Age increased the cancer-specific mortality risk of thyroid cancer with lung metastasis.

OBJECTIVE: To investigate the relationship between age and cancer-specific mortality in thyroid cancer (TC) with lung-metastasis. PATIENTS AND METHODS: A total of 1418 patients with initial distant metastases from Surveillance, Epidemiology, and End Results databases were investigated. Patients with a median follow-up time of 8 months (interquartile range [IQR]: 2-27] and a median age of 66 years (IQR: 55-76) were divided into five groups by age and the association between age and TC-specific mortality was analysed. RESULTS: The TC-specific mortality rates were 32.78% (118/360), 46.71% (156/334), 53.93% (199/369), 58.96% (158/268) and 82.76% (72/87) in patients aged ≤55 years, >55 but ≤65 years, >65 but ≤75 years, >75 but ≤85 years and >85 years. Kaplan-Meier curves showed that TC-specific mortality rate was associated with increased age (p < .001). Compared with patients ≤55 years, patients aged >55 but ≤65 years, >65 but ≤75 years, >75 but ≤85 years and >85 years had significantly higher hazard ratios (HRs) of 1.69 (1.26-2.26), 1.97 (1.47-2.64), 2.18 (1.59-2.99) and 3.24 (2.08-5.06) after adjustments for sex, tumour size and radiation therapy (all p < .001). In TC with initial lung-metastasis, compared with patients ≤55 years, patients aged >55 but ≤65 years, >65 but ≤75 years, >75 but ≤85 years and >85 years had significantly higher adjusted HRs of 1.68 (1.20-2.36; p = .003), 2.18 (1.57-3.02), 2.16 (1.51-3.08) and 2.91 (1.79-4.75; p < .001). Similar results were obtained in papillary TC. CONCLUSIONS: The TC-specific mortality was increased with age in TC patients with initial lung-metastasis, indicating that further risk stratification based on age was necessary for TC over 55 years with lung-metastasis. Individual treatment strategies maybe recommended for such patients.

Ageing as key factor for distant metastasis patterns and prognosis in patients with extensive-stage Small Cell Lung Cancer.

Background: Small cell lung cancer (SCLC) represents about 13% of lung cancer cases, which is highly invasive and has a high mortality rate, with the 5-year overall survival (OS) rate being only 6.3%. Age at diagnosis of advanced SCLC is much older, but studies describing the ageing factor for distant metastasis patterns and prognosis of extensive-stage SCLC (ES-SCLC) are limited. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) registry, we identified 18,682 patients with ES-SCLC (9,089 women and 9,053 men) who had complete clinical information between 2008 and 2015. Patients were classified into three groups (older group: ≥80 yrs, middle-aged group: 60-79 yrs, and younger group: ≤59 yrs). The role of different age at diagnosis of ES-SCLC (especially older group) in metastasis patterns was investigated, and OS and cancer-specific survival (CSS) of different age groups of metastatic ES-SCLC was assessed. Results: The most metastasis of ES-SCLC patients in the three groups was multiorgan metastases (MOM) metastasis (71.2%, 70.3% and 66.3%, respectively), the most single organ metastasis in the younger group was the lung (3.3%), the middle-aged group and the older group were the brain (3.5%, 3.1%, respectively). The analysis revealed that older patients were less likely to have MOM, but more likely to have all organs metastases than other two groups (p<0.001). Older group had the worst OS (p<0.001) and CSS (p<0.001). Furthermore, Radiotherapy and chemotherapy can improve survival (p<0.001), but the rate of radiotherapy and chemotherapy in older patients is lower than that in middle-aged and younger patients (50.4% vs 38.6% vs 20.7%, p<0.05). Compared with other two group, older group (odds ratios, ORs) for lung, all organ metastases, and MOM were 0.43 (95% CI 0.27-0.67), 1.77 (95% CI 1.55-2.03), 0.68 (95% CI 0.6-0.77), respectively. Conclusion: The mortality risk is highest with MOM and all organs metastasis followed by brain, lung, bone and liver metastases in elderly ES-SCLC patients. These results will be helpful for pre-treatment evaluation regarding the prognosis of ES-SCLC patients.

