Progress in pulmonary enteric adenocarcinoma / 中华肿瘤杂志

Pulmonary enteric adenocarcinoma (PEAC), as a rare histologic subtype of primary lung adenocarcinoma, is defined as an adenocarcinoma in which the enteric component exceeds 50%. It is named after its shared morphological and immunohistochemical features with colorectal cancer. While with such similarity, the differential diagnosis of PEAC and lung metastatic colorectal cancer is a great challenge in the clinic. PEAC may originate from the intestinal metaplasia of respiratory basal cells stimulated by risk factors such as smoking. Current studies have found that KRAS is a relatively high-frequency mutation gene, and other driver gene mutations are rare. In terms of immunohistochemistry, in pulmonary enteric adenocarcinoma, the positive rate was 88.2% (149/169) for CK7, 78.1% (132/169) for CDX2, 48.2% (82/170) for CK20 and 38.8% (66/170) for TTF1. As for clinical features, the average age of onset for pulmonary enteric adenocarcinoma was 62 years, male patients accounted for 56.5% (35/62), smokers accounted for 78.8% (41/52), and 41.4% (24/58) of the primary lesion was located in the upper lobe of the right lung. In terms of treatment, conventional non-small cell lung cancer (NSCLC) regimens rather than colorectal cancer regimens are now recommended. There is still an urgent need for more basic and clinical research, in-depth exploration of its molecular feature and pathogenesis from the level of omics and other aspects, to help diagnosis and differential diagnosis, and find the optimal chemotherapy regimen, possibly effective targeted therapy and even immunotherapy.

Advances in Clinical Application of Liquid Biopsy in Non-small Cell Lung Cancer / 中国肺癌杂志

Lung cancer, with the highest incidence in China, is the leading cause of death in cancer patients. Of these, about 85% are patients with non-small cell lung cancer (NSCLC). Therefore, the diagnosis and treatment of patients with lung cancer have always been a top priority nowadays. Fluid biopsy has many advantages, such as safety, convenience, repeatability, low trauma and so on, which are not available in traditional invasive biopsy. In recent years, with the rapid progress of molecular biological detection technology, fluid biopsy, as a new technology, has become the focus of attention. What's more, it contributes to the development of precision treatment and individualized treatment of lung cancer. Liquid biopsy mainly detects circulating tumor DNA (ctDNA), circulating tumor cells (CTCs) and exosomes in peripheral blood. We will make an introduce to the detection and clinical applications of ctDNA, CTCs and exocrine in this article, in order that it can provide insights into future clinical treatment for NSCLC.
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Caracterización de los pacientes operados de cáncer de pulmón de células no pequeñas / Characterization of Patients Operated on for Nonsmall-Cell Lung Cancer

RESUMEN Introducción: El tumor de pulmón de células no pequeñas es un problema de salud pública, y la primera causa de muerte por cáncer a nivel mundial. Objetivo: Describir las características epidemiológicas, clínicas e histológicas en la población de enfermos aquejados de cáncer de pulmón de células no pequeñas, así como de las técnicas de resección pulmonar y de linfadenectomías utilizadas. Métodos: Se realizó un estudio descriptivo y transversal en el Servicio de Cirugía General del Hospital Provincial "Saturnino Lora" de Santiago de Cuba, desde enero de 2009 hasta enero de 2019. La muestra aleatoria fue de 55 pacientes diagnosticados de cáncer de pulmón de células no pequeñas a los que se les realizó resección pulmonar más linfadenectomía mediastinal. Se utilizaron como medidas de resumen para caracterizar las variables, el número absoluto, el porcentaje y la media, así como la prueba de significación Ji al cuadrado de independencia para identificar su posible asociación. Resultados: Predominó el sexo femenino y el grupo etario de 55 a 64 años. El adenocarcinoma fue el tipo histológico más frecuente. El lóbulo superior izquierdo resultó el más afectado. La lobectomía pulmonar con disección ganglionar por muestreo fue la técnica quirúrgica más utilizada. Predominaron los pacientes en estadios IB y IIA de la enfermedad. Conclusión: La linfadenectomía sistemática del mediastino, permite una certera estadificación, lo que determina una mejor evaluación del tratamiento y del pronóstico en estos enfermos(AU)

