bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinicopathologic and survival analysis of patients with lung cancer treated at a tertiary care centre in India.
Authors: Raina Vinod , Malik Prabhat Singh , Mohanti B. K , Sharma Mehar C , Mohan Anant , Deo S. V. S , Shukla N. K 
Published: March 2020

e17505 Background: Lung cancer ranks among the most common and lethal malignancies worldwide and also in India. There are geographic and ethnic variations in incidences, clinical and pathological profile of lung cancer. There is paucity of data of changing trend of pathological and clinical profile from this part of the world. Methods: A total of 434 patients with lung cancer were analyzed who were registered at All India Institute of Medical Sciences, over a 3 year period, from July 2008 till June2011, based on information in hospital records. Survival analysis was performed on 310 patients who have received at least one modality of treatment. Results: Median age of the whole cohort was 55 years (23-84 years). There were 357 (82.26%) males and 77 (17.74%) females, 295(69.91%) smokers and 127 (30.09%) non smokers. 370 (85.25%) patients had NSCLC and 64 (14.74%) had SCLC. Among NSCLC, adenocarcinoma was the commonest histology (45.41%) followed by squamous cell carcinoma (29.46%) and unclassified NSCLC (20.54%). Majority (66.13%) of the diagnosis were based on biopsy (needle or bronchoscopic). Among NSCLC, 26.3% patients were of stage 1-3A and 73.7% were of stage 3B and 4. Among SCLC 25% patients were of limited stage and 75% patients were of extensive stage. 73.18% of NSCLC patients received chemotherapy, 19.15% received TKI and 5.75% received RT as first line treatment modality. Among SCLC 93.88% received chemotherapy and 6.12% received RT as first line treatment. Median PFS and OS of patients with NSCLC were 7.8 months and 13.2 months respectively while that of SCLC were 6.1 months and 9.2 months respectively. Conclusions: Pathological profile of lung cancer has changed in India. Adenocarcinoma has become the commonest histology, contrary to the older reports when squamous cell carcinoma was more common. Majority of the patients are diagnosed in advanced stage and survival of these patients remains poor.
Induction gefitinib followed by concurrent chemoradiotherapy in patients with unresectable stage IIIA/b lung adenocarcinoma harboring mutations of epidermal growth factor receptor: Three case reports.
Authors: Horio Yoshitsugu , Kondo Chiaki , Park Jangchul , Shimizu Junichi , Yoshida Kimihide , Hida Toyoaki 
Published: March 2020

e17510 Background: Gefitinib has shown good activity in lung cancer harboring mutations in the epidermal growth factor receptor (EGFR) gene. However, how to integrate gefitinib into concurrent chemoradiotherapy for unresectable locally advanced non-small cell lung cancer (NSCLC) with EGFR mutations is uncertain. Methods: We present three cases of locally advanced lung adenocarcinoma with EGFR mutation, which were treated with gefitinib followed by weekly paclitaxel and carboplatin concurrent with radiation. Three female patients (median age, 73 years; range, 61–77 years) received induction gefitinib 150 mg daily for 1-2 months followed by weekly paclitaxel 40 mg/m2 weekly over 1 hour; carboplatin at AUC (area under the curve) of 2 weekly over 1 hour; and radiation therapy of 60 Gy in 30 fractions. Results: Gefitinib induced very rapid response within the first month without pulmonary toxicity. Subsequent concurrent chemoradiotherapy was performed with safety. One patient recurred as hematogenous lung metastases at 5 months after treatment. The remaining two patients are well doing without adverse events. Conclusions: The very quick response to induction gefitinib and sequential chemoradiotherapy may be an effective treatment with good tolerance. We believe that this treatment strategy deserves further evaluation in unresectable locally advanced NSCLC with EGFR mutations.
Analysis of regulatory T cells in patients of NSCLC with malignant pleural effusion.
Authors: Malik Prabhat Singh , Raina Vinod , Singh Amar , Mitra Dipendrea Kumar 
Published: March 2020

