Proportion Of Adenocarcinomas Research Articles

Proportion of adenocarcinoma and the distribution of HPV genotypes in China: a meta-analysis

Objectives: To examine the proportion and trends of cervical adenocarcinoma in cervical cancer (ICC), mainly including cervical adenocarcinoma (CADC) and squamous cervical cancer (SCC) in China, and to analyze the distribution of human papilloma virus (HPV) in CADC and SCC. Methods: Published studies reporting HPVs distribution in various histological types or relative proportions of CADC in ICC in China were identified manually and searched systematically in Medline, Embase, Cochrane Library databases, CNKI and Wanfang since the databases were established until October 2022. Meta-analysis was performed using Stata 16.0 software. And we applied the random-effects models to estimate the combined effect values due to the high heterogeneity. Results: Twenty-three studies were eligible. The relative prevalence of CADC was 9.0% (95% CI, 7.7%－10.3%). According to the diagnosis time of ICC, the patients were divided into three time periods, which is 1979-2005, 2006-2011, 2012-2022 respectively. The prevalence of CADC by time was: 6.0% in 1979-2005, 8.1% in 2006-2011, and 9.5% in 2012-2022, respectively, with no statistically significant trend in proportions over time (χ2=5.03, P=0.081). Meanwhile, the percentage of CADC also varies by regions, and the highest percentage of CADC was found in the eastern region (11.2%), followed by the western region (7.3%) and the central region (5.9%). The total prevalence of HPV infection in CADC was 72.3%, which was lower than 92.0% in SCC, and the difference was statistically significant (χ2=300.89, P＜0.01). To be specific, the top three HPV types prevalent in CADC were HPV18 (45.0%), HPV16 (22.0%), and HPV52 (7.3%), and those prevalent in the SCC were HPV16 (64.2%), HPV52 (5.6%), HPV18 (5.4%). The results of the Egger's test, and Begg's test showed that there was no publication bias in this study and sensitivity analysis showed that the results of this study were fairly stable. Conclusions: The proportion of CADC in China has increased in a limited way in the past decades, and there are regional differences in the proportion of CADC. The predominant type is HPV18 in CADC and HPV16 in SCC. To eliminate the limitations of the secondary literature, a multicenter study with consistent diagnostic levels and identical HPV genotyping tests is still needed in the future to better characterize the relative proportion of cervical adenocarcinoma and the trend of HPV changes, which will provide a basis for the improvement of HPV vaccine and screening policies.

Cervical Lymph Nodes Metastasis From Non-head and Neck Primary Carcinomas: A Retrospective Analysis of 1448 Patients.

To investigate the clinicopathological features of individuals who have cervical lymph node metastasis (CLNM) from non-head and neck primary carcinomas. The data of 1448 patients diagnosed with CLNM from non-head and neck primary carcinomas at the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, China, from January 2013 to December 2023 were collected. The patients' general information, imaging data, and pathological information were retrospectively analyzed. There were 780 men and 668 women among the 1448 patients, for a male-to-female ratio of 1.17:1. The median age was 56 years (range 21-81 years). The most prevalent primary sites in males were the lung (n = 508, 65.1%) and, in females, the breast (n = 276, 41.3%). The most prevalent pathological kind (n = 949), or 65.5% of cases, was adenocarcinoma. There was a significant difference in the proportion of adenocarcinoma between males (n = 385, 49.4%) and females (n = 564, 84.4%). The common sites of CLNM from non-head and neck primary carcinomas were level V (1,236 cases, 85.4%). In a subgroup of 1133 patients with primary cancer located in symmetrical or unilateral organs, 60.3% exhibited ipsilateral lymph node metastasis, 27.6% had bilateral lymph node metastasis, and 12.1% showed contralateral lymph node metastasis exclusively. For patients with CLNM, especially those with metastasis to cervical areas IV-V and those with adenocarcinoma pathology, it is particularly important to screen for primary foci in the lungs, breast, urogenital system, and digestive system after excluding head and neck primary cancers.

Clinic information, pathological, and imaging characteristics in 2 058 surgical patients with lung cancer from a single center.

Lung cancer is characterized by its high incidence and case fatality rate. Factors related to population composition and cancer prevention programme policy have an effect on the incidence and diagnosis of lung cancer. This study aims to provide scientific support for early diagnosis and treatment of lung cancer by investigating the clinic information, pathological, and imaging characteristics of surgical patients with lung cancer. The data of 2 058 patients, who underwent surgery for lung cancer in the Department of Thoracic Surgery of Xiangya Hospital of Central South University from 2016 to 2019, were retrospectively collected to analyze changes in clinic information, pathological, and imaging characteristics. From 2016 to 2019, the number of patients per year was 280, 376, 524, and 878, respectively. Adenocarcinoma (68.1%) was the most common pathological type of surgical patients with lung cancer. From 2016 to 2019, the proportion of adenocarcinoma was increased from 55.5% to 74.1%. The proportion lung cancer patients in stage IA was increased from 38.9% to 62.3%, and the proportion of patients who underwent sublobar resection was increased from 1.8% to 8.6%. The proportion of lymph node sampling was increased in 2019. Compared with the rate in 2016, the detection rate of nodules with diameter≤1 cm detected by CT before surgery in 2019 was significantly improved (2.0% vs 18.2%), and the detection rate of nodules with diameter>3 cm was decreased (34.7% vs 18.3%). From 2016 to 2019, the proportion of lesions with pure ground-glass density and partial solid density detected by CT was increased from 2.0% and 16.6% to 20.0% and 37.3%, respectively. The proportion of solid density was decreased from 81.4% to 42.7%. The number of lung cancer surgery patients is rapidly increasing year by year, the proportion of CT-detected purely ground-glass density and partially solid density lesions are increasing, the proportion of patients with adenocarcinoma is rising, the proportion of early-stage lung cancer is increasing, smaller lung cancers are detected in earlier clinical stage leading to a more minimally invasive approach to the surgical methods.

