Diagnosis Of Primary Lung Cancer Research Articles

P2.03b-009 Brain Metastasis and Epidermal Growth Factor Receptor Mutations in Croatian Caucasians with Lung Adenocarcinoma: Topic: Brain Meta

The brain is a common site of metastasis in non-small cell lung cancer (NSCLC). The aim of this study was two-fold: 1) to determine the incidence of brain metastasis (BM) in Caucasian lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) mutations and 2) to evaluate the frequencies and potential relationship of the different EGFR mutations with BM. A retrospective cohort study was conducted at a Croatian tertiary hospital (Clinic for Respiratory Diseases “Jordanovac”) using data collected from medical records. Caucasian patients with primary NSCLC who were tested for EGFR mutation status between January 2014 and October 2015 were included. Of 1040 NSCLC samples tested, 122 (11.7%) patients with lung adenocarcinoma harbored EGFR mutations; six EGFR positive (+) patients (four with BM) had repeat EGFR testing. The majority of EGFR mutants were females (n= 90, 77.6%), non-smokers (including never-smokers and former-smokers; n= 95, 92.2%), diagnosed with advanced disease (stage IIIB/IV) at first presentation (n= 75, 68.8%), and median age at initial diagnosis of primary lung cancer was 65 years (35 - 90). Twenty-three (19.8%) of 116 EGFR+ patients were diagnosed with BM; for six EGFR+ patients, data about BM was missing. Most were 64 years of age or younger (n= 15, 65.2%) at diagnosis of BM (median age: 62 years, 48 - 72). Synchronous BM disease at initial diagnosis of lung cancer was found in 43.5% of EGFR+ patients with BM (n= 10). There were more EGFR+ women with BM (n= 20, 87%) than men. Single exon 19 deletion and exon 21 L858R mutations were the most common subtypes in both EGFR+ patients without BM (n= 44, 47.3% and n= 27, 27.8%, respectively) and with BM (n= 13, 56.5% and n= 5, 21.7%, respectively). One BM patient (4.3%) had a double mutation (exon 19 and 21), while six non-BM patients (6.2%) had simultaneous pairings, most commonly between exon 19 and 20 (n=3, 3.1%). Although exon 18 mutations were seen in six patients without BM (6.2%), none were found in BM+EGFR+ patients. Exon 20 T790M mutation occurred in 17.4% of BM patients (n= 4) versus 15.3% of non-BM patients (n= 15). Rare EGFR double mutations (exon 18 and 20) were found in two non-BM patients (2.2%). Larger long-term prospective studies to explore and confirm these results in BM+EGFR+ patients are warranted. In the era of precision oncology, molecular testing of EGFR mutations may further clarify the pathogenesis of lung cancer-associated BM.

Traditional transbronchial needle aspiration biopsy in the diagnosis of primary lung cancer in the use of value in the primary hospital

Objective To investigate traditional transbronchial needle aspiration biopsy (C-TBNA) using the diagnostic value of lung cancer in primary hospital. Methods The clinical data of patients with 118 cases of primary lung cancer was analyzed retrospectively and the respiratory department of the First Hospital of Jiaxing from January 2013 to December 2014 period was analyzed by C-TBNA pathologic diagnosis, including the lymph nodes and lung tumor puncture biopsy.Meanwhile, all patients did chest CT. Results By means of the positive C-TBNA pathologic analysis among the 118 cases of patients, it gets the result of 45 cases of adenocarcinoma (38.1%), squamous cell carcinoma and 28 cases (23.7%), small cell carcinoma in 17 patients (14.4%). Combining the TNBA lymph nodes and the chest CT comparison, C-TBNA lymph node biopsy in the diagnosis and staging of lung cancer was found significantly better than the chest CT.It can reduce the false negative rate of the chest CT lymph nodes.The positive rate of C-TBNA lymph nodes 1is regardless of the puncture area.118 patients made 289 parts by lymph node biopsy specimens, including 194 positive samples which are divided into three regions (the mediastinum and lower mediastinal region, 10-14 region). Comparing the three groups’region rates, no statistical significant difference was found (P=0.407). All patients was well tolerated, no complications. Conclusion As hilus pulmonis and mediastinal lymph nodes and lung tumor pathology assessment tools, C-TBNA can significantly improve the diagnostic yield of lung cancer.In addition, the positive rate is regardless of the puncture puncture area.The application of bronchoscopy of lung cancer diagnosed is safe, effective and feasible. Key words: Lung neoplasms; Lymph nodes; Biopsy, needle; Tomography, X-ray computed

Experience with palliative sedation (PS) in an inpatient oncology setting.