Choice of Treatment for Stage IA Non-small Cell Lung Cancer Patients Ineligible for Surgery: Ablation or Stereotactic Body Radiotherapy?

Purpose: To compare the survival outcomes of ablation and stereotactic body radiotherapy (SBRT) in inoperable patients with stage IA non-small cell lung cancer (NSCLC). Patients and Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 6,395 patients with stage IA NSCLC who had complete clinical information from 2004 to 2015. Kaplan-Meier analysis was performed to determine the propensity score based on the clinical characteristics of patients with stage IA NSCLC. Overall survival (OS) was compared between patients with stage IA NSCLC who were treated with ablation and SBRT after adjusting, stratifying, or matching. Results: Kaplan-Meier analysis demonstrated no significant difference in survival curves (log-rank, p>0.05) between the ablation and SBRT groups. Compared with the SBRT group, the hazard ratio (HR) (95% confidence interval [CI]) of OS was 0.930 (0.817-1.058, p=0.269) in the ablation group on univariate analysis. On multivariate analysis, similar effects on OS (HR: 0.974, 95% CI: 0.858-1.105, p=0.680) were seen in patients with stage IA NSCLC in both the groups. Conclusions: This study suggests that survival does not differ significantly between patients with stage IA NSCLC treated with ablation and SBRT. These results will be helpful for patients with stage IA NSCLC who are ineligible for surgery.

Role of surgery in patients with early stage small-cell lung cancer.

PURPOSE: Currently, systemic chemotherapy combined with thoracic radiation is the standard treatment for patients with small-cell lung cancer (SCLC). However, the treatment of early stage SCLC remains controversial. This study evaluated the survival outcomes of surgical treatments and the effect of adjuvant chemotherapy and radiotherapy on lung cancer-specific survival (LCSS) in patients with early stage SCLC. METHODS: Using the Surveillance, Epidemiology, and End Results registry, we identified 2,453 patients with early stage SCLC (1,295 women and 1,158 men) who had complete clinical information between 2004 and 2015. The Kaplan-Meier analysis was used to determine the propensity score based on the characteristics of patients with early stage SCLC. LCSS was compared between patients treated with surgery and non-surgery after adjusting, stratifying, or matching patients with early stage SCLC. In addition, we compared the effects of chemotherapy and radiotherapy on LCSS in patients with early stage SCLC. RESULTS: Overall, 687 (28.0%) and 1,766 (72.0%) patients with early stage SCLC did and did not undergo surgery, respectively. Kaplan-Meier analysis demonstrated a statistically significant difference in survival curves between the surgery and non-surgery groups (log-rank p<0.001). Compared with the non-surgery group, the LCSS of the surgery group was better (hazard ratio [HR]:0.494, 95% confidence interval [CI]:0.415-0.587, p<0.001) in patients with early stage SCLC when using a Cox model for multivariate analysis. There was no statistically significant difference (p=0.847) in LCSS between patients with early stage SCLC with and without chemotherapy in the multivariate analysis. Radiotherapy had favorable effects on LCSS (HR: 0.579, 95% CI: 0.500-0.671, p<0.001) in patients with early stage SCLC using multivariate analysis. CONCLUSIONS: Our study results suggest that LCSS conferred by surgery was higher than that conferred by non-surgery and that radiotherapy is associated with better survival in patients with early stage SCLC. This study findings should be confirmed in prospective studies.

The prognostic impact of lymph node metastasis in patients with non-small cell lung cancer and distant organ metastasis.

