Achieving Thoracic Oncology data collection in Europe: a precursor study in 35 Countries.

BACKGROUND: A minority of European countries have participated in international comparisons with high level data on lung cancer. However, the nature and extent of data collection across the continent is simply unknown, and without accurate data collection it is not possible to compare practice and set benchmarks to which lung cancer services can aspire. METHODS: Using an established network of lung cancer specialists in 37 European countries, a survey was distributed in December 2014. The results relate to current practice in each country at the time, early 2015. The results were compiled and then verified with co-authors over the following months. RESULTS: Thirty-five completed surveys were received which describe a range of current practice for lung cancer data collection. Thirty countries have data collection at the national level, but this is not so in Albania, Bosnia-Herzegovina, Italy, Spain and Switzerland. Data collection varied from paper records with no survival analysis, to well-established electronic databases with links to census data and survival analyses. CONCLUSION: Using a network of committed clinicians, we have gathered validated comparative data reporting an observed difference in data collection mechanisms across Europe. We have identified the need to develop a well-designed dataset, whilst acknowledging what is feasible within each country, and aspiring to collect high quality data for clinical research.

Lung adenocarcinoma mimicking pulmonary fibrosis-a case report.

BACKGROUND: Lung cancer is usually presented with cough, dyspnea, pain and weight loss, which is overlapping with symptoms of other lung diseases such as pulmonary fibrosis. Pulmonary fibrosis shows characteristic reticular and nodular pattern, while lung cancers are mostly presented with infiltrative mass, thick-walled cavitations or a solitary nodule with spiculated borders. If the diagnosis is established based on clinical symptoms and CT findings, it would be a misapprehension. CASE PRESENTATION: We report a case of lung adenocarcinoma whose symptoms as well as clinical images overlapped strongly with pulmonary fibrosis. The patient's non-productive cough, progressive dyspnea, restrictive pattern of pulmonary function test and CT scans (showing reticular interstitial opacities) were all indicative of pulmonary fibrosis. The patient underwent a treatment consisting of corticosteroids and antibiotics, to no avail. Histopathology of the lung showed that the patient suffered from mucinous adenocarcinoma. Albeit the immunohistochemical staining was not consistent with lung adenocarcinoma, tumor's morphological characteristics were consistent, and were used to make the definitive diagnosis. CONCLUSION: Given the fact that radiography cannot always make a clear-cut difference between pulmonary fibrosis and lung adenocarcinomas, and that clinical symptoms often overlap, histological examination should be considered as gold standard for diagnosis of lung adenocarcinoma.

Characteristics of lymphovascular metastatic spread in lung adenocarcinoma according to the primary cancer location.

Aim To compare the localization of lung adenocarcinoma with tumour size and lymphovascular invasion (LVI) presence, and to determine the frequency of metastasis findings in hilar and mediastinal lymph nodes depending on the localization of the tumour and status of lymphovascular invasion. Method This observational cross-sectional study included 261 patients with complete resection of confirmed lung adenocarcinoma. The dependence between categorical variables were performed with χ2 and Fisher's exact tests. A p<0.05 was considered as statistically significant. Result Metastases to hilar lymph nodes at lung adenocarcinoma with central localization and presented lymphovascular invasion were more frequently found than tumours with peripheral localization (p<0.001). In tumours with peripheral localization, lymphovascular invasion was less frequent; even in tumours greater than 7 cm in the largest dimension the presence of LVI was not 100%. Metastases to mediastinal lymph nodes in tumours with central localization and presented lymphovascular invasion were less frequent than in tumours with peripheral localization and presented lymphovascular invasion (p=0.002). Conclusion In invasive adenocarcinoma, lymphovascular invasion was much more common in centrally positioned than in peripherally positioned tumours. Metastases to the hilar and mediastinal lymph nodes, regardless of the findings of lymphovascular invasion, usually originated from upper lobe tumours.

Preoperative tumour size as a predictor of the presence of lymphovascular invasion in lung adenocarcinoma.

Aim To examine whether preoperative tumour size may serve as a biomarker for the occurrence of lymphovascular invasion (LVI) in centrally and peripherally located lung adenocarcinoma. Method The study included 261 patients surgically treated for diagnosed lung adenocarcinoma. A ROC curve was used to determine the biomarker potential of tumour size relative to the occurrence of LVI. Binary logistic regression was used to show changes of tumour size impact on the status of LVI. Result Tumour prevalence according to localization had no statistical significance (p=0.464), while the presence of LVI in central, as well as peripheral positions, was statistically significantly different (p<0.001). The area under the curve of 0.978 highlights the fact that tumour size is an excellent marker of the presence of LVI in centrally located adenocarcinomas of the lung. A similar finding was confirmed in peripherally located lung adenocarcinomas with an area below the curve of 0.943. Binary logistical regression showed that in centrally localized adenocarcinomas of the lung, each additional centimetre of tumour growth represents an increase in the likelihood of LVI+ by 17.14 times. In peripherally located adenocarcinomas of the lung, this increase in likelihood of LVI for each centimetre of growth was 5.46 times. Conclusion With a high degree of sensitivity and specificity, preoperative tumour size may serve as an important biomarker and positive predictor of the presence of LVI in lung adenocarcinoma of any location.

