Biomarker testing of lung cancer in North America versus globally.

Staging of Lung Cancer

The IASLC Lung Cancer Staging Project: External Validation of the Revision of the TNM Stage Groupings in the Eighth Edition of the TNM Classification of Lung Cancer

BackgroundTransbronchial needle aspiration (TBNA), serving as a remarkably invaluable and minimally invasive technique, has been widely used for the diagnosis and staging of mediastinal adenopathy and masses. To date, the International Association for the Study of Lung Cancer (IASLC) and Wang's nodal map are two well-documented intrathoracic lymph node guidelines for the TBNA procedure.MethodWe characterized IASLC's and Wang's map, and interpreted the correlation of the two maps station by station.ResultsThe pivotal role of IASLC map is to determine N descriptor in the tumor node metastasis (TNM) staging system of lung cancer, whilst Wang's map is employed to facilitate the localization of biopsy sites for bronchoscopists during TBNA performance. Furthermore, stations 1, 3 and 5 in Wang’ map are equivalent to 4R station in IASLC’ system, while stations 4 and 6 in Wang's account for IASLC station 4L as N2 stations. In addition, Wang's stations 2, 8 and 10 are correlated with station 7 in IASLC's. Wang's stations 7 and 9 are responsible for station 11R in IASLC's map.ConclusionGiven their unique benefits and limitations, and the practical links between the two maps, it appears reasonable to highlight the significance of their complementary utilization upon TBNA performance and lung cancer staging.

MS 03.03 Limited vs. Standard Surgical Resection: European Experience

The role of transbronchial needle aspiration (TBNA) in the diagnosis and staging of lung cancer has been well established. Recently, the efficacy of conventional TBNA in the staging of lung cancer has been enhanced by the use of endobronchial ultrasound (EBUS)-TBNA. Our study sought to evaluate the adequacy of TBNA of International Association for the Study of Lung Cancer (IASLC) stations 4R, 4L and 7 using endobronchial landmarks provided by the Wang nodal mapping system in the staging of lung cancer. We retrospectively analyzed all bronchoscopic cases with conventional TBNA punctures positive for malignancy at our institution from 1 January to 31 October 2014. The endobronchial puncture site was guided by the Wang nodal mapping system. The Wang stations were correlated with the IASLC lymph node map. No endobronchial ultrasound or rapid on-site evaluation was used. Pathological analysis included cytological and histological examination. Diagnosis by histological analysis was obtained in 115 (55.3%) out of 208 puncture sites. The metastatic lymph nodes were distributed at IASLC stations 4R (W1, 3, 5) 46.6 %, 7 (W2, 8, 10) 19.7%, 4L (W4, 6) 11.5%, 11R (W7, W9) 11.1% 11L (W11) 9.6%, 2R (high station W3) 0.5%, and the proximal portion of station 8 (station W10 beyond the middle lobe orifice) 1%. No complications were observed. IASLC station 4R (W1, 3, 5), 7 (W2, 8, 10) and 4L (W4, 6) are adequate for the staging of lung cancer.

The contemporary world has become increasingly interdependent in terms of economic, social and political development. These various forms of interdependence, usually termed globalization, help disseminate ideas, information, products, and services around the world. Increase in globalization has also increased path-dependence, affecting economic, social, and institutional development and completing some industries, products and technologies to grow in line with the global demand and changing standards. While the role of globalization in economic growth, technology transfer and institutional development is established in literature, the role of globalization in reversing environmental deterioration is not explored yet. The current study looks at how globalization has affected renewable energy use in high, upper middle and lower middle income countries. The empirical results based on a fixed effects model show that countries differ in terms of taking advantage of different types of globalization, i.e., economic, social and political, while transitioning towards renewable energy (RE) projects. Economic globalization has a positive influence on RE usage in the case of high and lower middle income countries, Social globalization in case of high and upper middle income countries. Contrary to the positive impacts of economic and social globalization, political globalization has a negative impact on RE usage in the case of high income countries. In addition to globalization, the effect of government effectiveness, GDP per capita and CO2 vary across the groups of countries.