63 Background: Palliative sedation (PS) is an intervention to treat refractory symptoms and to relieve suffering at the end of life. Its prevalence and practice patterns vary widely. Methods: This is a retrospective study of the use of PS in cancer patients who died at our comprehensive cancer center between March 1, 2012 and December 31, 2014. PS was defined as the use of continuous infusion of midazolam or neuroleptics for refractory symptoms as stated in the progress notes. Patients who died in the ICU were excluded. The aim of our study was to evaluate PS practice patterns, describing its frequency, clinical indications and outcomes. Results: During the study period, 556 cancer patients died at the institution and 203 (36.5%) received PS. Main reasons for exclusion were death in the ICU (168 patients) and no use of midazolam or neuroleptics (77 patients). Patients who received PS as compared to those not sedated were younger (67.8 vs. 71.5 years-old, p = 0.007) and more likely to have a primary diagnosis of lung cancer (23% vs. 15% p < 0.001). Patients receiving PS were more likely to be seen by oncology/hematology rather than other specialties (70% vs 45% p < 0.001) and more likely to have a longer hospital stay from admission to death (47.9 days vs 26.2 days p < 0.001). Only 25 patients (12%) were seen by a dedicated palliative care team. The most common indications for sedation were dyspnea (51.5%) and delirium (19.5%) and the most common dugs used were midazolam (52.9%) or midazolam and a neuroleptic (39.2%). Median initial midazolam infusion rate was 0.75 mg/h (interquartile range – IQR - 0.6-1.5) and final rate was 1.5 mg/h (IQR 0.9-3.0). Median time from sedation to death was 27 hours (IQR 12-58). Conclusions: Palliative sedation is a common practice at our hospital and it is not associated with shortening of hospital stay. Further research is needed to identify factors that may affect the frequency and outcomes associated with palliative sedation.

Socio-economic inequalities in stage at diagnosis, and in time intervals on the lung cancer pathway from first symptom to treatment: systematic review and meta-analysis.

CRD42014007145.

Trends in the Incidence of Lung Cancer Hospitalizations in Spain, 2001–2011

ObjectiveTo analyze changes in the incidence, diagnostic procedures, comorbidity, length of hospital stay, and costs of patients hospitalized for lung cancer in Spain between 2001 and 2011. Patients and methodsRetrospective study including all patients hospitalized with a primary diagnosis of lung cancer between 2001 and 2011. Data were collected from the National Hospital Discharge Database, encompassing the entire Spanish population. Economic and sociodemographic characteristics and health-related variables were analyzed. ResultsA total of 298435 hospitalizations occurred. The overall crude incidence increased from 61.18 per 100000 inhabitants in 2001 to 65.08 per 100000 in 2011 (P<.05), with a decrease in men and a proportionate increase in women. The age group with the highest incidence was 70–79 years. In 2001, 4.5% of patients had a Charlson comorbidity index (CCI) >2, and in 2011, prevalence of CCI>2 increased to 9.1% (P<.05). Mean length of hospital stay decreased during the study period. Computed tomography was the most common procedure. Mean cost per patient increased from €4471.22 in 2001 to €5562.54 (P<.05) in 2011. Factors related to the incidence of hospitalizations were age, sex and year of study in the multivariate analysis. ConclusionsWe found a decrease in the rate of hospitalizations in men and an increase in women, with a concomitant increase in comorbidities and cost; however, length of hospital stay decreased. Factors related to incidence of hospitalizations were age, sex, and year of study.

