Characteristics analysis of inpatients primary diagnosed with lung cancer

Objective To investigate the clinical usefulness of quantitative dual-source dual-energy CT (DECT) iodine enhancement metrics combined with morphological CT features in distinguishing different lung cancer subtypes. Methods One hundred and sixty-two consecutive patients suspected with lung cancer were prospectively enrolled and underwent DECT in arterial phase prior to biopsy or surgery. Tumor histological subtypes were determined in 110 patients. Two radiologists interpreted CT morphologic features of 110 lesions in a consensual manner. In addition, two radiologists independently contoured lesions and placed regions of interest in descending aorta or subclavian artery on the same section for normalization, from which automated computer measurements were generated: iodine density and iodine ratio (the ratio of iodine density of lesion to that of artery on the same section). DECT metrics and morphological CT features were compared among different lung cancer subtypes. Chi-square was used to compare qualitative parameters. One way ANOVA was used to compare quantitative parameters satisfying normal distribution, while those parameters not satisfying normal distribution or ranked data were compared by Kruskal-Wallis rank sum test. Multinomial logistic regression models were used to differentiate the histological subtypes of lung cancer: adenocarcinoma, squamous cell carcinoma (SCC), small cell lung cancer (SCLC). Results There were 48 cases of adenocarcinomas, 36 cases of SCC and 26 cases of SCLC. In analysis of CT features, tumor diameter, distribution, spiculation, pleural retraction, vascular involvement, confluent mediastinal lymphadenopathy, encasement of mediastinal structures and enhancement heterogeneity showed statistical difference (all P<0.05). The diameter of SCC[(5.73±3.67)cm] and SCLC [(6.08±4.39)cm] were larger than adenocarcinoma [(3.75±2.80 cm)] (H=13.806, P<0.05). Adenocarcinomas were mostly located in the periphery (31 cases), while SCC (26 cases) and SCLC (21 cases) were mainly centrally located. Spiculation was mostly found in adenocarcinoma (44 cases) rather than SCLC (13 cases). Pleural retraction was mostly observed in adenocarcinoma (36 cases) rather than SCC (10 cases) and SCLC (5 cases). Vascular involvement was mostly found in SCLC (19 cases) rather than adenocarcinoma (15 cases). Confluent mediastinal lymphadenopathy was more frequently found in SCLC (15 cases) compared with adenocarcinoma (3 cases) and SCC (4 cases). Encasement of mediastinal structures was mostly found in SCLC (13 cases) rather than adenocarcinoma (7 cases). Homogeneous enhancement was more frequently found in SCLC (10 cases) than SCC (6 cases). No significant differences were observed in other CT features between any other two groups. Iodine density and iodine ratio were statistically different among these three subtypes lung cancer (H=16.817, 20.338, P<0.001). Iodine density of adenocarcinoma and SCC was (1.50±0.80) and (1.40±0.40) mg/ml, respectively, higher than the (1.20±0.40) mg/ml for SCLC (P<0.01). Iodine ratio of adenocarcinoma and SCC was (16.10±7.02)% and (15.05±4.62)%, respectively, higher than the (11.55±3.15)% for SCLC (P<0.01). No significant difference was observed between adenocarcinoma and SCC. Accuracy of the model based on CT features was 69.1%, accuracy of the model based on CT features combined with DECT parameters was 80.9%. Conclusions Quantitative DECT metrics are different among adenocarcinoma, SCC and SCLC, when combined with morphological CT features, higher diagnostic accuracy can be achieved. Key words: Lung neoplasms; Tomography, X-ray computed; Diagnosis

