Presence Of Lung Cancer Research Articles

P27.24.A SYSTEMIC AND LOCAL THERAPIES BEFORE AND AFTER DIAGNOSIS OF LEPTOMENINGEAL DISEASE IN PATIENTS WITH BRAIN METASTASES: AN EXPLORATIVE, SINGLE-CENTER RETROSPECTIVE COHORT STUDY

Abstract BACKGROUND Leptomeningeal metastasis (LMD), the dissemination of cancer cells into leptomeninges and/or cerebrospinal fluid, is believed to increase in incidence due to improved survival of oncological patients. Real-world data on therapies before and after diagnosis of LMD in brain metastasis patients are still limited. We aimed to characterize local and systemic therapies before and after diagnosis of LMD in these patients. MATERIAL AND METHODS We included 120 patients (treated from 2012 to 2023) with underlying solid malignancy, presence of brain metastasis together with leptomeningeal spread, either confirmed by MRI, cerebrospinal fluid sampling, or both modalities. Data on demographics, radiological, and therapy-related characteristics were collected. Kaplan-Meier estimates and Cox model regression analysis were performed to identify factors associated with survival. RESULTS Breast cancer (35.8%), NSCLC (20.8%), melanomas (16.7%), and gastric cancer (5.7%) were among the most common entities. In 56% of cases, the diagnosis was made by MRI, in 5% by cerebrospinal fluid puncture (LP) alone, and in 39% by both MRI and LP. The median overall survival (OS) of the cohort was 2.77 months [95% CI: 2.27 - 4.20]. Patients who received systemic after diagnosis of LMD, either chemotherapy (n=26), targeted therapies (n=21) or checkpoint inhibitors (n=9) showed increase survival as compared to respective control patients. The only independent prognostic factors at diagnosis of LMD were presence of lung cancer (HR: 2.36 [95% CI: 1.28 - 4.4], p=0.006) and melanoma (HR: 2.30 [95% CI: 1.27 - 4.2], p=0.006). Local or systemic treatment modalities before LMD diagnosis were not associated with survival. CONCLUSION This study provides insights into the complex treatment modalities for LMD patients, both in terms of prior therapies and therapies after diagnosis of LMD. These results underscore the need for large prospective multi-center registries and interventional studies to further improve interdisciplinary and personalized therapy for these patients.

Cell-Free DNA Fragmentomes in the Diagnostic Evaluation of Patients With Symptoms Suggestive of Lung Cancer

The diagnostic workup of individuals suspected of having lung cancer can be complex and protracted because conventional symptoms of lung cancer have low specificity and sensitivity. Among individuals with symptoms of lung cancer, can a blood-based approach to analyze cell-free DNA (cfDNA) fragmentation (the DNA evaluation of fragments for early interception [DELFI] score) enhance evaluation for the possible presence of lung cancer? Adults were referred to Bispebjerg Hospital (Copenhagen, Denmark) for diagnostic evaluation of initial imaging anomalies and symptoms consistent with lung cancer. Numbers and types of symptoms were extracted from medical records. cfDNA from plasma samples obtained at the prediagnostic visit was isolated, sequenced, and analyzed for genome-wide cfDNA fragmentation patterns. The relationships among clinical presentation, cancer status, and DELFI score were examined. A total of 296 individuals were analyzed. Median DELFI scores were higher for those with lung cancer (n= 98) than those without cancer (n= 198; 0.94 vs0.19; P< .001). In a multivariate model adjusted for age, smoking history, and presenting symptoms, the addition of the DELFI score improved the prediction of lung cancer for those who demonstrated symptoms (area under the receiver operating characteristic curve, 0.74-0.94). The DELFI score distinguishes individuals with lung cancer from those without cancer better than suspicious symptoms do. These results represent proof-of-concept support that fragmentation-based biomarker approaches may facilitate diagnostic resolution for patients with concerning symptoms of lung cancer.

Clinical features and risk factors of lung cancer in elderly patients with dermatomyositis.