Updates of Primary Lung Cancer Diagnosis and Treatment Norms (2015 Edition) radiation therapy

Primary lung cancer is one of the most common malignant tumors in China. The 2015 Edition of primary lung cancer diagnosis and treatment norms was updated based on 2010 Edition. This 2015 edition was published by the National Health and Family Planning Commission, which has referenced to the international authority of the lung cancer treatment guidelines and the actual situation of China. This paper mainly introduces the new content of lung cancer radiotherapy, including radical radiotherapy, palliative radiotherapy, adjuvant radiotherapy and preventive radiotherapy. Key words: Lung neoplasms/RT; Benchmarking; Editorial

Development of Multiple Primary Cancers in Lung Cancer Patients: Appalachian Versus Non-Appalachian Populations of Kentucky.

The aim of this study was to investigate whether patients with lung cancer in Appalachian Kentucky are more likely to develop multiple primary cancers than patients in non-Appalachian Kentucky. Additional analyses were conducted to identify other factors that may be associated with an increased hazard of developing multiple primary cancers in patients with lung cancer. The data for this retrospective, population-based cohort study of 26,456 primary lung cancer patients were drawn from the Kentucky Cancer Registry. For inclusion in the study, patients must have been diagnosed between January 1, 2000 and December 31, 2013 and they must either have continually resided in Appalachian Kentucky or continually resided in non-Appalachian Kentucky. Cases were excluded if the patient was diagnosed as having additional primary cancers within 3 months of the initial diagnosis of primary lung cancer. The medical records for each case were examined to determine whether the patient was subsequently diagnosed as having additional primary cancers. The Cox proportional hazards model was then used to assess whether there was an association between the region in which the patients live and the likelihood of developing multiple primary cancers. Time to event was considered as the time from diagnosis to either death or development of a second primary cancer. The results presented here indicate that the risk of developing multiple primary cancers is the same for patients with lung cancer throughout Kentucky (hazard ratio [HR] 1.002, P = 0.9713). We found no evidence for a greater hazard in patients from Appalachia; however, additional analyses revealed several high-risk groups. Male patients and older patients had a significantly greater hazard of developing multiple primary cancers (HR 1.169, P = 0.012 and 1.015, P = 0.0001, respectively). In addition, patients who underwent surgery and those who were diagnosed initially as having an earlier stage of cancer also were more likely to develop multiple primary cancers (HR 1.446, P = 0.0003 and 0.684, P = 0.0015, respectively). This is a negative study. Patients with primary lung cancer living in Appalachian Kentucky are not at a greater risk of developing multiple primary cancers than those residing in non-Appalachian Kentucky. High-risk groups identified in this study are male patients and older patients. The increased hazard seen in patients who underwent surgery or those who were diagnosed as having earlier stages of lung cancer are likely an artifact of these patients living longer and, therefore, having more time to develop additional primary cancers.

A pilot study-is there a role for mitoxantrone pleurodesis in the management of pleural effusion due to lung cancer?

Lung cancer is the leading cause of malignant pleural effusion (MPE). Management of MPEs remains a clinical challenge due to recurrence and poor quality of life. An ideal sclerosing agent has yet to be found. The aim of this cohort pilot study was to evaluate the role of mitoxantrone pleurodesis (MP) as an alternative to talc sclerotherapy for managing MPEs in lung cancer patients. A retrospective chart review was conducted on consecutively admitted patients with MPE to the Department of Post-Intensive Care at the Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, in Croatia. Of 34 patients with MPE, twenty-one (64.8±9.46 years; 47-84 years) with primary lung carcinoma who received MP (30 mg of mitoxantrone) between December 2003 and February 2009 were included in this study. Chest radiographs taken prior to sclerotherapy and at 1-, 2-, and 3-month follow-up were compared. At the post-sclerotherapy evaluation periods, overall success (OS) rates of MP were 88.2% [17.6%, complete response (CR); 70.6%, partial response (PR)], 53.9% (7.7% CR; 46.2% PR), and 45.5% (PR), respectively. Kaplan-Meier median survival from MP until death was 5.2 months, while that from diagnosis of primary lung cancer was 12.3 months. MP may be a safe and effective method of managing MPE due to lung cancer. Future randomized controlled studies comparing mitoxantrone and talc pleurodesis in lung cancer patients are warranted to elucidate whether a significant difference exists between these agents. Factors affecting success, survival probability, and quality of life also require further investigation.