This study aimed to identify the prognostic value of lymph node metastasis in patients with non-small cell lung cancer (NSCLC) and distant organ metastasis. A total of 42,613 NSCLC patients with distant metastasis from the surveillance, epidemiology, and end results database between 2010 and 2013 were included for analysis. The proportion of N0 stage in M1a patients was significantly higher than that in M1b patients, 34.0% and 22.7% respectively (P < 0.001). Compared with N0 patients, patients had higher odds of experiencing multiorgan metastases (MOM) if they had higher N stage at diagnoses (P < 0.001). The Kaplan-Meier curves suggested both M1a and M1b groups patients at stage N0 had better survival than those at higher N stage (P < 0.001). Further analysis indicated that better survival was observed in N0 stage compared with N2 or N3 stage if patients had bone metastasis, brain metastasis, or MOM (P < 0.001, P < 0.001, and P = 0.002, respectively), but there was no significant difference in survival among each N stage patients with liver metastasis only. Cox regression analysis showed that compared with N0 patients, higher hazard for disease-specific mortality was observed for patients with higher N stage. Among NSCLC patients with distant organ metastasis, lymph node metastasis was associated with higher odds of experiencing MOM and a worse prognosis in terms of longer survival except patients with liver metastasis. Better understandings of the role of lymphatic metastasis in M1 NSCLC could help clinicians with better management of the disease.

The efficacy and safety of adjunctive corticosteroids in the treatment of tuberculous pleurisy: a systematic review and meta-analysis.

PURPOSE: To evaluate the efficacy and safety of adjunctive corticosteroids in the treatment of patients with tuberculous pleurisy. METHODS: The PubMed, Cochrane, Medline, Embase, Web of Science and Chinese National Knowledge Infrastructure were searched. Clinical trials of corticosteroids compared with control were eligible for inclusion. RESULTS: Ten studies (6 randomized controlled trials [RCTs] and 4 non-RCTs) with 957 participants met the inclusion criteria. Compared to the controls (placebos or non-steroids), adjunctive corticosteroid use reduced the risk of residual pleural fluid after 4 weeks and the number of days to symptom improvement; however, there was no convincing evidence to support the positive effects of corticosteroids over the long term (8 weeks) on residual pleural fluid, pleural thickening, or pleural adhesions, and there was no statistical difference between the corticosteroid group and control group with respect to 7-days relief of the clinical symptoms or death from any cause. In addition, more adverse events were observed in patients who received corticosteroids than in those in the control group. CONCLUSIONS: Our results suggest that adjunctive corticosteroid use did not improve long-term efficacy and might induce more adverse events, although the risk of residual pleural fluid at 4 weeks and the number of days to symptom improvement were reduced.

[The value of autofluorescence bronchoscopy in assessment of tumor extent and guide of therapeutic strategy in central lung cancer].

OBJECTIVE: To determine the sensitivity of autofluorescence bronchoscopy (AFB) in the assessment of tumor size and therapeutic strategy. METHODS: Patients with imaging suspected of malignancy were examined with both white light bronchoscopy (WLB) and AFB. The area of tumor infiltration, imaging information and pathological results were analyzed. RESULTS: A total of 212 patients were enrolled, including 180 male and 32 female. In 24 patients (13.2%), greater tumor volume was revealed by AFB than by WLB alone. In these patients, the median diameter of tumor was >1 cm wider on AFB examination than on WLB. Therapeutic strategy was changed in 18 patients (9.9%) after receiving AFB, including 15 patients with expanded scope of removal and 3 patients with avoidance of surgery. In the univariate analysis, the pathological type of squamous cell carcinoma and tumor invasion in two or more segments of bronchus were independent predictive factors. Diagnostic sensitivity of AFB group was 85.7%, specificity 73.3%, positive predictive value 95.1%, false predictive value 45.8%. Diagnostic sensitivity of WLB group was 72.5%, specificity 60.0%, positive predictive value 91.7%, false predictive value 26.5%. CONCLUSION: Our study suggests that compared with WLB alone, autofluorescence bronchoscopy plus WLB significantly improves the diagnostic value and treatment outcome of central lung cancer.

[Endobronchial ultrasound transbronchial lung biopsy with guide-sheath for the diagnosis of peripheral pulmonary lesions].