Although there are concerns about the association between dermatomyositis (DM) and malignancy, the clinical features in elderly DM patients with lung cancer are largely unknown. Here, we elucidated the clinical features and risk factors of lung cancer in elderly DM patients. The data of elderly DM patients (≥65 years old) with or without lung cancer admitted to the Second Xiangya Hospital, Central South University from January 2016 to November 2022 were retrospectively analyzed. Male patients with elderly onset DM (EODM) symptoms were found to be prone to lung cancer (p< 0.001). Elderly DM patients with lung cancer had a higher ratio of a history of smoking and were more likely to present with heliotrope rash, V sign and dysphasia and elevated monocyte-to-lymphocyte ratio (MLR) and there was a higher ratio of anti-TIF1-γ-Ab-positive patients (all p< 0.05). Occurrence of interstitial lung disease (ILD), elevated aspartate aminotransferase (AST) and anti-aminoacyl-tRNA synthetase (anti-ARS)-antibody positive rates were less common in elderly DM patients with lung cancer than those without lung cancer (all p< 0.05). Multivariate logistic regression analysis showed smoking history (p= 0.011, OR= 4.532), elevated MLR (p= 0.018, OR= 1.159) and anti-TIF1-γ-Ab-positive status (p= 0.034, OR= 8.529) were independently associated with the presence of lung cancer, while ILD might be a protective factor (p= 0.024, OR= 0.179) for lung cancer in elderly patients with DM. Lung cancer is more common in male patients with EODM symptoms. Smoking, elevated MLR and being anti-TIF1-γ-Ab-positive were associated with higher frequencies of lung cancer in elderly DM patients. It is necessary to screen lung cancer in elderly DM patients with a history of smoking, elevated MLR or being anti-TIF1-γ-Ab-positive.

DNA damage and antioxidant capacity in COPD patients with and without lung cancer

Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation of the lower airways, and COPD patients show two to five times higher risk of lung cancer than smokers with normal lung function. COPD is associated with increased oxidative stress, which may cause DNA damage and lung carcinogenesis. Our aim was to evaluate DNA damage and oxidative stress (lipid peroxidation and antioxidant status) and their relationship in patients with COPD with and without lung cancer. We evaluated 18 patients with COPD, 18 with COPD with lung cancer, and 18 controls (former or current smokers). DNA damage was evaluated in peripheral blood lymphocytes using a comet assay; the concentration of malondialdehyde (MDA) and hydrophilic antioxidant performance (HAP) were measured in the plasma. DNA damage was higher in patients with COPD with cancer than in the controls (p = 0.003). HAP was significantly lower in patients with COPD with cancer than in those without cancer and controls. The presence of lung cancer and COPD showed a positive association with DNA strand breaks and the concentration of MDA. COPD with lung cancer was associated with elevated DNA damage in peripheral lymphocytes, and cancer and COPD showed a positive correlation with DNA damage. The antioxidant capacity showed a negative association with the interaction COPD and cancer and presence of COPD. The mechanisms underlying the increased incidence of lung cancer in COPD are unknown; DNA damage may be involved. Further research may provide insights into their development and treatment.

Association between asthma, chronic bronchitis, emphysema, chronic obstructive pulmonary disease, and lung cancer in the US population.

Lung cancer is one of the primary causes of death with poor life expectancy after diagnosis. History of past respiratory diseases such as asthma, chronic obstructive lung disease (COPD), emphysema, and chronic bronchitis can increase the risk of lung cancer. Very few studies are available to simultaneously assess multiple respiratory diseases and lung cancer. The objective of this study was to investigate correlations between asthma, emphysema, chronic bronchitis, and chronic obstructive lung disease with lung cancer in the US adult population. This was a cross-sectional study using data from a total of 23,523 adult participants from the National Health Examination and Nutrition Survey (NHANES) datasets for seven cycles ranging from 2003-2004 to 2015-2016. To analyze the data, specialized weighted complex survey logit regressions were conducted. Linear logit regression models using only main-effects were constructed first to assess the correlation between the selected demographic and lifestyle variables and asthma, emphysema, chronic bronchitis, and COPD. A second set of linear, main-effects logit regression models were constructed to examine the correlation between lung cancer and asthma, emphysema, chronic bronchitis, COPD when corrected for the selected covariates. The study identified positive correlations between emphysema, chronic bronchitis, COPD, and lung cancer. No correlation between asthma and lung cancer was established. Of the covariates studied, race/ethnicity, marital status, highest educational level, age, family income to poverty ratio, and lifetime smoking were also found to be correlated with the presence of lung cancer. Correlations between the covariates gender, body mass index, alcohol consumption, and country of birth and lung cancer were not found. The study established statistically significant correlations between lung cancer and the lung diseases emphysema, chronic bronchitis, and COPD. The lack of association between asthma and lung cancer may arise from the timeline of diagnosis asthma or type of lung cancer. The study also established significant correlations between lung cancer and several of the covariates included in the analysis. It also established correlations between the covariates and the lung diseases asthma, emphysema, chronic bronchitis, and COPD.

