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The nonsmokers' and smokers' pathways in lung adenocarcinoma: Histological progression and molecular bases.

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TLDR
In this paper, the authors describe the two pathways with special reference to potential relationships between histological subtypes, malignant grades, and driver mutations, and show that the non-smokers' pathway is mostly driven by EGFR mutations, whereas in the smokers' pathway, approximately one-quarter of LADCs have KRAS mutations, but the other three-quarters have no known driver mutations.
Abstract
There could be two carcinogenetic pathways for lung adenocarcinoma (LADC), that are, the non-smokers' pathway and the smokers' pathway. This review article describes the two pathways with special reference to potential relationships between histological subtypes, malignant grades, and driver mutations. The lung is composed of two different tissue units, the terminal respiratory unit (TRU) and the central airway compartment (CAC). In the non-smokers' pathway, LADCs develop from the TRU, and their histological appearances change from lepidic to micropapillary during the progression process. In the smokers' pathway, LADCs develop from either the TRU or the CAC, and their histological appearances vary among cases in the middle of the progression process, but they are likely converged to acinar/solid at the end. On a molecular genetic level, the non-smokers' pathway is mostly driven by EGFR mutations, whereas in the smokers' pathway, approximately one-quarter of LADCs have KRAS mutations, but the other three-quarters have no known driver mutations. p53 mutations are an important factor triggering the progression of both pathways, with unique molecular alterations associated with each, such as MUC21 expression, chromosome 12p13-21 amplification in the non-smokers' pathway, and HNF4α expression and TTF1 mutations in the smokers' pathway. However, investigation into the relationship between histological progression and genetic alterations is in its infancy. Tight cooperation between traditional histopathological examinations and recent molecular genetics can provide valuable insight into better understanding the nature of LADCs.

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Constructing a Prognostic Gene Signature for Lung Adenocarcinoma Based on Weighted Gene Co-Expression Network Analysis and Single-Cell Analysis

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References
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Journal ArticleDOI

Identification of the transforming EML4–ALK fusion gene in non-small-cell lung cancer

TL;DR: It is shown that a small inversion within chromosome 2p results in the formation of a fusion gene comprising portions of the echinoderm microtubule-associated protein-like 4 (EML4) gene and the anaplastic lymphoma kinase (ALK) gene in non-small-cell lung cancer (NSCLC) cells.
Journal ArticleDOI

Tracking the Evolution of Non–Small-Cell Lung Cancer

Mariam Jamal-Hanjani, +82 more
TL;DR: Intratumor heterogeneity mediated through chromosome instability was associated with an increased risk of recurrence or death, a finding that supports the potential value of chromosome instability as a prognostic predictor.
Journal ArticleDOI

Mutations of the Epidermal Growth Factor Receptor Gene in Lung Cancer Biological and Clinical Implications

TL;DR: Exons 18–21 of the tyrosine kinase domain of the epidermal growth factor receptor(EGFR) gene define a distinct subset of pulmonary adenocarcinoma without KRAS mutations, which is not caused by tobacco carcinogens.
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