Long-term trends of lung cancer incidence and survival in southeastern China, 2011–2020: a population-based study

BackgroundLung cancer is the primary cause of cancer-related deaths in China. This study analysed the incidence and survival trends of lung cancer from 2011 to 2020 in Fujian Province, southeast of China, and provided basis for formulating prevention and treatment strategies.MethodsThe population-based cancer data was used to analyse the incidence of lung cancer between 2011 and 2020, which were stratified by sex, age and histology. The change of incidence trend was analysed using Joinpoint regression. The relative survival of lung cancer with onset in 2011–2014, 2015–2017 and 2018–2020 were calculated using the cohort, complete and period methods, respectively.ResultsThere were 23,043 patients diagnosed with lung cancer in seven registries between 2011 and 2020, with an age-standardized incidence rate (ASIR) of 37.7/100,000. The males ASIR increased from 51.1/100,000 to 60.5/100,000 with an annual percentage change (APC) of 1.5%. However, females ASIR increased faster than males, with an APC of 5.7% in 2011–2017 and 21.0% in 2017–2020. Compared with 2011, the average onset age of males and females in 2020 was 1.5 years and 5.9 years earlier, respectively. Moreover, the proportion of adenocarcinoma has increased, while squamous cell carcinoma and small cell carcinoma have decreased over the past decade. The 5-year relative survival of lung cancer increased from 13.8 to 23.7%, with a greater average increase in females than males (8.7% and 2.6%). The 5-year relative survival of adenocarcinoma, squamous cell carcinoma and small cell carcinoma reached 47.1%, 18.3% and 6.9% in 2018–2020, respectively.ConclusionsThe incidence of lung cancer in Fujian Province is on the rise, with a significant rise in adenocarcinoma, a younger age of onset and the possibility of overdiagnosis. Thus, Fujian Province should strengthen the prevention and control of lung cancer, giving more attention to the prevention and treatment of lung cancer in females and young populations.

The real-world comparison of non-small cell lung cancer survival outcomes depending on immunotherapy treatment and PD-L1 expression level.

The incidence and mortality trends of lung cancer in Slovakia are not favorable. In our single-center, non-interventional retrospective cohort study, we provide comprehensive information about Slovakia's non-small cell lung cancer (NSCLC) patient population. We evaluated how the introduction of immunotherapy agents affected the survival of NSCLC patients and tried to identify whether the PD-L1 expression level was associated with a negative patient survival effect. The demographics, results of histological and immunohistochemical (PD-L1) examinations, and information about treatment (immunotherapy or standard of care (SOC)) were recorded. In males, squamous cell carcinomas occurred more often than adenocarcinomas (54.40% and 45.08%, respectively), in females, adenocarcinomas clearly dominated (71.88% vs. 27.08%, respectively). The overall proportion of adenocarcinomas was 53.98%. NSCLC patients with stage III and IV treated with SOC treatment (n=54) showed significantly worse overall survival than patients with immunotherapy (n=9) (p=0.026). The comparison of immunotherapy-treated (n=7) and SOC-treated (n=32) adenocarcinoma patients stage III and IV showed similar results (p=0.046). The negative effect of PD-L1 expression level on survival of females with NSCLC and females with adenocarcinoma was visible already at the TPS level of 20-25%. In males with NSCLC, the negative effect was visible at a TPS level of 70-90%. Our results confirm the positive impact of immunotherapy in real-world conditions and show different effects of PD-L1 expression level on patients' survival depending on sex and histology. Determination of different PD-L1 expression breaking points in males and females with NSCLC is a solid starting point for more research on this topic.

Vulvar cancer incidence and net survival in Sweden 1960 to 2019: A population-based national study.

