Peter Hatlen

Prolonged Survival in Patients with Lung Cancer with Diabetes Mellitus

Introduction: Patients with lung cancer have a high frequency of comorbidity. Data on the impact of diabetes mellitus, the most frequent endocrine disorder, on the prognosis of lung cancer are conflicting. The aim was to investigate the impact of diabetes mellitus on survival in lung cancer. Method: We analyzed data from a cohort, the Nord-Trøndelag Health Study (HUNT study) linked to the Norwegian Cancer Registry and controlled the results using two lung cancer studies, the Pemetrexed Gemcitabine study and the Norwegian Lung Cancer Biobank. Survival in lung cancer with and without diabetes mellitus was compared using the Kaplan-Meier method and Cox regression model for each study and the studies combined. Results: One thousand six hundred seventy-seven cases of lung cancer were included, 1031 from HUNT study, 436 from the Pemetrexed Gemcitabine study, and 210 from the Norwegian Lung Cancer Biobank registry, and among these 77 patients had diabetes mellitus. In the combined analysis, patients with lung cancer with diabetes mellitus had increased survival compared with those without (p = 0.005). The 1-, 2-, and 3-year survival in patients with lung cancer with and without diabetes mellitus were 43% versus 28%, 19% versus 11%, and 3% versus 1%, respectively. Adjusting for age, gender, histology, and stage of disease in the Cox regression model, the hazard ratio for survival in patients with lung cancer with diabetes mellitus was 0.55 (95% CI, 0.41–0.75) as compared with without. Conclusion: Patients with lung cancer with diabetes mellitus have an increased survival compared with those without diabetes mellitus.

Learning endobronchial ultrasound transbronchial needle aspiration – a 6-year experience at a single institution

Endobronchial ultrasound with transbronchial needle aspiration (EBUS‐TBNA) has become an important diagnostic tool for the pulmonologist. Learning this procedure and maintaining technical skills requires continuous practice and evaluation.

Learning EBUS‐TBNA – a 6‐year experience at a single institution

Endobronchial ultrasound with transbronchial needle aspiration (EBUS‐TBNA) has become an important diagnostic tool for the pulmonologist. Learning this procedure and maintaining technical skills requires continuous practice and evaluation.

Self-reported cardiovascular disease and the risk of lung cancer, the HUNT study.

Introduction: Inflammation is involved in development of lung cancer and cardiovascular disease (CVD), and we hypothesize that self-reported CVD is an independent risk factor for lung cancer. Methods: Data from the Nord-Trøndelag Health Study (1984–2008) linked to the Norwegian Cancer and Death Cause Registry were analyzed stratified by smoking status. In total, 97,087 persons (1,634,967 person years) were included (never smokers 567,575 person years, former smokers 295,685 person years, current smokers 444,922 person years, and unknown 326,785 person years) and followed for an average of 15 years. The proportional hazard model was applied to estimate the hazard ratio (HR) with a 95% confidence interval (CI) for self-reported CVD on lung cancer incidence rate adjusted for age, sex, body mass index, burden of tobacco smoking and chronic cough with phlegm. Results: 1080 cases of lung cancer (1.1%) occurred. A total of 5981 (6.9%) participants had at baseline or developed during follow-up self-reported CVD. After adjusting for confounders, self-reported CVD was an independent risk factor for the development of lung cancer in former (HR [95% CI] 1.74 [1.11–2.73]) and current smokers (HR [95% CI] 1.38 [1.04–1.83]), but not in never smokers (HR [95% CI] 0.87 [0.34–2.23]). Conclusions: Self-reported CVD was independently associated with increased occurrence of lung cancer in former and current smokers. CVD may be a novel risk factor for lung cancer screening.

Bone mass density, fracture history, self-reported osteoporosis as proxy variables for estrogen and the risk of non-small-cell lung cancer--a population based cohort study, the HUNT study: are proxy variables friends or faults?

