The IASLC Lung Cancer Staging Project: A Renewed Call to Participation

Over the past two decades, the International Association for the Study of Lung Cancer (IASLC) Staging Project has been a steady source of evidence-based recommendations for the TNM classification for lung cancer published by the Union for International Cancer Control and the American Joint Committee on Cancer. The Staging and Prognostic Factors Committee of the IASLC is now issuing a call for participation in the next phase of the project, which is designed to inform the ninth edition of the TNM classification for lung cancer. Following the case recruitment model for the eighth edition database, volunteer site participants are asked to submit data on patients whose lung cancer was diagnosed between January 1, 2011, and December 31, 2019, to the project by means of a secure, electronic data capture system provided by Cancer Research And Biostatistics in Seattle, Washington. Alternatively, participants may transfer existing data sets. The continued success of the IASLC Staging Project in achieving its objectives will depend on the extent of international participation, the degree to which cases are entered directly into the electronic data capture system, and how closely externally submitted cases conform to the data elements for the project.     

内镜诊断隐性肺癌（附45例分析）

天津市肿瘤医院经7150次纤维支气管镜检出X线平片隐性肺癌41例,X线与内镜双隐性肺癌4例。中位年龄各为56岁及63岁,男性为主。X线隐性癌分布于Ⅰ~Ⅱ级气道,隆突和气管,后者占60%,包括双侧病灶而一侧X线隐性。早期癌含原位癌约占25%。文章分析了各类隐性癌的表现及分期情况;指出X线隐性癌病理分期及浸润程度的混杂性。本文评价了普通X线片、断层及CT、NMR在诊断隐性肺癌中的特点,提出因部位不同而适当选择不同的方法;强调支气管镜在早期诊断中的重要作用,指出确诊双隐性肺癌须多部位重复取材活检可有裨益。     

Lung Cancer and Lung Transplantation: A Review

With the increase in the number of lung transplants, it is expected that there will be a corresponding increase in the number of lung cancers reported in these patients. Longevity of the transplant recipients, lung transplantation for chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis, a history of smoking, and the increasing age of the lung donors make lung cancer more likely. Nodules and masses seen in chest imaging in lung transplant patients call for work up until a final diagnosis is achieved because there is a high likelihood of a serious infection or malignancy. The presence of a native lung is a major risk factor for lung cancer occurring in the transplant setting. Lung cancer of donor origin is rare. Bronchioloalveolar carcinoma confined to one lung can potentially be treated by transplanting the affected lung. Treatment for patients with lung cancer in the lung transplant setting has to be individualized because of the complexity of their medical problems and multiple medications. Attention needs to be focused on detecting lung cancer early in these patients to achieve a favorable outcome.     

Metastases to Breast from Primary Lung Cancer

Metastatic disease to the breast from extra mammary sites is uncommon and has an incidence of 0.5 to 3%. It is important to make an accurate diagnosis as this has an impact on the therapeutic planning and management. Clinically, it can be difficult to differentiate between primary breast cancer and a metastatic disease. An incorrect diagnosis can lead to unnecessary surgical interventions. Immunohistochemistry has a significant role in identifying the primary origin of tumor and has to be considered in the presence of unusual cytologic patterns. We report three cases of metastatic disease to breast from primary lung tumors. The cases demonstrate the difficulties encountered in the diagnosis and the impact on the management of these patients.     

肺癌早期诊断相关标志物研究进展

肺癌是死亡率居于我国首位的肿瘤,早发现、早诊断是影响肺癌治疗效果的关键,但目前仍然缺乏精准安全的肺癌早期诊断方法,这极大地影响了肺癌患者的生存期。肺癌作为一种高度恶性肿瘤,其诊断生物标志物的相关研究受到了极大的关注。这些诊断生物标志物具有多样性,在肺癌早期诊断中的价值有待进一步探讨。     

Breathprinting and Early Diagnosis of Lung Cancer

The electronic nose (e-nose) is a promising technology as a useful addition to the currently available modalities to achieve lung cancer diagnosis. The e-nose can assess the volatile organic compounds detected in the breath and derived from the cellular metabolism. Volatile organic compounds can be analyzed to identify the individual chemical elements as well as their pattern of expression to reproduce a sensorial combination similar to a fingerprint (breathprint). The e-nose can be used alone, mimicking the combinatorial selectivity of the human olfactory system, or as part of a multisensorial platform. This review analyzes the progress made by investigators interested in this technology as well as the perspectives for its future utilization.     