Tendencias en la incidencia de hospitalizaciones por cáncer de pulmón en España entre 2001 y 2011

ObjectiveTo analyze changes in the incidence, diagnostic procedures, comorbidity, length of hospital stay and costs of patients hospitalized for lung cancer in Spain between 2001 and 2011. Patients and methodsRetrospective study including all patients hospitalised with a primary diagnosis of lung cancer between 2001 and 2011. Data were collected from the National Hospital Discharge Database, encompassing the entire Spanish population. Economic and sociodemographic characteristics and health-related variables were analyzed. ResultsA total of 298,435 hospitalizations occurred. The overall crude incidence increased from 61.18 per 100,000 inhabitants in 2001 to 65.08 per 100,000 in 2011 (P <.05), with a decrease in men and a proportionate increase in women. The age group with the highest incidence was 70 to 79 years. In 2001, 4.5% of patients had a Charlson comorbidity index (CCI) >2, and in 2011, prevalence of CCI >2 increased to 9.1% (P<.05). Mean length of hospital stay decreased during the study period. Computed tomography was the most common procedure. Mean cost per patient increased from €4,471.22 in 2001 to €5,562.54 (P<.05) in 2011. Factors related to the incidence of hospitalizations were age, sex and year of study in the multivariate analysis. ConclusionsWe found a decrease in the rate of hospitalizations in men and an increase in women, with a concomitant increase in comorbidities and cost; however, length of hospital stay decreased. Factors related to incidence of hospitalizations were age, sex and year of study.

COPD in primary lung cancer patients: prevalence and mortality.

BackgroundPrevious studies have relied on international spirometry criteria to diagnose COPD in patients with lung cancer without considering the effect lung cancer might have on spirometric results. The aim of this study was to examine the prevalence of COPD and emphysema at the time of primary lung cancer diagnosis and to examine factors associated with survival.Materials and methodsMedical records, pulmonary function tests, and computed tomography scans were used to determine the presence of COPD and emphysema in patients diagnosed with primary lung cancer at the University Hospital of North Norway in 2008–2010.ResultsAmong the 174 lung cancer patients, 69% had COPD or emphysema (39% with COPD, 59% with emphysema; male:female ratio 101:73). Neither COPD nor emphysema were significantly associated with lung cancer mortality, whereas patients with non-small-cell lung cancer other than adenocarcinoma and squamous cell carcinoma had a risk of lung cancer mortality that was more than four times higher than that of patients with small-cell lung cancer (hazard ratio [HR] 4.19, 95% confidence interval [CI] 1.56–11.25). Females had a lower risk of lung cancer mortality than males (HR 0.63, 95% CI 0.42–0.94), and patients aged ≥75 years had a risk that was twice that of patients aged <75 years (HR 2.48, 95% CI 1.59–3.87). Low partial arterial oxygen pressure (4.0–8.4 kPa) increased the risk of lung cancer mortality (HR 2.26, 95% CI 1.29–3.96). So did low partial arterial carbon dioxide pressure (3.0–4.9 kPa) among stage IV lung cancer patients (HR 2.23, 95% CI 1.29–3.85). Several patients with respiratory failure had previously been diagnosed with COPD.ConclusionThe observed prevalence of COPD was lower than that in previous studies. Neither COPD nor emphysema were significantly associated with lung cancer mortality.