ABSTRACT Introduction: Non-small cell lung tumor is a public health problem, and the leading cause of cancer death worldwide. Objective: To describe the epidemiological, clinical and histological characteristics in the population of patients suffering from non-small cell lung cancer, as well as the techniques of lung resection and lymphadenectomies used. Methods: A descriptive and cross-sectional study was carried out in the General Surgery Service of the Provincial Hospital "Saturnino Lora" in Santiago de Cuba, from January 2009 to January 2019. The random sample consisted of 55 patients diagnosed with cell lung cancer non-small patients who underwent lung resection plus mediastinal lymphadenectomy. The absolute number, the percentage and the mean were used as summary measures to characterize the variables, as well as the Chi-squared significance test of independence to identify their possible association. Results: The female sex and the age group 55 to 64 years predominated. Adenocarcinoma was the most frequent histological type. The left upper lobe was the most affected. Pulmonary lobectomy with sampling lymph node dissection was the most widely used surgical technique. Patients in stages IB and IIA of the disease predominated. Conclusion: Systematic lymphadenectomy of the mediastinum allows an accurate staging, which determines a better evaluation of treatment and prognosis in these patients(AU)

Real-world molecular testing and treatment patterns in brazilian patients with newly diagnosed locally advanced or metastatic NSCLC

OBJECTIVES: To evaluate the molecular testing and treatment patterns in a retrospective cohort of newly diagnosed treatment-naïve patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC). METHODS: This is an observational retrospective cohort study conducted across 10 cancer centers in Brazil. Treatment-naïve patients with locally advanced or metastatic NSCLC were enrolled from January to December 2014. The following data were collected from the medical records of patients from diagnosis until the last record (death, loss to follow-up, or the end of the maximum follow-up period): demographics; medical history; smoking status; disease characteristics; previous treatments; and molecular testing patterns and results. The overall survival (OS) was also estimated. Results: A total of 391 patients from 8 different Brazilian states were included, with a median age of 64.1 years (23.7-98.7), with most patients being males (60.1%). The smoking status of 74.2% of patients was a 'former' or 'current smoker'. Stage IV NSCLC at diagnosis was observed in 82.4% of patients, with 269 of them (68.8%) presenting adenocarcinoma (ADC). Among the stage IV ADC patients, 54.0% were referred for molecular testing. Among the patients with an available epidermal growth factor receptor (EGFR) mutation status, 31 (24.0%) were EGFR-positive. The first-line treatment was a platinum-based chemotherapy for 98 patients (25.1%), while non-platinum-based regimens were used in 54 patients (13.8%). OS data were available for 370 patients, with a median OS of 10.8 months. Never smokers had a significantly higher median OS versus current or former smokers (14.6 versus 9.1 months; log-rank p=0.003). Among the patients for whom molecular testing data were available, those with EGFR-positive results had a longer median OS (34.6 versus 12.8 months; log-rank p=0.003). Conclusion: Our findings provide relevant information for prescribers and policy decision-makers by highlighting the unmet needs of patients and the importance of molecular testing in newly diagnosed locally advanced or metastatic lung adenocarcinoma. We also highlight the respective EGFR-tyrosine kinase inhibitor treatment when the result is positive and the areas in which further efforts are required to grant access to effective treatment.

Epigenetics in non-small cell lung carcinomas / Epigenetica en carcinomas pulmonares de células no pequeñas

Abstract: Objective: To perform a systematic review of the main epigenetic aberrations involved in non-small cell lung carcinomas' (NSCLC) diagnosis, progression, and therapeutics. Materials and methods: We performed a systematic review of the scientific literature on lung cancer epigenetics, focusing on NSCLC. Results: Several advances in the molecular study of classical epigenetic mechanisms and massive studies of lung cancer epigenome have contributed relevant new evidence revealing that various molecular complexes are functionally influencing genetic-epigenetic and transcriptional mechanisms that promote lung tumorigenesis (initiation, promotion, and progression), and are also involved in NSCLC therapy-resistance mechanisms. Conclusion: Several epigenetic complexes and mechanisms must be analyzed and considered for the design of new and efficient therapies, which could be fundamental to develop an integrated knowledge to achieve a comprehensive lung cancer personalized medicine.

