Background: Epidermal growth factor (EGFR) gene mutation status in lung adenocarcinoma has been demonstrated to reflect the therapeutic efficacy of tyrosine kinase inhibitors (TKIs). In this study, we investigated the association of EGFR mutation status with prognostic impact. Method: From January 2010 to December 2018, we retrospectively reviewed 450 patients with resected lung adenocarcinomas who underwent EGFR mutation status analysis. Clinicopathological factors analyzed included age, sex/gender, smoking history, serum carcinoembryonic antigen (CEA) levels, lymphatic invasion (Ly), vascular invasion (V), histological grade, malignant component, pathological stage, and EGFR mutation. Univariate and multivariate analyses of overall survival (OS) and recurrence-free survival (RFS) were conducted. Result: The study group comprised 450 patients (260 men, 190 women; age range: 32e88 years; mean age: 67.6±9.9 years). The median follow-up period was 35.4 months. A total of 282 patients were smokers and 168 were nonsmokers. EGFR mutation analysis identified 186 patients with EGFR mutation and 264 patients with wild-type EGFR. Preoperative CEA was elevated in 117 patients. Ly, V, high grade, high malignant component and advanced stage were observed in 72, 73, 209, 120 and 102 patients, respectively. The 5-year OS in patients with EGFR mutation was 80.6% compared with 75.6% for those with wild-type EGFR (p¼0.011). The 5-year RFS in patients with EGFR mutation status was 77.1% compared with 66.8% for patients with wild-type EGFR (p¼0.036). There were no significant differences in OS and RFS between patients with exon 21 L858R, exon 19 deletion and other mutation subtypes. In addition, there was no survival difference in patients with EGFR mutation who received TKI or not after lung cancer recurrence. In multivariate analysis for OS, EGFR mutation status was an independent significant prognostic factor, as well as age, Ly, and pathological stage. Conclusion: EGFR mutation status is an independent good prognostic factor in patients with resected lung adenocarcinoma regardless of TKI use. EGFR mutation subtypes did not show significant differences in prognosis.

Cancer is a major problem plaguing human society today. With the research and development of nano-drug delivery technology and new non-surgical treatment methods, many types of early cancers can be cured or effectively controlled. However, the current treatment methods for advanced cancer are still limited, and efficient early cancer identification is crucial for enhancing patients prognosis and survival rates. Magnetic resonance imaging (MRI) and X-ray technologies are currently the mainstream and generally applicable means of early cancer detection. However, there is a lack of unified comparison and interpretation for their respective applicable cancer detection types. Herein, the paper first provides a comprehensive comparison and explanation of the working principles of the two technologies, as well as their advantages and disadvantages. Further, this article introduces the application of MRI and X-ray technology in the early detection of different common cancer types, including lung, breast, and brain cancers. The paper found that MRI is crucial in the early detection of brain cancer, and X-ray is a common method for lung cancer screening. With further advances in technology, cancer-related deaths can be further curbed.

Background: Lung adenosquamous carcinomas (ASC) are morphologically mixed tumors that contain the two cell components adenocarcinomas (AC) and squamous cell carcinomas (SCC). However, to date, the genomic profile, TMB status, evolutionary relationship, and immune microenvironment of the two components still remain unclear. Method: Adenocarcinomas component (ACC) and squamous cell carcinomas component (SCCC) in ASC (n¼30) were validated by immunohistochemistry and obtained separately by means of laser capture microdissection. Gene panel and T cell receptor (TCR) repertoire sequencing were performed in both components. Normal tissues adjacent to the cancer were used as controls. The two components were compared from the dimension of somatic mutations, TMB, evolution, and the TCR clones. 626 AC tumors and 83 SCC tumors were also included for comparison with ASC. Results: Comparison of frequency of recurrently altered genes in lung SCCC, ACC, AC, and SCC were performed. EGFR (Fisher Exact test, p¼0.0476, OR 2.6) and MAP3K1 (p¼0.0020, OR 10.2) were enriched but no KRAS were found in ACC compared to AC. Compared with SCC, EGFR (p<0.0001, OR 14.3) is enriched in SCCC, while TP53 (p¼0.0129, OR 0.3) with lower mutation frequency. Different mutational spectra suggest that ACC is different from AC, and SCCC is different from SCC. Despite the heterogeneity, there were shared mutations in lung SCCC and ACC. 79% of ACC and 75% of SCCC samples harbored EGFR mutations. 46% of ACC and 64% of SCCC samples harbored TP53 mutations. In the evolutionary tree analysis, EGFR (in 75% of patients) and TP53 (43%) are the most frequent trunk genes. Above 90% (27/28) of patients had trunk genes, indicating that SCCC and ACC in ASC come from the same origin. In ACC, SCCC, AC, and SCC, 14%, 29%, 23%, and 48% of samples were identified as TMB-H respectively. The TMB index of SCCC was higher than that of ACC (Wilcoxon matched pairs test, p¼0.0065). The ACC TMB was equivalent to AC (Mann-Whitney test, p¼0.9352). The SCCC TMB is marginally lower than SCC (Mann-Whitney test, p¼0.0553). Significant difference is showed in the diversity of TCRs between ACC and SCCC (Wilcoxon matched pairs test, p¼0.0383). Although the difference is not significant, 65% (14/20) of SCC samples have a higher clonality index than ACC. Conclusion: Our study promote a better knowledge about ACC and SCCC from ASC, supporting the hypothesis that ACC and SCCC in ASC come from the same origin. However, two components also exhibit diverse genomic profile, TMB status, and TCR repertoire.