MA10.01 Validations of the 8th AJCC/UICC Lung Cancer Staging System in a Large North America Cohort

To what extent do education, health and nutrition poverty rates differ by the spatial and social characteristics of households? And how has the composition of education, health and nutrition poverty changed since the 1990s in terms of the spatial and social characteristics of households? This paper provides an analysis of education, health and nutrition poverty in low-income countries (LICs) and lower middle-income countries (LMICs) by geography, education, employment and ethnicity characteristics of the household head based on the Demographic and Health Surveys (DHS) from countries with surveys in both the 1990s and 2000s. It should be noted at the outset that such an aggregated attempt to assess the changing pattern of poverty across low and lower middle-income countries would be best viewed as an indicative ‘sketch’ of changing patterns of poverty. The data suggests that the composition of education, health and nutrition poverty –by the indicators chosen in this paper– has changed somewhat since the 1990s in terms of the spatial and social characteristics of households. This can be presented as a set of five ‘stylised facts’ on poverty as follows: I. More than three-quarters of education, health and nutrition poverty in LICs and LMICs (combined) is to be found in rural areas. However, an increasing proportion of education, health and nutrition poverty is in urban areas. II. Half of the education, health and nutrition poverty in LICs and LMICs (combined) is concentrated in those households where the head has ‘no education’. However, this share has fallen since the 1990s. III. A third of the education, health and nutrition poverty in LICs and LMICs (combined) is focused in the poorest wealth quintile (by DHS Wealth Index). And this share is increasing. IV. A third of the education, health and nutrition poverty in LICs and LMICs (combined) is concentrated among those in households where the head is ‘not in work’ and a further third where the household head is working in agriculture. V. Two-thirds of the education, health and nutrition poverty in LICs and LMICs (combined) is to be found among those households where the head is the member of an ‘ethnic minority group’ (meaning an ethnic group which is not the largest ethnic group). However, this finding should be viewed as tentative due to data constraints. Further, the composition of education, health and nutrition poverty differs between LICs and LMICs quite notably. The poor in LMICs – by the indicators used – are more urban and more educated than in LICs. Indeed, there are indications of marked differences in poverty profiles.

123 Background: Despite recent advances in cancer precision medicine, patients from underserved communities do not have equal access to biomarker testing and targeted therapies. This study used a mixed-methods approach to identify barriers to equitable precision medicine access among underserved patients with non-small cell lung cancer (NSCLC). Methods: Paired national surveys (one clinician-facing and one patient-facing) were developed respectively by the Association of Community Cancer Centers (ACCC) and LUNGevity Foundation. Administered online in spring/summer 2020, the surveys were designed to identify key attitudes/barriers related to biomarker testing, resource needs, and current practice patterns for pertinent stakeholders. Survey data was triangulated with data from focus groups (2 clinician and 6 patient) conducted in fall 2020. The study was approved by Advarra IRB. Results: A total of 99 clinicians responded, with 67% (66/99) representing oncologists from community cancer programs. 248 patients responded to the LUNGevity survey, with 161 coming from the general population and 87 from the LUNGevity network (patients with relatively high income and education levels). Most clinicians surveyed indicated they were “very” (34%) or “extremely” likely (44%) to discuss biomarker testing with NSCLC patients. Academic clinicians, however, were more likely than community-based clinicians to order testing at the time of initial biopsy (76% vs 52%, P =.02). Academic clinicians were also more likely to involve the patient’s family in biomarker testing discussions (85% vs 59%, P =.009). Patient survey results identified that medical oncologists are the primary source of biomarker testing information; 64% of LUNGevity-connected and 37% of underserved patients. Eighty-five percent of LUNGevity-connected patients receive biomarker testing versus 52% for general patients (p < 0.05). Notably, more than a quarter (27%) of underserved patients who have undergone biomarker testing do not know their results. Clinician focus group participants corroborated survey findings that most clinicians receive testing results in 7-14 days, but for 23% of community and 6% of academic clinicians the process can take over 2 weeks. They identified disparities in offering biomarker testing and results to patients with known or presumed low socioeconomic status (SES) and/or health literacy. This was supported by patient survey data, which showed biomarker testing was proactively offered to only 40% of low-SES patients. Conclusions: This study identifies key areas of ongoing need related to equitable biomarker testing. Quality-improvement opportunities exist to address both clinician and patient barriers to guideline-concordant biomarker testing for underserved patients with NSCLC.