Our experiences with erlotinib in second and third line treatment patients with advanced stage IIIB/ IV non-small cell lung cancer.

HeadHER1/EGFR is known to play a pivotal role in tumorigenesis and is overexpressed in up to 80% of NSCLCs. The study of an Expanded Access Clinical Program of Erlotinib in NSCLC is a phase IV open-label, non-randomized, multicenter trial in patients with advanced (inoperable stage IIIb/IV) NSCLC who were eligible for treatment with erlotinib but had no access to trial participation. Patients for the study from Bosnia and Herzegovina (B&H) were selected from two Clinical centres (Sarajevo and Banja Luka). The aim of study was to evaluated efficacy and tolerability of erlotinib monotherapy in this setting. All patients who received at least one dose of erlotinib and data were entered in the database as of the CRF cut-off date of 14th May 2008 were included in analysis of data (n = 19). This population is defined as the Intent to Treat (ITT) population and includes all patients who had at least one dose of erlotinib regardless of whether major protocol violations were incurred. The findings are consistent with the results of the randomized, placebo-controlled BR.21 study. Indicating that erlotinib is an effective option for patients with advanced NSCLC who are unsuitable for, or who have previously failed standard chemotherapy. In B&H group of patients DCR was almost 84%, and PFS was approximately 24,7 weeks (compared with 44% and 9,7 weeks for erlotinib reported in phase III). Almost three quarter of the patients received erlotinib as their second line of therapy. Overall, erlotinib was well tolerated; there were no patients who withdrew due to a treatment-related AE (mainly rash) and there were few dose reductions. 24% of patients experienced an SAE (most commonly gastrointestinal (GI) disorders).

The role of inhalatory corticosteroids and long acting beta(2) agonists in the treatment of patients admitted to hospital due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

There is the question about the role of fixed combination of inhalatory corticosteroids and long acting beta(2) agonists in the treatment of patients admitted in hospital due to AECOPD. The objective of this study is to determine the frequency of etiologic factors of AECOPD, to research the length of recovery time and the time free from exacerbation due to AECOPD at the patients treated with fixed combination inhalers containing F/S versus patients who were not treated with this combination. This is retrospective-prospective, randomized, clinical study with a sample size of 70 patients who admitted to hospital due to AECOPD type I or II. Patients are randomized in two groups. Prospective group from 36 patients have been treated with oral or parenteral corticosteroids 7-14 days, other medications and fixed combination inhalers containing a F/S. Second, retrospective group from 34 patients have been treated with oral or parenteral corticosteroids 7-14 days (in time when we didn't have fixed combination inhalers containing a F/S) and other medications. In both groups (prospective and retrospective) the most frequent etiological factors of AECOPD was bacterial infection, after that viral infection, other factors as well as congestive heart failure. Average recovery time for symptoms of AECOPD was statistically significant shorter in group patients treated with fixed combination inhalers containing F/S (prospective group) than in group treated without this fixed combination. There are also significant differences in average number of days need for recovery in subgroups of patients by etiological factors of AECOPD, except in cases of AECOPD onset because of congestive heart failure. Average free time from exacerbation at the patients treated with fixed combination inhalers was statistically significant longer than in group of patients who were not treated with this combination. In this study has demonstrated the presence of pathogenic bacteria in 53% our patients hospitalized due to AECOPD. There were 26% patients whose exacerbation is signed as viral origin. 11% cases had congestive heart failure. Average recovery time for non-viral AECOPD was 14.8 days and for exacerbations of viral origin 27.4 days. Average free time from exacerbation at the patients treated with fixed combination inhalers containing a F/S was statistically significant longer than in group of patients who were not treated with this combination. There were no statistically significant differences in average number of exacerbation during the year, between observed groups.

Quality of life for tobacco smokers in relation to their socioeconomic status.

AIM: To analyze differences in quality of life between smokers and non-smokers in relation to socioeconomic factors. METHODS: This study was conducted on a sample of 600 respondents equally divided in two groups, smokers (300) and non-smokers (300). Former smokers were excluded. The study included both sexes equally further distributed into age groups: 19-34, 35- 49, 50-64 and 65-70 years. A questionnaire SF-36 to test the quality of life (36 questions measuring eight dimensions of quality of life) and questionnaire EuroQoL to examine the socioeconomic status was used. For the assessment of a given factor impact multivariant and univariant analyses of variance were used. RESULTS: A significant difference in the quality of life between smokers and non-smokers according to the gender was found, but only at the subscales of physical functioning and bodily pain (p=0.000). An analysis of individual dimensions of quality of life in relation to marital status of smokers and non-smokers showed significant differences on the subscales of physical functioning (p=0.032), vitality (p=0.0430) and mental health (p=0.016). An analysis of life quality in relation to smoking status of respondents and the average monthly income showed that the average scores on all subscales were higher in non-smokers compared to smokers (p=0.000) and they were increased with the average monthly income. CONCLUSION: The results of this study prove that there are significant differences in quality of life according to the smoking status. Also the socioeconomic factors which include age, gender, the surrounding, marital status, employment, total monthly income and level of education are of great influence on the quality of life with significant differences in relation to smoking status.