Resumen: Objetivo: Realizar una revisión sistemática y estructurada de las principales aberraciones epigenéticas involucradas en el diagnóstico, progresión y terapia del cáncer pulmonar de células no pequeñas (CPCNP). Material y métodos: Revisión sistemática de literatura científica sobre epigenética del cáncer pulmonar del grupo CPCNP. Resultados: El estudio de los diversos mecanismos epigenéticos y su impronta epigenética en el epigenoma del cáncer pulmonar han arrojado nuevas evidencias a nivel biológico, biomédico y médico-clínico del impacto que los mecanismos epigenético-transcripcionales promueven de manera activa y reversible sobre los procesos de tumorigénesis, progresión histopatológica y mecanismos de resistencia a la terapia oncológica pulmonar. Conclusión: Deben analizarse diferentes complejos y mecanismos epigenéticos para el estudio y diseño de esquemas nuevos y eficaces de terapia epigenética, los cuales podrían ser fundamentales para desarrollar un conocimiento integral en el desarrollo de la medicina personalizada en el cáncer pulmonar del grupo CPCNP.

Characteristics of non-small cell lung cancer: differences by sex and hormonal status in a Mexican population / Características del cáncer de pulmón de células no pequeñas: diferencias por sexo y estado hormonal en una población mexicana

Abstract: Objective: To analyze the differences in the clinico-pathological and molecular characteristics of non-small cell lung cancer (NSCLC) as well as the clinical outcome of patients by sex and hormonal status. Materials and methods: We performed a retrospective study among 1 104 NSCLC patients. Clinic-pathologic data was recorded and survival outcomes were compared between male and female sex patients, and further by pre and postmenopausal status in females. Results: Women were significantly more likely to be non-smokers (p<0.001), had higher frequency of wood-smoke exposure (p<0.001), EGFR-sensitizing mutations (p<0.001), had better performance status (p=0.020) and had a better overall survival (OS) compared to men (p=0.021). Differences were found also by hormonal status, postmenopausal women had a longer OS compared to premenopausal women (31.1 vs. 19.4 months p=0.046). Conclusion: Our results support the differences in lung cancer presentation by sex and also by hormonal status.

Resumen: Objetivo: Analizar las diferencias en las características clínico-patológicas, moleculares y en la evolución del cáncer de pulmón de células no pequeñas (CPCNP) por sexo y estadio hormonal. Material y métodos: Estudio retrospectivo (N=1 104) en pacientes con CPCNP. Se recabaron datos clínico-patológicos y desenlaces de sobrevida y se compararon entre hombres y mujeres, y entre mujeres pre y postmenopáusicas. Resultados: Las mujeres de este estudio tuvieron significativamente mayor probabilidad de ser no fumadoras (p<0.001), tener exposición a humo de leña (p<0.001), mutaciones en EGFR (p<0.001), mejor estado funcional (p=0.020), y una mejor sobrevida global (SG) en comparación con los hombres (p=0.021). Estas diferencias también se encontraron en cuestión al estatus hormonal, con las mujeres postmenopáusicas presentando una mayor sobrevida en comparación con las premenopáusicas (31.1 vs. 19.4 meses; p=0.046). Conclusión: Los presentes resultados apoyan las diferencias en la presentación del CPCNP de acuerdo con el sexo y estatus hormonal.

Metástasis a colon de un carcinoma de pulmón, una presentación inusual: Reporte de un caso y revisión de la literatura / Colonic metastases from carcinoma of the lung, an unusual presentation: Case report and literature review

Las metástasis sintomáticas al colon de un carcinoma de pulmón son raras, a pesar de ser una neoplasia que representa el 12,9% de la incidencia mundial de cáncer. El colon es un sitio infrecuente de metástasis, con una prevalencia reportada menor al 0,5% en pacientes con carcinomas de pulmón, existiendo en la literatura mundial pocos casos. Es inusual que sea la forma de presentación de este tipo de neoplasia. Con respecto a las manifestaciones clínicas que se reportan pueden cursar con obstrucción intestinal como síntoma cardinal. Se presenta el caso de un paciente que curso con hemorragia de vías digestivas bajas como manifestación inicial de múltiples lesiones metastásicas a colon de un carcinoma de pulmón de célula no pequeña.