Innovations in bronchoscopic techniques will go a long way for diagnosis of early-stage lung cancers

Lung cancer is one of the most common malignancies and a leading cause of cancer-related death worldwide (1). In China, the morbidity and mortality rates of lung cancer have been increasing over the past decades along with the worsening environment (2) and concerning situation of tobacco use (3). Imaging studies and sputum cytology as the conventional diagnostic approaches for lung cancer, are in fact very limited for detecting the early-stage lesions, and therefore do not help reduce the death toll. A number of clinical practice guidelines have recommended bronchoscopy as an important common tool for diagnosis of primary lung cancers (PLCs) (4). The direct vision of bronchoscopy enables brush and puncture biopsies, and performing bronchoalveolar lavage for cytological and histological diagnosis, which contributes to significant improvement in detection rate, and ultimately, to early identification, early diagnosis and early treatment of lung cancers. With the advance and refinement in molecular biology, endoscopic and imaging techniques, current practice with bronchoscopic examination has been recognized to remarkably enhance clinical diagnosis of lung cancer, and have an extraordinary role in improving the prognosis and survival rate of patients. This article reviews the use of several diagnostic modalities related to bronchoscopic techniques in individuals with high risk for lung cancers.

Abstract A87: Cardiovascular disease (CVD) and hospitalization costs among lung cancer patients: Examining the effect of race and gender

Abstract Objective: Delineate race and gender variations in cardiovascular disease associated with lung cancer and hospitalization cost of Tennessee lung cancer patients in 2008. Methods: We examined Tennessee Hospital Discharge Database for2008 for patients (aged 20+) discharged with a primary diagnosis of lung cancer (LC). The LC patient sample (n= 6665) included black males (BM; n=494), white males (WM; n=3286), black females (BF; n=387); and white females (WF; n=2498). For each patient, we extracted data on cardiovascular risk factors and hospitalization costs for the entire year of 2008. Age-adjusted hospitalization rate for lung cancer (LC) per 100K 2000 US population for white and black as well as male &amp; female groups were developed per CDC methodology. To delineate CVD risk factors, multivariate logistic models were used for each group separately to determine CVD risk factors of LC. Results: Our analyses revealed four major trends: (i) Age-adjusted LC rates were higher for blacks and males compared to white and females; (ii) LC patients had an average of 3 co-morbid conditions which varied from 3 conditions among WM, to 2.86 among BF, 2.75 among BM, and 2.70 among WF; (iii) Regression analyses revealed COPD predicted LC for all four groups. In addition, BM had cardiac arrhythmia and high cholesterol, The same factors were associated with LC among both WM and WF. Among BF, hypertension and COPD predicted higher rates of LC; and (iv) hospitalization cost for the year was highest among BF ($97,085) and lowest among WF ($66,758). Among males, the cost was higher among BM compared to WM ($91,384 vs. 71,716, p&amp;lt;.001). Hospitalization costs were higher among blacks compared to whites ($94,235 vs. 69,237, p&amp;lt;.001), in part, due to longer hospitalization compared to whites. Conclusion: Lung cancer rates and hospitalization costs are higher for blacks. While males have higher LC rate compared to females, the hospitalization costs are similar among them. COPD, cardiac arrhythmia, and high cholesterol are CVD factors that are associated with lung cancer and need to be aggressive managed through intensive population-based education programs in the minority populations. Citation Format: Baqar Husaini, Rebecca Selove, Elizabeth Williams, Meggan Novotny, Janice Emerson, Van Cain, Margaret Whalen, Robert Levine. Cardiovascular disease (CVD) and hospitalization costs among lung cancer patients: Examining the effect of race and gender. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A87.

Chinese consensus on early diagnosis of primary lung cancer (2014 version).

The incidence and mortality of lung cancer in China have rapidly increased. Lung cancer is the leading cause of cancer death in China, possibly because of the inadequate early diagnosis of lung cancer. Reaching a consensus on early diagnostic strategies for lung cancer in China is an unmet needed. Recently, much progress has been made in lung cancer diagnosis, such as screening in high-risk populations, the application of novel imaging technologies, and the use of minimally invasive techniques for diagnosis. However, systemic reviews of disease history, risk assessment, and patients' willingness to undergo invasive diagnostic procedures also need to be considered. A diagnostic strategy for lung cancer should be proposed and developed by a multidisciplinary group. A comprehensive evaluation of patient factors and clinical findings should be completed before treatment.