Vulvar cancer is a rare gynecological cancer affecting mostly older women. The aim of this population-based study was to investigate the incidence and net survival of vulvar cancer in Swedish women from 1960 to 2019. Data were retrieved from the mandatory Swedish Cancer Registry consisting of all women diagnosed with vulvar cancer between 1960 and 2019. Only women with a morphologically verified diagnosis of vulvar cancer were included. The individuals were then further matched with the Swedish Death Registry up until May 31, 2020. In total, 8499 women were included with the following morphologies: squamous cell carcinoma 7250 (85.8%), malignant melanoma 539 (6.4%), adenocarcinoma 401 (4.8%) and other: 259 (3.1%). More than 50% of vulvar cancer cases occurred in women aged between 65 and 84 years of age. The 5-year age-standardized net survival increased from 53.0% (95% confidence interval [CI] 48.9-57.5) in 1960 to 72.1% (95% CI 68.8-75.5) in 2019. The proportion of adenocarcinoma among all cases increased from 2.0% to 8.7% between the 1960s and 2010s and an increase in age-standardized 5-year net survival was found for adenocarcinoma. The age-standardized incidence of vulvar cancer cases in Sweden was stable between 1960 and 2019. During the study period, an increase in adenocarcinoma and a decrease in malignant melanoma cases was found. Five-year net survival increased by 20 percent units during the study period. For squamous cell carcinoma, an increased age-specific 5-year net survival was observed for all age groups, apart for women aged ≥85.

Silva Classification System for HPV-Related EAC of Stage I ∼ IIIc1p Cervical Adenocarcinoma and Its Effect on Prognosis and Survival

The proportion of adenocarcinoma in cervical cancer gradually increased and presented a younger trend. The previous pathological classification of cervical adenocarcinoma is difficult to provide reference for clinical treatment. In recent years, Silva classification, a new pathologic system for cervical adenocarcinoma, has been confirmed to be suitable for HPV-associated adenocarcinoma (HPVA), and has shown certain clinical application value in subsequent studies. Therefore, this study will retrospectively analyze the distribution of Silva typing system in patients with HPVA under standard treatment mode and its relationship with prognosis and survival. From January 2010 to September 2021, 124 cervical adenocarcinoma patients with HPVA were retrospectively included, who underwent radical resection of cervical cancer. The HE staining sections of the patients were divided into SilvaA, SilvaB, and SilvaC types according to the Silva typing system. Kaplan-Meier calculation was used for single-factor analysis, and COX stepwise regression model was used for multi-factor analysis. Of the 124 patients with HPVA who could be graded according to the Silva system, 16 (12.9%, 16/124) were SilvaA, 27 (21.7%, 27/124) SilvaB, and 81 (65.4%, 81/124) SilvaC. In Silva classification, FIGO staging of Silva A and B was stage I. And FIGO staging of Silva C was more significantly later than the staging of Silva A and B. All lymph node metastases and paruterine infiltrates were found only in Silva C. In addition, the patients with Silva C large mass accounted for a higher proportion (41.7%). SilvaA type cervical adenocarcinoma patients were in a survival state by the end of follow-up. Among Silva B, 3 patients died due to tumor, and the 5-year OS rate were 91.3%. Among SilvaC, 15 patients died due to tumor, and the 5-year OS rate were 76.5%. FIGO stage and lymph node invasion were the influencing factors for survival and prognosis of Silva classification (P <0.05). FIGO stage, tumor size, lymph node invasion, and paralegal invasion were the influencing factors for survival and prognosis of SilvaC patients (P <0.05). Silva model classification system combined with clinicopathological features has certain clinical value for the prognostic guidance of HPVA patients. Among Silva classification, SilvaC had the worst prognosis. Late FIGO stage, lymph node metastasis, and paralegal infiltration are the influencing factors for survival and prognosis of SilvaC type.

Treatment and survival analysis for 40-year SEER data on upper esophageal cancer.

Upper esophageal cancer (UEC) is rare in both Eastern and Western countries. The epidemiological characteristics and long-term survival of UEC patients are less known. In addition, the choice of optimal treatment for UEC has been controversial. Cases of UEC (C15.3 and C15.0) arising during the period from 1973 to 2013 were identified and selected using the SEER database. Student's t-test and Pearson's chi-square test were used to compare the differences in parameters among different groups. Esophageal cancer-specific survival (ECSS) and overall survival (OS) rates were calculated by using the Kaplan-Meier method. Cox proportional hazard regression was used to analyze predictive factors. In the past 40 years, the cases of UEC have gradually increased, and the proportion of adenocarcinoma (AD) has gradually increased (from 3.6% to 11.8%, p < 0.001). There has been a significant increase (1973-1982 vs. 2004-2013) in median OS (7 months vs. 10 months, p < 0.001) and median ECSS (7 months vs. 11 months, p < 0.001) among UEC patients from 1973 to 2013. For the impact of different treatments, the results showed that the ECSS and OS of surgery without radiation (SWR) and radiation plus surgery (R+S) were superior to those of radiation without surgery (RWS). Subgroup analysis showed that ECSS and OS were highest among patients treated with SWR compared with R+S and RWS for patients with localized disease. For regional disease, ECSS and OS were highest among patients with R+S compared with SWR or RWS. Among patients with regional-stage squamous cell carcinoma (SCC), OS was higher with neoadjuvant radiotherapy or adjuvant radiotherapy compared with SWR. Multivariate analysis showed that radiotherapy sequence was dependently associated with OS among patients with regional-stage SCC. Although the long-term survival of UEC remains poor, it has gradually increased since 1973. This should be closely related to the improvement of medical care over the past 40 years. Different treatment methods have a great influence on the long-term survival of UEC. For localized diseases, surgery may be a better choice. For regional disease, surgery plus adjuvant or neoadjuvant radiotherapy may be more beneficial to improve the long-term prognosis of UEC patients.

