Using the Systemic Immune-Inflammation Index (SII) as a mid-treatment marker for survival among patients with stage-III locally advanced non-small cell lung cancer (NSCLC)

The Systemic Immune-Inflammation Index (SII) is an important marker of immune function, defined as the product of neutrophil-to-lymphocyte ratio (NLR) and platelet count (P). Higher baseline SII levels have been associated with improved survival in various types of cancers, including lung cancer. Data were obtained from PROCLAIM, a randomized phase III trial comparing two different chemotherapy regimens pemetrexed + cisplatin (PEM) vs. etoposide + cisplatin (ETO), in combination with radiotherapy (RT) for the treatment of stage III non-squamous non-small cell lung cancer (NSCLC). We aimed to determine if SII measured at the mid-treatment window for RT (weeks 3-4) is a significant predictor of survival, and if the effect of PEM vs. ETO differs by quartile (Q) level of SII. Hazard-ratios (HR) for survival were estimated using a proportional hazards model, accounting for the underlying correlated structure of the data. A total of 548 patients were included in our analysis. The median age at baseline was 59 years. Patients were followed for a median of 24 months. Adjusting for age, body mass index, sex, race, and chemotherapy regimen, SII was a significant mid-treatment predictor of both overall (adjusted HR (aHR) = 1.6

A pilot study examining the prognostic utility of tumor shrinkage on cone-beam computed tomography (CBCT) for stage III locally advanced non-small cell lung cancer patients treated with definitive chemoradiation

There has been growing interest in utilizing information from cone-beam computed tomography (CBCT) to help guide both treatment delivery and prognosis. In this assessment of locally advanced unresectable stage III non-small cell lung cancer (NSCLC) treated with definitive chemoradiation, we aimed to determine the survival advantage associated with using CBCT to measure tumor regression. Patient, tumor, and treatment characteristics were collected. The serial tumor shrinkage for each patient was determined from tumor volume contours on weekly CBCTs. Survival analysis was performed using the Kaplan-Meier technique and a Cox proportional hazards model. At least two-thirds of patients had a tumor volume reduction of at least 5% after each week of chemoradiation. A weekly reduction in tumor volume of 5% or greater seen on the CBCT images during radiation therapy was significantly associated with improved overall survival, which remained significant when adjusted for age, histology, grade, and T- and N-stages

Pretreatment neutrophil-to-lymphocyte ratio as an important prognostic marker in stage III locally advanced non-small cell lung cancer: Confirmatory results from the PROCLAIM phase III clinical trial

Background: Neutrophil-to-lymphocyte ratio (NLR) is an important pretreatment marker of systemic inflammation and tumor aggressiveness. Increased levels of this ratio have been associated with reduced survival in several observational studies of lung cancer. However, supporting analyses from large clinical trial data are lacking. Methods: To validate the prognostic role of NLR, the current study evaluated data from a randomized phase III study (PROCLAIM; clinicaltrial.gov ID: NCT00686959) of patients with stage IIIA/B, unresectable, non-squamous, non-small cell lung cancer (NSCLC), originally comparing combination pemetrexed-cisplatin chemoradiotherapy with etoposide-cisplatin chemoradiotherapy. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for survival were estimated using a Cox proportional hazards model. Models were adjusted for age, race, sex, stage, treatment, and body mass index (BMI). Patients were followed for a median of 24 months. Results: Increased NLR levels at baseline were associated with reduced overall ( Conclusions: These findings provide substantiating evidence that NLR, which is routinely available from standard blood testing of patients diagnosed with NSCLC, is an important inflammation-based prognostic marker for survival among patients with locally advanced disease undergoing chemoradiation. Future research will benefit by assessing the prognostic potential of NLR in the context of genetic mutations and molecular markers

