Abstract Purpose: The magnitude of the lung cancer epidemic combined with a change in proportion of gender and histological subtypes underscore the need to identify survival trends with a focus on underlying gender and histology variations as to better target prevention, screening, research and treatment efforts. Materials and Methods: We present complete national data on 40,118 lung cancer cases prospectively collected in The Cancer Registry of Norway the last 20 years (1988-2007). One and 5-year overall relative survival rates (RSR) were computed with 95% confidence intervals (CI) for each of the four successive 5-year periods of diagnosis stratified by gender, histological subgroups, age and stage. Results: A significant increase in overall 5-year RSR from the first to last 5-year period was observed for both men and women, in women from 10.1% (95% CI: 8.8% − 11.4%) to 15.4% (95% CI: 14% − 16.9%), and in men from 7.9% (95% CI: 7.1% − 8.7%) to 11.6% (95% CI: 10.5% − 12.8%). Five-year RSR were significantly higher for women than for men in all periods. Also 1-year RSR increased significantly, in women from 30.6% (95% CI: 28.7% − 32.5%) in 1988-1992 to 40.9% (95% CI: 39.5% − 42.4) in 2003-2007. In men, the corresponding rates were 28.2% (95% CI: 27%-29.4%) and 35.3% (95% CI: 34.2%-36.5%), respectively. Five-year RSR were lowest in patients diagnosed with small cell carcinoma, with no significant survival improvement over time in either gender, whereas in adenocarcinoma in women, and squamous cell carcinomas in both genders long-term relative survival rates improved significantly. Women diagnosed with adenocarcinoma had significantly higher 5-year RSR compared to men the three last 5-year periods studied. This gender difference was not significant in other histological subtypes. In both men and women, increasing age was associated with decreasing 1- and 5-year RSR. In women, a significant improvement in 5-year RSR was observed in all age groups from 50-79 years over the 20-year period. Women with localized disease at time of diagnosis had significantly better 5-year relative survival compared to men with localized disease throughout the period studied. In 2003-2007, 5-year RSR for localized disease were 51.8% (95% CI: 46.5%-56.8%) in women and 40.9% (95% CI: 36.1%-45.9%) in men. Conclusion: These complete national data highlight important prognostic characteristics of the lung cancer epidemic in Norway that presumably can be extrapolated to most developed countries. Improvements in short-term survival rates and modest but statistically significant improvements in long-term survival rates are encouraging; however long-time survival still remains poor. The apparent gender differences in survival should be a focus of further research. Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 877.
Lung cancer is increasingly affecting women. The aim of this study was to identify sex-specific trends in lung cancer incidence and survival.
Methods
Complete national data on 40 118 cases from the Cancer Registry of Norway sampled from 1988 to 2007 are presented, with incidence rates, 1- and 5-year relative survival in 5 year intervals and multivariate HRs adjusted for covariates, each with 95% CIs.
Results
Lung cancer incidence increased by 64%, with an age-adjusted annual average increase of 4.9% in women and 1.4% in men in this period. Relative survival was lower in men than in women in all time periods, and men had an increased risk of dying within 5 years of diagnosis compared with women (HR 1.14, 95% CI 1.11 to 1.17), adjusted for covariates. Adenocarcinoma is now the most frequent histological group in men and women, yet the risk of dying was higher in men in all histological subtypes except squamous cell carcinoma. A higher proportion of women than men were diagnosed with localised disease, and the risk of dying was significantly higher in men among all stages, most apparent in localised disease (HR 1.25, 95% CI 1.18 to 1.33).
Conclusion
The findings highlight important characteristics of the lung cancer epidemic; despite a rising incidence of female lung cancer cases, women are diagnosed with less advanced disease than men; when adjusted for covariates, men have an increased risk of excess death at 5 years compared with women, irrespective of stage, age, period of diagnosis and selected histological subgroups.