How Corporate Sponsors Can Optimize The Impact of Their Message Content

¹⁸F-FPPRGD2, which was approved for clinical study recently, has favorable properties for integrin targeting and showed potential for antiangiogenic therapy and early response monitoring. However, the time-consuming multiple-step synthesis may limit its widespread applications in the clinic. In this study, we developed a simple lyophilized kit for labeling PRGD2 peptide (¹⁸F-AlF-NOTA-PRGD2, denoted as ¹⁸F-alfatide) using a fluoride–aluminum complex that significantly simplified the labeling procedure. <b>Methods:</b> Nine patients with a primary diagnosis of lung cancer were examined by both static and dynamic PET imaging with ¹⁸F-alfatide, and 1 tuberculosis patient was investigated using both ¹⁸F-alfatide and ¹⁸F-FDG imaging. Standardized uptake values were measured in tumors and other main organs at 30 min and 1 h after injection. Kinetic parameters were calculated by Logan graphical analysis. Immunohistochemistry and staining intensity quantification were performed to confirm the expression of integrin α_vβ₃. <b>Results:</b> Under the optimal conditions, the whole radiosynthesis including purification was accomplished within 20 min with a decay-corrected yield of 42.1% ± 2.0% and radiochemical purity of more than 95%. ¹⁸F-alfatide PET imaging identified all tumors, with mean standardized uptake values of 2.90 ± 0.10. Tumor-to-muscle and tumor-to-blood ratios were 5.87 ± 2.02 and 2.71 ± 0.92, respectively. <b>Conclusion:</b>¹⁸F-alfatide can be produced with excellent radiochemical yield and purity via a simple, 1-step, lyophilized kit. PET scanning with ¹⁸F-alfatide allows specific imaging of α_vβ₃ expression with good contrast in lung cancer patients. This technique might be used for the assessment of angiogenesis and for planning and response evaluation of cancer therapies that would affect angiogenesis status and integrin expression levels.

Development and Validation of Electronic Health Record-based Triggers to Detect Delays in Follow-up of Abnormal Lung Imaging Findings.

Purpose To develop an electronic health record (EHR)-based trigger algorithm to identify delays in follow-up of patients with imaging results that are suggestive of lung cancer and to validate this trigger on retrospective data. Materials and Methods The local institutional review board approved the study. A "trigger" algorithm was developed to automate the detection of delays in diagnostic evaluation of chest computed tomographic (CT) images and conventional radiographs that were electronically flagged by reviewing radiologists as being "suspicious for malignancy." The trigger algorithm was developed through literature review and expert input. It included patients who were alive and 40-70 years old, and it excluded instances in which appropriate timely follow-up (defined as occurring within 30 days) was detected (eg, pulmonary visit) or when follow-up was unnecessary (eg, in patients with a terminal illness). The algorithm was iteratively applied to a retrospective test cohort in an EHR data warehouse at a large Veterans Affairs facility, and manual record reviews were used to validate each individual criterion. The final algorithm aimed at detecting an absence of timely follow-up was retrospectively applied to an independent validation cohort to determine the positive predictive value (PPV). Trigger performance, time to follow-up, reasons for lack of follow-up, and cancer outcomes were analyzed and reported by using descriptive statistics. Results The trigger algorithm was retrospectively applied to the records of 89 168 patients seen between January 1, 2009, and December 31, 2009. Of 538 records with an imaging report that was flagged as suspicious for malignancy, 131 were identified by the trigger as being high risk for delayed diagnostic evaluation. Manual chart reviews confirmed a true absence of follow-up in 75 cases (trigger PPV of 57.3% for detecting evaluation delays), of which four received a diagnosis of primary lung cancer within the subsequent 2 years. Conclusion EHR-based triggers can be used to identify patients with suspicious imaging findings in whom follow-up diagnostic evaluation was delayed. (©) RSNA, 2015.

Expression of two basic mRNA biomarkers in peripheral blood of patients with non-small cell lung cancer detected by real-time rt-PCR, individually and simultaneously.

