In this issue of the journal, we publish the 39th installment of our Lung Cancer Worldwide series focusing on the Czech republic - Lung Cancer in the Czech Republic. Dr Simona Borilova, and her colleagues discuss the current landscape of Lung Cancer in the Czech Republic. This comprehensive manuscript covers screening, diagnosis and treatment of lung cancer, as well as the challenges in treating this disease in the Czech Republic.
Globally, with an aging population, a large number of patients, including cancer patients, have multiple co-morbidities. In the US, it is estimated that 30.8 million people had 3 or more chronic diseases in 2015, and this number will rise to 83.4 million people in 2030. Thus, the role of comorbidities in treatment outcome in non-small cell lung cancer (NSCLC) is a relevant problem. Unfortunately, there is a paucity of data on the outcome of these patients. In this issue of Journal, Garcia-Pardo and colleagues present the results of a study investigating the impact of respiratory or cardiovascular comorbidity on key outcomes in NSCLC care, utilizing epidemiological data collected and standardized by the International Lung Cancer Consortium. These data are from more than 10,000 participants representing 11 countries and four continents. All comorbidity data were self- reported at time of NSCLC diagnosis. The data indicated that patients with potentially curable NSCLC (stage I-IIIa) and respiratory comorbidity were less likely to undergo surgery, and had worse lung cancer-specific survival. Correspondingly, patients with cardiovascular comorbidity had a higher risk of death from causes other than cancer. The authors provide clear definitions on respiratory (COPD, asthma) and cardiovascular comorbidity (coronary artery disease, diabetes, other heart disease, and vascular related disease). These findings underline the importance of differentiating between comorbidities based on their impact on treatment tolerability and prognoses. Dr Ufe Bodtger puts these data into perspective in an excellent accompanying editorial.
Neuroendocrine tumors of the lung are a heterogenous group of diseases that range from low grade typical carcinoids to small cell lung cancer (SCLC) and high grade neuroendocrine tumors. The more aggressive SCLC and HNEC are typically characterized by RB1 loss and p53 mutations. While these tumors respond to systemic therapies, a number of them relapse quickly and are fatal. A better understanding of the molecular composition of these tumors is needed. In this issue of the Journal, Zhang and colleagues present molecular, genetic, histopathological, and spatial transcriptomic data to characterize the role of PTEN loss on the development and heterogeneity of neuroendocrine tumors initiated by Rb1 and Trp53 deletion. Complete loss of PTEN resulted in more rapid tumor development with shortened survival and greater heterogeneity in tumor histopathology ranging from adenocarcinoma to SCLC. Additionally, gene expression analysis showed that complete loss of PTEN drives transcriptional heterogeneity, expanding the lineage plasticity of the resulting lung cancers. This observation about PTEN loss sheds insights into neuroendocrine carcinogenesis. These findings are discussed and their relevance put in perspective in an excellent accompanying editorial by Dr Charis Eng and colleagues.
Alex A. Adjei, MD, PhD