The symptomatic metastasis of the colon from a pulmonary cancer is rare; however, the global incidence of pulmonary cancer is 12.9%. It is an infrequent site of metastasis, with a prevalence of less than 0.5% in patients with pulmonary cancer. One of the most common manifestation is intestinal obstruction. We present a case report of a patient with an acute lower intestinal bleeding from multiple metastasis lesion of the colon as the initial manifestation of a non-small cell lung carcinoma.

Experimental study of peripheral-blood pro-surfactant protein B for screening non-small cell lung cancer

Abstract Purpose: To evaluate the possibility of using peripheral-blood presurfactant protein B (Pro-SFTPB) for screening non-small cell lung cancer (NSCLC). Methods: A total of 873 healthy volunteers and 165 lung cancer patients hospitalized in the Fifth People's Hospital of Dalian were tested Pro-SFTPB once every half year from January 2014 to September 2015. The healthy volunteers were also conducted spiral computed tomography (CT) examination once every year. The data were then com-pared and statistically analyzed. Results: The positive expression rate of Pro-SFTPB in NSCLC was significantly higher than that in healthy volunteers, and significantly higher in lung adenocarcinoma than in squamous cell carcinoma; additionally, the expression rate was increased with the in-crease of smoking index, and the intergroup differences showed statistical signifi-cance (p≤0.05). The positive rate of newly diagnosed lung cancer was 29.55%, higher than healthy volunteers (22.34%), but there was no significant difference (p>0.05). Conclusion: Pro-SFTPB is over expressed in non-small cell lung cancer, especially in lung adeno-carcinoma, but it can't be used as a clinical screening tool for lung cancer.

Eficacia de los inhibidores de ALK en dos casos con evaluación positiva por inmunohistoquímica y negativa por FISH / Efficacy of ALK inhibitors in two cases with positive evaluation by immunohistochemistry and negative by FISH

En el carcinoma de pulmón de células no pequeñas (CPCNP), la activación de ALK se produce por la formación de genes de fusión. El perfil clínico donde ocurre con más frecuencia corresponde a pacientes jóvenes, mayormente mujeres, no fumadores, histología de adenocarcinoma y ausencia de mutaciones de EGFR y KRAS. Su presencia se describe en el 3-10% de los CPCNP. La importancia de la determinación de ALK radica en que identifica un subgrupo de pacientes con un comportamiento biológico diferente, en los cuales el tratamiento con inhibidores específicos, como el crizotinib, ceritinib o alectinib, es más eficaz que los convencionales. Las alteraciones moleculares de ALK pueden identificarse por hibridación in situ (ISH), por inmunohistoquímica (IHQ) y por RT-PCR, aunque el FISH es el procedimiento diagnóstico de referencia a nivel clínico. Se examinaron 308 casos de CPCNP y se compararon los resultados por FISH e IHQ. De los 8 (3%) identificados con expresión positiva, sólo 6 presentaron el rearreglo de ALK. Se presentan dos casos clínicos con ALK positivo por IHC y FISH negativo, uno presentó respuesta al tratamiento dirigido y otro no. A pesar de que el FISH es el gold standard, se acepta el uso de IHQ ya sea para definir conducta como único test o para screening y ulterior confirmación por FISH en los casos positivos. Estos dos casos con distinta respuesta al tratamiento con IHQ positiva pero FISH negativo, indican la ausencia de pautas, requiriendo de más conocimiento en el futuro para optimizar las conductas médicas (AU)