Abstract PURPOSE: Lung cancer retains its status as the most common cancer in the world, with an estimated 1.5 million cases diagnosed in 2007, accounting for about 12% of all cancers. Identifying microscopic lynph-node metastases, could have clinical importance in selecting patients for adjuvant treatment. The purpose of this study wasis to Iidentify and evaluate molecular markers for detection of micrometastases in regional lymph nodes from patients undergoing surgery for non-small cell lung cancer. PATIENTS AND METHODS: Candidate micrometasis markers were selected based on digital transcript profiling in EST and SAGE databases, searching for transcripts with high levels in lung cancers and very low levels in normal lymph nodes. Surfactant protein C (SFTPC) and cytokeratin 19 (CK19) mRNA levels in tumor biopsies and resected regional lymp nodes (N=38) from 24 patients undergoing surgery for non-small cell lung cancer were measured by quantitative RT-PCR. A control material consisting of 22 normal mesenterial lymph nodes from patients undergoing surgery for benign colon disorders was analyzed in parallell. RESULTS: The median relative CK19SFTPC mRNA level in the non-small cell lung tumor biopsies were 446 times higher than the highest level in normal control lymph nodes. SFTPC mRNA was not detectable in the normal lymph nodes, whereas the tumor levels were high (Cq-values ranging from 17-25). Using the highest CK19 mRNA level in the normal lymph nodes as a cut-off, four out of five (80%) lymph nodes from patients with known lymph node metastases (by routine histology) had elevated CK19 levels. Accordingly, 5 (15%) of 33 lymph nodes from patients without known metastases (node-negative) had elevated levels of CK19 mRNA. SFTPC mRNA were detectable in 31 of the 33 lymph nodes from node-negative patients, although the median relative level was 7.1 times higher in the 5 lymph nodes from node-positive patients (P=0.002, Mann-Witney test). Elevated CK19 and SFTPC mRNA levels in regional lymph nodes without known metastases may reflect the presence of micrometastases. CONCLUSION: SFTPC and CK19 mRNA are promising surrogate markers for detection of micrometastases in regional lymph nodes from non-small cell lung cancer patients. However, clinical follow-up in a larger cohort is needed to eludicate the prognostic value of such findings. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 343. doi:10.1158/1538-7445.AM2011-343
A 63-year-old man was admitted to the emergency room with chest pain. He had experienced a painful, tingling sensation in the right arm for the last three months, as well as pain in the right scapula. ECG and standard blood samples were normal. An X-ray of the thorax showed a mass in the superior sulcus on the right side. Further investigation with CT and MRI identified a large tumour, about 6 cm in size, with infiltrative growth involving the upper costae. Biopsy revealed a non-small cell carcinoma of the lung. The patient underwent a tri-modal treatment regimen with induction chemotherapy (two courses of cisplatin and etopside) and concominant radiotherapy (50Gy in 2Gy fractions) before a right upper lobectomy was performed. 1 year after surgery the patient is alive, with no signs of recurrent or metastatic disease. Pancoast tumours are an infrequent subtype of lung cancers. Diagnostic delay is not uncommon. The peripheral location of the tumour generates symptoms that may easily be attributed to other causes, such as those of a musculoskeletal origin. Pre-operative chemo-radiotherapy has showed improved survival outcomes compared to pre-operative radiotherapy alone.
Background. Unlike cervical, anogenital and oropharyngeal cancers, where high-risk human papillomavirus (hrHPV) has long been known to play a major role, a causative link between HPV and lung cancer has been investigated for decades with discrepant results.Methods. Lung cancer patients eligible for surgical treatment were tested for the presence of HPV-DNA in excised, fresh frozen lung tumor tissue. Patients that tested positive were further examined for the presence of HPV-DNA in adjacent normal lung parenchyma. HPV detection and genotyping was performed using a polymerase chain reaction (PCR)-based approach and allowed the typing of 13 "high-risk"-HPV-types and 2 "low-risk"-HPV-types.Results. Of the 334 tumor-DNA samples tested, 13 (3.9%) showed presence of HPV-DNA, of which 12 were of a high-risk HPV type (16, 33, 66). In those tested positive, HPV-DNA was not found in adjacent normal lung tissue. No correlation with smoking or EGFR/KRAS mutation status was seen, and only one of 84 squamous cell carcinomas was HPV-positive.Conclusion. We conclude that HPV is rarely associated with lung cancer in a Northern European population and in those tested positive, more functional studies are required to determine the role HPV plays in lung cancer oncogenesis.
TP53 mutations are among the most common mutations found in lung cancers, identified as an independent prognostic factor in many types of cancers. The purpose of this study was to investigate the frequency and prognostic impact of TP53 mutations in never-smokers and in different histological subtypes of lung cancer.We analyzed tumor tissue from 394 non-small cell carcinomas including adenocarcinomas (n = 229), squamous cell carcinomas (n = 112), large cell carcinomas (n = 30), and others (n = 23) for mutations in TP53 by the use of Sanger sequencing (n = 394) and next generation sequencing (n = 100).TP53 mutations were identified in 47.2% of the samples, with the highest frequency (65%) of mutations among squamous cell carcinomas. Among never-smokers, 36% carried a TP53 mutation, identified as a significant independent negative prognostic factor in this subgroup. For large cell carcinomas, a significantly prolonged progression free survival was found for those carrying a TP53 mutation. In addition, the frequency of frameshift mutations was doubled in squamous cell carcinomas (20.3%) compared to adenocarcinomas (9.1%).TP53 mutation patterns differ between the histological subgroups of lung cancers, and are also influenced by smoking history. This indicates that the histological subtypes in lung cancer are genetically different, and that smoking-induced TP53 mutations may have a different biological impact than TP53 mutations occurring in never-smokers.
