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Biopsy frequency and complications among lung cancer patients in the United States. 美国肺癌患者的活检频率和并发症
IF 2.8 Q3 Medicine Pub Date : 2020-08-17 DOI: 10.2217/lmt-2020-0022
Yichen Zhang, Lizheng Shi, Michael J Simoff, Oliver J Wagner, James Lavin

Objective: This study aimed to describe the frequency and distribution of biopsy procedures for patients diagnosed and treated for primary lung cancer.

Study design: Retrospective cohort study within an administrative database.

Materials & methods: This observational study used data from the IBM MarketScan® Databases between 2013 and 2015.

Results: The total number of lung biopsies performed among eligible subjects was 32,814; an average of 1.7 biopsies per patient. Bronchoscopy and percutaneous approaches accounted for 95% of all procedures. Complication rates by procedure are remarkably similar irrespective of biopsy frequency.

Conclusion: Nearly half (46%) of patients in this population experienced multiple biopsies prior to diagnosis. Further, biopsy choice or sequence in patients receiving multiple procedures was unpredictable.

目的:本研究旨在描述诊断和治疗原发性肺癌的患者活检手术的频率和分布。研究设计:在行政数据库中进行回顾性队列研究。材料与方法:本观察性研究使用了2013年至2015年IBM MarketScan®数据库中的数据。结果:符合条件的受试者进行肺活检的总次数为32,814次;每位患者平均做1.7次活检。支气管镜检查和经皮入路占所有手术的95%。无论活检频率如何,手术并发症的发生率都非常相似。结论:该人群中近一半(46%)的患者在诊断前进行了多次活检。此外,在接受多种手术的患者中,活检的选择或顺序是不可预测的。
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引用次数: 16
The role of palliative care in the management of patients with lung cancer. 姑息治疗在肺癌患者管理中的作用。
IF 2.8 Q3 Medicine Pub Date : 2020-07-29 DOI: 10.2217/lmt-2020-0016
Irena Tan, Kavitha Ramchandran

Palliative care (PC) is the care of patients and their families with serious illness and is rapidly becoming an important part of the care of cancer patients. Patients with advanced lung cancer are a highly symptomatic population of patients and clearly experience benefits in quality of life and potentially benefits in overall survival when PC is incorporated early on after diagnosis. However, referrals to PC are still reliant on clinical judgment of patient prognosis and symptom burden. Moving forward, improving the integration of PC and lung cancer care will require more efficient real-time screening of patient symptoms, which may be accomplished through the use of patient-reported outcomes.

姑息治疗(Palliative care, PC)是对患有严重疾病的患者及其家属的护理,正迅速成为癌症患者护理的重要组成部分。晚期肺癌患者是一个高度症状化的患者群体,如果在诊断后早期合并PC,显然会在生活质量和总生存期方面获益。然而,转介到PC仍依赖于临床对患者预后和症状负担的判断。展望未来,改善PC和肺癌治疗的整合将需要更有效地实时筛查患者症状,这可以通过使用患者报告的结果来实现。
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引用次数: 1
Choosing the best first-line therapy: NSCLC with no actionable oncogenic driver. 选择最佳一线治疗:无可操作的致癌驱动因素的非小细胞肺癌。
IF 2.8 Q3 Medicine Pub Date : 2020-07-24 DOI: 10.2217/lmt-2020-0003
So Yeon Kim, Balazs Halmos

Combination platinum-based therapy has been the standard of care for the treatment of advanced non-small-cell lung cancer (NSCLC). Immunotherapy has emerged and demonstrated to show benefit in the treatment of patients with advanced NSCLC. In this review, we discuss the pivotal trials that led to the US FDA approval of specific immunotherapy regimens in particular patient populations. We discuss the optimal use of immunotherapy as monotherapy based on the KEYNOTE-024, KEYNOTE-042 and IMpower110 trials, chemo-immunotherapy based on KEYNOTE-189, KEYNOTE-407, IMpower150 and IMpower130 trials, and as doublet immunotherapy based on CheckMate-227. We also discuss the role and limitations of PD-L1 expression and tumor mutational burden as predictive biomarkers in response to single-agent immunotherapy and combination chemoimmunotherapy. Furthermore, we discuss emerging resistance markers such as STK11 and KEAP1 mutations in immunotherapy response and briefly discuss the role of immunotherapy in elderly patients and in patients with actionable mutations.