Lung cancer has the highest mortality of all cancers. Patients with early stage disease have the best cure rates and that emphasizes the importance of early detection. About half of all non-small cell lung cancers (NSCLC) are estrogen receptor positive. The impact of estrogen and its receptors for NSCLC carcinogenesis has been studied but is still unclear. Low estrogen levels are associated with osteoporosis. We hypothesize that low bone mineral density (BMD), a positive history of fracture or self-reported osteoporosis, used as a proxy variable for life time estrogen exposure, are associated with a low incidence of NSCLC. We analyzed data from a cohort study, the Nord-Trøndelag Health Study 2 (1995-1997) linked to the Norwegian Cancer Registry. Using the logistic regression model we calculated the odds ratio (OR) with a 95% confidence interval (CI) for the risk of NSCLC for the three proxy variables, stratified by sex. Participants older than 50 years of age, having measured bone density (N = 18,156), having answered the questions on self-reported fracture (N = 37,883) and osteoporosis (N = 25,701) and known body mass index (BMI) (N = 29,291), were evaluated for inclusion. In 6996 participants all these information was available in addition to tobacco use, and in women also hormonal replacement therapy (HRT). Lung function (FEV1 percent of predicted) was included in a sensitivity analysis. We identified 132 (1.9%) cases of NSCLC, 59 (1.2%) and 73 (3.3%) cases in women and men, respectively. Low BMD was associated with a higher risk of NSCLC, OR: 2.38, 95% CI: 1.09-5.18 and OR: 2.67, 95% CI: 1.39-5.16 in women and men, respectively. No association was found between the two other proxy variables and the risk of NSCLC. Inclusion of lung function in the model did not change the results. Contrary to our hypothesis, women and men with low BMD had a higher risk for NSCLC. In addition the study demonstrates that the risk depends on which proxy variable was chosen, and we may ask: are proxy variables reliable?

Pulmonologist evaluation on new CT visualization for guidance to lung lesions during bronchoscopy

Abstract Objective: Endoluminal visualization in virtual and video bronchoscopy lacks information about the surrounding structures, and the traditional 2 D axial, coronal and sagittal CT views can be difficult to interpret. To address this challenge, we previously introduced a novel visualization technique, Anchored to Centerline Curved Surface, for navigated bronchoscopy. The current study compares the ACCuSurf to the standard ACS CT views as planning and guiding tools in a phantom study. Material and methods: Bronchoscope operators navigated in physical phantom guided by virtual realistic image data constructed by fusion of CT dataset of phantom and anonymized patient CT data. We marked four different target positions within the virtual image data and gave 12 pulmonologists the task to navigate, with either ACCuSurf or ACS as guidance, to the corresponding targets in the physical phantom. Results: Using ACCuSurf reduced the planning time and increased the grade of successful navigation significantly compared to ACS. Conclusion: The phantom setup with virtual patient image data proved realistic according to the pulmonologists. ACCuSurf proved superior to ACS regarding planning time and navigation success grading. Improvements on visualisation or display techniques may consequently improve both planning and navigated bronchoscopy and thus contribute to more precise lung diagnostics.

Aggressive Treatment of Brain Metastasis Increases Survival in Patientswith Lung Cancer

Introduction: In selected patients superior survival has been observed when treated aggressively for lung cancer and brain metastasis (BM). The aim of the study was to evaluate treatment-modalities and survival in our region retrospective. Method: Retrospectively we compared survival for lung cancer patients treated either with microsurgery or Gamma knife surgery (GKS) for BM to a control group (N=510) patients with lung cancer stage IV and a mean age of 68 years. Results: 42 patients with non-small cell lung cancer were included, 22 (52%) treated with microsurgery and 20 (45%) with GKS for BM. Patients treated aggressively for lung cancer and BM had a significant survival-benefit, 21 months (CI 95%: 9.4-32.6) vs. 4 months in the control group (CI 95%: 3.5-4.5) (p<0.001). Treatment with microsurgery showed a survival-benefit compared to GKS, 33 months (CI 95%: 15.7-50.2) vs. 15 months (CI 95%: 6.0-23.9). A later onset of BM was associated with a survival-benefit 24.6 months (CI 95%: 18.6-30.6) vs. 10.2 months (CI 95%: 4.4-16.1). Prognostic factors were age and the number of BM however patients with 3-4 BM had still a survival benefit (20% 2 years survival) compared to stage IV. Conclusion: Lung cancer patients with BM, also more than 1, show a significant better overall survival after receiving aggressive BM treatment. The size of the BM seems to be less important.