Journal of thoracic disease最新文献

Background: Most recurrences of non-small cell lung cancer (NSCLC) after lung resection occur within 5 years, which is why 5-year overall survival rates are used to give prognoses for lung cancer. Elderly individuals also often show comorbidities and may die from other diseases. Few studies have examined the long-term prognosis of elderly patients with NSCLC, and no reports have investigated drop-out from follow-up after resection of NSCLC, including in elderly patients. This retrospective cohort study analyzed and surveyed long-term prognosis and drop-out from follow-up, including in elderly patients, after resection of lung cancer.

Methods: We identified 349 consecutive patients after lung resection between January 2009 and March 2011. Twenty-two cases were excluded because of small cell lung cancer, past metachronous multiple lung cancers, recurrences of lung cancer, surgical biopsy, and other reasons. We investigated recurrences and causes of death in all patients and defined cases for which follow-up could not be conducted even by telephone or documentation from patients or the public office as cases of drop-out from follow-up.

Results: Of the 327 cases analyzed, 81 cases dropped out from follow-up and 246 cases completed >10 years of follow-up. Multivariable analysis demonstrated age ≥75 years [odds ratio 1.83; 95% confidence interval (CI): 1.01-3.32] and female sex (odds ratio 1.87, 95% CI: 1.06-3.3) as independent risk factors for drop-out from follow-up. Recurrence was detected >5 years after surgery in 5 cases (2.0%, 5/246 cases). Five- and 10-year overall survival rates were 67.2% and 52.9% for patients <75 years of age, and 42.1% and 21.1% for patients of age ≥75 years (P<0.001). Overall survival was significantly better for those of age <75 years than for those of age ≥75 years. Disease-specific survival did not differ significantly between groups (5-year disease-specific survival rate: 71.9% vs. 73.4%; 10-year disease-specific survival: 66.0% vs. 61.2%, P=0.80). Using Cox proportional hazard regression, age ≥75 years (hazard ratio 2.221; 95% CI: 1.507-3.274; P<0.001) and stage ≥2 (hazard ratio 2.628; 95% CI: 1.868-3.698; P<0.001) were significantly associated with overall survival.

Conclusions: In patients with NSCLC after lung resection, age ≥75 years and female sex were risk factors for dropping out from follow-up over 10 years. In addition, patients ≥75 years of age have a high possibility of dying from other diseases and sufficient consideration of and informed consent for surgical indications are necessary.

Background: The pathogenesis of idiopathic pulmonary fibrosis (IPF) is not well understood. Given the known role of hepatitis C virus (HCV) in inducing cirrhosis, the virus has also received attention in the study of IPF. An earlier retrospective study found an increased incidence of IPF in patients with HCV, supported by evidence in the alveolar lavage fluid of the patients, whereas another set of observational studies did not find an association, which prompted us to explore a causal relationship. It is well known that HCV and hepatitis B virus (HBV) have some similarities: both are RNA viruses, and both have a strong ability to induce cirrhosis, which in turn leads to poor prognosis and increased mortality in patients with viral hepatitis. This factor also inspired us to start exploring whether there is a causal relationship between HBV and IPF. Due to the inherent limitations of previous studies, causality between chronic HBV/HCV infection and IPF is yet to be established. Mendelian randomization (MR) uses genetic variation as exposure and can be used to determine the causal effect of exposure on outcomes. Therefore, we used a two-sample MR study to determine if there is a causal relationship between viral hepatitis and IPF risk.

Methods: Single nucleotide polymorphisms (SNPs) were used as instrumental variables (IVs), with chronic HBV and HCV infections as exposure factors and IPF as the outcome variable. Three methods, inverse variance weighting (IVW), weighted median (WM), and MR-Egger regression, were employed for the bidirectional MR. Sensitivity analyses, including horizontal pleiotropy analysis, Cochran's Q test, and leave-one-out evaluation of result reliability, were conducted. Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO) and MR-Egger regression tests were used to monitor potential horizontal pleiotropic effects. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to interpret the causal relationship between chronic HBV and HCV infections and IPF. Finally, reverse MR analysis was performed to validate the robustness of the results.