Objective To analyze the clinical features of lung cancer patients in department of thoracic surgery and provide ideas for early diagnosis and treatment of lung cancer.Methods The retrospective study of 1 695 patients with lung cancer treated in the department of thoracic surgery of Shanghai Ruijin hospital was carried out in order to analyze clinical features,including age,risk factors,diagnosis stage,and curative effect.Results Among the patients,the ratio of male to female was 2.4 ∶ 1.The mean smoking index was 39.80 pack-years (40.62 pack-years in males and 29.52 pack-years in females).The pathologic type showed:692 adenocarcinoma patients (50.47％),452 squamous cell carcinoma patients (32.97％),86 small cell lung cancer patients (6.27％).Of the adenocarcinoma patients,54.34％ was male and 45.66％ was female,while in the squamous cell carcinoma,92.26％ was male and 7.74％ was female.The amount of lung cancer patients with chronic obstructive pulmonary disease was 167 (9.85％),in whom 105 patients were candidates for surgery.In these patients,the incidence of postoperative complication (22.86％) and the mortality rate within 30 days (2.86％) were both higher than those in normal ones (15.96％,1.82％).26 patients died within 30 days after the operation,70％ of whom belonged to stage Ⅲ or stage Ⅳ.Among the dead patients,the amount of central lung cancer and peripheral lung cancer patients was 17 and nine,respectively.According to pathological type,the amount of squamous cell carcinoma and adenocarcinoma patients was 14 and eight,respectively.Conclusions Due to long-time smoking,the morbidity of lung cancer in males is higher than that in females.And it is true that the adenocarcinoma has become the most common type of lung cancer,which may be related to environmental pollution.The pathological type is mostly squamous cell carcinoma in the lung cancer patients with chronic obstructive pulmonary disease,in whom the incidence of postoperative complication and mortality are higher.And in the peripheral adenocarcinomama patients,the postoperative mortality is lower.Anyway,timely operation is of great significance for lung cancer patients. Key words: Lung cancer; Chronic obstructive pulmonary disease; Operation; Postoperative mortality