Association between Chest CT–defined Emphysema and Lung Cancer: A Systematic Review and Meta-Analysis

Background Given the different methods of assessing emphysema, controversy exists as to whether it is associated with lung cancer. Purpose To perform a systematic review and meta-analysis of the association between chest CT-defined emphysema and the presence of lung cancer. Materials and Methods The PubMed, Embase, and Cochrane databases were searched up to July 15, 2021, to identify studies on the association between emphysema assessed visually or quantitatively with CT and lung cancer. Associations were determined by emphysema severity (trace, mild, or moderate to severe, assessed visually and quantitatively) and subtype (centrilobular and paraseptal, assessed visually). Overall and stratified pooled odds ratios (ORs) with their 95% CIs were obtained. Results Of the 3343 screened studies, 21 studies (107 082 patients) with 26 subsets were included. The overall pooled ORs for lung cancer given the presence of emphysema were 2.3 (95% CI: 2.0, 2.6; I2 = 35%; 19 subsets) and 1.02 (95% CI: 1.01, 1.02; six subsets) per 1% increase in low attenuation area. Studies with visual (pooled OR, 2.3; 95% CI: 1.9, 2.6; I2 = 48%; 12 subsets) and quantitative (pooled OR, 2.2; 95% CI: 1.8, 2.8; I2 = 3.7%; eight subsets) assessments yielded comparable results for the dichotomous assessment. Based on six studies (1716 patients), the pooled ORs for lung cancer increased with emphysema severity and were higher for visual assessment (2.5, 3.7, and 4.5 for trace, mild, and moderate to severe, respectively) than for quantitative assessment (1.9, 2.2, and 2.5) based on point estimates. Compared with no emphysema, only centrilobular emphysema (three studies) was associated with lung cancer (pooled OR, 2.2; 95% CI: 1.5, 3.2; P < .001). Conclusion Both visual and quantitative CT assessments of emphysema were associated with a higher odds of lung cancer, which also increased with emphysema severity. Regarding subtype, only centrilobular emphysema was significantly associated with lung cancer. Clinical trial registration no. CRD42021262163 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Hunsaker in this issue.

Evaluation of Risk Factors for Cardiac Complications After Lung Resection

Aim: The aim of this study is to evaluate cardiac complications (CC) and risk factors associated with these complications in patients after lung resection. Methods: Cardiac complications were observed in 136 (11.4%) of 1186 patients who underwent lung resection in a single center between 2017 and 2020. 136 patients who developed complications in the same period and 215 patients who had consecutive operations and did not develop complications were included in the study Results: 287 (81.7%) of the patients were male and the mean age was 58.9 years. There is a statistically significant relationship between cardiac complications after lung resection with geriatric age, male gender, presence of hypertension (HT), presence of lung cancer, neoadjuvant therapy, high SOFA score, chronic obstructive pulmonary disease (COPD), and cerebrovascular accident (CVA). In addition, CVA, EF&lt;60%, neoadjuvant therapy, pneumonectomy, high Sequential Organ Failure Assessment score (SOFA) and intraoperative blood transfusion were found to be independent risk factors for the development of complications. Among the intraoperative factors, pneumonectomy (p&lt;0.001), thoracotomy (p=0.002), intraoperative blood product use (p&lt;0.001) and inotropic use (p&lt;0.001) were correlated with CC. In multiple logistic regression analysis, preoperative thyroid disease (p=0.04), CVA (p=0.001), neoadjuvant therapy (p=0.002), EF&lt;60% (p=0.01), pneumonectomy (p=0.003), intraoperative blood transfusion (p&lt;0.0001) and high SOFA score (p&lt;0.0001) emerged as independent risk factors affecting the development of cardiac complications. Conclusions: There is significant relationship between cardiac complications after lung resection with geriatric age, male sex, HT, lung cancer presence, neoadjuvant therapy, high SOFA score, COPD, CVA presence. In addition, CVA, EF&lt; 60%, neoadjuvant therapy, pneumonectomy and high SOFA score and intraoperative blood transfusion were identified as independent risk factors in the development of complications.