Results: The results of the IVW suggested that there was no causal relationship between chronic HBV infection (OR =1.039, 95% CI: 0.935-1.154, P=0.48) and chronic HCV infection (OR =1.146, 95% CI: 0.834-1.576, P=0.40) and the risk of IPF. Sensitivity analysis showed no evidence of reverse causation, horizontal pleiotropy, and heterogeneity.

Conclusions: This study, using the bidirectional MR, provides preliminary evidence that chronic HBV and HCV infections are not causally related to IPF at the genetic level. However, this conclusion requires support from larger sample sizes in genome-wide association study (GWAS) databases for further MR analysis, and additional clinical studies and animal experiments are needed for validation.

[This corrects the article DOI: 10.21037/jtd-24-711.].

Background: Esophageal squamous cell carcinoma (ESCC) is common in China and has a poor prognosis despite radical surgery. Guidelines around the use of adjuvant therapy (AT) in ESCC are indecisive. We assessed the benefit of AT on recurrence-free survival (RFS) in Chinese patients with ESCC using propensity score (PS) matching.

Methods: This retrospective cohort study used hospital electronic medical records (EMRs) of 523 adults diagnosed between 2013 to 2019 with pathologically confirmed ESCC after R0 esophagectomy without neoadjuvant therapy. PSs were calculated using a generalized linear regression model based on demographic, clinical, and pathologic features. Patients with and without AT were matched using nearest neighbor method and caliper value 0.05. Subgroup analyses were stratified by PS.

Results: Younger patients with more advanced/poorly differentiated disease were more likely to receive AT (P<0.05). There were 137 matched pairs in the AT/No AT groups. After matching, the AT group tended to have longer median RFS [95% confidence interval (CI): 2.21 years (1.54-3.20)] than the No AT group [1.75 years (1.37-2.21)] (P=0.18). The benefit was significant in patients with PS ≥0.40 [hazard ratio 0.55, 95% CI: 0.32-0.87, median RFS (95% CI): 2.22 years (1.30-3.52) versus 1.23 years (0.90-1.64), P=0.03]. In other PS subgroups, median RFS was similar in AT and No AT groups.

Conclusions: After adjusting for baseline characteristics, AT tended to improve RFS after R0 esophagectomy in Chinese patients, with significant benefit associated with a higher PS score. The utility of PS to guide patient selection for AT in clinical practice needs further investigation.

Background: Robotic-assisted thoracoscopic surgery (RATS) is widely accepted for small-to-moderate-size thymomas. However, limited data exists comparing the feasibility of RATS for large tumors ≥5 cm. The aim of this study is to compare the oncological and perioperative outcomes of open thymectomy (OT) versus RATS for these larger tumors.

Methods: The National Cancer Database (2010-2020) was queried for patients who underwent RATS and OT. Patients were excluded if they had thymic carcinoma, neoadjuvant therapy, tumors <5 cm, and underwent a video-assisted thoracoscopic approach. The primary outcome was overall survival (OS). Secondary outcomes included length of stay (LOS), 30-day readmission, and mortality rates. Survival outcomes were estimated using the Kaplan-Meier estimator and compared using log-rank test. Propensity score-matched analysis was performed (1:1, Caliper 0.2 without replacement), controlling for age, race, facility type, tumor size, comorbidity index, and year of diagnosis.

Results: Of the 1,178 patients identified, 1,015 (86.2%) underwent OT, and 163 (13.8%) underwent RATS. RATS cases were more likely to be performed in academic centers and have a smaller median tumor size compared to OT cases. In the matched cohort, there was no difference between the groups' 30-day readmission, 30-day and 90-day mortality rates. RATS patients had a shorter median LOS compared to OT patients. The median follow-up time was 76 months; 5-year OS was 88% after OT and 90% after RATS (P=0.23). On multivariable Cox regression analysis, the surgical approach was not a predictor of worse survival.