Objective：The term lung cancer or known as bronchogenic carcinoma,whichrefers to malignancies that originate in the airways or pulmonary parenchyma. Lung cancers are classified as small cell lung cancer (SCLC) (13%) or non-small cell lung cancer (NSCLC) (82%). These cell types of lung cancer comprise up to 95% of all lung cancer. Only 5% of lung cancers are comprised of other cell types. Non-small cell lung cancer can be further divided into three major cell types, including squamous cell lung cancer (SCC) (20%), adenocarcinoma (ADC) (38%) and large cell carcinoma (5%). Lung cancer is the most common cancer worldwide. In the year 2009, it was estimated to have 1,600,000 new cases and 1,380,000 deaths directly related with lung cancer occurred in the US. The absolute and relative frequency of lung cancer has increased dramatically. Lung cancer has became the most common cause of cancer deaths in men since the year of 1953 and has also became the most common cause of cancer deaths in women after the year 1985. Despite the cause of lung cancer deaths in male starts to decrease, but the trend of lung cancer deaths continues to increase in female. It was estimated that approximately half of cancer deaths occur in women. In Taiwan, lung cancer has also become the leading cause of deaths since the year 1980. In the past 30 years, lung cancer remains to be the leading cause of deaths. In both men and women, the incidence of lung cancer has increased 8 times and is also the most rapidly increased cancer among all cancers. The incidence of small cell lung cancer in Taiwan is approximately 88-90% and the incidence of small cell lung cancer is about 10-12%. The primary risk factor for the development is cigarette smoking, especially in squamous cell lung cancer. The overall survival and prognosis is poor. In all lung cancer patients, the overall 5 year survival rate is about 15%. Usually, patients are in late clinical staging at the time of cancer diagnosis. In non-small cell lung cancer, nearly 30-40% of cases were in stage four. Likewise, about 60% of small cell lung cancer patients were in disseminated stage. Many factors are related with prognosis in both small cell and non-small cell lung cancer, among these, cancer stage is the most important prognostic factor. Other related prognostic factors include, clinical parameters, histopathology, molecular characterization, positron- computerizedtomography (PET-CT) findings, and whether there is any recurrence after tumor resection. Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) is also being utilized to be a diagnostic assay to detect whether there is any lymphatic metastasis in non-small cell lung cancer. The immune system is a complex and sophisticatenetwork, that is designed to protect the host from both external (such as bacteria and virus) and internal threats (such as malignant transformation). Cytokines are hormone-like proteins that enable immune cells to communicate and play an integral role in the initiating, perpetuation and subsequent downregulation of the immune response. Cytokines are as important to the termination of the immune response as they are to its initiation. Interleukine-10 (IL-10) is also known as a human cytokine synthesis inhibitor factor (CSIF). It is an important immunoinhibitory cytokine or function as an anti-inflammatory cytokine. It also plays an integral role in the complex but balanced immune network system. Previous studies have shown that interleukine-10 promoter polymorphisms at (-1082A>G, -819C>T, -592C>A) is closely related to its transcription activities. Blocking the tumor immune-surveillance by suppressing T-cell immunity could explain the important role of IL-10 in the progression of tumor. Several other studies have also observed that Il-10 promoter polymorphisms are also related to many other cancers, including diffuse B-cell lymphoma, non-Hodgkin’s lymphoma, breast cancer, gastric cancer, colon cancer, myeloma, advancedmelanoma and skin squmaous cell carcinoma occurred after renal transplantation. Squamous cell lung cancer is closely related to cigarette smoking, a procarcinogen extracted from cigarette (NNK)Nicotine-derived nitrosamine ketone, or 4-(methylnitrosamino)- 1-(3-pyridyl)-1-butanone, is a nitrosamine, which could induce the production of IL-10. It probably plays an important role in the development of lung cancer. In our previous study, we hypothesized that IL-10 haplotypes categorized by IL-10 promoter polymorphisms at (-1082A>G, -819C>T, -592C>A), might influence IL-10 expression and may be related with poor clinical outcomes and relapse in patients with non-small cell lung cancer. We have observed that lung tumors with non-ATA haplotypes had significantly higher mRNA level when compare with tumor with ATA-haplotypes. The overall survival (OS) and relapse free survival (RFS) in tumors with non-ATA haplotypes was significantly shorter then tumors with ATA-haplotypes. Furthermore, T-cells collected from peripheral blood in healthy donors when co-cultured with cancer cells, were more susceptible to apoptosis and less cytoxic to tumor cells in patients with non-ATA haplotypes than in patients with ATA-hapoltypes. T-cells apoptosis could be increased and tumor cell apoptosis could be decreased by adding IL-10 recombinant protein. On the contrary, T-cell apoptosis could be decreased and tumor cell apoptosis could be increased by adding neutralizing antibody. This was also consistent with our hypothesis that IL-10 haplotypes categorized by IL-10 promoter polymorphisms at (-1082A>G, -819C>T, -592C>A), might influence IL-10 expression and may be related with poor clinical outcomes and relapse in patients with non-small cell lung cancer. The influence of IL-10 was further demonstrated in our animal experiment. In the histological examination of TC-1 tumors in lung following intravenous injection of TC-1 cells into experiment mice. Lung metastasis was found in mice injected with IgG antibody but not in mice injected with IL-10 neutralizing antibody. We have concluded that, IL-10 can promote tumor malignancy via promoting T-cell apoptosis and tumor cell survival, and IL-10 haplotypes may be used to predict survival and relapse in resected non-small cell lung cancer. The overall survival and prognosis of lung cancer is poor, therefore we are expecting to apply and utilize the state of the art molecular technology, in predicting the response of lung cancer treatment and overall survival. Interleukin-10 (IL-10) may play an importance role in the progression of lung cancer. The objective of this study is to evaluate the different impact of IL-10 haplotypes on prognosis, including overall survival (OS) and relapse-free survival (RFS) in lung squamous cell cancer (SCC) and adenocarcinoma (ADC). Methods and Materials：In this study, we included 439 non-small cell lung cancer (NSCLC) patients recruited from Taichung Veteran General Hospital (TCVGH). Study samples were collected from immediately frozen section during surgery. Surgically resected normal lung tissues adjacent to the lung tumor were examined. Genomic DNA was extracted by conventional methods, which was prepared by prokinase K digestion and phenol-chloroform extraction; followed by ethanol precipitation. The genotypes of IL-10 were determined by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). Polymorphisms of IL-10 were determined by direct sequencing of Polymerase Chain Reaction(PCR) products amplified from the DNA of normal tissues adjacent to the tumors. For continuous or discrete data analysis, Student’s t-test and Chi-square test were applied. Kaplan-Meier method and log-rank test were used to determine the association between IL-10 promoter polymorphisms and patients’ survival. Cox regression models were used to adjust potential confounders. Statistical testing was conducted by using two-sided tests and p-values G, -819C>T, and =592G>A). The non-ATA haplotype in NSCLC is more prevalent both in nodal metastatic tumors than in non-nodal metastatic tumors (N0) (59.7% vs. 48.4%, p = 0.017). In our previous study, we have also shown that patients with non-ATA haplotypes had higher IL-10 mRNA expression levels than patients with ATA haplotypes. In tumor histology, IL-10 haplotypes also correlated with nodal metastasis (63.0% vs 40.5%, p < 0.01) and tumor stage in SCC (59.2% vs 46.3%, p = 0.047). This was not observed in ADC patients. The non-ATA haplotypes may be used as a biomarker for poor prognosis in surgically resected NSCLC. Kaplan-Meier and Cox regression analysis showed that patients with ATA haplotypes had poorer OS and RFS. (HR 1.522, 95% CI = 1.191-1.945, p=0.001 for OS; HR 1.611, 95% CI = 1.247-2.082, p < 0.01 for RFS). The median survival duration and five years survival rate of patients with non-ATA haplotypes were significantly shorter when compare with patients ATA (median OS = 25.8 vs. 42.9 months; median RFS =16.8 vs. 30.9 months; 5-year OS = 28.6% vs. 44.7% and RFS = 22.2% vs. 36.2%). SCC patient with non-ATA haplotypes had poorer OS and RFS than patients with ATA haplotypes. No prognostic value was observed in ADC patients. These results suggest that IL-10 haplotypes has different impacts on OS and RFS in SCC patients from those with ADC. Conclusion and Suggestion：The IL-10 haplotypes has been associated with lung cancer risk. A prognostic value of non-ATA haplotypes was observed for SCC, but not for ADC. Non-ATA haplotypes were associated with nodal metastasis and tumor stage. In summary, IL-10 may have a stronger influence on tumor progression in SCC than ADC.