In non-small cell lung cancer, ALK activation is produced by gene fusion. The clinical scenario where this type of tumor appears more frequently is in young, female patients, without smoking history, adenocarcinoma histology and with no EGFR or KRAS mutation. It is described as 3 to 10% of non- small cell lung cancer cases. The importance of ALK determinations lies in the identification of a subgroup of patients with a different biological behavior and sensible tumor to target therapy with ALK inhibitors. Molecular alterations of ALK can be determined by in situ hybridization, immunohistochemistry (IHC) and RT-PCR, FISH is the reference diagnostic procedure in clinical applications. Were evaluated 308 cases of non-small cell lung cancer, and FISH and IHC results were compared. Eight (3%) cases presented positive expression, but only 6 of them presented ALK rearrangements. These two clinical cases of patients with IHC positive but FISH negative for ALK are presented, observing good clinical response in only one of them. Although FISH is considered the gold standard technique, IHC use is accepted for treatment decisions as a lone procedure or as screening with FISH confirmation in positive cases. These two particular cases express the absence of guidelines in this infrequent scenario, needing more knowledge in the future in order to take better medical decisions (AU)

Linfadenectomía transcervical diagnóstico-terapéutica en el carcinoma pulmonar de células no pequeñas / Diagnostic-therapeutic transcervical lymphadenectomy in non-small cell lung carcinoma

El cáncer de pulmón es el tumor más frecuente del árbol respiratorio y el que origina mayor número de muertes. Uno de los objetivos más importantes en su manejo es la estadificación, de la cual, el análisis de los ganglios linfáticos del mediastino es de suma importancia para definir los pacientes que pueden recibir cirugía. Para el estudio ganglionar invasivo, la linfadenectomía transcervical ocupa un lugar importante cuando existe evidencia de afectación ganglionar de la zona superior como método diagnóstico y terapéutico inicial en pacientes que después de quimioterapia de inducción y re-estadificación reúnen las condiciones para resección. Se presenta este trabajo con el objetivo de mostrar a la comunidad quirúrgica, la linfadenectomía transcervical utilizada para el diagnóstico y tratamiento del carcinoma pulmonar de células no pequeñas en el Hospital Provincial Universitario Manuel Ascunce Domenech de Camagüey por el grupo de cirugía torácica(AU)

Lung cancer is the most common tumor of the respiratory tract and the one casing more deaths. One of the most important objectives in its treatment is stage characterization, for which analyzing mediastinal lymph nodes is paramount to define patients who can receive surgery. For the nodal invasive study, transcervical lymphadenectomy occupies an important place, when there is evidence of lymph node involvement in the upper area as an initial diagnostic and therapeutic method in patients who, after inducted chemotherapy and stage characterization, are candidates for resection. This work is presented with the aim to present to the surgical community the transcervical lymphadenectomy used by the group of thoracic surgery for diagnosis and treatment of non-small cell lung carcinoma at the Manuel Ascunce Domenech University Provincial Hospital of Camagüey(AU)

Survival and prognostic factors in patients with Non-Small Cell Lung Cancer treated in private health care / Sobrevida e fatores prognósticos em pacientes com câncer de pulmão de células não pequenas assistidos na saúde suplementar

INTRODUCTION: Outcomes data on Non-Small Cell Lung Cancer (NSCLC) are scarce with regard to the private health care in Brazil. The aim of this study was to describe the characteristics, treatments performed, and the survival of patients with NSCLC in a Brazilian private oncologic institution. METHODS: Medical charts from patients treated between 1998 and 2010 were reviewed, and data were transferred to a clinical research form. Long-term follow-up and survival estimates were enabled through active surveillance. RESULTS: Five hundred sixty-six patients were included, and median age was 65 years. Most patients were diagnosed in advanced stages (79.6% III/IV). The overall survival was 19.0 months (95%CI 16.2 - 21.8). The median survival was 99.7, 32.5, 20.2, and 13.3 months for stages I, II, III, and IV, respectively (p < 0.0001). Among patients receiving palliative chemotherapy, the median survival was 12.2 months (95%CI 10.0 - 14.4). CONCLUSIONS: The outcomes described are favorably similar to the current literature from developed countries. Besides the better access to health care in the private insurance scenario, most patients are still diagnosed in late stages. .