以铂为基础的联合治疗已成为晚期非小细胞肺癌(NSCLC)的标准治疗方案。免疫疗法已经出现,并证明在治疗晚期非小细胞肺癌患者中显示出益处。在这篇综述中,我们讨论了导致美国FDA批准特定患者群体的特异性免疫治疗方案的关键试验。基于KEYNOTE-024, KEYNOTE-042和IMpower110试验,基于KEYNOTE-189, KEYNOTE-407, IMpower150和IMpower130试验的化学免疫治疗,以及基于CheckMate-227的双重免疫治疗,我们讨论了免疫治疗作为单一治疗的最佳使用。我们还讨论了PD-L1表达和肿瘤突变负担作为单药免疫治疗和联合化疗免疫治疗反应的预测性生物标志物的作用和局限性。此外,我们讨论了新出现的耐药标志物,如STK11和KEAP1突变在免疫治疗反应中的作用,并简要讨论了免疫治疗在老年患者和具有可操作突变的患者中的作用。
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引用次数: 13
Computed tomography texture analysis of response to second-line nivolumab in metastatic non-small cell lung cancer. 转移性非小细胞肺癌对二线纳武单抗反应的计算机断层扫描结构分析。
IF 2.8 Q3 Medicine Pub Date : 2020-07-22 DOI: 10.2217/lmt-2020-0002
Rahul Ladwa, Kate E Roberts, Connor O'Leary, Nicole Maggacis, Kenneth J O'Byrne, Kenneth Miles

Objectives: Assess computed tomography texture analysis of patients likely to benefit from nivolumab.

Materials & methods: Texture analysis was used to quantify heterogeneity within the largest tumor before immunotherapy. Histogram analysis was classified as hyperdense (positive skewness) or hypodense (negative skewness) and subclassified on median standard deviation value or entropy measurement.

Results: 47 patients were included. At a median follow-up of 18 months, statistical significant differences in progression-free survival were observed when stratified by positive skewness with low entropy, hazard ratio: 0.43 (0.19-0.95); p = 0.036, and positive skewness with low standard deviation, hazard ratio: 0.42 (0.18-0.96); p = 0.04.

Conclusion: Patients who derive a clinical benefit to Nivolumab show a computed tomography texture of a hyperdense yet homogenous tumor.

目的:评估可能受益于纳武单抗的患者的计算机断层结构分析。材料与方法:使用质地分析来量化免疫治疗前最大肿瘤内的异质性。直方图分析分为高密度(正偏度)或低密度(负偏度),并根据中位标准差值或熵测量进行细分。结果:纳入47例患者。在中位随访18个月时,采用低熵正偏度分层时,观察到无进展生存的统计学差异,风险比:0.43 (0.19-0.95);P = 0.036,正偏度标准差低,风险比为0.42 (0.18-0.96);p = 0.04。结论:从Nivolumab获得临床益处的患者显示出高密度但均质肿瘤的计算机断层结构。
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引用次数: 8
Prognostic significance of the neutrophil/lymphocyte ratio in patients undergoing treatment with nivolumab for recurrent non-small-cell lung cancer. 中性粒细胞/淋巴细胞比值在接受纳武单抗治疗复发性非小细胞肺癌患者中的预后意义
IF 2.8 Q3 Medicine Pub Date : 2020-07-20 DOI: 10.2217/lmt-2020-0014
Bernardo L Rapoport, Annette J Theron, Daniel A Vorobiof, Lizanne Langenhoven, Jacqueline M Hall, Ronwyn I Van Eeden, Teresa Smit, Sze-Wai Chan, Michael C Botha, Johann I Raats, Margriet De Necker, Ronald Anderson

Aim: We investigated the prognostic potential of pretherapy measurement of the neutrophil/lymphocyte ratio (NLR) in patients (n = 56) with non-small-cell lung cancer deemed suitable for treatment with nivolumab.

Materials & methods: This was a multicenter, noninterventional, retrospective data analysis, involving five oncology centers.

Results: Patients with prenivolumab NLR values of <5 and ≥5 had respective median overall survival (OS) values of 14.5 and 7.02 months (p = 0.0026). Patients with ≤2 and >2 metastatic sites had median OS values of 11.4 and 6.1 months, respectively (p = 0.0174). A Cox multiple regression model revealed baseline NLR ≥5 as the only variable significantly associated with decreased OS (p < 0.0447).