Objective To investigate the significance of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 125 (CA125), neuron specific enolase (NSE), cytokeratin 19 fragment (CYFRA21-1) and squamous cell carcinoma antigen (SCC) for evaluation of first-line chemotherapeutic response and the prognostic value of these markers for prediction of overall survival (OS) in patients with advanced lung cancer. Methods Patients diagnosed with Ⅲb/Ⅳ stage untreated, primary lung cancer and received first-line chemotherapy in Peking University Cancer Hospital & Institute from June 2013 to December 2014 were enrolled retrospectively into this study. The results of tumor markers before and after two cycles of chemotherapy and the clinical data of 181 eligible patients, including 133 males and 48 females with the average age of 58 years, were collected. The serum levels of six tumor markers were measured by electrochemiluminescence assay. Using RECISTv1.1 as standard, the sensitivity and specificity of tumor markers in classifying PR, SD, PD, were observed. The Kappa agreement test was used to evaluate the correlation between serum tumor markers and CT in evaluating chemotherapy response. The follow-up of OS was derived by telephone. Results The top three positive rates of biomarkers were CEA, CA125 and NSE in adenocarcinoma patients, CYFRA21-1, NSE and SCC in squamous carcinoma patients, NSE, CA125 and CYFRA21-1 in small cell lung cancer patients, respectively. In Kappa agreement test, the changes of serum levels of CEA and CA125, CYFRA21-1 and SCC, NSE were significantly correlated with CT for chemotherapy response evaluation in the mention above three kinds of carcinomas respectively (P 0.05), but the OS of PR was longer than SD and PD in squamous and small cell lung carcinoma (median overall survival 28 months vs 22 months vs 4 months, 12 months vs 8 months vs 8 months, P<0.05). Of these six tumor markers, only SCC was of statistical significance for classifying PR, SD and PD in squamous carcinoma (median overall survival 30 months vs 11 months vs 4 months, P<0.05). Conclusions Tumor marker has high sensitivity for predicting PR, but the value of tumor marker predicting SD and PD of advanced lung cancer was limited. The evaluation of patients would be comprehensive by combined use of tumor markers and CT. The changes of SCC after 2 cycles of chemotherapy are predictive of survival in squamous cell carcinoma patients.(Chin J Lab Med, 2017, 40: 693-699) Key words: Lung neoplasms; Tumor markers, biological; Treatment outcome; Survivors

Objective To investigate the expression of miRNA-22(miR-22) in serum of patients with lung cancer and its value in the diagnosis of lung cancer. Methods Serum samples were collected from total 116 non-small cell lung cancer (NSCLC) cases, 10 small cell lung cancer (SCLC) cases and 152 cancer-free controls.The expression of serum miR-22 was evaluated in all the samples by quantitative real time RT-PCR.Receiver operating characteristic curve (ROC) analysis was used to evaluate the impact of miR-22 on its diagnostic value for lung cancer. Results The relative expressions of serum miR-22 in NSCLC patients, SCLC patients and cancer-free controls were 1.63±1.43, 1.10±1.64 and -0.02±1.31, respectively.The expression of miR-22 in NSCLC patients was higher than that in SCLC patients and cancer-free controls (F=49.35, P 0.05). Moreover, the expressions of miR-22 in patients with stage Ⅰ, Ⅱ and Ⅲ/Ⅳ NSCLC were 1.65±1.36, 1.49±1.60 and 1.00±1.42 respectively and they were all higher than cancer-free controls (all P 0.05). There was no significant difference of miR-22 expression among different pathological subtypes of NSCLC: adenocarcinoma, squamous cell carcinoma, and large cell lung cancer(all P>0.05). ROC analyses were performed using cancer-free group as negative control and the area under curve values of serum miR-22 were ranged between 0.72-0.82 in either NSCLC group, or its histological subtypes or different stages.When optimal cut-offs were selected the sensitivities and specificities were 70.59%-75.32% and 54.61%-73.03% respectively. Conclusions These data indicated serum miR-22 is of great significance for early diagnosis of lung cancer.As a non-invasive detection method, microRNA-22 is expected to become a new indicator for early diagnosis of lung cancer. Key words: Carcinoma, non-small-cell lung; Tumor makers, biological; Early diagnosis; miR-22