OBJECTIVE: To evaluate the diagnostic yield and safety of endobronchial ultrasound transbronchial lung biopsy with guide-sheath (EBUS-GS-TBLB) in peripheral pulmonary lesions (PPL). METHODS: Between August 2012 and March 2013, EBUS-GS-TBLB was performed in patients with PPL inaccessible by conventional bronchosopy in Shanghai Tenth People's Hospital. The diagnostic yield, safety and the associated factors were analyzed. RESULTS: Seventy five patients [46 males and 29 females, mean age (62.4 ± 11.4) years, ranged from 34 to 81 years] with PPL confirmed by computed tomography and conventional bronchosopy were recruited in this study. Mean bronchoscopic procedure time lasted for (15.4 ± 6.3) min. The average number of biopsy specimens obtained in each PPL was 4.6 ± 0.8. A total of 78 PPL were examined in 75 patients, and 68 PPL from 65 patients were detected by EBUS. Fifty eight PPL were diagnosed by EBUS-GS and the diagnostic rate was 74.4%. The diagnosis rate of malignancy was 84.4% (27/32) while that of benign disease was 67.4% (31/46). The most important factors that helped enhance EBUS-GS-TBLB diagnostic accuracy included lesion diameter greater than 20mm, EBUS probe within the lesions, the presence of a bronchus sign on CT imaging and central lesions. All the patients tolerated the procedure well. Mild bleeding was observed when performing biopsy in some patients. No pneumothorax, hemoptysis or other serious complications were observed. CONCLUSIONS: The procedure of EBUS-GS-TBLB was minimally invasive, had higher diagnostic rate and fewer complications. It was a safe and effective method to diagnose PPL, while careful selection of suitable cases could further improve the diagnostic accuracy.

Serum miR-499 as a novel diagnostic and prognostic biomarker in non-small cell lung cancer.

The aim of the present study was to determine whether serum miR-499 may be used as a biomarker for early detection of non-small cell lung cancer (NSCLC). The present study was designed as an initial screening phase and a subsequent validation phase. In the screening phase, we analyzed serum levels of miR-499 in a subset of 40 patients with stage I (n=20) and stage IV (n=20) NSCLC. In the validation phase, miR-499 expression levels in serum (n=514) and tissue (n=136) from NSCLC patients were detected in a large and independent cohort of 514 patients. miR-499 in the screening phase was found to be significantly elevated in the serum of stage I NSCLC patients compared with that in stage IV NSCLC patients (P<0.001). Validation analysis showed that serum miR-499 levels were robust in differentiating NSCLC patients from control subjects [area under the curve (AUC)=0.906; 95% confidence interval (CI)=0.879 to 0.929). Serum miR-499 levels were significantly lower in stage III and IV patients compared with those with stage I (both P<0.001) or II (both P<0.001). Low serum miR-499 levels were associated with shorter overall survival and served as an independent prognostic biomarker in NSCLC patients [hazard ratio (HR)=1.63; 95% CI=1.33-2.0; P<0.0001). In addition, low serum levels of miR-499 indicated a poor disease-free survival in stage I-II NSCLC patients. Serum miR-499 may prove to be a promising biomarker for early detection and prognosis prediction of NSCLC.

[Narrow-band imaging bronchoscopy improves assessment of tumor extent and affects therapeutic strategy for central lung cancer].

OBJECTIVE: To determine the sensitivity of narrow-band imaging bronchoscopy (NBI) in the assessment of tumor extent and therapeutic strategy. METHODS: A total of 196 patients with imaging abnormalities for malignancy were examined with both white light bronchoscopy (WLB) and NBI (Olympus, EVIS LUCERA). Record the tumor infiltration, image and pathological results. RESULTS: There were 152 male and 44 female with a mean age of 58 years. In 22 patients (13.1%), NBI revealed greater tumor extent than WLB alone. And tumor margins were >1 cm wider on NBI examination than on WLB. In 19 patients (11.3%), that finding influenced further therapeutic course, leading to greater resection level (n = 14) or avoidance of surgery (n = 5). According to univariate analysis, tumor size > 30 mm and pathological type of squamous cell carcinoma were independent predictive factors (OR 3.13, 95% CI: 1.06-9.21, P = 0.038; OR 4.68, 95% CI: 1.02-21.58, P = 0.048). The diagnostic sensitivity of NBI group was 88.2%, specificity 83.3%, positive predictive value 98.1% and false predictive value 41.7%. And the diagnostic sensitivity of WLB group was 80.3%, specificity 55.6%, positive predictive value 94.7% and false predictive value 22.2%. CONCLUSIONS: The combined use of NBI bronchoscopy and conventional white-light examination has greater sensitivity and specificity for assessing tumor margins. And this technique also significantly improves the assessment of central lung cancer infiltration and influences the therapeutic strategy.