Azithromycin induces read-through of the nonsense Apc allele and prevents intestinal tumorigenesis in C3B6F1 ApcMin/+ mice

Therapeutic strategies that promote read-through of a mutant gene have proved effective for certain non-neoplastic diseases. However, the efficacy of this approach is unproven regarding neoplastic diseases with germline nonsense mutations, including familial adenomatous polyposis. Here we examined the cancer-preventive efficacy of the macrolide antibiotic azithromycin, with a reported read-through effect, on intestinal tumorigenesis in C3B6F1 ApcMin/+ mice harboring a nonsense Apc mutation resulting in a truncated Apc protein. Mice were given drinking water lacking azithromycin or containing 0.0125-0.2mg/mL azithromycin from 3 weeks of age. The small intestine and cecum were analyzed for pathological changes and alterations of intestinal flora. Azithromycin suppressed the number of tumors and the proportion of adenocarcinomas, with the most effective drinking-water concentration being 0.0125mg/mL. Furthermore, azithromycin recovered the cellular level of full-length Apc, resulting in downregulation of β-catenin and cyclin D1. Conversely, the effect of azithromycin on the diversity of the intestinal microbiota depended on the drinking-water concentration. These results suggest that the balance between azithromycin-mediate read-through of mutant Apc mRNA and antibacterial effects influences intestinal tumorigenesis. Thus, azithromycin is a potential anticancer agent for familial adenomatous polyposis patients harboring nonsense mutations.

Genomic landscape and clonal evolution between adenocarcinoma and squamous components in adenosquamous carcinoma of the pancreas.

e16265 Background: Adenosquamous carcinoma of the pancreas (ASCP) is a rare histological subtype of pancreatic cancer with high metastasis rate and poor prognosis, which is characterized by a variable proportion of adenocarcinoma and squamous carcinoma components with at least 30% of the tumor showing squamous differentiation. To get further insight into the tumorigenesis and progression, we profiled the genetic characterization and explored the evolutionary model of this subtype. Methods: A total of 10 patients with ASCP were enrolled. For each sample, glandular and squamous carcinoma tissues were separated by microdissection. Whole exome sequencing for 20 samples with matched peri-carcinomatous tissues were performed by next-generation sequencing. Results: Genetic profiling revealed that top 5 mutated genes of adenocarcinoma and squamous components were highly consistent including TP53 (100% vs 100%), KRAS (100% vs 90%), CDKN2A (40% vs 40%), KDM6A (20% vs 20%) and LRP1B (20% vs 20%). KEGG pathway analysis showed that PI3K-Akt, MAPK and FoxO signaling pathways were the most frequently mutated pathways in adenocarcinoma. In contrast, Apelin and Rap1 signaling pathways were highly mutated in squamous components, advocating that these pathways may play important roles in the transformation of squamous carcinomas. A higher proportion of indels were identified in adenocarcinoma than squamous components (12.1% vs 3%). The chromosome regions of 3p21.3, 9p21.3, 11p15.5, 16p13.11 and 21q22.3 were the most commonly deleted regions in the adenocarcinoma components, while losses of 1p36.21, 3p25.3, 3q13.13, 6p22.3 and 11p15.5 had been observed in the squamous components. Some of these regions had important effects on development and progression of cancer. For example, 9p21.3 had well-established impact on cell proliferation and apoptosis containing two crucial tumor suppressor genes, CDKN2A and CDKN2B. Additionally, the C &gt; T mutation was predominant among the 6 types of single nucleotide variations. Most common signatures were related to aging (Single base substitutions, SBS1), BRCA1/2 mutations and responders to platinum therapy (SBS3), and defective DNA mismatch repair (SBS6). Tumor evolution analysis showed that the glandular and squamous components shared a common origin. There were two evolutionary scenarios in the early stages of tumor evolution, with a third of nine patients ware parallel evolution and the remaining patients were linear evolution. KRAS (100%), TP53 (66.7%) and TTN (33.3%) were frequently identified as clonal mutations. Conclusions: This is the first study to elucidate the genomic alteration as well as the clonal evolution using whole-exome sequencing in ASCP patients. It provides evidence for more comprehensive understanding of pathophysiology of ASCP at genomic level, which could contribute to the amelioration for ASCP patients’ management.

