A practical molecular assay to predict survival in resected non-squamous, non-small-cell lung cancer: development and international validation studies.

BACKGROUND: The frequent recurrence of early-stage non-small-cell lung cancer (NSCLC) is generally attributable to metastatic disease undetected at complete resection. Management of such patients depends on prognostic staging to identify the individuals most likely to have occult disease. We aimed to develop and validate a practical, reliable assay that improves risk stratification compared with conventional staging. METHODS: A 14-gene expression assay that uses quantitative PCR, runs on formalin-fixed paraffin-embedded tissue samples, and differentiates patients with heterogeneous statistical prognoses was developed in a cohort of 361 patients with non-squamous NSCLC resected at the University of California, San Francisco. The assay was then independently validated by the Kaiser Permanente Division of Research in a masked cohort of 433 patients with stage I non-squamous NSCLC resected at Kaiser Permanente Northern California hospitals, and on a cohort of 1006 patients with stage I-III non-squamous NSCLC resected in several leading Chinese cancer centres that are part of the China Clinical Trials Consortium (CCTC). FINDINGS: Kaplan-Meier analysis of the Kaiser validation cohort showed 5 year overall survival of 71·4% (95% CI 60·5-80·0) in low-risk, 58·3% (48·9-66·6) in intermediate-risk, and 49·2% (42·2-55·8) in high-risk patients (p(trend)=0·0003). Similar analysis of the CCTC cohort indicated 5 year overall survivals of 74·1% (66·0-80·6) in low-risk, 57·4% (48·3-65·5) in intermediate-risk, and 44·6% (40·2-48·9) in high-risk patients (p(trend)<0·0001). Multivariate analysis in both cohorts indicated that no standard clinical risk factors could account for, or provide, the prognostic information derived from tumour gene expression. The assay improved prognostic accuracy beyond National Comprehensive Cancer Network criteria for stage I high-risk tumours (p<0·0001), and differentiated low-risk, intermediate-risk, and high-risk patients within all disease stages. INTERPRETATION: Our practical, quantitative-PCR-based assay reliably identified patients with early-stage non-squamous NSCLC at high risk for mortality after surgical resection. FUNDING: UCSF Thoracic Oncology Laboratory and Pinpoint Genomics.

Effects of dietary carnosine and vitamin E on antioxidant and oxidative status of rats.

The purpose of this study was to determine if moderate levels of carnosine supplement, alone or in combination with vitamin E, enhance antioxidant status and/or provide protection against oxidative stress. Fifty-four one-month-old male Sprague-Dawley rats were fed a basal vitamin E-deficient diet supplemented with either 0, 200, or 1000 mg L-carnosine, and either 0, 10, or 100 IU vitamin E (as all rec-alpha-tocopheryl acetate) per kg diet for 15 weeks. The antioxidant and oxidative status were assessed in the skeletal muscle, liver, and blood. Dietary vitamin E, but not carnosine, increased levels of vitamin E, decreased tissue peroxidizability, prevented incidence of myodegeneration, and reduced erythrocyte hemolytic stress. The levels of conjugated dienes, protein carbonyls, ascorbic acid, and nonprotein sulfhydryls, and activities of catalase, glutathione (GSH) peroxidase, and aldehyde dehydrogenase were not significantly altered by dietary carnosine or vitamin E. The results obtained suggest that supplementation of carnosine at levels of up to 1000 mg/kg diet does not significantly affect the antioxidant and oxidative status of rats.