Heart Hospital, Hallym

University Medical Center, Hallym University College of Medicine, Seoul 150-

950, Republic of Korea

23 | P a g e


We reviewed medical records of patients with advanced NSCLC who received a

first-line chemotherapy between January 2004 and December 2013 and compared

tumor responses according to the two criteria using computed tomography.

Results

A total of 64 patients who had at least two target lesions in any organ according

to the RECIST 1.1 were included in the study. The differences in the percentage

changes of the sum of tumor measurements between the RECIST 1.1 and

mRECIST 1.1 were all within 10%. Thirty-three patients (51.6%) showed an

increase in the absolute value of the percentage change when adopting the

mRECIST 1.1, instead of the RECIST 1.1. The tumor responses showed high

concordance between the two criteria (k = 0.899). Only three patients (4.7%)

showed disagreement of the responses between the RECIST 1.1 and mRECIST

1.1. The overall response rates (20.3% vs. 20.3%) and disease control rates

(89.1% vs. 90.6%) of first-line chemotherapy were not significantly different

between the two criteria.

Conclusion

The modified RECIST 1.1 was comparable to the original RECIST 1.1 in the

response assessment of patients with advanced NSCLC. Our result suggests that

it may be possible to measure the single largest target lesion per organ for

evaluation of the best tumor response.

Lung Cancer, Volume 85, Issue 3, Pages 385–389, September 2014.

دفترچه های دارندگاندرمان رورش ، ـوزش و پـح ،آمـسلـای مـروهـنی

یدهـیاد شـنـرو ، بـیـداد ، وزارت نـه امـیتـکم

.انجام می پذیرد رایگاندر این مرکز

طرف قرارداد بیمه های تامین اجتماعی

خدمات درمانی

نیروهای مسلح

امامکمیته امداد

بیمه ایران

بیمه دانا

بیمه سینا

بیمه آسیا

خدمات درمانی

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