Association of mannose-binding lectin 2 (mbl2) gene heterogeneity and its serum concentration with osteoporosis in postmenopausal women.

The aim of the study was to detect prevalence of MBL2 exon 1 (codons 52, 54 and 57) genetic polymorphism in postmenopausal women in Bosnia and Herzegovina and its possible role as genetic risk factor for susceptibility to occurrence of osteoporosis in this study group. Also, we investigated association between MBL serum concentrations and osteoporosis in postmenopausal women. Genetic codons' variations were determined by PCR-RFLP and MBL in serum was measured by ELISA method in 75 postmenopausal women (37 with osteoporosis and 38 apparently healthy, non-osteoporotic women serving as a control). Serum MBL levels were not significantly different between osteoporosis and control group (492 (37-565.1) and 522.6 (477-559.4) ng/mL respectively, p=0.206). Genotype frequencies were not significantly different (p=0.997) between the studied groups of postmenopausal women. Genotype frequencies A/A, A/0 and 0/0 in osteoporosis group were 0.576; 0.405; 0.018 and in control group 0.562; 0.412; 0.026, respectively. Frequencies of A and 0 allele were 0.78 and 0.22 in osteoporosis and 0.77 and 0.23 in control group. The results do not suggest association of functional polymorphism of MBL2 gene and MBL serum concentration with osteoporosis in postmenopausal females.

Prevalence of 1691G>A FV mutation in females from Bosnia and Herzegovina--a preliminary report.

Factor V is the liver-synthesized multidomain glycoprotein encoded by a gene localised on chromosome 1q23. The point mutation 1691G>A in this gene results in formation of an altered protein of V Factor resistant to activated protein C (APC) cleavage. This mutation alone is the most frequent cause of inborn thrombophilia and the most widely acknowledged genetic risk factor for venous thrombosis in a Caucasian population. This study was designed to provide the first estimate of the frequency of the allele 1691A FV in the Bosnian female population. The 1691G>A FV mutation was examined by polymerase chain reaction-restriction fragment length polymorphism, in a group of 67 women, mean age of 58.6 years with no history of cardiovascular incident. Our findings revealed an absence of the mutated allele 1691A FV in the studied group. This is the first report on the 1691G>A FV mutation in a population from Bosnia and Herzegovina. Further research is needed to establish prevalence of the mutated allele in the population from Bosnia and Herzegovina.

Status of lipids and the frequency diseases of cardiovascular origin in smokers according to the length period of smoking and a number of cigarettes smoked daily.

Cigarette smoking affects all phases of atherosclerosis from endothelial dysfunction to acute occlusive clinical events. The problem is, whether the length of the period of cigarette smoking has a more reflection to the status of lipids and illnesses of cardiovascular system or the bigger number of smoked cigarettes in a shorter time-period? The observed sample has constituted of two groups of smokers, both gender, age 25-64 years old. The first group consisted of 210 examinees divided in 7 subgroups according to a number of years they have been smoking. The second group consisted of 150 examinees, which was divided in 5 subgroups, according to average number of cigarettes smoked daily. The average values of serum cholesterol (6.98 vs. 6.13 mmol/L), triglycerides (3.15 vs. 3.13 mmol/L) and LDL-cholesterol (3.80 vs. 3.64 mmol/L) were always higher in a group of smokers according to a number of daily smoked cigarettes. Average value of smoking consumption period was higher in a group of smokers according to the length of smoking consumption period than in a group of smokers according to a number of cigarettes smoked daily (20.34 y vs. 13.55 y.). Hypertension (72% vs. 30.9%), angina pectoris (44.6% vs. 20.4%), CHD (30.6% vs. 22.8%) and myocardial infarction (16% vs. 11.4%) appeared much more in the group of smokers according to a number of cigarettes smoked daily. More reflection to the status of lipids and illnesses of cardiovascular system has the bigger number of smoked cigarettes daily than the length of the period of cigarette smoking.

Retraction: Evaluation of carcinogenic effects of electromagnetic fields (EMF).

The Editor-in-chief of the Bosnian Journal of Basic Medical Sciences has decided to retract the article from Bayazit V et al. [1] entitled as: "Evaluation of carcinogenic effects of electromagnetic fields (EMF)" published in Bosn J Basic Med Sci. 2010 Aug;10(3):245-50. After the editorial office was alerted of possible plagiarism in the article, it conducted thorough investigation and concluded that the article apparently represents plagiarized material from two World Health Organization reports, one European Commission report and other sources. Since this is considered scientific plagiarism and scientific misconduct, Editor-in-chief has decided to withdraw the article. The authors have agreed with the editorial office decision.