Objective To investigate the clinical significance and the expression of mutated K - ras in non - small cell lung cancer (NSCLC). Methods Immunohistochemical method was used to examine K - ras protein expression of the sections from 56 cases of NSCLC and 45 normal lung tissues (NL). Results The positive rate of K - ras expression in squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma and large cell carcinoma was 26. 67% (8/30), 53.33% (8/15), 16.67% (1/6) ,20.00% (1/5) respectively. The positive rate of adenocarcinoma was significantly higher than that of normal lung tissue and squamous cell carcinoma(P < 0.05). Besides, expression area of K - ras was often in the cytoplasma for squamous cell carcinoma and adenocarcinoma. The expression of K - ras gene was not related to differentiation, but the expression of K - ras gene was related to pathological type, smoking, stage and lymph nodes metastasis. Condusions The results suggest that overexpression of K - ras involve in genesis and development of non - small cell lung cancer (NSCLC). Detection of K - ras protein can be used as a prognostic factor for the patients. Key words: Non -small cell lung cancer; Protein K- ras; Immunohistochemistry

Objective To explore the value of serum cytokeratin 19 fragment antigen (CYFRA21-1), carbohydrate antigen 125 (CA125) and carbohydrate antigen 50 (CA50) levels in the diagnosis of lung cancer. Methods A retrospective analysis of 233 cases of lung cancer admitted to the Department of Oncology from January 2012 to December 2013 in Tai′an Central Hospital, including 181 cases of non small cell lung cancer (129 cases of adenocarcinoma, 52 cases of squamous cell carcinoma), 47 cases of small cell carcinoma, 5 cases of other types and 30 cases of benign lung lesions in the same period as control group. The serum levels of CYFRA21-1, CA125 and CA50 were detected by electrochemiluminescence. The levels of the 3 markers in patients with different pathological types of lung cancer and the diagnostic value of combined detection on the diagnosis of lung adenocarcinoma and TNM staging were compared, and the Kaplan-Meier survival curve was used to analyze the relationship between the patient′s life cycle of the single positive and multiple positive lung adenocarcinoma of the 3 markers in the serum. Results The levels of CA125 and CA50 were significantly higher in the adenocarcinoma group [(125.06±42.98)U/mL, (17.43±8.51)U/mL] than those in the squamous cell carcinoma group [(65.06±39.03)U/mL, (11.28±9.01)U/mL], and the small cell carcinoma group [(70.32±49.88)U/mL, (7.43±6.07)U/mL] (adenocarcinoma compared with squamous cell carcinoma, CA125: q=18.21, P=0.01, CA50: q=3.98, P=0.05; adenocarcinoma compared with small cell carcinoma, CA125: q=16.64, P=0.03, CA50: q=5.98, P=0.03). The levels of CYFRA21-1 [(12.28±7.08)μg/L] in adenocarcinoma was higher than that of small cell carcinoma group [(7.07±6.23)μg/L] (q=5.12, P=0.03). In the TNM stage of cancer, the levels of CYFRA21-1 and CA125 in stage Ⅰ [(9.12±8.09)μg/L, (35.23±18.77)U/mL] were significantly lower than that of stage Ⅳ patients [(48.40±13.61)μg/L, (179.36±33.19)U/mL](CYFRA21-1: q=8.28, P=0.02; CA125: q=31.21, P=0.00); the sensitivity of the 3 markers combined detection was 89.97%, while the specificity was 85.09%, and the survival period of the 3 marker single positive patients was longer than that of multiple positive lung adenocarcinoma (χ2=2.91, P<0.01). Conclusion Serum CYFRA21-1, CA125 and CA50 play important roles in the diagnosis, staging and prognosis of lung cancer. Key words: Cytokeratin 19 fragment antigen; CA-125 antigen; CA-50 antigen; Lung neoplasms; Survival time