Conclusion: Pretreatment elevated NLR values are associated with poor outcomes in patients with recurrent metastatic non-small-cell lung cancer treated with nivolumab.

目的:我们研究了治疗前测量中性粒细胞/淋巴细胞比率(NLR)对56名非小细胞肺癌患者(n = 56)的预后潜力,这些患者被认为适合用纳武单抗治疗。材料与方法:这是一项涉及五个肿瘤中心的多中心、非介入性、回顾性数据分析。结果:2个转移部位的prenivolumab NLR值患者的中位OS值分别为11.4和6.1个月(p = 0.0174)。Cox多元回归模型显示,基线NLR≥5是唯一与OS降低显著相关的变量(p)。结论:预处理升高的NLR值与纳沃单抗治疗的复发性转移性非小细胞肺癌患者预后不良相关。
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引用次数: 4
Lung cancer screening guidelines are clear but are they being followed? 肺癌筛查指南很明确,但是否得到了遵守?
IF 2.8 Q3 Medicine Pub Date : 2020-06-22 DOI: 10.2217/lmt-2020-0015
Coral Olazagasti, Carolina Bernabe, Nagashree Seetharamu
Lung cancer is the second most common cause of cancer worldwide and the leading cause of cancer death in the USA [1]. The American Cancer Society (NY, USA) estimated a total of 228,150 new cases of lung cancer with 142,670 deaths from lung cancer in the USA for 2019 [1]. Smoking is the main cause of lung cancer and contributes to 80% of lung cancer deaths in women and 90% in men [2]. Lung cancer is typically diagnosed at advanced stages and carries a high mortality rate, with a 5-year survival rate of only 18% [3]. Randomized controlled trials targeted toward lung cancer screening started in the 1970s when the US National Cancer Institute (NCI; MD, USA) sponsored several clinical trials to evaluate the benefit of adding sputum cytology to annual chest radiography (CXR) [4,5]. However, none of the trials showed a reduction in lung cancer mortality (Supplementary Table 1). Decades later, the NCI initiated the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), a large randomized controlled trial that aimed to reduce disease-specific cancer mortality by evaluating the use of CXR for screening [6]. The study found that 2% of participants that had a positive radiographic findings were diagnosed with lung cancer within 12 months of the screen, 44% of whom were diagnosed with stage I disease [6]. Pertinent findings that paved the road for future guidelines included the discovery that high incidences of lung cancer were noted in active smokers or those that had quit within 15 years of randomization [6]. In the 2000s, prospective studies were created throughout the world to evaluate the role of low-dose computed tomography (LDCT) for screening. The Lung Screening Study compared LDCT and CXR as screening modalities and revealed that LDCT was twice as effective as CXR in detecting lung cancer [7]. It also showed that 48% of lung cancers detected by LDCT screening were diagnosed at stage I [7]. Inspired by the Lung Screening Study, a large scale study called the National Lung Screening Trial (NLST), which enrolled 53,456 participants, was created. Participants were randomized to LDCT or CXR at a 1:1 ratio. The study demonstrated a 20% relative reduction in mortality in patients screened with LDCT compared with CXR [8]. Results from this trial were updated in 2013 and confirmed the benefit of LDCT for lung cancer screening in specific patient populations [9]. Similar results were showcased from The Dutch–Belgian Randomized Lung Cancer Screening Trial (NELSON) which began in Europe in 2003 [10]. More than 15,000 participants were enrolled and assigned to either computer tomography (CT) screening or to the control group with no screening [10]. The study reported a 41% positive predictive value with screening and 50% of the cancers diagnosed in the screening arm were found at early stages of the disease [10]. During a 10-year follow-up, there was a 26% mortality rate reduction in men and 39% in women [10]. Updated results published in the New E
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引用次数: 1
Understanding sex disparities in lung cancer incidence: are women more at risk? 了解肺癌发病率的性别差异:女性是否更危险?
IF 2.8 Q3 Medicine Pub Date : 2020-06-22 DOI: 10.2217/lmt-2020-0013
Meera V Ragavan, Manali I Patel
Meera V Ragavan*,1 & Manali I Patel2,3,4 1Department of Medicine, Stanford University School of Medicine, Stanford, 94305 CA 94305, USA 2Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA 3Division of Oncology, VA Palo Alto Healthcare System, Palo Alto, CA 94304, USA 4Center for Health Policy/Primary Care Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA *Author for correspondence: mragavan@stanford.edu
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引用次数: 11
Lung cancer management challenges amidst COVID-19 pandemic: hope lives here. COVID-19大流行给肺癌管理带来的挑战:希望就在这里。
IF 0.9 Q4 RESPIRATORY SYSTEM Pub Date : 2020-05-01 DOI: 10.2217/lmt-2020-0012
Abhishek Shankar, Deepak Saini, Ruchir Bhandari, Sachidanand Jee Bharati, Sunil Kumar, Geetika Yadav, Tarun Durga, Nalin Goyal
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引用次数: 0
Identification of nine key genes by bioinformatics analysis for predicting poor prognosis in smoking-induced lung adenocarcinoma. 通过生物信息学分析鉴定9个预测吸烟诱导肺腺癌不良预后的关键基因。
IF 2.8 Q3 Medicine Pub Date : 2020-04-27 DOI: 10.2217/lmt-2020-0009
Chuanli Ren, Weixiu Sun, Xu Lian, Chongxu Han