e17511 Background: Enrichment of regulatory T (Treg) cells at the affected anatomic site in cancer may suppress the anti-tumor immune response influencing the cancer progression. Understanding of the clinical relevance of Treg mediated suppression of anti-tumor immune response and mechanisms underlying their preferential trafficking to the affected anatomic site is still limited. The aim of this study was to enumerate the frequencies of Treg cells in malignant pleural effusion and peripheral blood of patients with advanced NSCLC and it’s trend after treatment. Methods: Treg frequencies were evaluated in pleural effusion and peripheral blood of the patients with advanced NSCLC (n=27) using flowcytometry and compared with peripheral blood of age and sex matched healthy controls (n=15) and tubercular pleural effusions (n=10). The Treg cells were characterized as CD4+CD25+Foxp3+ T cells gated on CD4+CD25+ T cells. We assessed the effect of treatment response on Treg frequency. We have also looked for the expression of chemokine receptors CCR4 and CCR6 on the Tregs in pleural effusion and peripheral blood of the patients. Results: Compared to healthy controls, frequency of CD4+CD25+Foxp3+ Tregs was significantly increased in peripheral blood of patients with NSCLC (p=0.0036). In pleural effusion of patients, Treg frequency was higher than their corresponding peripheral blood (p=0.025). As compared to tubercular pleural effusion Treg frequency was higher in malignant effusion (p<0.0001). We had 12 patients who completed treatment and in whom response evaluation was available. Treg frequency reduced at the time of response (PR or SD) and increased again at disease progression. Surface expression of CCR4 and CCR6 was higher on Treg cells as compared to non Treg CD4 cells among the patients (p=0.0001; p=0.001 respectively). However, there was no difference in expression of these chemokine receptors on Tregs in pleural fluid and peripheral blood. Conclusions: Tregs are increased in patients of NSCLC, both at disease site and in systemic circulation. This increase may be chemokine receptors mediated. Treg frequency changes with treatment and response. Modulation of Tregs may have therapeutic implication in the management of advanced NSCLC.
Efficacy and safety of amrubicin in patients with advanced or recurrent thymoma.
Authors: Yoh Kiyotaka , Goto Koichi , Niho Seiji , Umemura Shigeki , Ohmatsu Hironobu , Ohe Yuichiro 
Published: March 2020

e17513 Background: Thymoma is rare thoracic tumor, which is chemoresponsive with anthracycline or cisplatin-containing regimen in advanced or recurrent setting. Amrubicin is a novel anthracycline agent that is well known to exert significant activity against small-cell lung cancer. The purpose of this study was to determine the efficacy and safety of amrubicin in patients with advanced or recurrent thymoma. Methods: We reviewed 11 consecutive patients with advanced or recurrent thymoma treated with single-agent amrubicin therapy at our institution from May 2006 to September 2010, retrospectively. Amrubicin was administered intravenously at 40 or 45 mg/m2 on day 1 to 3 of 3-4 weeks until disease progression or development of intolerance. Results: Profile of patients included: median age was 57 years (range 25–74); Male/Female=5/6; PS 0/1= 7/4; and Masaoka stage IVA/IVB/recurrence=7/2/2. All patients had received no prior chemotherapy. The median number of treatment cycles was 4 (range 3-6). A partial response was achieved in 1 patient and 10 patients exhibited stable disease. The overall response rate was 9%, but 3 patients had at least a 20% reduction in tumor size with amrubicin. The median reduction rate in tumor size was 13% (range 0-40). The median progression-free survival period was 5.4 months (range 2.3-15.8 months). The median overall survival has not been reached although a median follow-up time was 2.5 years. Based on the Kaplan-Meier method, the estimated 3-year survival rate was 83%. The most common adverse events were hematological toxicities. Five patients had grade 3/4 neutropenia, but febrile neutropenia was not observed. Non-hematological grade 3 toxicities were less frequent. There were no treatment-related deaths. Conclusions: Single-agent amrubicin showed modest activity and acceptable safety profile as chemotherapy for advanced or recurrent thymoma. Additional testing of amrubicin combined with cisplatin in this disease is warranted.
Effect of thoracic radiotherapy in extensive-disease small cell lung cancer on progression-free and overall survival: A retrospective review.
Authors: Wilson James Matthew , Grundy Anna , Best Kate , Mulvenna Paula M , McMenemin Rhona 
Published: March 2020