Objective To investigate the diagnostic value of combined detection of serum tumor markers,including CEA,CA125,neuron-specific enolase (NSE) and cytokeratin fragment antigen 21-1 (CYFRA21-1) for lung cancer patients.Methods The subjects involved 138 diagnosed lung cancer patients (82 males,56 females,average age 58.6 years,from October 2010 to March 2012),96 patients with benign lung diseases (56 males,40 females,average age 51.3 years) and 45 healthy adults (30 males,15females,average age 43.9 years).The pathological types of lung cancer consisted of 66 squamous cell carcinoma (SCC),52 adenocarcinoma and 20 small cell lung cancer (SCLC).The serum levels of CEA,CA125,NSE and CYFRA21-1 were measured with electrochemiluminescence immunoassay.The diagnostic efficacy for different pathological types was compared among each single tumor marker and combination of tumor markers.One-way analysis of variance q test were used for statistical analysis.Results The serum levels of CEA,CA125,NSE and CYFRA21-1 in patients with lung cancer were higher than those in patients with benign lung diseases and in healthy subjects (CEA:(19.99±30.99),(10.78±19.77),(3.25±3.42) μg/L;CA125:(79.70±95.98),(44.96±44.97),(20.66±7.13) μg/L; NSE:(35.23±40.22),(15.31±8.42),(13.30±5.65) μg/L; CYFRA21-1:(18.07±43.71),(8.30±8.83),(3.13±1.60) μg/L; F=4.481,5.436,4.776,6.002,all P＜0.05).The highest level of CEA,NSE or CYFRA21-1 were found in adenocarcinoma (F=4.932,P＜0.05),SCLC (F=5.119,P＜0.05) or SCC (F=5.378,P＜0.05),respectively.The highest sensitivity tumor markers for SCC,SCLC and adenocarcinoma were CYFRA21-1 (78.8％,52/66),NSE (75.0％,15/20) and CEA (57.7％,30/52),respectively.In combined detection,the highest sensitivity combinations for SCC,SCLC and adenocarcinoma were CEA+CYFRA21-1+NSE (89.4％,59/66),CEA+CYFRA21-1+NSE (80.0％,16/20) and CEA+CA125+NSE (78.8％,41/52),respectively.Conclusions Combined detection of serum tumor markers is more sensitive for the diagnosis of lung cancer.The expressions of the above four tumor markers is correlated with pathological types of lung cancer. Key words: Lung neoplasms ; Carcinoembryonic antigen ; Antigens, tumor-associated,carbohydrate ; Phosphopyruvate hydratase ; Keratins

To investigate the expression of UNC-112 protein in lung cancer and discuss its value. The method of immunohistochemical SP was employed to detect the expression of UNC-112 protein in 210 cases of lung cancer, and evaluate its correlation with pathological classification. UNC-112A and UNC-112B protein were highly expressed in non-small cell lung cancer, not expressed or expressed at very low levels in small cell lung cancer(P < 0.05);the expression of UNC-112A protein in squamous cell carcinoma was significantly higher than those in adenocarcinoma (P < 0.001)and large cell lung cancer (P < 0.01), but there is no significant difference between adenocarcinoma and large cell lung cancer (P = 0.18).UNC-112A protein expression level was positively correlated with the differentiation of squamous cell carcinoma(P = 0.0024). The expression of UNC-112B protein was significantly higher in large cell lung cancer than those in adenocarcinoma (P = 0.002) and squamous cell carcinoma (P < 0.01), and it was significantly higher in adenocarcinoma than squamous cell carcinoma (P = 0.005). UNC-112 protein may be related to the heterogeneity of lung cancer, UNC-112A and UNC-112B protein play different roles in invasion and migration of lung cancer.