The Role of Surgery in the Treatment of Limited Disease Small Cell Lung Cancer: Time to Reevaluate

Chemo-radiation is considered the standard procedure for the management of limited disease small-cell lung cancer (SCLC). Controversy remains as to when surgery should be considered. We sought to determine the survival after complete resection of SCLC and the prognostic impact of clinical and pathologic stage.MethodsA retrospective review was undertaken of patients who underwent surgery between 1980 and 2006. Patients were staged according to the 6th edition of the Tumor, Node, Metastasis classification of lung cancer, actuarial survival estimated with Kaplan Meier methods and comparisons were undertaken using Cox regression.ResultsWe identified 59 patients who underwent complete resection with nodal dissection for SCLC. The mean age (SD) was 62 (11) years and 41 (69%) were men. Clinical staging information was available in 53, listed by stage with IA (n = 9), IB (n = 21), IIA (n = 0), IIB (n = 13), IIIA (n = 9), IIIB (n = 1). The median time to follow-up (1st to 3rd quartile) was 2.8 (0.79–8.65) years with an overall survival (95% confidence interval) at 1 and 5 years of 76% (65, 88), 52% (40, 68). There were no clear differences in the survival of patients in clinical T categories (p = 0.366) with good overall results in patients across the spectrum of nodal disease from N0 to N2 (p = 0.498).ConclusionsThis study shows excellent survival for stage I to III patients who underwent lung resection with nodal dissection for SCLC and supports the need to reevaluate surgery as primary treatment and use of clinical Tumor, Node, Metastasis criteria in the selection of patients with very limited disease for surgery.     

The Impact of Genetic Markers on the Diagnosis of Lung Cancer: A Current Perspective

Lung cancer is the leading worldwide source of cancer-related death. It is acknowledged that prognosis and treatment outcomes in lung cancer might be improved by increasing the effectiveness of early-stage diagnosis. Several recently published studies have produced intriguing results regarding the detection of biomarkers in tumor samples, but also in easily accessible specimens such as sputum, plasma, and exhaled breath condensate. This review presents advances in genetic diagnostics of lung cancer, with particular reference to the clinical usefulness of individual biomarkers, specimens, and methods. The adequacy of their sensitivity and specificity for cancer screening and early detection is discussed in detail.     

Turning Gray: The Natural History of Lung Cancer Over Time

As newer therapies for lung cancer are being explored it becomes more important to understand the natural history of lung cancer. A systematic review of the data shows that untreated lung cancer is almost uniformly rapidly fatal, even if it is stage I. Analysis of data regarding tumor volume doubling times shows that conventionally detected lung cancers have short mean doubling times, and only a small proportion with very long doubling times. Lung cancers found during the course of a CT screening program have markedly longer mean doubling times and a substantially greater proportion with very long doubling times (>400 days). Models of tumor growth, however, are not understood well enough to use the observed doubling time to predict length of survival without treatment.     