e17519 Background: Extensive-disease small cell lung cancer (ED-SCLC) carries a poor prognosis. The current standard practice of 4-6 cycles of a platinum based chemotherapy (PC) leads to a median survival of only 9-11 months. The role of thoracic radiotherapy (TRT) in ED-SCLC remains controversial. We report patient outcomes with ED-SCLC with respect to whether they received TRT or not. Methods: The practice of two oncologists from 2005-2009 was retrospectively reviewed. Patient age, performance status (PS) at presentation and site of progression were recorded. Progression-free survival (PFS) and overall survival (OS) were calculated with respect to the patient receiving 4-6 cycles of PC or not and then again in this subgroup with respect to whether or not they had TRT at any time after chemotherapy. Survival data was compared using the log-rank test. Results: 141 patients age 42-86 years old (mean 67.4 years) were identified. 58% were PS 0-2. 56 patients (40%) completed 4-6 cycles of PC with a median PFS of 8.4 months compared to 2.4 months in those that did not (p<0.001), median OS was 8.9 and 3.1 months (p<0.001). Of the 45 who had the site of progression recorded - 49% progressed within the thorax. Of 87 patents who received any chemotherapy, 43 received TRT and 44 did not with median PFS of 7.8 and 5.4 months respectively (p= 0.003) and median OS of 8.9 and 5.9 months (p=0.002). In the 56 patients who received 4-6 cycles of PC, median PFS was 9.2 with and 7.7 months without TRT (p=0.02). Median OS was 10.2 months with and 7.7 without TRT (p=0.02). Conclusions: Patients who received TRT at some point in their treatment demonstrated improved median PFS and OS. The role of TRT in ED-SCLC warrants further evaluation. The results of the REST trial are eagerly anticipated.
The utility of DR-70, a novel blood biomarker, in the early detection of lung cancer.
Authors: Motamed-Khorasani Afsaneh , Etemadi Hooman 
Published: March 2020

e17521 Background: Lung cancer accounts for the largest percentage of cancer in adults in North America. Non-small cell lung cancer (NSCLC) accounts for 85-90% of all lung cancers with a death rate of 85%. Early diagnosis is the only chance of a cure when surgery or chemo-radiotherapy can be performed. Chest X-ray is the routine first diagnostic step but is not confirmatory. The purpose of this study was to further validate DR-70 utility in lung cancer early detection considering the relatively high sensitivity of this test. Onko-Sure is a regulatory approved blood test for detection/monitoring of lung cancer treatment/recurrence. It measures the accumulation of fibrin/fibrinogen degradation products in the serum using anti-DR-70 antibody. Methods: A total of 239 serum samples were retrospectively obtained from a serum bank and were tested with DR-70. There were two arms: healthy controls (n= 120) and biopsy-confirmed lung cancers (n= 119) including: small cell lung cancer (SCLC) (n=7) and NSCLC (n=112). The NSCLC included adenocarcinoma (n=65), squamous carcinoma (n=37), large cell lung cancer (n=4) and others (n=6). The data were analyzed to find the optimal cut point, sensitivity and specificity of DR-70. Results: The sensitivity and specificity of 63% and 87.5% were achieved, respectively (cut-point of 1.2 ug/ml). For SCLC, the sensitivity and specificity of 57.1% and 82.5% were achieved (cut-point: 1.1 ug/ml). For NSCLC, the sensitivity and specificity of 65.2% and 87.5% were achieved (cut-point: 1.2 ug/ml). Among the subcategories of NSCLC, DR-70 showed the highest sensitivity for acinar cell carcinoma (81.8%). Furthermore, DR-70 showed sensitivity of 59.5%, 70.4, 66.7 and 70% for stages I, II, III, and IV. Conclusions: Chest X-Ray is the routine first step in lung cancer detection with the sensitivity of 78.3%. It is not confirmatory and it can miss lesions smaller than 1 cm. These findings are promising and highlight DR-70 test as an additional first line diagnostic tool that can potentially replace X-ray to increase the diagnosis sensitivity as early as stage I. An enhanced ability to diagnose NSCLC in an early stage (I/II) should significantly improve prognosis, treatment options and survival rate for patients with lung cancer.
Surgical outcomes of advanced NSCLC (stage IIIB and IV).
Authors: Kim Jae Hyun , Park Jong Ho , Lee Hae Won , Hwang Jin Wook , Kang Moon Chul , Baek HeeJong 
Published: March 2020