Sec62 Bridges the Gap from 3q Amplification to Molecular Cell Biology in Non–Small Cell Lung Cancer

Background. Cigarette smoking is variably associated with the various histological cell types of lung cancer. The primary aim of this study was to analyse various strengths of association between the common histological cell types of lung cancer and smoking in a Western Cape population. The secondary aim examined whether an association exists between scar carcinoma and smoking. Methods . We retrospectively analysed the records from 386 patients over a 2-year period. Both smokers and non-smokers were subdivided and analysed as two groups, which included those with non-small cell and small cell lung cancer. Smokers and non-smokers were also analysed separately according to the presence or absence of lung scarring. Results. In total, 94.3% of all patients with lung cancer were current or past smokers. There was a disproportionately higher number of patients with adenocarcinoma who were non-smokers compared with all the other cell types ( p =0.01), whereas patients with squamous cell carcinoma were more likely to be smokers ( p =0.05). Although the vast majority of patients with and without lung scars were found to be smokers (96.4% v. 93.7% respectively), there was no statistically significant difference found between these two groups ( p =0.43). Conclusion . In a Western Cape population, patients with adenocarcinoma were more likely to be non-smokers, while those with squamous cell carcinoma were relatively more likely to be smokers. No clear association between scar carcinoma and smoking status was found.

Objective To investigate the clinical characteristics of interstitial lung disease associated with lung cancer (ILD-LC). Methods Sixty-eight patients with lung cancer firstly detected on the basis of diagnosis with interstitial lung disease (ILD) from January 2015 to January 2018 in the First Affiliated Hospital of Zhengzhou University were allocated to ILD-LC group; and 192 patients with ILD firstly detected in the same period were set as ILD group. The differences in general data, tumor markers and lung function between the two groups were retrospectively analyzed and compared, and the characteristics of the ILD-LC group in the high-resolution computed tomography (HRCT) manifestations, pathological types, pathological stages and EGFR gene mutations were analyzed. Results The differences were significant in sex, age, smoking history and smoking index of patients between the ILD-LC group and ILD group (P all<0.05). It was significantly higher in age, male proportion, proportion of smokers and smoking index of patients in the ILD-LC group than those in the ILD group [(65.8±10.5) years vs. (59.5±11.9) years, 86.8% vs. 55.2%, 70.6% vs. 31.8%, 36.71±18.10 vs. 13.47±8.45, P all<0.05]. In the ILD-LC group, the serum levels of CA199, CA125, CEA, NSE and Cyafra21-1 were higher than the normal levels, and the serum levels of CA199, CA125, CEA, NSE and Cyafra21-1 of patients were significantly higher than those in the ILD-LC group [(40.15±10.18) U/ml vs. (20.69±4.53)U/ml, (58.03±11.87) U/ml vs. (35.55±9.55)U/ml, (30.22±2.86) ng/ml vs. (8.25±0.62)ng/ml, (22.14±7.19) ng/ml vs. (14.34±6.20)ng/ml, (10.45±3.45) ng/ml vs. (3.67±1.22) ng/ml, P all<0.05]. The pulmonic dispersion function of the ILD-LC group was worse than the ILD group (P<0.05). The HRCT scan pattern of the ILD-LC patients showed that the UIP-type was the main type in interstitial changes, and the majority of tumors of the ILD-LC group were peripheral lung cancers, located in the lower lobes and the leison of ILD.The pathological types of lung cancer mainly were adenocarcinoma (39.7%)and squamous cell lung cancer (32.4%). On the pathologic stage in the ILD-LC group, non-small cell lung cancer were mainly in Ⅲ(44.9%) or Ⅳ(38.8%) period, and 19 cases were small cell lung cancer in extensive period. Conclusions Elderly, smoking and male ILD patients are more likely to be suffered from lung cancer. Patients with ILD-LC have higher tumor markers and worse lung function than the patients with ILD. Monitoring tumor markers and lung function and regular HRCT examination are helpful for the early diagnosis of ILD-LC. Key words: Interstitial lung disease; Lung cancer; Clinical characteristics

Objective To analyze the application values of human epididymis protein 4 (HE4) in lung cancer. Methods A total of 196 patients with lung cancer in Shandong Provincial Hospital affiliated to Shandong University from January 1, 2015 to December 31, 2015 were enrolled, including 68 cases of squamous cell carcinoma, 92 cases of adenocarcinoma and 36 cases of small cell lung cancer.A total of 65 cases of lung benign diseases and 90 healthy subjects were chosen as controls. Results The level and positive rate of HE4 in patients with lung cancer were significantly higher than those in patients with lung benign diseases and healthy controls (all P<0.01). The level and positive rate of HE4 in lung benign disease group were significantly higher than those in healthy control group (all P<0.01). The level and positive rate of HE4 in lung adenocarcinoma were significantly higher than those in squamous cell carcinoma and small cell lung cancer (all P<0.01). There was no significant difference in HE4 level and positive rate between lung squamous cell carcinoma and small cell lung cancer.The level of HE4 in patients with stage Ⅲ+ Ⅳ was significantly higher than that in patients with stage Ⅰ+ Ⅱ (P<0.01). When the HE4 level was 85.99 pmol/L, the sensitivity of lung cancer diagnosis was 88.6% and the specificity was 90% by the receiver operating characteristic curve. Conclusions HE4 has higher sensitivity and specificity for the diagnosis of lung cancer, and could effectively improve the diagnosis rate of lung cancer. Key words: Lung cancer; Human epididymis protein 4; Tumor markers

