Introduction: Precise pre-treatment staging of non-small cell lung cancer (NSCLC) determines initial treatment and provides more accurate prognostic information for patients.

Aim: To determine the agreement between clinical and pathological stage for patients with NSCLC, and its effect on 2-year survival in a cohort of patients who had modern staging investigations.

Methods: Patient data were prospectively collected from 11 local MDTs. We included consecutive patients in the West of Scotland who underwent surgical resection from 2015 to 2017. Clinical and pathological TNM stages were recorded and compared and we investigated the effect of stage change on survival.

Results: 975 patients had a complete data and fulfilled the inclusion criteria. 55% were female and the mean age was 69. Concordance between clinical and pathological TNM was achieved in 558 (57%) patients, 280 (29%) were pathologically upstaged, and 137 (14%) downstaged after surgery. 124 patients (13%) had a higher pathological N stage, of which 70 (56%) had unforeseen N2 or N3 disease. Patients who were pathologically upstaged had poorer survival(Figure 1, p< 0.0001).However, this difference was explained by pathological stage.

Conclusions: Accuracy of pre-operative NSCLC staging is poor despite the widespread availability of PET-CT and endobronchial ultrasound. Improvement in pre-operative staging is necessary to ensure the correct first treatment is delivered to patients.

Introduction Lung cancer is relatively common in patients with fibrotic ILD. The presence of ILD can influence patient selection for treatment and raises concerns about treatment risks and outcomes.

Aim To investigate the prevalence of ILD among patients with advanced lung cancer who received chemotherapy as an initial treatment and to explore clinical features and prognosis in this group compared to other lung cancer patients without ILD.

Method We studied consecutive lung cancer patients in the West of Scotland Lung Cancer Database treated with chemotherapy in one year (2017). Pre-treatment chest CT scans were evaluated by two radiologists with double reading of a proportion to assess consistency. If present, ILD was further classified into 3 groups: usual interstitial pneumonia (UIP), possible UIP, and inconsistent with a UIP pattern according to ATS/ERS/JRS/ALAT guidance.

Results 448 patients were included in the study, with 44 (9.8%) identified as having ILD (15 UIP, 14 possible UIP and 15 inconsistent with UIP). Compared with those without ILD, patients with ILD were older (mean:72 vs 66 years, p<0.001), predominantly male (77% versus 46%, P >0.01), had a significantly higher performance status score (p=0.014) and earlier TNM stage (49% stage IV versus 70% stage IV, p=0.009). Small Cell Lung Cancer was the most common histologic type in the ILD group (50%), while in the non-ILD group adenocarcinoma (37.4%) was followed by squamous cell carcinoma (36.4%). Pre-treatment pulmonary function tests showed that patients with ILD had significantly lower forced vital capacity (FVC) (median: 92% versus 105%, P = 0.002) and diffusing capacity for carbon monoxide (DLco) (median: 55% versus 72.5%, P<0.001).

Median survival times for ILD and non-ILD group were not significantly different at 319 and 344 days respectively (log-rank test P=0.3).

Conclusion Lung cancer patients with concomitant ILD have specific demographic, histological and functional features. However, concomitant ILD does not confer a survival disadvantage after receiving chemotherapy in this group with advanced lung cancer. These patients should not be denied the chance of treatment based solely on their underlying ILD.

 J Physiol Biochem. 2011; 67(3):339-349. PMID: 21336648

Abstract Recent studies have shown that lead (Pb) could disrupt tissue prooxidant/antioxidant balance which lead to physiological dysfunction. Natural antioxidants are particularly useful in such situation. Current study was designed to investigate efficacy of green tea extract (GTE), on oxidative status in brain tissue and blood caused by chronic oral Pb administration in rats. Four groups of adult male rats (each 15 rats) were utilized: control group; GTE-group (oral 1.5% w/v GTE for 6 weeks); Pb-group (oral 0.4% lead acetate for 6 weeks), and Pb+GTE-group (1.5% GTE and 0.4% lead acetate for 6 weeks). Levels of prooxidant/antioxidant parameters [lipid peroxides (LPO), nitric oxides (NO), total antioxidant capacity (TAC), glutathione (GSH), glutathione-S-transferase (GST), superoxide dismutase (SOD)] in plasma, erythrocytes, and brain tissue homogenate were measured using colorimetric methods. Pb concentrations in whole blood and brain tissue homogenate were measured by atomic absorption. In Pb-group, levels of LPO were higher while NO and GSH were lower in plasma, erythrocytes, and brain tissue than controls. TAC in plasma, SOD in erythrocytes, and GST in brain tissue homogenate were lower in Pb-group versus control. GTE co-administrated with Pb-reduced Pb contents, increased antioxidant status than Pb-group. In erythrocytes, Pb correlated positively with LPO and negatively with NO, GSH, SOD, and Hb. In brain tissue homogenate, Pb correlated positively with LPO and negatively with GSH. This study suggests that lead induce toxicity by interfering balance between prooxidant/antioxidant. Treatment of rats with GTE combined with Pb enhances antioxidant/ detoxification system which reduced oxidative stress. These observations suggest that GTE is a potential complementary agent in treatment of chronic lead intoxication. Keywords Rat . Brain tissue homogenate . Erythrocyte . Lead toxicity. Green tea extract . Oxidative stress