Expression and Clinical Significance of Tumor Markers CEA and CYFRA21-1 in Patients with Lung Cancer

To explore the application value of tumor markers carcinoembryonic antigen and cytokeratin 19 fragment in the progression and prognosis of middle-advanced non-small cell lung cancer. Clinical data of 97 patients initially diagnosed with lung lesions in our hospital from January 2018 to December 2019 were collected and divided into the lung cancer group and benign lesion group. There were 52 patients diagnosed with stage I or II lung cancer by computed tomography and clinical diagnosis in the lung cancer group and 45 patients with benign lesions in the benign lesion group. The levels of serum tumor markers were detected by electrochemiluminescence immunoassay. The results showed that the levels of carcinoembryonic antigen and cytokeratin 19 were significantly higher in the lung cancer group compared with the benign lesion group and the difference was statistically significant (p<0.05). Both carcinoembryonic antigen and cytokeratin 19 can be used in the diagnosis of squamous cell carcinoma and adenocarcinoma. The sensitivity of the combined detection was significantly higher than that of the single detection, while the specificity of the combined detection was significantly lower than that of carcinoembryonic antigen alone (p<0.05). In lung cancer with positive combined detection, the proportion of adenocarcinoma was significantly higher than that of squamous cell carcinoma. When cytokeratin 19 was positive and carcinoembryonic antigen was negative, the proportion of squamous cell carcinoma was significantly higher than that of adenocarcinoma. Serum carcinoembryonic antigen and cytokeratin 19 were abnormally highly expressed in non-Small cell lung cancer patients, which are useful for clinical diagnosing, treatment planning, efficacy monitoring, and prognosis evaluation.

Cohort profile: a nationwide population-based retrospective assessment of oesophageal cancer in the Finnish National Esophago-Gastric Cancer Cohort (FINEGO)

PurposeThe Finnish National Esophago-Gastric Cancer Cohort (FINEGO) was established to combine the available registry data with detailed patient information to form a comprehensive, retrospective, population-based research platform of surgically treated...

576 P40, P63-NEGATIVE NON-SQUAMOUS CELL CARCINOMA OF ESOPHAGUS EXCEPT FOR ADENOCARCINOMA OF ESOPHAGOGASTRIC JUNCTION, REPORT OF TWO CASES

Abstract Esophageal cancer is the eighth most common human malignancy and the sixth most common cause of death from cancer worldwide. In Europe and the United States, the proportion of adenocarcinoma has increased due to the increase of Barrett's adenocarcinoma. On the other hands, in Japan most cases are squamous cell carcinoma and adenocarcinoma except esophagogstric junction including Barrett's adenocarcinoma is extremely rare. Methods We experienced two cases of tumors with morphologically no distinct squamous or glandular differentiation and confirmed not to be Barrett’s adenocarcinoma. No clear positive findings for p40 and p63 by immunohistochemistry. Case 1 is 69-year-old man. Esophagectomy was performed after neoadjuvant chemotherapy. Macroscopic findings of the resected specimen showed 59 × 43 mm of tumor (type 2) at upper to middle thoracic esophagus. Case 2 is 53-year-old man. Esophagectomy was performed without neoadjuvant chemotherapy. Macroscopic findings of the resected specimen showed 68 × 46 mm of tumor (type 1) at middle thoracic esophagus. Results Pathological examination revealed that the cancer cells showed mainly solid proliferation and no clear keratinization and gland formation was observed. The relationship with the duct of esophageal gland proper was not observed. Immunohistochemistry, tumor cells showed no neuroendocrine differentiation(ChromograninA-, synaptophysin-)and negative for p40, p63 and CK14, on the other hands tumor cells were positive for CK18. Conclusion By the WHO classification, in addition to adenocarcinoma of the esophagogastric junction, squamous cell carcinoma, neuroendocrine tumor, and salivary gland type tumor, there is an item of undifferentiated carcinoma. However, tumor cells of our cases had not such strong atypia, and immunohistochemical study showed glandular differentiation. Although we could not clarify the origin of tumor, it was suggested that there may be carcinoma other than adenocarcinoma of the esophagogastric junction, which may have glandular elements.

P2.14-34 Tyrosine-Kinase Inhibitors (TKI) in First-Line Treatment of 470 Patients with Non-Small Cell Lung Cancer (NSCLC) from the Czech Republic

From October 2013 there is a possibility to treat patients with NSCLC and with activated epidermal growth factor receptor (EGFR) mutations with three TKI in the Czech Republic. We have tried to find differences among patient groups treated with single TKI in 1st line of treatment. The TULUNG registry was used as a data source for this analysis. This clinical registry is focused on the collection of epidemiological and clinical data of patients with NSCLC treated with target therapy in the Czech Republic. A total of 959 patients treated with TKI inhibitors was enrolled in registry until December 31, 2018. Only patients with EGFR mutation and in which 1st line treatment started in October 2013 and later were included in analysis. With respect to defined inclusion criteria we analysed 470 patients. With gefitinib were treated 234, with afatinib 180 and with erlotinib 56 patients. Descriptive statistics and frequency tables were used to characterize the sample data set. Statistical significance of differences among three TKI inhibitors subgroups was assessed using the Fisher’s exact test or Kruskal-Wallis test for continuous variables. OS and PFS were estimated using Kaplan-Meier method and all point estimates include 95% confidence intervals (95% CI). Statistical significance of differences in survival between subgroups was assessed using the log-rank test. All statistical tests were performed at a significance level of α=0.05. There was statistically significant difference according to age (<0.001) and PS (<0.001), patients treated with gefitinib were statistically significant older and had significantly significant higher PS than patients treated with afatinib and erlotinib There was statistically significant difference in the occurrence of adverse events (p<0.001). Patients treated with gefitinib had a significantly lower incidence of adverse events than patients treated with afatinib and erlotinib. Between these three groups of patients there was no statistically significant difference in sex (p=0.863), in smoking habits (p=0.463, in type of EGFR mutation (p=0.103), in adenocarcinoma proportion (p=0.183). There was no statistically significant difference according to disease control (p=0.183), in response to treatment (p = 0.804), in OS and (p=0.053, in PFS (p=0.06). Between these three groups of patients we found a statistically significant difference in age, PS segmentation and in occurrence of adverse events. We have not found any important statistically difference in sex, smoking, in histology type of EGFR mutation, difference in response to treatment, in disease control and OS.