Introduction In 2018 the World Health Organization (WHO) launched the Global Burn Registry (GBR). Its purpose is to help improve the understanding of burn injury worldwide. The purpose of this study was to identify early findings from this database. Methods The GBR was accessed in September 2019. Cases from centers in low income (LIC) and low-middle income countries (LMIC) were combined into a Low Resource (LR) group, and cases in High Income (HIC) and Upper Middle Income (UMIC) countries were combined into a High Resource group (HR). Statistical analysis was performed with SAS 9.4. Data are expressed as mean ± SEM. Logistic Regression was used to identify risk factors for death. Revised Baux Score (RBS) was calculated as described by Osler (2010). Odds ratios are expressed as mean (95% confidence interval). The LA50 was calculated from the regression of death and total burn size (TBSA) for different age groups. Results At the time of analysis, there were 2,315 cases in the GBR treated at 23 facilities in 15 countries (4 HIC, 5 UMIC, 4 LIMC, and 2 LIC). There were 1,346 cases (58%) from HR countries and 969 (42%) from LR countries. The patients in LR were older than those in HR (26.2 ± 0.6 years vs 20.7 ± 0.6, p< 0.01) and had larger TBSA burns (31.0 ± 0.8 % TBSA vs 16.6 ± 0.4, p< 0.01). There were fewer scald burns and more flame injuries in the LR countries (26 ± 1.4 % vs 54 ± 1.4, and 56 ± 1.6 % vs 32 ± 1.3, p< 0.01). Case fatality and RBS were greater in LR (31.5 ± 1.5 % vs 4.8 ± 0.6 and 61.4 ± 1.3 % vs 38.9 ± 0.9, p< 0.01). In regression analysis, LR was an independent risk factor for death with an odds ratio of 6.3 (4.3 – 9.4). The LA50 for HR countries was similar to those in the National Burn Repository. For LR countries the LA50 was lower for all ages except those 65 and older, ranging from 30–45% TBSA. Conclusions Only a few facilities have contributed data to the GBR so far, with lower resourced countries less represented than higher resourced ones. The proportion of cases in the pediatric age group is much less represented in LR countries than in HR, possibly because many burned children in LR countries do not get burn care at specialized centers. Survival in HR countries is similar to that in North America. The GBR provides early insights into global burn care. Opportunities for improvement are greatest in LR countries. New Innovations may be necessary to increase participation from burn centers in LR countries. Applicability of Research to Practice This report provides an early look at burn care across the globe based on cases in the GBR. It may inform further efforts to characterize and improve burn care in low resourced countries.

Human babesiosis is an emerging tick-borne protozoan zoonosis caused by parasites of the genus Babesia and transmitted by ixodid ticks. It was thought to be a public health problem mainly for the immunocompromised, however the increasing numbers of documented cases among immunocompetent individuals is a call for concern. In this systematic review and meta-analysis, we reported from 22 countries and 69 studies, an overall pooled estimate (PE) of 2.23% (95% CI: 1.46–3.39) for Babesia infections in humans. PEs for all sub-groups varied significantly (p < 0.05) with a continental range of 1.54% (95% CI: 0.89–2.65) in North America to 4.17% (95% CI: 2.11–8.06) in Europe. PEs for country income levels, methods of diagnosis, study period, sample sizes, Babesia species and targeted population ranged between 0.43% (95% CI: 0.41–0.44) and 7.41% (95% CI: 0.53–54.48). Babesia microti recorded the widest geographic distribution and was the predominant specie reported in North America while B. divergens was predominantly reported in Europe. Eight Babesia species; B. bigemina, B. bovis, B. crassa-like, B. divergens, B. duncani, B. microti, B. odocoilei and B. venatorum were reported in humans from different parts of the world with the highest prevalence in Europe, lower middle income countries and among individuals with history of tick bite and other tick-borne diseases. To control the increasing trend of this emerging public health threat, tick control in human settlements, the use of protective clothing by occupationally exposed people and the screening of transfusion blood in endemic countries are recommended. Abbreviations AJOL: African Journals OnLine, CI: Confidence interval, CIL: Country income level, df: Degree of freedom, HIC: Higher-income countries, HQ: High quality, I 2: Inverse variance index, IFAT: Indirect fluorescent antibody test, ITBTBD: Individuals with tick-bite and tick-borne diseases, JBI: Joanna Briggs Institute, LIC: Lower-income countries, LMIC: Lower middle-income countries, MQ: Medium quality, NA: Not applicable, N/America: North America, OEI: Occupational exposed individuals, OR: Odds ratio, PE: Pooled estimates, PCR: Polymerase chain reaction, Prev: Prevalence, PRISMA: Preferred Reporting System for Systematic Reviews and Meta-Analyses, Q: Cochran’s heterogeneity statistic, QA: Quality assessment, Q-p: Cochran’s p-value, qPCR: Quantitative polymerase chain reaction, S/America: South America, Seq: Sequencing, UMIC: Upper middle-income countries, USA: United States of America

Brief Report: Evaluating Early Stage Lung Cancer Survival Patterns in Patients at the Upper Age Limit for Lung Cancer Screening.

Liquid biopsy in non-small cell lung cancer: Is it ready for prime time yet?

Impact of the New Lung Cancer Staging System for a Predominantly Advanced-Disease Patient Population

Prevention and early detection of lung cancer-clinical aspects