Impact of cancer diagnoses on the outcomes of patients with COVID-19: a systematic review and meta-analysis

BackgroundThe COVID-19 has caused significant mortality and morbidity across the globe. Patients with cancer are especially vulnerable given their immunocompromised state. We aimed to determine the proportion of COVID-19 patients...

The association of lung cancer with pulmonary fibrosis.

In this study using a large database of US decedents, the overall presence of lung cancer was lower in those with idiopathic pulmonary fibrosis compared to those without idiopathic pulmonary fibrosis https://bit.ly/30d6dC4

An EBC/Plasma miRNA Signature Discriminates Lung Adenocarcinomas From Pleural Mesothelioma and Healthy Controls.

BackgroundDespite significant improvement in screening programs for cancers of the respiratory district, especially in at-risk subjects, early disease detection is still a major issue. In this scenario, new molecular and non-invasive biomarkers are needed to improve early disease diagnosis.MethodsWe profiled the miRNome in exhaled breath condensate (EBC) and plasma samples from fourteen patients affected by lung AdCa, nine healthy subjects. miRNA signatures were then analyzed in another neoplasia of the respiratory district, i.e. pleural mesothelioma (n = 23) and subjects previously exposed to asbestos were used as controls for this cohort (n = 19). Selected miRNAs were analyzed in purified pulmonary neoplastic or normal epithelial and stromal cell subpopulation from AdCa patients. Finally, the plasmatic miRNA signature was analyzed in a publicly available cohort of NSCLC patients for data validation and in silico analysis was performed with predicted miRNA targets using the multiMiR tool and STRING database.ResultsmiR-597-5p and miR-1260a are significantly over-expressed in EBC from lung AdCa and are associated with AdCa. Similarly, miR-1260a is also up-regulated in the plasma of AdCa patients together with miR-518f-3p and correlates with presence of lung cancer, whereas let-7f-5p is under-expressed. Analysis of these circulating miRNAs in pleural mesothelioma cases confirmed that up-regulation of miR-518f-3p, -597-5p and -1260a, is specific for lung AdCa. Lastly, quantification of the miRNAs in laser-assisted microdissected lung tissues revealed that miR-518f-3p, 597-5p and miR-1260a are predominantly expressed in tumor epithelial cells. Validation analysis confirmed miR-518f-3p as a possible circulating biomarker of NSCLC. In silico analysis of the potentially modulated biological processes by these three miRNAs, shows that tumor bioenergetics are the most affected pathways.ConclusionsOverall, our data suggest a 3-miRNAs signature as a non-invasive and accurate biomarker of lung AdCa. This approach could supplement the current screening approaches for early lung cancer diagnosis.

Thoracoscopic Talc Insufflation Versus Talc Slurry in Patients with Malignant Pleural Effusion

Background: Malignant Pleural Effusion (MPE) is defined as an accumulation of pleural fluid in which malignant cells are present. It is a poor clinical indicator as it represents an advanced stage neoplasm with median survival ranging from one to 12 months. Aim: We aimed at comparing Thoracoscopic Talc Insufflation with tube thoracostomy talc slurry pleurodesis in regard to the efficacy and complications in patients with MPE. Patients and Methods: 128 patients with MPE were divided into two groups, 64 in each. One group had tube thoracostomy talc slurry (TS) pleurodesis while the other had thoracoscopic talc insufflation (TTI) pleurodesis. Results: Talc slurry was associated with a longer hospital stay. Complications recorded included chest pain (TS 29%, TTI 25.4%), dry cough (TS 16%, TTI 39%), vomiting (TS 29%, TTI 13.6%), tachycardia (TS 16.13%, TTI 18.64%), surgical wound infection (TS 11.29%, TTI 10.17%), and respiratory failure complicating talc pneumonitis (TS 3.23%, TTI 0%). Pleurodesis success was enhanced by the presence of lung cancer (OR 2.34, p=0.02) or breast cancer (OR 2.55, p= 0.03) as the primary malignancy, the younger the patient's age at pleurodesis time (OR 1.004, p=0.89) and the higher the pleural fluid glucose content (OR 1.01, p=0.09). Pleurodesis failure was strongly correlated to the presence of any of the pre-procedural factors, female gender, hepatocellular carcinoma as the primary malignancy, and low pH pleural fluid. Conclusion: In MPE patients with no evidence of lung trapping, talc pleurodesis method used should depend on local expertise (availability of thoracoscopy), whether additional tissue is needed for molecular-marker analysis (would favor thoracoscopy), plus patient-related factors (operable or not). However, TTI has a significant irrefutable benefit in patients with adhesions and trapped lung.