Clinical epidemiological analysis of 2 403 cases of lung cancer.

Objective To understand preliminaryly the epidemiological trend of lung cancer in recent years by retrospective analysis of 2 403 cases of lung cancer in Zhongnan Hospital of Wuhan University from 2013 to 2017. Methods The clinical data of patients with primary bronchogenic cancer diagnosed in Zhongnan Hospital of Wuhan University from 2013 to 2017 were collected. The clinical data such as gender, age, history of tobacco and alcohol, operation, pathological type, clinical stage and epidermal growth factor receptor (EGFR) gene mutation were analyzed statistically. Results A total of 2 403 cases of lung cancer were collected, including 1 766 males and 637 females. There was no significant difference in gender ratio between male and female in five years (χ2=8.481, P=0.075). There were 2 398 cases with age information, the male-to-female ratios of lung cancer patients aged less than 40, 40-49, 50-59, 60-69, 70-79, 80 and over were 0.9∶1.0, 1.4∶1.0, 2.4∶1.0, 3.6∶1.0, 3.4∶1.0 and 3.3∶1.0 respectively, and the difference was statistically significant (χ2=59.004, P<0.001). The composition difference of adenocarcinoma was not statistically significant in five years (χ2=2.165, P=0.705). There was no statistically significant difference in the composition ratio of squamous cell carcinoma (χ2=4.788, P=0.310). Adenocarcinoma accounted for 43.15% (762/1 766) and 81.95% (522/637) of the pathological types of male and female patients respectively, and the difference was statistically significant (P<0.001). Squamous cell carcinoma accounted for 39.01% (689/1 766) and 7.28% (47/637) respectively, and the difference was statistically significant (P<0.001). The proportion of squamous cell carcinoma in smoking patients was 42.99% (583/1 356), which was significantly higher than that in non-smoking patients (14.61%, 153/1 047); the proportion of squamous cell carcinoma in drinking patients was 40.56% (277/683), which was higher than that in non-drinking patients (26.69%, 459/1 720), and the differences were statistically significant (both P<0.001). A total of 1 252 patients underwent surgery, accounting for 52.10% (1 252/2 403) of the total cases. The surgical rate of small cell carcinoma was 21.72% (48/221), and that of non-small cell carcinoma was 55.18% (1 204/2 182). In five years, the surgical rates of lung cancer patients were 55.11% (221/401), 51.53% (252/489), 58.23% (244/419), 53.18% (276/519) and 45.04% (259/575) respectively, and there was significant difference in the proportion of surgical and non-surgical patients in each year (χ2=19.553, P=0.001). A total of 483 patients were tested for EGFR mutation, the EGFR mutation rate was 58.8% (251/427) in adenocarcinoma patients and 15.6% (5/32) in squamous cell carcinoma patients. Among lung cancer patients aged less than 40, 40-49, 50-59, 60-69, 70-79, 80 and over, the proportions of adenocarcinoma were 76.74% (33/43), 62.39% (136/218), 57.73% (381/660), 47.95% (455/949), 52.22% (235/450) and 52.56% (41/78) respectively, and the difference was statistically significant (χ2=33.078, P<0.001); the proportions of squamous cell carcinoma were 9.30% (4/43), 21.56% (47/218), 28.03% (185/660), 34.14% (324/949), 32.44% (146/450) and 35.90% (28/78) respectively, and the difference was statistically significant (χ2=26.977, P<0.001). The difference of composition ratio of TNM staging was statistically significant in five years (χ2=21.003, P=0.034). Conclusion There has been no significant change of male-to-female ratio in patients with lung cancer in the past five years. With the increase of age, the male-to-female ratio increases first and then decreases. The proportion of adenocarcinoma and squamous cell carcinoma has not increased or decreased significantly in the past five years. Adenocarcinoma and squamous cell carcinoma are both common in male lung cancer patients, while the pathological type of female patients is mainly adenocarcinoma. Squamous cell carcinoma is highly prevalent in smokers and drinkers. The surgical rate of squamous cell carcinoma is higher than that of adenocarcinoma, and the surgical rate of non-small cell lung cancer is higher than that of small cell lung cancer. The EGFR mutation rate is higher in adenocarcinoma. With the increase of age, the proportion of adenocarcinoma in all pathological types tends to decrease, while that of squamous cell carcinoma tends to increase. The patients′ TNM staging has a downward trend, and the operation rate decreases slightly. Key words: Lung neoplasms; Epidemiology; Pathology

Clinical Characteristics and Outcomes of Non-small Cell Lung Cancer Patients with HER2 Alterations in Korea.