Overexpression of adenylate cyclase-associated protein 1 is associated with metastasis of lung cancer.

Lung cancer ranks first in both prevalence and mortality rates among all types of cancer. Metastasis is the main cause of treatment failure. Biomarkers are critical to early diagnosis and prediction and monitoring of progressive lesions. Several biomarkers have been identified for lung cancer but none have been routinely used clinically. The present study assessed the diagnostic and prognostic value of cyclase-associated protein 1 (CAP1) for lung cancer. CAP1 mRNA abundance and protein content were determined by real-time PCR and western blot analysis and/or immunostaining in biopsy specimens (24 neoplastic and 6 non-neoplastic) freshly collected at surgical lung resection, in 82 pathologically banked lung cancer specimens and in cultured non-invasive (95-C) and invasive (95-D) lung cancer cells. Multivariate regression analysis was performed to correlate immunoreactive CAP1 signal with cancer type and stage. In vitro cell migration was performed to determine the effect of RNA interference-mediated CAP1 gene silencing on invasiveness of 95-D cells. These analyses collectively demonstrated that: i) both CAP1 mRNA abundance and protein content were significantly higher in neoplastic compared to non-neoplastic specimens and in metastatic compared to non-metastatic specimens but not different between adenocarcinoma and squamous cell carcinoma; ii) immunoreactive CAP1 signal was significantly stronger in metastatic specimens and 95-D cells compared to non-metastatic specimens and 95-C cells; and iii) RNA interference-mediated CAP1 gene silencing adequately attenuated the invasive capacity of 95-D cells in vitro. These findings suggest that overexpression of CAP1 in lung cancer cells, particularly at the metastatic stage, may have significant clinical implications as a diagnostic/prognostic factor for lung cancer.

Statins and the risk of lung cancer: a meta-analysis.

PURPOSE: Several epidemiologic studies have evaluated the association between statins and lung cancer risk, whereas randomized controlled trials (RCTs) on cardiovascular outcomes provide relevant data as a secondary end point. We conducted a meta-analysis of all relevant studies to examine this association. METHODS: A systematic literature search up to March 2012 was performed in PubMed database. Study-specific risk estimates were pooled using a random-effects model. RESULTS: Nineteen studies (5 RCTs and 14 observational studies) involving 38,013 lung cancer cases contributed to the analysis. They were grouped on the basis of study design, and separate meta-analyses were conducted. There was no evidence of an association between statin use and risk of lung cancer either among RCTs (relative risk [RR] 0.91, 95% confidence interval [CI] 0.76-1.09), among cohort studies (RR 0.94, 95% CI 0.82-1.07), or among case-control studies (RR 0.82, 95% CI 0.57-1.16). Low evidence of publication bias was found. However, statistically significant heterogeneity was found among cohort studies and among case-control studies. After excluding the studies contributing most to the heterogeneity, summary estimates were essentially unchanged. CONCLUSION: The results of our meta-analysis suggest that there is no association between statin use and the risk of lung cancer.

Bronchial fibroepithelial polyp: a case report and review of the literature.

Fibroepithelial polyps of the bronchus are uncommon. We herein report a rare case of a recurrent bronchial fibroepithelial polyp. A 61-year-old man was admitted to the hospital due to recurrent pneumonia. Chest computed tomography showed consolidation and atelectasis in the right lower lobe. Bronchoscopy revealed a mobile polypoid tumor protruding from the right lower lobe bronchus. We performed endobronchial resection, and a pathological examination revealed a fibroepithelial polyp. However, surveillance bronchoscopy performed six months after tumor resection detected a relapse. We herein report a case of a recurrent bronchial fibroepithelial polyp and also review the relevant literature.

Pemetrexed plus platinum as the first-line treatment option for advanced non-small cell lung cancer: a meta-analysis of randomized controlled trials.