INTRODUÇÃO: Dados de desfechos em câncer de pulmão de células não pequenas (CPCNP) são escassos no contexto da saúde suplementar no Brasil. O objetivo deste estudo foi descrever as características, tratamentos realizados e a sobrevida desses pacientes em uma instituição oncológica privada brasileira. MÉTODOS: Foram revisados os prontuários de pacientes atendidos entre 1998 e 2010 com diagnóstico de CPCNP. Os dados foram transferidos para uma ficha clínica individual e posteriormente analisados. Pacientes ou familiares foram contatados a fim de otimizar o seguimento e a estimativa da sobrevida. RESULTADOS: Foram incluídos 566 pacientes, com idade mediana de 65 anos. Predominaram os diagnósticos em estádios avançados (79,6% III/IV). A sobrevida mediana foi de 19,0 meses (IC95% 16,2 - 21,8), sendo de 99,7, 32,5, 20,2 e de 13,3 meses nos estádios I, II, III e IV, respectivamente (p < 0,0001). Entre os pacientes que receberam quimioterapia paliativa, a sobrevida mediana foi de 12,2 meses (IC95% 10,0 - 14.4). CONCLUSÕES: Os desfechos encontrados se assemelham aos de países desenvolvidos. Apesar do maior acesso médico em pacientes com cobertura de planos de saúde, a maioria dos diagnósticos ocorre tardiamente. .

Prognostic Significance of Initial Platelet Counts and Fibrinogen Level in Advanced Non-Small Cell Lung Cancer

Thrombocytosis and coagulation systems activation are commonly associated with disease progression and are suggested poor prognostic factors in patients with malignancies. This study aimed to investigate the prevalence and prognostic significance of thrombocytosis and elevated fibrinogen levels in patients with advanced non-small cell lung cancer (NSCLC). Initial platelet counts and fibrinogen levels were reviewed in 854 patients with histologically proven NSCLC. Thrombocytosis was defined as platelet counts > 450 x 10(9)/L. A serum fibrinogen level > 4.5 g/L was considered high. At the time of diagnosis, initial platelet counts and serum fibrinogen levels were evaluated before treatment. Clinicopathologic data including histological type, tumor, node, metastasis (TNM) stage, performance status, treatment method, and survival time were evaluated. Initial thrombocytosis was found in 6.9% of patients, and elevated fibrinogen levels were found in 55.1% of patients. Patients with thrombocytosis had a significantly poorer prognosis than patients with normal platelet counts (P < 0.001). In multivariate survival analysis, thrombocytosis was an independent prognostic factor (P < 0.001). An elevated serum fibrinogen level was associated with poor prognosis (P < 0.001). In conclusion, initial thrombocytosis and a high fibrinogen level are independent factors for predicting poor prognosis in patients with advanced NSCLC.

A Case of Residual Non-Small Cell Lung Cancer Cells Coexisting With Newly Developed Small Cell Lung Cancer Cells in Ascitic Fluid after Chemotherapy for Non-Small Cell Lung Cancer

No abstract available.

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for the Diagnosis of Central Lung Parenchymal Lesions

PURPOSE: The purpose of this study was to evaluate the usefulness of convex probe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for detecting malignancy in parenchymal pulmonary lesions located adjacent to the central airways. MATERIALS AND METHODS: We retrospectively reviewed the diagnostic performance of EBUS-TBNA in consecutive patients with high clinical suspicion of a centrally located primary lung cancer who had undergone EBUS-TBNA at the Samsung Medical Center between May 2009 and June 2011. RESULTS: Thirty-seven patients underwent EBUS-TBNA for intrapulmonary lesions adjacent to the central airways. Seven lesions were located adjacent to the trachea and 30 lesions were located adjacent to the bronchi. Cytologic and histologic samples obtained via EBUS-TBNA were diagnostic in 32 of 37 (86.4%) of patients. The final diagnosis was lung cancer in 30 patients (7 small cell lung cancer, 23 non-small cell lung cancer), lymphoma in one and malignant fibrous histiocytoma in one patient. The diagnostic sensitivity of EBUS-TBNA in detecting malignancy and detecting both malignancy and benignity was 91.4% and 86.5%, respectively. Two patients experienced minor complications. CONCLUSION: EBUS-TBNA is an effective and safe method for tissue diagnosis of parenchymal lesions that lie centrally close to the airways. EBUS-TBNA should be considered the procedure of choice for patients with centrally located lesions without endobronchial involvement.