Introduction: Although extensive research has been conducted on lung cancer markers, a singular clinically applicable marker has not been found yet. The objective of this study was to evaluate the sensitivity and the specificity of carcinoembryonic antigen (CEA) mRNA and lung-specific X protein (LUNX) mRNA biomarkers in peripheral blood to detect lung cancer individually and simultaneously. Methods: Thirty patients affected by lung cancer and 30 healthy individuals were studied in this research. Three vials of cDNA were made from each sample after taking peripheral blood samples and extracting total RNA. Each sample was examined by the real-time RT-PCR technique. The result from each vial was then compared with the sensitivity of overall marker. Results: The CEA mRNA was positive in 24 out of 30 lung cancer patients. Hence, its sensitivity was determined at 80%, differing significantly from that observed in healthy individuals, where 11 positive cases were seen. The overall sensitivity of this marker was significantly associated with positivity in vials 2 and 3 but not in vial 1. The LUNX mRNA was positive in 21 out of 30 patients, indicating 70% sensitivity. This finding significantly differed from that in healthy individuals. The overall sensitivity of this marker was significantly associated with positivity in vials 1 and 3, but not in vial 2. In 93.3% of the patients, at least one positive marker was observed. Conclusion: The mentioned mRNA could be suggested as sensitive and specific markers in peripheral blood for primary diagnosis of lung cancer.

Clinicopathological features and outcome of gastric metastases from primary lung cancer: A case report and systematic review.

Primary lung cancer is the fourth most frequently diagnosed cancer, but gastric metastasis from lung cancer is extremely rare. Little is known about its clinicopathological features, prognosis and optimal treatment strategy. The present study reports a case of primary lung cancer that metastasized to the stomach and to the best of our knowledge, is the first to identify discordance in epidermal growth factor receptor (EGFR) mutation status between the primary tumor and gastric metastasis. The study also systematically searched the Medline database for similar cases to provide a literature review. Data concerning the clinicopathological features, treatment strategies and outcomes were extracted and analyzed. In total, 22 eligible cases were identified from 16 studies. The average age at presentation was 67.3 years and there was a male predominance of 90.9%. Epigastric pain (45.5%) was the most common chief complaint, followed by melena (22.7%), nausea/vomiting (13.6%) and hematemesis (9.1%). Three patients were asymptomatic. Five patients sought the initial consultation for gastrointestinal symptoms. The median time between the primary lung cancer diagnosis and the confirmation of gastric metastasis was five months. Endoscopically, gastric lesions were described as polypoid masses or volcano-like ulcers, mostly involving the gastric corpus, which were identified in 62.5% of the 16 cases in which information regarding the site of metastasis was available. Gastric metastases were reported from adenocarcinoma, squamous cell carcinoma, small cell lung cancer and pleomorphic carcinoma of the lung. The median survival following comprehensive treatment strategies was four months, and the one-year post-metastasis survival rate was 35.3%. In conclusion, although primary lung cancer metastasis to the stomach is rare, clinicians should be aware of the possibility of its occurrence. Comprehensive and personalized treatment may be beneficial to patients. EGFR tyrosine-kinase inhibitor therapy may be the treatment of choice for non-small cell lung carcinoma patients harboring an activating EGFR mutation in the metastatic lesion.

Abstract A90: Changes in lung cancer rate over four years in a tobacco producing state: Examining the effect of race and gender