P09.44 Outcomes of Covid-19 Infection in Lung Cancer Patients: Experience from a Large Tertiary Care Cancer Center

SARS-COV-2 or Covid-19 has become a major contributor of significant morbidity and mortality around the world. Patients with cancer constitute a high risk group. Furthermore, presence of lung cancer, advanced stage and active immune-suppressive treatment has been associated with poor outcomes. We sought to evaluate the outcomes of lung cancer patients with PCR confirmed Covid-19 infection at a large tertiary care referral cancer center.

Pulmonary Nodule Classification Using Feature and Ensemble Learning-Based Fusion Techniques

The Pulmonary nodule indicates the presence of lung cancer. The deep convolutional neural networks (DCNNs) have been widely used to classify the pulmonary nodule as benign or malignant. However, an individual learner usually performs unsatisfactorily due to limited response space, incorrect selection of hypothesis space, or falling into local minimums. To investigate these issues, we propose ensemble learners fusion techniques based on averaging of prediction score and maximum vote score (MAX-VOTE). First, the support vector machine (SVM) and AdaBoostM2 machine learning algorithms are trained on the deep features from DCNNs. The results of both classifiers are fused separately based on averaging of the prediction score. Secondly, the feature fusion technique is developed by fusing the feature of three DCNNs (AlexNet, VGG-16 and VGG-19) through predefined rules. After that, the SVM and AdaBoostM2 are trained on fused features independently to build ensemble learners by fusing the multiple DCNN learners. The predictions of all DCNN learners are fused based on the MAX-VOTE. The results show that the ensemble learners based MAX-VOTE technique yields better performance out of twelve single learners for binary class classification of pulmonary nodules. The proposed fusion techniques are also tested for multi-class classification problem. The SVM based feature fusion technique performs better as compared to all the implemented and the state-of-the-art techniques. The achieved maximum accuracy, AUC and specificity scores are 96.89%±0.25, 99.21%±0.10 and 97.70%±0.21, respectively.

Neutrophil to Lymphocyte Ratio in Lung Cancer: Implications for Depressive Symptoms and Survival.

Background:Depression very commonly appears in the presence of lung cancer. Multiple contexts have shown that depression is associated with inflammation. The Neutrophil to Lymphocyte Ratio (NLR) provides an easy to interpret the measure of both inflammation and immunity, but its use as an inflammatory biomarker has not been evaluated in patients with lung cancer. We hypothesize that NLR will be elevated in depressed patients with lung cancer and that both elevated NRL and depression will have prognostic implications.Methods:Patients (n=109) were assessed for depression and anxiety using the Hospital .Anxiety and Depression Scale (HADS) and for distress using the Distress Thermometer. NLR was derived from a complete blood count obtained on the day of the cross-sectional survey. Data were dichotomized (NLR ≥5 and HADS-D ≥8) and analysed for survival estimations using Kaplan-Meier plots.Results:NLR was found to be significantly correlated with depression (r=.21, p=.03) and was associated with depression while controlling for age, sex, and marital status (β=.21, p=.004). NLR trended toward correlation with anxiety (r=.19, p=.07). Elevated NLR (≥5) predicted for worse survival (chi square= 10.08, p=.001), which was similarly seen when combined with meeting depression criteria (chi square = 16.00,p<.001).Conclusion:NLR provides a reasonable assessment of lung cancer related inflammation with survival implications that may indicate the presence of depression. These results warrant further research.