EML4-ALK Fusion Gene in Korean Non-Small Cell Lung Cancer

A fusion gene between echinoderm microtubule-associated protein-like 4 (EML4) and the anaplastic lymphoma kinase (ALK) has been identified in non-small cell lung cancers (NSCLCs). Although a few studies have evaluated EML4-ALK fusion genes in Korean NSCLCs, the prevalence of different EML4-ALK fusion variants has yet to be clearly assessed. Herein, we have examined the profiles of EML4-ALK fusion gene variants in Korean patients of NSCLCs. EML4-ALK fusion genes have been detected in 10 (6.0%) of 167 patients of NSCLCs and in 9 (7.4%) of 121 patients of adenocarcinoma. Of the 10 patients with fusion genes identified, 8 (80%) were E13;A20 (variant 1) and 2 (20%) were E6;A20, with an additional 33-bp sequence derived from intron 6 of EML4 (variant 3b). These results indicate that the profiles of EML4-ALK fusion gene variants in Korean patients of NSCLC may differ from those in other ethnic populations. Herein, we describe for the first time the profiles of EML4-ALK fusion variants of Korean patients with NSCLCs.

Changes in the Demographics and Prognoses of Patients with Resected Non-Small Cell Lung Cancer: A 20-Year Experience at a Single Institution in Korea

The demographics and prognosis of non-small cell lung cancer patients have changed during the last few decades. We conducted this study to assess the change in demographics and prognosis in resected non-small cell lung cancer patients during a 20-yr single-institution study in Korea. We retrospectively reviewed the medical records of 2,076 non-small cell lung cancer patients who underwent pulmonary resection between 1990 and 2009. Their clinical characteristics and survival were analyzed over a five-year period. With time, the proportions of female, adenocarcinoma, stage IA, and lobectomy patients increased, whereas the proportions of male, squamous cell carcinoma, stage IIIA, and pneumonectomy patients decreased. These demographic changes caused improved prognosis. The five-year survival rate of all patients was 53.9%. The five-year survival rate increased from 31.9% in 1990-1994, to 43.6% in 1995-1999, 51.3% in 2000-2004, and 69.7% in 2005-2009 (P < 0.001). In conclusion, among patients with resected non-small cell lung cancer, the proportions of female, adenocarcinoma, stage IA, and lobectomy patients have increased, and the five-year survival rate has gradually improved during the last 20 yr in Korea.

Nodal Stations and Diagnostic Performances of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Patients with Non-Small Cell Lung Cancer

There are no accurate data on the relationship between nodal station and diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). We evaluated the impact of nodal station and size on the diagnostic performance of EBUS-TBNA in patients with non-small cell lung cancer (NSCLC). Consecutive patients who underwent EBUS-TBNA of mediastinal or hilar lymph nodes for staging or diagnosis of NSCLC were included in this retrospective study. Between May 2009 and February 2010, EBUS-TBNA was performed in 373 mediastinal and hilar lymph nodes in 151 patients. The overall diagnostic sensitivity, specificity, accuracy and negative predictive value (NPV) of EBUS-TBNA were 91.6%, 98.6%, 93.8%, and 84.3%, respectively. NPV of the left side nodal group was significantly lower than those of the other groups (P = 0.047) and sensitivity of the left side nodal group tended to decrease (P = 0.096) compared with those of the other groups. Diagnostic sensitivity and NPV of 4L lymph node were 83.3% and 66.7%, respectively. However, diagnostic performances of EBUS-TBNA did not differ according to nodal size. Bronchoscopists should consider the impact of nodal stations on diagnostic performances of EBUS-TBNA.