UNLABELLED: To compare the efficacy and toxicities of pemetrexed plus platinum with other platinum regimens in patients with previously untreated advanced non-small cell lung cancer (NSCLC). METHODS: A meta-analysis was performed using trials identified through PubMed, EMBASE, and Cochrane databases. Two investigators independently assessed the quality of the trials and extracted data. The outcomes included overall survival (OS), progression-free survival (PFS), response rate (RR), and different types of toxicity. Hazard ratios (HRs), odds ratios (ORs) and their 95% confidence intervals (CIs) were pooled using RevMan software. RESULTS: Four trials involving 2,518 patients with previously untreated advanced NSCLC met the inclusion criteria. Pemetrexed plus platinum chemotherapy (PPC) improved survival compared with other platinum-based regimens (PBR) in patients with advanced NSCLC (HR = 0.91, 95% CI: 0.83-1.00, p = 0.04), especially in those with non-squamous histology (HR = 0.87, 95% CI: 0.77-0.98, p = 0.02). No statistically significant improvement in either PFS or RR was found in PPC group as compared with PBR group (HR = 1.03, 95% CI: 0.94-1.13, p = 0.57; OR = 1.15, 95% CI: 0.95-1.39, p = 0.15, respectively). Compared with PBR, PPC led to less grade 3-4 neutropenia and leukopenia but more grade 3-4 nausea. However, hematological toxicity analysis revealed significant heterogeneities. CONCLUSION: Our results suggest that PPC in the first-line setting leads to a significant survival advantage with acceptable toxicities for advanced NSCLC patients, especially those with non-squamous histology, as compared with other PRB. PPC could be considered as the first-line treatment option for advanced NSCLC patients, especially those with non-squamous histology.

[Meta-analysis of efficacy and safety of oral theophylline in chronic obstructive pulmonary disease].

OBJECTIVE: To evaluate the efficacy and safety of oral theophylline versus placebo in patients with stable chronic obstructive pulmonary disease (COPD). METHODS: The databases Medline, Embase, Web of Science, Cochrane Central Register of Controlled Trials and Chinese Biomedical Database were retrieved by using the key words "Uniphyl or Theophylline or Theo-Dur or theo or Theotrim or Elixophyllin or Elixophyllin or Phyllocontin or aminophylline or Methylxanthine or nuelin or doxofylline" and "obstructive or bronchitis or pulmonary emphysema or bronchial hyperreactivity or COPD or COLD or emphysema" so as to search the materials about the randomized controlled clinical trials comparing the effectiveness of stable COPD treated by oral theophylline and placebo. A meta-analysis was conducted. For continuous variables, the results of individual studies were pooled using fixed-effect weighted mean difference (WMD) with a corresponding 95% confidence interval (CI). Where the results were expressed as dichotomous variables, the relative risk (RR) with 95%CI was calculated. RESULTS: Thirty-four documents about randomized controlled clinical trials, including a total of 2087 patients, from the retrieved 2010 documents accorded to the demand of enrollment. The results of meta-analysis showed that theophylline significantly improved the forced expiratory volume in 1 s, forced vital capacity and peak expiratory flow rate (WMD 0.09 L, 95%CI 0.09 - 0.09; WMD 0.14 L, 95%CI 0.13 - 0.14; WMD 17.0 L/min and 95%CI 6.9 - 27.2 respectively). Arterial oxygen tension and arterial carbon dioxide tension at rest both improved with treatment (WMD 2.89 mm Hg, 95%CI 1.11 - 4.66; WMD -2.05 mm Hg and 95%CI -3.59 to -1.42 respectively). Six-minute walk distance significantly improved (WMD 38.89 meters, 95%CI 21.55 - 56.22) in treatment group. The RR of acute exacerbations was smaller between both groups (RR 0.74, 95%CI 0.59 - 0.93). The RR of total adverse events was similar (RR 1.05, 95%CI 0.95 - 1.16) while RR of drug-related adverse events was greater (RR 2.54, 95%CI 1.37 - 4.70). And there was significant statistical difference. CONCLUSION: Compared with the placebo, theophylline can improve lung function, arterial blood gas tensions and walking distance while the incidence of drug-related adverse events is higher.