Race, insurance type, and stage of presentation among lung cancer patients

The purpose of this study was to determine whether African-American lung cancer patients are diagnosed at a later stage than white patients, regardless of insurance type. The relationship between race and stage at diagnosis by insurance type was assessed using a Poisson regression model, with relative risk as the measure of association. The setting of the study was a large tertiary care cancer center located in the southeastern United States. Patients who were diagnosed with lung cancer between 2001 and 2010 were included in the study. A total of 717 (31%) African-American and 1,634 (69%) white lung cancer patients were treated at our facility during the study period. Adjusting for age, sex, and smoking-related histology, African-American patients were diagnosed at a statistically significant later stage (III/IV versus I/II) than whites for all insurance types, with the exception of Medicaid. Our results suggest that equivalent insurance coverage may not ensure equal presentation of stage between African-American and white lung cancer patients. Future research is needed to determine whether other factors such as treatment delays, suboptimal preventive care, inappropriate specialist referral, community segregation, and a lack of patient trust in health care providers may explain the continuing racial disparities observed in the current study

Fabrication of PVA-Silver nanoparticle composite film for elimination of microbial contaminant from effluent

The effluent contains many harmful microbes which should be eliminated before it is discharged into a water body. Silver nanoparticles (AgNPs) being high-quality significance and have a great impact on this research field as it inhibits microbial proliferation and infection. Therefore, it may use for Bioremediation purposes, our laboratory is fascinated by the production of polymer matrix entrapment silver nanoparticles for in situ bio-remediation purposes. The AgNPs was prepared from sawdust by decoction method. The yellowish solution turns into dark brown colour indicating the formation of AgNPs. A sharp SPR (Surface Plasmon Resonance) band formation in UV-vis spectroscopy scan establishes the formation and stability of silver nanoparticles in an aqueous solution. SEM microphotograph indicated roughly spheroidal structure with (63±3) nm average diameters of newly synthesized AgNp. Polyvinyl alcohol (PVA) is eco-friendly and non-toxic to the environment was chosen for the preparation of polymeric matrix. The non-toxic concentration (1 μg/mL) of AgNp was dispersed into PVA solution followed by cross-linked with maleic acid. PVA- maleic acid is cross-linked by the formation of an ester bond, whereas silver nanoparticles physically entrap into the cross-linked matrix. The silver nanoparticles were released from the matrix nearly after 10 min of swelling of the composite film. In a microbial assay using E. coli agar medium, PVA-AgNp composite film shows the significant killing of microorganisms. Microbial elimination is measured indirectly by pH measurement and dissolved oxygen concentration measurement of the effluent in situ against RO- water, taken as control. The dissolved oxygen concentration from RO water and effluent water was measured on Day “0” followed by treatment and incubation at the BOD chamber. The treatment with PVA-AgNp composite film reduced the BOD Level and increase dissolved oxygen level simultaneously increasing the quality of water

On the Frontiers of Breast Cancer Diagnosis and Treatment: Current and Future Directions in a Rapidly Changing Field

Breast cancer (BCa) represents a medically heterogeneous group of malignancies, with differing biological and genetic makeups [...

Oligometastatic Non-Small Cell Lung Cancer: A Practical Review of Prospective Trials

Oligometastatic non-small cell lung cancer (NSCLC) is an intermediate state between localized and widely metastatic NSCLC, where systemic therapy in combination with aggressive local therapy when feasible can yield a favorable outcome. While different societies have adopted different definitions for oligometastatic NSCLC, the feasibility of curative intent treatment remains a major determinant of the oligometastatic state. The management involves a multidisciplinary approach to identify such patients with oligometastatic stage, including the presence of symptomatic or potentially symptomatic brain metastasis, the presence of targetable mutations, and programmed death-ligand (PD-L1) expression. Treatment requires a personalized approach with the use of novel systemic agents such as tyrosine kinase inhibitors and immune checkpoint inhibitors with or without chemotherapy, and addition of local ablative therapy via surgery or stereotactic radiation therapy when appropriate