Early detection and treatment of squamous cell lung cancer / Diagnóstico precoce e tratamento do carcinoma escamoso de pulmão

In this review, we discuss the detection, staging, and treatment of early-stage squamous cell lung cancer, with a focus on bronchoscopic techniques, including electrocauterization, argon plasma coagulation, cryotherapy, neodymium: yttriumaluminum-garnet laser therapy, photodynamic therapy, and intraluminal brachytherapy.The cure rate achieved with bronchoscopic techniques is 43-97%. Most bronchoscopic strategies are less morbid and less toxic than is non-bronchoscopic radiation therapy. Success depends on the application of stringent selection criteria forappropriate tumors, smaller tumors responding better. In some cases, electrocauterization, argon plasma coagulation, and cryotherapy can be conducted safely in an outpatient setting. There is sufficient technology available for the detection and treatment of early-stage squamous cell lung cancer. The greatest challenge is to determine whether early detection and treatment improves survival in high-risk populations and is cost-effective.

Neste artigo de revisão, discutimos os métodos para detecção, estadiamento e tratamento do carcinoma epidermoideprecoce com foco em técnicas broncoscópicas, como eletrocautério, coagulação com plasma de argônio, crioterapia, laser neodímio:ítrio-alumínio-granada, terapia fotodinâmica e braquiterapia intraluminal. A taxa de cura com as técnicas broncoscópicas é 43-97%. A maioria das estratégias broncoscópicas apresenta menor morbidade e toxicidade que a radioterapia. O sucesso depende da aplicação rigorosa de critérios de seleção de acordo com o tumor, sendo que aqueles menores apresentam melhor resposta. Em alguns casos, o eletrocautério, a coagulação com plasmade argônio e a crioterapia podem ser utilizados ambulatorialmente com segurança. Há suficiente tecnologia disponível para a detecção e tratamento precoce do câncer de pulmão epidermoide. O maior desafio é determinar se a detecção e o tratamento precoces melhoram a sobrevida em coortes de alto risco e se tal abordagem é custo-efetiva.

Determination of neuron specific enolase [NSE] in small cell lung carcinoma [SCLC] and non-small cell lung carcinoma [NSCLC] patients

Neuron specific enolase [NSE] is routinely used as tumor marker in Small cell lung carcinoma [SCLC], and to some extent in non-small cell lung carcinoma [NSCLC]. In Pakistan, tumor marker technology is not a new one. It is however mostly directed towards uses in hepatic, breast, ovarian, uterine and colorectal cancers, whereas availability and general practice of its use for diagnosis of respiratory metastasizing disease such as lung cancer is seldom and rare, especially the SCLC/NSCLC specific NSE. The aim of present study is to determine the potential usefulness of NSE in diagnosis and prognosis of SCLC and NSCLC patients in our setting. Fifty-eight patients of lung cancer were identified and selected, between January 2004 to December 2007, and divided into various groups depending upon their clinical stage of disease. NSE level was determined in all patients and clinical history data and related pathophysiological components of all selected patients were carefully assessed and compulsorily followed to avoid any bias. Cancer status of patients were evaluated by data available from multiple bronchoscopies, X rays, cytology and histopathology examinations and grouped as SCLC with all five stages [I, II, IIIA, IIIB and IV] and NSCLC with only stage IV. NSE level was also determined in Healthy subjects and patients with non-malignant lung diseases [NMLD] for comparison. We observed significant elevation in levels in NSE for different stages of SCLC and NSCLC in comparison with healthy and NMLD groups. Most significant increase was noted in SCLC stage IV not only in comparison with healthy [P <0.001] and NMLD groups [P < 0.001] but also with stage I [P <0.001] within the group. Elevated difference in NSE levels was also correlated with stage II, IIIA and IIIB of SCLC group. As regard NSCLC, where patients belonged only to stage IV of disease, significant difference was observed with healthy [P <0.01] when compared with NSCLC, whereas non-significant difference in NSE levels was noted in group-SCLC stage II, IIIA and IIIB. In comparison, all stage IV patients [n=7] of SCLC exhibited higher levels of NSE with a range of 136.19 ng/ml to 175.01 ng/ml, higher than detected in patents of stage IV in NSCLC. The result of our study suggests that NSE appears to be a useful tumor marker for SCLC and to some extent, NSCLC. Moreover, NSE exhibits higher levels in some stages of SCLC suggesting, its specificity, not only for advanced stage of SCLC but also for SCLC in general as compared to NSCLC. Its determination, therefore, is beneficial in the diagnosis, treatment and a possible follow-up for patients survival