between oral leukoplakia and lung cancer in the Linxian General Population Trial cohort. Method: The Linxian General Population Trial cohort, with 29,584 healthy adults enrolled in 1985 and followed through the end of 2012. With collected baseline data, hazard ratios (HR) and 95% confidence intervals (95% CI) for developing lung cancer were estimated using Cox proportional hazard models. Results: Overall, a total of 29449 were included in the final analysis. During 28 years of follow up, we confirmed a total of 277 incident lung cancer cases. Overall, participants with oral leukoplakia had little risk for developing lung cancer (HR¼1.01, 95%CI: 0.67, 1.16). No significant associations were observed for lung cancer in either all subjects or subgroups. Conclusion: Our results suggest that oral leukoplakia is not associated with increased risk of lung cancer mortality. Future studies are needed to confirm these findings.

Background: Cyber Knife robotic stereotactic radiosurgery is minimally invasive tumor treatment modality that can deliver high precision radiotherapy to any part of the body with minimal exposure to adjacent and surrounding vital organs and is used to treat oligometastasis of the lung from primary breast cancer patients. In the modern high precision treatment delivery, utmost care should be taken for motion management of tumor targets. The Objective of this study was to investigate the accuracy and efficacy of Cyber knife in the treatment of lung metastasis from breast cancer using fuducial free respiratory tracking system using cyberknife stereotactic radiosurgery. Method: We examined toxicity and local control rate with fiducial-free CyberKnife stereotactic body radiation therapy (SBRT) for lung metastases from 20 breast cancer patients. All patients had favorable performance status (ECOG 0e2), oligometastatic disease. Total of 56 Lungs lesions were treated with a prescribed dose of 30e35 Gy delivered in five fractions to the planning target volume (PTV) using the CyberKnife with X-sight lung tracking. A median 30 Gy (IQR, 30e35 Gy) dose was delivered to a median prescription isodose line of 70% (IQR, 65e77%) to 20 patients with a total median follow up of 34 months. Results: The toxicity and local control rates were favourable and 1-and 2-year local control estimates were 87% and 73%, respectively. Two of the five local failures were infield in patients who had received irradiation to the gross tumor volume and remaining 3 were in patients who had received irradiation to clinical target volume. No local failures were identified beyond 21 months of therapy. There was no lung, oesophageal or spinal cord toxicity noted in the above patients. Conclusion: Initial evaluation with fiducial free based respiratory tracking system using five-fraction CyberKnife SBRT is a promising treatment option for lung metastasis from breast cancer patients, demonstrating encouraging local control rates with no toxicity. a dose escalation study for the pheripheral lung metastasis from breast cancers is being planned.Background: Recent randomized phase III trials (ALTA-1L and ALEX) reported the robust efficacy of next-generation anaplastic lymphoma kinase (ALK) inhibitors (brigatinib and alectinib) for the first-line treatment of patients with advanced ALK-positive non-small-cell lung cancer (NSCLC). However, there is no head-to-head comparison of brigatinib vs. alectinib. In this study, we aimed to explore the optimal choice of ALK inhibitors treatment for advanced ALK-Positive NSCLC. Method: We performed an indirect comparison of ALTA-1L and ALEX to compared therapeutic efficacy and adverse event (AE) between brigatinib and alectinib as the first-line treatment of advanced ALK-Positive NSCLC. The clinical outcomes were progression-free survival (PFS), overall survival (OS), objective response rate (ORR) and AE. Hazard ratio (HR, for PFS and OS) / risk ratio (RR, for ORR and AE) and its 95% confidence interval (CI) were extracted. R...