用Cyfra21—1检测血中细胞角质素片断CKS—19在肺癌诊断中的意义

用酶联免疫方法，试剂Cyfra21－1，测定42例健康人，23便非肿瘤性肺部疾病病人，68例肺癌病人血清中的细胞角质素片断CKS－19。健康人为1．45±0．86ng／ml，非肿瘤性肺疾病病人为1．64±1．40ng／ml。肺癌中鳞癌16例，腺癌33例，小细胞肺癌19例，Cyfra21－1阳性率各为75．0％，66．7／，31．6％。比较Cyfra21－1和CEA，NSE三种肺癌标志物的ROC曲线，Cyfra21－1的曲线最接近左上角，证明Cyfra21－1是敏感性，特异性较好的肺癌标志物。     

Validation of the Eighth Edition TNM Lung Cancer Staging System

IntroductionWe performed a validation study at our institution, the International Union Against Cancer (Union for International Cancer Control latest version of TNM Classification of Malignant Tumors Eighth Edition).MethodsData were collected from the Queensland Oncology Online registry of NSCLC or SCLC cases between 2000 and 2015 and validated against the Queensland Integrated Lung Cancer Outcomes Project registry using case identification number, first name, last name, and date of birth. Where data were available, cases were classified according to the Union for International Cancer Control TNM seventh edition stage groupings and then compared with the eighth edition groupings. Kaplan-Meier curves were plotted, and the log-rank test of survival differences was performed with SPSS version 25 (IBM Corp, Armonk, NY).ResultsOf the 3636 cases, 3352 and 1031 had complete clinical and pathologic staging, respectively. Median survival time was found to reduce with increasing clinical stage: seventh edition (IA: 88, IB: 44, IIA: 31, IIB: 18, IIIA: 15, IIIB: 8, and IV: 5 mo) versus eighth edition TNM stage (IA1: not reached, IA2: 88, IA3: 53, IB: 56, IIA: 36, IIB: 22, IIIA: 14, IIIB: 9, IIIC: 8, IVA: 6, and IVB: 3 mo). A similar overall pattern was reflected in the pathologic stage: seventh edition (IA: 124, IB: 110, IIA: 48, IIB: 42, IIIA: 26, IIIB: 31, and IV: 27 mo) versus eighth edition (IA1: not reached, IA2: 122, IA3: 125, IB: 144, IIA: 98, IIB: 57, IIIA: 31, IIIB: 24, and IVA: 7 mo). The log-rank test for survival curves was significant at p < 0.001.ConclusionsOur external validation study confirms the prognostic accuracy of the eighth edition TNM lung cancer classification. Our analyses also indicated that IIIB, IIIC, and IVA stage groups had similar survival outcomes and suggest further research for refinement.     

The Biology of Lung Cancer: A review

Advances in the understanding of the biology of lung cancer have progressed rapidly over the last decade. It is clear that considerable heterogeneity exists both in small-cell and non-small-cell lung cancer tumours with common properties being shared by both cell types. To further understand the prognostic and clinical significance of these biological properties it is clear that in future clinical trials of both tumour types these properties should be taken into consideration.     

Characteristics of Patients With Second Primary Lung Cancer Following Breast Cancer: A Retrospective Descriptive Study

BackgroundBreast cancer (BC) is the most common noncutaneous malignancy in women and survivors are at an increased risk for secondary malignancy with lung cancer (LC) being the most common. There are few studies that have explored the clinicopathological specifics of LC in BC survivors.MethodsIn this single-institution, retrospective study, we identified BC survivors who subsequently developed LC, examined their breast and LC clinical and pathological characteristics and compared them to the general BC and LC population as published in the literature.ResultsIn our study, we found the following associations that could be meaningful: an association between receiving radiation (RT) and LC (including a statistically significant P = .03 chance of ipsilateral LC after BC treatment with RT), a higher incidence and amount of smoking and LC, high BRCA positivity (78.9%) in the few patients who had germline testing, and a higher incidence of EGFR mutations in NSCLC after BC (60.9%) as well as an earlier stage of NSCLC disease.ConclusionTreatments such as RT, genetic factors such as BRCA mutations, and tobacco use may increase the risk of developing LC amongst BC survivors. Exploring this further can potentially lead to better risk stratification through modified low-dose CT chest screening protocols to catch LCs earlier and ultimately improve outcomes. Past studies have shown that BC survivors who are subsequently diagnosed with NSCLC may have improved OS compared with primary NSCLC and our study showed a high incidence of EGFR mutated NSCLC, which also suggest both improved prognosis and a different molecular profile of NSCLC, which warrants further investigation. Lastly, BC survivors who subsequently are diagnosed with NSCLC had earlier stage disease in our study, perhaps a result of surveillance, highlighting the importance of close monitoring of BC survivors.     