PurposeHuman epidermal growth factor receptor 2 (HER2) alterations are found in approximately 1%-3% of non-small cell lung cancers (NSCLCs). We evaluated the clinical features and outcomes of NSCLC harboring HER2 alteration detected by next-generation sequencing (NGS) in Korea.Materials and MethodsA total of 1,108 patients who were diagnosed with NSCLC between December 2015 and December 2017 were screened and analyzed by NGS. Medical records were reviewed retrospectively to analyze the clinical characteristics and outcomes from various treatments.ResultsHER2 alterations were identified in 36 NSCLC patients. Of the patients, 22 (61.1%) had an exon 20 in-frame insertion mutation, 15 (41.7%) had HER2 amplification, and one had both. The median patient age was 58 years, 55.6% were male, and 50.0% were never-smokers. Adenocarcinoma was predominant (88.9%). The most common metastatic site was bone (58.3%), and 66.7% of patients were stage IV at initial diagnosis. Six patients (16.7%) had a coexistent sensitizing epidermal growth factor receptor (EGFR) mutation, and two patients (5.6%) had anaplastic lymphoma kinase (ALK) rearrangement. With a median 14 months of follow-up, the median progression-free survival of first-line treatment was 6 months (95% confidence interval, 4.172 to 7.828), and median overall survival was not reached. The proportions of adenocarcinoma, never-smokers, and metastasis to the liver were higher in the exon 20 in-frame insertion mutation group, whereas coexistence of EGFR mutation was more frequently found in the HER2 amplification group.ConclusionHER2-altered NSCLC showed distinct clinical features. Moreover, different characteristics were identified between the HER2 in-frame insertion mutation group and the HER2 amplification group.

Tobacco Smoking and Trends in Histological Subtypes of Female Lung Cancer at The Cancer Hospital of The Chinese Academy of Medical Sciences Over 13 Years

Background: Smoking among Chinese women accounts for a small proportion, but the incidence and mortality rates of female lung cancer is increasing in recent years. Studies found that there were changes in histologic subtypes of lung cancer patients in China. Aim: This study investigated the tobacco smoking and trends in histologic subtypes of female lung cancer in a cancer hospital in China. Methods: Demographic, smoking history and histologic information about female lung cancer patients diagnosed or treated from 2000 to 2012 was collected from Cancer Hospital, Chinese Academy of Medical Science (CHCAMS). Trends of histologic subtypes calculated with annual percentage change (APC). The distribution differences of adenocarcinoma (ADC), squamous cell carcinoma (SCC), small cell lung cancer (SCLC) and the other subtypes between smokers and nonsmokers were calculated by 7th AJCC cancer staging. Results: Totally of 5,870 female cases of lung cancer, including 630 with history of smoking and 5,240 without, were analyzed. The number of female lung cancer patients increased from 509 (2000-2002) to 1744 (2012-2013). The main histologic type of lung cancer was adenocarcinoma (ADC) (72.93%), followed by small cell lung cancer (SCLC) (11.06%), squamous cell carcinoma (SCC) (8.38%) and the other (7.63%). Among smokers, the proportion of SCC decreased from 40.5% to 23.7% (APC = -11.68%, P = 0.005), however, the ADC increased from 35.7% to 50.7% (APC = 8.63%, P = 0.009). In nonsmokers, the ADC was 76.1%, and SCC was 5.9%. ADC increased from 63.1% to 80.6% (APC = -21.33%, P = 0.006), SCC decreased from 13.6% to 4.5% (APC = 3.86%, P = 0.016). Among squamous cell carcinoma, the cases with history of smoking were more likely diagnosed at early stages (I/II: 47.1%) than those at late stages (III, 34.3%; IV, 18.6%). Conclusion: The number of female lung cancer patients was increased in CHCAMS by year of diagnosis. In both smoking and nonsmoking cases, the proportion of adenocarcinoma was increasing. Among the squamous cell carcinoma, smokers seem to find in early stages.