Lung cancer symptoms at diagnosis: results of a nationwide registry study

BackgroundLung cancer is currently the leading cause of cancer death. Despite its high incidence and mortality, there are few studies describing its symptoms at diagnosis broken down by tumour stage and tobacco use. Accordingly, this study was proposed to describe the frequency of the most common symptoms of non-small cell lung cancer and small cell lung cancer (SCLC) at diagnosis, with a breakdown by stage and tobacco use.Patients and methodsCases were collected from the Spanish Thoracic Tumour Registry, a nationwide registry sponsored by the Spanish Lung Cancer Group. More than 50 hospitals recruited histologically confirmed lung cancer cases and information was gathered through personal interview plus data contained in the electronic clinical record. There were no data available on the lag between the appearance of the first symptoms and diagnosis of lung cancer.ResultsA total of 9876 patients (74% male, median age 64 years) were recruited from 2016 to 2019. Of these, 12.5% presented with SCLC. Stage IV was the most frequent stage at diagnosis (46.6%), and the most frequent symptom was cough (33.9%), followed by dyspnoea (26.7%). No symptom was present in 59% of patients diagnosed in stage I; 40% of stage I patients presented with at least one symptom, while 27.7% of patients in stage IV had no symptoms at diagnosis. Cough was the most frequent symptom in SCLC (40.6%), followed by dyspnoea (34.3%). The number of symptoms was similar across the respective smoking categories in SCLC, and differences between the symptoms analysed did not exceed 7% in any case.ConclusionThe absence of the most frequent symptoms (ie, cough, pain, dyspnoea) should not lead to a decision to rule out the presence of lung cancer. A relevant percentage of stage IV patients displayed no symptoms at diagnosis.

Nonpharmacological Interventions for Pain Management in Lung Cancer Patients: A Systematic Review.

Background:The presence of lung cancer is almost always associated with pain, a symptom that causes severe distress in patients. Although many pharmacological methods are available to manage pain in this oncologic population, the medications often cause undesirable sideeffects and inadequate relief. Nonpharmacological interventions can be used as adjuvants to pharmacological interventions in reducing pain and increasing quality of life.Objectives:The purpose of this review is to compare the efficacy of nonpharmacological interventions in reducing pain in lung cancer patients.Materials and Methods:This is a systematic review study guided by the Preferred Reporting Items of Systematic reviews and Meta-Analysis Protocol. Interventions identified in the present systematic review have been categorized as physical treatment, technologybased, cognitive behavioral, coping, and coaching.Results:Results indicate that the nonpharmacological interventions such as physical treatment interventions, selfmanagement and coaching interventions, cognitive behavioral interventions, and technologybased interventions or coping skills interventions had limited and shortterm effects on alleviating pain among the patients. However, previous studies have provided limited evidence regarding nonpharmacologic therapy due to the lack of a comparison group, small sample sizes, and lack of longterm followup periods to determine whether sustained effects are feasible.Conclusion:Healthcare professionals should consider additional research on the added advantage of utilizing the nonpharmacological interventions as an adjunct option while managing pain in lung cancer patients.

Deep Learning Assisted Predict of Lung Cancer on Computed Tomography Images Using the Adaptive Hierarchical Heuristic Mathematical Model

Lung cancer is known to be one of the most dangerous diseases which are the main reason for disease and death when diagnosed in primitive stages. Since lung cancer can only be detected more broadly after it spread to lung parts and the occurrence of lung cancer in the earlier stage is very difficult to predict. It causes a greater risk as radiologists and specialist doctors assess the existence of lung cancer. For this reason, it is important to build a smart and automatic cancer prediction system that is accurate and at which stage of cancer or to improve the accuracy of the previous cancer prediction that will help determines the type of treatment and treatment depth depending on the severity of the disease. In this paper, the Adaptive Hierarchical Heuristic Mathematical Model (AHHMM) has been proposed for the deep learning approach. To analyze deep learning based on the historical therapy scheme in the development of Non-Small Cell Lung Cancers (NSCLC) automated radiation adaptation protocols that aim at optimizing local tumor regulation at lower rates of grade 2 RP2 radiation pneumonitis. Furthermore, the system proposed consists of several steps including acquiring the image, preprocessing, binarization, thresholding, and segmentation, extraction of features and detection of deep neural network (DNN). Segmentation of the lung CT image is carried out to extract any significant feature of a segmented image, and a specific feature extraction method is implemented. The test evaluation showed that the model proposed could detect 96.67 % accuracy of the absence or presence of lung cancer.