e17523 Background: The role of surgery in the stage IIIB or IV NSCLC (AJCC 6th edition) patients is has been controversial. Now in AJCC 7th edition, the operable T4 and M1 stages were regrouped to IIIA. We analyzed the clinical outcome of the surgical resection for the patients with operable NSCLC of stage IIIB or IV in AJCC 6th edition to evaluate the role of surgery in this group. Methods: From January 1990 to Desember 2009, the 102 patients with stage IIIB(T4) NSCLC and the 36 patients with stage IV (separate tumor in ipsilateral different lobe) NSCLC had been operated in Korean cancer center. We analyzed the long term survival and the risk factors for long term survival of the 138 patient retrospectively. Results: 59 (42.7%) patients had the invasion of major mediastinal organ, and 43 (31.1%) had separate tumor nodules in ipsilateral different lobe, and 36 (26%) had satellite nodules in same lobe. N0 stage was identified in 42 (30.4%) patients, N1 stage in 29 (21%), and N2 stage in 67 (48.6%). Lobectomy was performed in 56 (40.5%) patients, bilobctomy in 14 (10.1%) and pneumonectomy in 68 (49.2%). Complete resection was achieved in 123 (89.1%) and operation mortality rate was 6.5% (9/138 patients). Median survival was 34 months and 5-year and 10-year survival rate was 34.6% and 21.9% respectively. Recurrence, surgery alone, N2 stage, incomplete resection were risk factors of long term survival in multivariate analysis. Conclusions: Although the role of a surgery in the stage IIIB, IV NSCLC patients is very limited, the long term outcomes of surgical resection of them are tolerable in Korean cancer center. So we thought the shifting of stage of the group with operable stage IIIB or IV NSCLC to IIIA is appropriate.
Mixed-histology small cell lung cancer: The University of Missouri, Columbia, experience.
Authors: Wallace Audrey S , Doll Donald C. 
Published: March 2020