Conclusions: Patients who underwent RATS for tumors ≥5 cm had equivalent survival and perioperative outcomes compared to OT with a shorter LOS.

Background: The pathologic feature of lung adenocarcinoma is extremely complex because the prognosis of same-stage lung adenocarcinoma significantly differs because of pathological diversity. This study aimed to evaluate the clinical association between histologic subtype and recurrence. Further, the prognostic significance of histologic subtype in stage I lung adenocarcinoma was examined.

Methods: The medical records of 752 patients with pathological stage I lung adenocarcinoma were reviewed. The size of each histologic subtype was assessed. Receiver operating characteristic curve analysis was performed to identify the prognostic significance of histologic subtype. Univariate and multivariate analyses were conducted to validate the prognostic role of recurrence indicator.

Results: The median age of the participants was 64 years, and female patients were predominant. The acinar-predominant subtype (44.7%) was the most common. According to each subtype size for predicting recurrence, >1 cm size of acinar subtype showed significant difference and the only presence of micropapillary and solid subtype themselves showed significant difference. As the area under the receiver operating characteristic curve for recurrence, an acinar subtype size of >1 cm, or the presence of the micropapillary or solid subtypes was 0.710 (P<0.001). This variable was significant for recurrence in the multivariate analysis (P<0.001).

Conclusions: The presence of micropapillary, solid subtype or an acinar size of >1 cm are an independent prognostic factor of stage I lung adenocarcinoma. A more sizable acinar subtype affects the prognosis of stage I lung adenocarcinoma. This factor can provide additional information for predicting prognosis and can be a valuable supplement for the current classification.

Background: The unfolded protein response (UPR) is a critical biological process related to a variety of physiological functions and cardiac disease. However, the role of UPR-related genes in acute myocardial infarction (AMI) has not been well characterized. Therefore, this study aims to elucidate the mechanism and role of the UPR in the context of AMI.

Methods: Gene expression profiles related to AMI and UPR pathway were downloaded from the Gene Expression Omnibus database and PathCards database, respectively. Differentially expressed genes (DEGs) were identified and then functionally annotated. The random forest (RF) and least absolute shrinkage and selection operator (LASSO) regression analysis were conducted to identify potential diagnostic UPR-AMI biomarkers. Furthermore, the results were validated by using external data sets, and discriminability was measured by the area under the curve (AUC). A nomogram based on the feature genes was developed to predict the AMI-risk rate. Then we utilized two algorithms, CIBERSORT and MCPcounter, to investigate the relationship between the key genes and immune microenvironment. Additionally, we performed uniform clustering of AMI samples based on the expression of UPR pathway-related genes. The weighted gene co-expression network analysis was conducted to identify the key modules in various clusters, enrichment analysis was performed for the genes existing in different modules.

Results: A total of 14 DEGs related to the UPR pathway were identified. Among the 14 DEGs, CEBPB, ATF3, EIF2S3, and TSPYL2 were subsequently identified as biomarkers by the LASSO and RF algorithms. A diagnostic model was constructed with these four genes, and the AUC was 0.939. The calibration curves, receiver operating characteristic (ROC) curves, and the decision curve analysis of the nomogram exhibited good performance. Furthermore, immune cell infiltration analysis revealed that four feature genes were linked with the infiltration of immune cells such as neutrophils. The cluster analysis of the AMI samples identified two distinct clusters, each with differential expression of genes related to the UPR pathway, immune cell infiltration, and inflammatory cytokine secretion. Weighted gene coexpression network analysis and enrichment analysis showed that both clusters were associated with the UPR.

Conclusions: Our study highlights the importance of the UPR pathway in the pathogenesis of myocardial infarction, and identifies four genes CEBPB, ATF3, EIF2S3, and TSPYL2 as diagnostic biomarkers for AMI, providing new ideas for the clinical diagnosis and treatment of AMI.

Background: A discernible correlation exists between gastroesophageal reflux disease (GERD) and chronic obstructive pulmonary disease (COPD). However, the precise nature of the association between reflux esophagitis (RE) and COPD remains inadequately understood. In this study, we investigated the link between RE and pulmonary function, with a specific emphasis on elucidating the interplay between RE and COPD regarding lung function.