Clinical characteristics and outcomes of patients with lung cancer, gastrointestinal cancer and urologic cancer with venous thromboembolism

Objective: To compare the clinical characteristics and outcomes of patients with lung cancer, gastrointestinal (GI) cancer and urologic cancer with venous thromboembolism (VTE). Methods: From January 2003 to January 2013, 192 lung cancer, GI cancer and urologic cancer patients with VTE were retrospectively evaluated for the clinical characteristics and outcomes. Results: Among 192 patients, 82 cases of lung cancer, 78 cases of GI cancer, 32 cases of urologic cancer were involved. The Eastern Cooperative oncology Group Performance Status score of GI cancer group was significantly higher than those of the lung cancer and urologic cancer groups[(2.4±1.1) vs (2.0±1.4), (1.8±1.0), both P<0.05]. The proportion of smoking patients in lung cancer group was significantly higher than that in GI cancer and urologic cancer groups (79.3% vs 30.8%, 53.1%, both P<0.05), while the proportion of operation was significantly lower than that in the latter two groups (35.4% vs 53.8%, 68.8%, both P<0.05). Pathological types of cancer were mostly adenocarcinoma, and the proportion of adenocarcinoma in lung cancer and GI cancer groups was significantly higher than that in urologic cancer group (76.9%, 73.8% vs 37.9%, both P<0.001). The proportion of moderately and/or poorly differentiated histodifferentiation in the first two groups was significantly higher than that of urologic cancer group (90.0%, 95.7% vs 40.0%, both P<0.001). The proportion of patients with TNM stage Ⅲ-Ⅳ in lung cancer group was significantly higher than that of the urological cancer group (87.0% vs 64.3%, P<0.05). The incidence of VTE in lung cancer group was significantly higher than those of GI cancer and urologic cancer groups within 6 months after tumor diagnosis, chemotherapy and operation (79.3% vs 60.3%, 46.9%; 76.5% vs 48.6%, 36.4%; 92.3% vs 57.9%, 59.1%; all P<0.05). The case fatality rate within one year in lung cancer and GI cancer groups was significantly higher than that in urologic cancer group (51.2%, 52.6% vs 18.8%, both P<0.01). The median survival time of the lung cancer and GI cancer groups was significantly shorter than that of the urological cancer group (P=0.001, 0.010, respectively). Conclusions: Adenocarcinoma, advanced cancer, and poor histodifferentiation are risk factors of VTE in cancer patients. Most events of VTE occur within 6 months after a diagnosis of cancer. The prognosis of lung cancer and GI cancer complicated with VTE is worse than that of urologic cancer with VTE.

Trends on clinical characteristics and medical service use of lung cancer in China 2005–14: a multicentre retrospective survey

Abstract Background Nationwide data on clinical diagnosis and treatment of lung cancer is scarce in China. The aim of this study was to investigate the 10-year profile of lung cancer on clinical characteristics and medical service use in China. Methods This study was a hospital-based multicentre retrospective survey. Patients diagnosed with primary lung cancer in tertiary hospitals during 2005–14 were selected from seven geographic regions of China. One month was randomly chosen to represent one year for each hospital by allocating a random number, and 100 cases were included for each month. Inclusion criteria included age 18 years or older, available data on pathological type, stage, and therapy regime. We used a structured questionnaire, designed by a multidisciplinary expert panel of the National Cancer Center of China, to extract information via medical records, including demographic and clinical characteristics and medical service use. To protect patients' privacy, we allocated an identical ID for each patient and filtered the private information. We applied Cochran-Armitage χ2 test to trend analyses and χ2 test to geographical variations. This study was approved by Cancer Hospital, Chinese Academy of Medical Sciences Ethics Committee. Findings Of 7184 included patients, mean age at diagnosis was 58·3 years (SD 10·2) and non-small cell lung cancer accounted for 6481 (90·2%) patients· Over the decade, the number of patients aged 60 years or older increased from 282 (41·2%) in 2005 to 460 (56·2%) in 2014 (p Interpretation The sustaining high smoking exposure, increase of female patients, and upstaging cancer demonstrate potential challenges and future directions on lung cancer prevention and control in China. Despite substantial changes of clinical characteristics, main treatment options remained unchanged, which merits further investigation. Funding National Health and Family Planning Commission of China.

Sex differences in lung cancer survival: long-term trends using population-based cancer registry data in Osaka, Japan.

Several studies of sex differences in lung cancer survival have been reported. However, large-size population-based studies based on long-term observation are scarce. We investigated long-term trends in sex differences in lung cancer survival using population-based cancer registry data from Osaka, Japan. We analyzed 79 330 cases from the Osaka Cancer Registry (OCR) diagnosed between 1975 and 2007. We calculated 5-year relative survival in the six periods (1975-1980, 1981-1986, 1987-1992, 1993-1997, 1998-2002 and 2003-2007). To estimate the trends in sex differences in lung cancer survival throughout the study period, we applied a multivariate excess hazard model to control for confounders. The proportion of adenocarcinoma (ADC) and 5-year relative relative survival have increased for both sexes. Sex differences in lung cancer survival have widened over the period, especially in ADC and since the late 1990s. The excess hazard ratio of death within 5 years for males was 1.19 (95% CI: 1.16-1.21), adjusting for period at diagnosis, histologic type, stage, age group and treatment. We reported that females have better prognosis in lung cancer than males and the sex differences in lung cancer survival have become wider in Osaka, Japan. This can be partly explained by the sex differences in the proportions of histologic type and stage. Further studies considering other factors that influence sex differences in lung cancer survival are needed.