e17525 Background: In 1999, we reported demographics, staging, and treatment outcomes of patients with mixed histology small cell lung cancer (MHSCLC). The purpose of this abstract is to report pattern of presentation and survival in patients during 2000-2009. Methods: Records from 24 patients diagnosed with MHSCLC were reviewed under an institutional review board outcomes study. One patient was excluded as records were missing. Patient and disease characteristics, treatment, and outcomes were analyzed. Results: Twenty-three patients were analyzed, with median age at diagnosis of 63 (range 50 to 84). Twenty (86%) patients were Caucasian. Fourteen (61%) patients were female, 9 (39%) were male. Twenty-one (91%) patients were current or former smokers. Staging was as follows: 1-2: 3, 3: 6, 4: 11, extensive-stage: 1, limited-stage: 2. Sites of diagnosis were lung in 18 (78%), and metastatic sites in 5 (22%). Presenting symptoms were cough or shortness of breath in 12 (52%), CNS in 4 (17%), chest pain in 2 (9%), various others in 5 patients. Paraneoplastic syndrome was seen in 2 patients, and 6 patients reported weight loss of 10-15 lbs within 3-6 months of diagnosis. Metastatic presentation was as follows: 4 brain, 1 bone, and 1 soft tissue. Histology included 15 large cell, 6 adenocarcinoma, and 1 squamous cell. Seventeen patients were treated as follows: chemotherapy (14), 5 thoracic radiotherapy (RT), 3 cranial RT, with treatment status unknown in 1 patient with 3 year survival. Twenty-one (91%) patients had expired, with median survival of 4.6 months (range <1 month-53 months). Two patients were alive at 24.1 and 38.5 months. Conclusions: This review revealed female predominance, which is in line with the increasing number of women diagnosed with small cell lung cancer (SCLC), but could be due to exclusion of veteran administration patients. Best survival was seen in one patient with squamous cell carcinoma, followed by patients with adenocarcinoma, opening a possible role for targeted biologics in this subset of MHSCLC. In memory of Michael Perry, MD, 1945-2011, dedicated physician, researcher, and teacher who started as primary mentor on this project before his passing.
Association between genetic variations in transforming growth factor beta pathway and overall survival in patients with non-small cell lung cancer treated with definitive radiotherapy.
Authors: Wang Weili , Shedden Kerby A , Kong Feng-Ming (Spring) 
Published: March 2020

e17530 Background: The transforming growth factor beta (TGFβ) pathway, an important regulator in cellular metabolic process, has been reported for significant association with cancer prognosis. This study was to exam the association between single nucleotide polymorphisms (SNPs) of TGFβ pathway and overall survival (OS) in subjects with non-small cell lung cancer (NSCLC). Methods: Patients with stage I-III NSCLC received definitive radiotherapy with/without chemotherapy were eligible to this prospective study. The primary endpoint was OS which was calculated from radiation treatment start to death or censored. DNA samples for genotyping were extracted from buffy-coat which was collected before commencement of treatment. 19 SNPs in 10 genes (BMP1, BMP2, INHBC, SMAD1, SMAD3, SMAD4, SMAD6, SMAD7, SMAD8, TGFβ1), which was reported to have significant correlation with OS of lung cancer, were selected. MassArray System (Sequenom Company) was used for genotyping. Cox regression was performed for multivariate analysis to examine the effects of genotypes on OS using dominant and recessive genetic model. Results: 126 consecutive patients, 91% of them were Caucasian, were recruited in this study. All SNPs call rates were over 90%. Assay reproducibility was over 99% by random double-blinding duplicate or triplicate genotyping. Among clinical factors analyzed, radiation dose was only significant independent factor predicting OS (P=0.001). Genotypic association study showed that 7 SNPs (rs235756, rs11939979, rs12102171, rs6494633, rs12456284, rs12906898 and rs4803455) were significantly associated with OS, adjusted for age, gender, smoking, histology, clinical stage, tumor volume, Karnofsky Performance Status, radiotherapy dose, and chemotherapy. The strongest association was in SMAD3: rs12102171 (P=0.004, HR=2.28, 95%CI, 1.26-4.15). Conclusions: This study partly validated findings from previous studies that genetic variations in the TGFβ pathway are significant predictors of overall survival in NSCLC patients treated with definitive radiotherapy with/without chemotherapy.
Stage III NSCLC: How many patients are really suitable for radical treatment approaches?
Authors: Al-Shamsi Humaid Obaid , Ellis Peter Michael 
Published: March 2020