Methods: The study cohort comprised patients who underwent both pulmonary function tests (PFTs) and endoscopic examinations within a one-year period preceding and following their PFTs at The First Affiliated Hospital of Dalian Medical University from April 2021 to October 2023. Key demographic variables including age, gender, body mass index (BMI), as well as results from PFTs and endoscopy, were systematically documented for each participant. Statistical evaluations were conducted utilizing SPSS Statistics version 29.0, with significance determined at a threshold of P<0.05.

Results: Among patients with COPD, there were notable distinctions between cohorts categorized into RE and non-RE groups concerning several pulmonary function parameters, including forced expiratory volume in 1 second (FEV1), the ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC), maximum mid-expiratory flow (MMEF75/25), and expiratory reserve volume (ERV). Furthermore, there were statistically significant disparities observed in peak expiratory flow (PEF). Overall, RE did not exhibit an association with COPD severity, and there was no notable correlation found between the COPD severity and RE.

Conclusions: RE has been identified as a factor contributing to diminished pulmonary function in both individuals without underlying respiratory conditions and those diagnosed with COPD. Nevertheless, an absence of interaction was observed between the severity of COPD and the presence of RE.

Background and objective: Advanced breast cancer (BC) can involve the chest wall through local invasion by the primary tumor, locoregional recurrence, hematogenous metastasis, or sternum infiltration of the internal mammary chain lymph nodes. The purpose of this article is to review indications and the methods of chest wall resection and reconstruction in patients with advanced BC.

Methods: An online literature search was conducted on PubMed database using the following keywords: "chest wall reconstruction" or "chest wall resection" and "breast cancer". Articles in languages other than English were excluded.

Key content and findings: The treatment options should be discussed by a multidisciplinary team. The surgical principles include complete en bloc resection of the tumor including all involved or damaged skin, muscle and part of chest wall including ribs, complete or partial sternum and clavicles, as required, to achieve wide clear margins. The chest wall defect should be reconstructed with a good functional result. The optimal strategy for chest wall reconstruction depends on factors such as the defect`s size, location, and previous radiation or surgical intervention. A part of the reconstruction involves stabilizing the chest wall. Additionally, the defect should be covered with well-vascularized tissue, often necessitating reconstruction with muscle flaps or myocutaneous flaps.

Conclusions: A resection and reconstruction of the chest wall may be the best treatment option to achieve a high quality of life and favorable long-term outcomes, mostly as part of multimodality treatment for highly selected patients.

Background: Systemic rheumatic diseases (SRDs), particularly anti-melanoma differentiation-associated protein 5 positive dermatomyositis (MDA5⁺ DM), often affect the respiratory system and have a predisposition for developing into acute respiratory failure (ARF). Venovenous extracorporeal membrane oxygenation (VV-ECMO) can provide full respiratory support and can be used as a life-saving intervention. The present study describes the clinical profiles and prognoses of patients with MDA5⁺ DM and other SRDs receiving VV-ECMO for ARF.

Methods: A single-center retrospective study of patients with SRD who received VV-ECMO between June 2017 and February 2022 was conducted. Demographic and laboratory data, treatments, extracorporeal membrane oxygenation (ECMO) parameters, and clinical outcomes were extracted from electronic medical records and compared between patients with MDA5⁺ DM and other SRDs.

Results: Seven patients with MDA5⁺ DM and four patients with other SRDs were included in the study. Treatment by ECMO was provided for 152 days. Only one patient experienced ECMO-related complications. Three patients in the other SRD group survived to ECMO decannulation, and two of these patients survived to discharge. However, no patients in the MDA5⁺ DM group survived to decannulation or discharge.

Conclusions: Treatment by VV-ECMO could be safely applied to patients with SRDs to maintain normal respiration and oxygenation. However, patients with MDA5⁺ DM associated with ARF who underwent VV-ECMO had worse outcomes.