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Diagnostic criteria for invasive pulmonary aspergillosis in critically ill patients.

vival mechanism in cancer cells. Perhaps most striking, the authors demonstrated that EPCR expression by pulmonary adenocarcinomas was both prognostic and predictive of response to therapy.Using retrospective data from two clinical trials, the authors separated participants into cohorts of high and low tumorEPCRexpression and found that highEPCRexpression predicted shortermetastasis-free and total survival. In addition, patients with stage I adenocarcinomas that had high EPCR expression and received postsurgical adjuvant therapy had an overall and progression-free survival benefit, though these analyses had relatively small populations. Although the authors do not comment on the presence of other high-risk features, this effect was independent of tumor size, age, sex, and smoking status, suggesting that tumor EPCR expression carries prognostic information. Thus, EPCR expression status might be used to identify patients that could benefit from further therapy or to guide therapy if EPCR antagonists are found to be effective against lung cancer. Anton and colleagues have pointed out a new pathway that potentially promotes lung adenocarcinoma spread and could lead to novel therapeutic targets to control metastases, including APC, EPCR, and possibly other intracellular partners such as PAR1 or S1P1. The benefit of such an approach is yet to be determined and will require further evaluation. However, their findings again highlight that lung cancer management is moving beyond the use of pure clinicopathologic classifications and staging to include molecular characterization, creating new designations of lung cancer to refine our therapeutic and prognostic capabilities. The identification of specific “driver” mutations in lung cancer, such as EGFR, has expanded our understanding of oncogenesis and lung cancer care as targeted therapy directed against the mutant protein results in dramatic clinical improvements (14). Expression levels of genes and proteins that do not have somatic mutations also provide prognostic and predictive information in lung cancer. For example, low excision repair cross-complementation group 1 (ERCC1) expression portends a poor prognosis in non–small cell lung cancer but also predicts a better response to platinum-based therapy when compared with high ERCC1–expressing tumors (15). If the findings concerning EPCR are confirmed, EPCR would add to this expanding panel of markers and targets in lung adenocarcinomas tomove toward amore refined, molecularly based taxonomy and therapy of lung cancer.