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Eur J Cardiothorac Surg 2005;28:505-506
© 2005 Elsevier Science NL
Letter to the Editor |
a Pulmonary Rehabilitation, IRCCS San Raffaele, Rome, Italy
b Thoracic Surgery, Catholic University, Rome, Italy
c Clinical Respiratory Pathology Translational Laboratory, IRCCS San Raffaele, Rome, Italy
Received 28 April 2005; accepted 9 May 2005.
* Corresponding author. Address: Division of General Thoracic Surgery, Department of Surgical Sciences, Catholic University, Largo A. Gemelli 8, 00168 Rome, Italy. Tel.: +39 335 8366161; fax: +39 06 3051162. (Email: alfcesario{at}rm.unicatt.it).
Key Words: COPD • Lung cancer • Prognosis
We have read with great interest the report from Lopez-Encuentra and co-authors addressing the value of Chronic Obstructive Pulmonary Disease (COPD) as a prognostic factor in Non-Small Cell Lung Cancer (NSCLC) [1]. At the conclusion of their analysis on an impressive cohort of 2994 cases of lung cancer, the Authors have concluded that COPD can be considered as a prognostic factor and that there is a clear relationship between the severity of the condition (FEV1%) and survival.
We warmly congratulate the Authors for the clarity of their message and the rigorous methodology they adopted in the analysis, so much so as to insert COPD among the first line prognostic factors in NSCLC. Most interesting is that this is particularly true in early pathological stage (pI) condition, thus confirming COPD to be either an independent prognostic factor, or a completing (and stratifying) criterion within the pathological staging which is unanimously considered among the strongest of prognostic factors.
Along the lines of extreme simplification we would like to comment on this pattern: COPD, in the analysis reported in [1], has been demonstrated to be a purely ‘clinical’ prognostic factor. In fact, its detrimental effect on the overall 36-month survival is to be attributed to the diminished functional status (mainly Forced Expiratory Volume in 1s—FEV1).
In the last decades, a vast amount of literature has been published addressing other, and possibly very important, prognostic factors—those connected with the molecular status of the disease.
The gene expression analysis (microarray) of NSLSC [2,3] has led to the identification of specific signatures predictive of survival in patients with the same stage of disease. Furthermore, recent expression profile studies [4,5] demonstrated that gene expression profiles differed in the neoplastic and non-neoplastic tissues of smokers versus non-smokers. To date, it is not known whether these changes are unique to smokers who develop lung cancer or are present in all smokers and whether these changes are associated with the presence of concomitant COPD.
To our best knowledge an analysis of the possible molecular signature of COPD indicating a predisposing status toward the development of lung cancer has never been realised. Moreover, inside the molecular signature of COPD/Lung Cancer patients, an analysis of predisposing factors possibly indicating a worst (or better) prognosis has never been realised either.
In our opinion, it is now time to match and reconcile basic comprehensive information coming from molecular and cellular biology with those coming from clinical experiences (as that reported in [1]) to foster, in a translational attitude, further investigation.
References
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