Objective To evaluate the prognostic value of serum Pro gastrin releasing peptide (ProGRP), carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC) in lung cancer patients with high risk of lung cancer. Methods A total of 392 patients treated with Oncology and Respiratory Medicine from January 2011 to December 2015 were enrolled in this study, including 308 cases of non-small cell lung cancer (NSCLC), 84 cases of small cell lung cancer (SCLC) and 116 cases of benign lung tumors.In addition, 144 subjects were enrolled in this study as the healthy group at the same time in Jiaozhou People′s Hospital physical examination center.The diagnostic value of ProGRP, CEA and SCC was analyzed by multivariate Logistic regression model and receiver operating characteristic (ROC) curve, and the serum tumor markers in different stages of lung cancer were compared. Results Compared with the healthy group, ProGRP, CEA, and SCC in the NSCLC group increased significantly, they were (353.2±10.45) ng/L vs (12.87±9.20) ng/L, (3.03±1.79) ng/L vs (1.62±0.08) ng/L, (2.21±0.54) ng/L vs (1.90±0.34) ng/L.The sensitivity, specificity and accuracy of serum ProGRP in the diagnosis of lung cancer were more than 85% and the AUC was 0.940; the sensitivity, specificity and accuracy of serum CEA in lung cancer were 71%, 69% and 69%, AUC=0.926.The sensitivity, specificity, and accuracy of serum SCC in lung cancer were 95%, 55%, and 62%, AUC=0.932. Conclusions ProGRP, CEA and SCC can be used as tumor markers of NSCLC and SCLC, and have a certain correlation with the stage of lung cancer, which can effectively predict the risk of lung cancer in high risk groups of lung cancer. Key words: Carcinoma, non-small-cell lung; Small cell lung cancer; Pro-gastrin-releasing peptide; Carcinoembryonic antigen; Squamous cell carcinoma antigen

Lung cancer is the leading cause of cancer-related death in many countries, and an accurate histopathological diagnosis is of great importance in subsequent treatment. The aim of this study was to establish the random forest (RF) model based on radiomic features to automatically classify and predict lung adenocarcinoma (ADC), lung squamous cell carcinoma (SCC), and small cell lung cancer (SCLC) on unenhanced computed tomography (CT) images. Eight hundred and fifty-two patients (mean age: 61.4, range: 29–87, male/female: 536/316) with preoperative unenhanced CT and postoperative histopathologically confirmed primary lung cancers, including 525 patients with ADC, 161 patients with SCC, and 166 patients with SCLC, were included in this retrospective study. Radiomic features were extracted, selected, and then used to establish the RF classification model to analyse and classify primary lung cancers into three subtypes, including ADC, SCC, and SCLC according to histopathological results. The training (446 ADC, 137 SCC, and 141 SCLC) and testing cohorts (79 ADC, 24 SCC, and 25 SCLC) accounted for 85% and 15% of the whole datasets, respectively. The prediction performance of the RF classification model was evaluated by F1 scores and the receiver operating characteristic (ROC) curve. On the testing cohort, the areas under the ROC curve (AUC) of the RF model in classifying ADC, SCC, and SCLC were 0.74, 0.77, and 0.88, respectively. The F1 scores achieved 0.80, 0.40, and 0.73 in ADC, SCC, and SCLC, respectively, and the weighted average F1 score was 0.71. In addition, for the RF classification model, the precisions were 0.72, 0.64, and 0.70; the recalls were 0.86, 0.29, and 0.76; and the specificities were 0.55, 0.96, and 0.92 in ADC, SCC, and SCLC. The primary lung cancers were feasibly and effectively classified into ADC, SCC, and SCLC based on the combination of RF classification model and radiomic features, which has the potential for noninvasive predicting histological subtypes of primary lung cancers.