Correlations between the metabolic profile and 18F-FDG-Positron Emission Tomography-Computed Tomography parameters reveal the complexity of the metabolic reprogramming within lung cancer patients

Several studies have demonstrated that the metabolite composition of plasma may indicate the presence of lung cancer. The metabolism of cancer is characterized by an enhanced glucose uptake and glycolysis which is exploited by 18F-FDG positron emission tomography (PET) in the work-up and management of cancer. This study aims to explore relationships between 1H-NMR spectroscopy derived plasma metabolite concentrations and the uptake of labeled glucose (18F-FDG) in lung cancer tissue. PET parameters of interest are standard maximal uptake values (SUVmax), total body metabolic active tumor volumes (MATVWTB) and total body total lesion glycolysis (TLGWTB) values. Patients with high values of these parameters have higher plasma concentrations of N-acetylated glycoproteins which suggest an upregulation of the hexosamines biosynthesis. High MATVWTB and TLGWTB values are associated with higher concentrations of glucose, glycerol, N-acetylated glycoproteins, threonine, aspartate and valine and lower levels of sphingomyelins and phosphatidylcholines appearing at the surface of lipoproteins. These higher concentrations of glucose and non-carbohydrate glucose precursors such as amino acids and glycerol suggests involvement of the gluconeogenesis pathway. The lower plasma concentration of those phospholipids points to a higher need for membrane synthesis. Our results indicate that the metabolic reprogramming in cancer is more complex than the initially described Warburg effect.

A machine learning evolutionary algorithm-based formula to assess tumor markers and predict lung cancer in cytologically negative pleural effusions

Malignant pleural effusion is diagnostically challenging in presence of negative cytology. The assessment of tumor markers in serum has become a standard tool in cancer diagnosis, while pleural fluid sampling has not met universal consensus. The evaluation of a panel of markers both in serum and pleural fluid may be crucial to improve the diagnostic accuracy. Using a machine learning-based approach, we provide a mathematical formula capable to express the complex relation existing among the expressed markers in serum and pleural effusion and the presence of lung cancer. The formula indicates CEA and CYFRA21-1 in pleural fluid as the best diagnostic markers, with 97% accuracy, 98% sensitivity, 95% specificity, 96% area under curve, 98% positive predictive value, and 92% MCC (Matthews correlation coefficient).

Solitary pulmonary caseating granulomas: A 5-year retrospective single-center analysis

Solitary pulmonary caseating granulomas (SPCGs) are a characteristic type of tuberculomas associated with infection with non-tuberculous mycobacteria (NTM) and other microbes; however, their significance remains unclear. The aim of the present study was to describe the clinical characteristics of patients with SPCGs in terms of diagnosis, presence of lung cancer and treatment status. A retrospective analysis of 17 immunocompetent patients with histopathologically confirmed caseating granulomas after undergoing video-assisted thoracoscopic surgery (VATS) was conducted at our center between 2011 and 2015. The patients comprised 10 men and 7 women with a mean age of 59.1±14.4 years. Of the 17 patients, 14 (82.4%) were asymptomatic and the lesions were discovered incidentally. In 2 patients the SPCGs were accompanied by a small satellite nodule (SPCG mean diameter, 16.2±5.1 mm). Mycobacteria, including Mycobacterium tuberculosis (11.8%), Mycobacterium avium (11.8%) Mycobacterium kansasii (23.5%) and other Mycobacterium spp. (5.9%), were isolated from 9 of the patients (52.9%). Concurrent lung cancer was present in 3 patients (17.6%). When microbial agents could not be isolated, the interferon-γ release assay was useful for diagnosis. Positron emission tomography was not found to be useful for differentiating SPCGs from lung cancer, or for differentiating tuberculomas from NTM pulmonary nodules (NTMPNs). NTMPNs in cases of SPCGs were diagnosed more frequently in men. The findings indicate that a course of observation may be sufficient for patients in whom an SPCG from NTM (NTMPN) is identified by VATS. However, the presence of concurrent lung cancer in certain cases indicates that malignancy should not necessarily be excluded, particularly in NTMPNs, and highlights the necessity of aggressive diagnosis by VATS.