e17532 Background: Stage III NSCLC represents a heterogeneous population. Patients with good performance status (PS) and weight loss < 10% (WL<10) are generally considered for radical treatment with chemoradiation or trimodality approaches. Outcome data from Cancer Care Ontario show 30% of stage III NSCLC (6th edition TNM) patients receive chemoradiation.There is significant variation between local health networks. We examined the proportion of patients with stage III NSCLC suitable for radical treatment. Methods: We conducted a retrospective cohort study of patients diagnosed with stage III NSCLC at the Juravinski Cancer Center from July 2007 to June 2009. Demographic, pathologic and treatment data were abstracted from patients’ records. The primary outcome was the proportion of stage III NSCLC patients eligible for radical treatment. We also compared patients treated radically versus palliatively. Results: 159 stage III NSCLC patients (staged by 6th edition TNM) were seen. The median age was 69 yrs (sd 12) with 58% men and 42% women. There were 40% stage IIIA, 37% IIIB and 23% IIIB (wet). 61 (38%) patients were treated with radical intent and 98 (62%) were treated palliatively. Reasons for palliative treatment approach were WL >10% (7%), PS >2 (10% ), both WL >10% and PS >2 (20%), significant comorbidities (9%),patient declined (9%) and stage IIIB wet(23 %).The median OS for patients treated radically was 23.3 months v 7.1 months for those treated palliatively. Stage IIIA patients treated radically had better OS than IIIB (27m v 14m). Patients with poor PS, or WL>10% had similar OS to patients with wet stage IIIB (7.1m v 7.2m), whereas the survival of patients with poor PS and WL >10% was worse (3m). Conclusions: Using eligibility criteria from clinical trials of stage III NSCLC, only 40% of patients appear eligible for radical treatment approaches. Our data are consistent with published data. Significant WL>10% or poor PS (>2) predicted poor outcome. Combined WL>10% and poor PS predicted a very poor prognostic group. Criteria for radical treatment of stage III NSCLC should not be extrapolated beyond the eligibility criteria used in clinical trials.
Blood vessel invasion (BVI) in curatively (R0) resected stage II and IIIA non-small cell lung (NSCLC) cancer patients.
Authors: Brueckl Wolfgang M. , Wuerflein Dieter , Kraus Dietmar , Meyer Christian , Wagner Manfred , Ficker Joachim H 
Published: March 2020

e17536 Background: A single center study was conducted to identify the prognostic and predictive value of blood vessel invasion (BVI) in surgically R0 resected stage II and IIIA non-small cell lung cancer patients. Methods: A total of N=105 consecutive patients who had undergone complete (R0) resection for stage II/IIIA primary non-small cell lung cancer (NSCLC) between 01/2008 and 12/2010 at the Lung Cancer Center Nuremberg were evaluated. All pathological specimens were examined for evidence of BVI. All patients were followed for tumour recurrence and survival. Differences between groups were calculated with Chi-square test. Recurrence and survival data were analyzed for all patients using Kaplan-Meier test. Significance was univaratiately calculated by log-rank and multivariately by Cox-regression analysis. Results: The baseline clinical data showed no significant differences between patients with adjuvant chemotherapy (aCTx; cisplatin/vinorelbine; N=46) and without aCTx (N=59) beside of age (aCTx treated patients were younger p=0.03). Demographic data were as follows: male 64%; age <65 years 53%; ECOG 0/1/2 (47%/35%/3%); histology AC/SCC/other (53%/37%/10%); stage IIA/IIB/IIIA (13%/31%/55%); BVI 29%; pneumonectomy 19%. ECOG-PS 0 and no BVI were positive prognostic factors for both recurrence free survival (RFS) and overall survival (OS) in the group without aCTx and remained independent prognostic factors in the multivariate analysis (p<0.001; p=0.002). Additionally, ECOG-PS 0 and no BVI were independent predictive factors for RFS and OS in the aCTx treated group. Conclusions: BVI is an independent prognostic and predictive factor in R0 resected stage II/IIIA NSCLC patients. This subset of patients may have a greater benefit from aCTx and may need to be followed-up more closely.