Aim: To screen and identify key genes related to the development of smoking-induced lung adenocarcinoma (LUAD).

Materials & methods: We obtained data from the GEO chip dataset GSE31210. The differentially expressed genes were screened by GEO2R. The protein interaction network of differentially expressed genes was constructed by STRING and Cytoscape. Finally, core genes were screened. The overall survival time of patients with the core genes was analyzed by Kaplan-Meier method. Gene ontology and Kyoto encyclopedia of genes and genomes bioaccumulation was calculated by DAVID.

Results: Functional enrichment analysis indicated that nine key genes were actively involved in the biological process of smoking-related LUAD.

Conclusion: 23 core genes and nine key genes among them were correlated with adverse prognosis of LUAD induced by smoking.

目的:筛选和鉴定与吸烟诱导肺腺癌(LUAD)发生发展相关的关键基因。材料与方法:数据来源于GEO芯片数据集GSE31210。用GEO2R筛选差异表达基因。利用STRING和Cytoscape构建了差异表达基因的蛋白相互作用网络。最后筛选核心基因。采用Kaplan-Meier法分析核心基因患者的总生存时间。通过DAVID计算基因本体和京都基因基因组生物积累百科全书。结果:功能富集分析表明,9个关键基因积极参与吸烟相关性LUAD的生物学过程。结论:23个核心基因和9个关键基因与吸烟所致LUAD不良预后相关。
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引用次数: 1
Pretreatment nutritional status and response to checkpoint inhibitors in lung cancer. 肺癌的预处理营养状况和对检查点抑制剂的反应。
IF 2.8 Q3 Medicine Pub Date : 2020-04-24 DOI: 10.2217/lmt-2020-0008
Chung-Shien Lee, Craig E Devoe, Xinhua Zhu, Joanna Stein Fishbein, Nagashree Seetharamu

Background: Checkpoint inhibitors are integral to non-small-cell lung cancer treatment. Existing data suggests that nutritional status may play a role in antitumor immunity.

Materials & methods: This retrospective study of 106 non-small-cell lung cancer patients who started checkpoint inhibitors between 2014 and 2017 at our institution assessed relationship of nutritional parameters to overall survival (OS) and progression-free survival.

Results: Mean age was 68.7 ± 9.2 years and 59.4% patients were male. On multivariate analysis for OS, hypoalbuminemia and significant weight loss were prognostic at p-values of 0.0005 and 0.0052, respectively. We noted a parabolic association between age and OS (p = 0.026, 0.0025).

Conclusion: In our study, some malnutrition parameters were associated with decreased OS. U-shape relationship between age and OS noted here warrants further evaluation.

背景:检查点抑制剂是治疗非小细胞肺癌不可或缺的药物。现有数据表明,营养状况可能在抗肿瘤免疫中发挥作用。材料与方法:这项回顾性研究纳入了2014年至2017年在我院接受检查点抑制剂治疗的106例非小细胞肺癌患者,评估了营养参数与总生存期(OS)和无进展生存期的关系。结果:患者平均年龄68.7±9.2岁,男性占59.4%。在OS的多变量分析中,低白蛋白血症和显著体重减轻是预后因素,p值分别为0.0005和0.0052。我们注意到年龄和OS之间呈抛物线关系(p = 0.026, 0.0025)。结论:在我们的研究中,一些营养不良参数与OS降低有关。年龄与OS之间的u型关系值得进一步研究。
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引用次数: 17
期刊
Lung Cancer Management
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