Diagnosis of Lung Cancer Based on Plasma Metabolomics Combined with Serum Markers

Predicting the onset and metastasis of early tumor is the primary means of improving lung cancer prognosis. The purpose of this study was to identify the ability of plasma metabolomics combined with blood markers to establish benign lung disease versus lung cancer regression models. Blood samples were collected from 174 lung cancer patients, 350 benign lung disease patients and 100 healthy volunteers and the metabolites were analyzed by mass spectrometry. The target metabolites consisted of 23 amino acids, 26 acylcarnitines and 45 conventional blood markers. A regression analysis model was established based on 12 metabolites and five blood markers selected by elastic network analysis. Two-thirds of the data were used in a training set for modeling and signature construction, and the remaining one-third were used in a validation set to test the model. This model was identified to have good specificity and sensitivity in distinguishing between lung cancer and lung disease. The performance of the model was evaluated using the area under the receiver operating curve, which was 0.915 in training set and 0.875 in validation set. In conclusion, this study demonstrates that regression model established by plasma metabolomics in combination with conventional serum markers has potential for the diagnosis of lung cancer.     

Lung Cancer Survival with Current Therapies and New Targeted Treatments: A Comprehensive Update from the Srinagarind Hospital-Based Cancer Registry from (2013 to 2017)

Background: Lung cancer (LC) is a common malignancy and leading cause of cancer death worldwide and in Thailand. An update on LC survival factors after diagnosis at Srinagarind Hospital is needed. Methods: We conducted a retrospective cohort study, and the data were sourced from the Srinagarind Hospital-Based Cancer Registry. All LC cases were diagnosed between January 1, 2013, and December 31, 2017, and followed up until November 30, 2019. Cases of LC (ICD-O-3) numbered 2,149, but only those with coding C34.0-C34.9 were included. The survival rate was estimated using Kaplan-Meier, while the Log-rank test was used to estimate survival. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard regression models. Results: The 2,149 patients had a total follow-up of 269.6 person-years. Overall, 1,867 patients died during the study, for a corresponding case-fatality mortality rate of 86.0 per 100 person-years. The respective 1-, 3-, and 5-year survival rate was 31.2 % (95% CI; 29.21 to 33.15%), 12.9 % (95%CI: 11.49 to 14.45), and 10.2% (95%CI: 8.74 to 11.70). After patient diagnosis, the median survival time was 0.46 years (5.51 months) (95% CI: 0.42 to 0.50). Targeted therapy was associated with longer survival than non-targeted therapy (p-value < 0.001). After adjusting for sex, TNM stage, and histologic type, multivariable analysis of the entire cohort identified chemotherapy as an independent predictor of improved survival (adjusted HR= 0.48; 95% CI: 0.42 to 0.55; P < 0.001), and that sex, TNM stage, and histologic type were associated with survival. Conclusion: The study confirmed that sex, stage of disease, histology, and chemotherapy are associated with survival of LC. Primary prevention and screening for early detection improve survival. Further investigations into factors affecting survival of LC in Northeast Thailand should focus on targeted therapy.     

放射性核素全身骨显像诊断肺癌骨转移

本文报告１８４例经病理证实的原发性肺癌骨显像的结果，对不同组织学类型肺癌骨转移的特点和规律进行分析。本组肺癌骨转移性率６６．３％（１２２／１８４），骨转移部位以胸部最多，为３５％，其他依次为脊柱２５．２％，骨盆２２．４％，肢体１５．６％，颅骨１．８％。多发性转移灶占８１．１５％（９９／１２２），孤立性转移灶１８．８５％。肺癌患者应常规行全身骨显像检查，对分期、治疗方案的选择及预后均有重大意义。