Abstract Objective: According to a recent CDC report, lung cancer rates have declined in several states during 19975-2005. Tennessee, being a tobacco producing State, has received a large settlement from the tobacco industry and engaged in quit smoking program since 2006. Effective October 2007, the state also banned smoking in public places. However, the effect of this ban and smoking cessation program on lung cancer rates remains unknown. This presentation examines whether the lung cancer rates have changed over four years (2005-2008), and whether they vary by race and gender. Methods: We extracted relevant data pertaining to primary diagnosis of lung cancer (adenocarcinoma, ICD-9 codes of 160-165) and demographics from Tennessee Hospital Discharge Data system (HDDS) for 2005-2008. Data for each year pertained to 3,500 patients, mostly white (79%) and males (56.8%) with an average age of 66 years. To examine the effect of race and gender on cancer rate, we computed lung cancer prevalence rates per CDC procedures for age-adjusted rates (per 100,000 hospitalized patient population standardized to 2000 Census). Results: Our analyses show that the overall rates of lung cancer increased during four years by 26.3% (from 61.6/100K in 2005 to 77.8/100K in 2008). The increase was larger for blacks than whites (66.0% vs. 42.2%, p&amp;lt;.001). In general, in each year, rates were higher for blacks than whites (48.2 vs. 46.2 in 2005, 57.9 vs. 54.5 in 2006, 71.1 vs. 64.9 in 2007, and 80.0 vs. 65.7 in 2008). Similarly in each year, rates were higher for males than females (75.5 vs. 50.6 in 2005, 75.2 vs. 48.1 in 2006, 92.1 vs. 62.1 in 2007, and 93.8 vs. 65.3 in 2008). Further analyses revealed that (i) higher black rates were largely driven by higher rates among black males, and (ii) rates increased linearly from ages 45 through 74 years, and this was true for both black and white patients (both males and females). After age 84, rates dropped dramatically reflecting increasing mortality. Conclusion: Lung cancer rates have increased for both blacks and males. However, it is too early to tell if smoking cessation programs, banning asbestos use and smoking in public places will produce the desired decline in lung cancer rates. The results at present point to the need for more population-based intensive smoking cessation programs in Tennessee to lower lung cancer rates. Citation Format: Baqar A. Husaini, Van Cain, Mehhan Novotny, Zaheed Samad, Robert Levine. Changes in lung cancer rate over four years in a tobacco producing state: Examining the effect of race and gender. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A90. doi:10.1158/1538-7755.DISP13-A90

Effect of circulating tumor cells combined with negative enrichment and CD45-FISH identification in diagnosis, therapy monitoring and prognosis of primary lung cancer.

Circulating tumor cells (CTCs) are valuable for diagnosis, monitoring therapy and prognosis in primary lung cancer. Herein, we evaluated the clinical significance of lung cancer CTCs in this study. Detection of CTCs was performed using epithelial cell adhesion molecule-independent enrichment and CD45 fluorescence in situ hybridization detection. CTCs ≥ 2/3.2 mL were considered as positive. The positive rates in primary lung cancer, benign lung disease and healthy control groups were 84, 0 and 4.2 %. CTCs count was significantly higher in lung cancer patients than healthy controls and benign lung disease, with an area under ROC curve of 0.917 (95 % confidence interval 0.855-0.979; p = 0.000) between lung cancer and nonmalignant diseases. CTCs count significantly increased with an increase in pathological stage with mean count of 2.3 ± 2.6 (stage I-II), 3.5 ± 3.3 (stage III) and 4.5 ± 4.3 (stage IV), respectively. The positive detection rate of CTCs for primary lung cancer diagnosis was higher than serum tumor markers. In total, 25 metastasis lung cancer patients participated in the follow-up. Changes in CTCs count after two cycles of chemotherapy were consistent with radiographic appearance. Moreover, CTCs count was better than serum tumor markers for monitoring chemotherapy response. Median progression-free survival (PFS) was 2.05, 3.25 and 8.348 months (p < 0.05) in group in which post-treatment CTCs count was increased, unchanged and decreased, respectively. Furthermore, PFS in patients whose post-treatment CTCs count increased or were unchanged accompanied by a baseline CTCs count ≥3 was significantly shorter than those whose post-treatment CTCs count decreased or was unchanged accompanied with baseline value C < 3 (1.85 vs. 8.22 months, p = 0.000) [Corrected]. Therefore, CTCs are a reproducible indicator of disease status that may be superior to imaging.

Minimal requirements for the molecular testing of lung cancer.

From the aspect of the contemporary pathologic diagnostics of lung cancer, it is a key issue of the tissue obtained since small biopsies and cytology still play a major role. In the non-small cell lung cancer era, cytology considered equal to biopsy. However, in recent years it is unable to provide quality diagnosis and must be replaced by biopsy. Various molecular techniques can handle various different tissue samples which must be considered during molecular pathology diagnosis. Besides, tumor cell-normal cell ratio in the obtained tissue as well as the absolute tumor cell number have great significance whose information must be provided in the primary lung cancer diagnosis. Last but not least, for continuous sustainable molecular diagnostics of lung cancer rational algorythms, affordable technology and appropriate reimbursement are equally necessary.