Journal of thoracic disease最新文献

Background: In thoracic outlet syndrome (TOS), the resection of the first rib in case of costoclavicular pinch with neurological/venous/arterial symptoms is a widely performed surgery using a direct approach (cervical or axillary approach). A minimally invasive anterior approach assisted by robotics has been reported, but nothing is known about the feasibility of a posterior approach. We present a minimally invasive, robot-assisted posterior approach and report the preliminary results of this technique.

Methods: From July 2023 to December 2024, we prospectively collected data on patients who underwent first rib resection (for TOS resistant to physiotherapy treatment) using robotic assistance at the University Hospital of Rennes, France. Clinical and surgical results are reported.

Results: Eighteen (83%women) patients underwent the minimally invasive approach. The median age was 40.5 [interquartile range (IQR), 33.3-45.8] years old. Symptoms were arterial for two patients, venous for five, and neurological for 11. The median surgery time was 117.5 (IQR, 95.5-126.0) minutes, with a median hospital length of stay of 2 (IQR, 2-3) days. There were no perioperative complications, neurovascular injuries, or perioperative mortality. We had one postoperative complication that resolved without sequelae. Symptoms had disappeared or significantly decreased within the month following the surgery. Persistent but decreasing paresthesia was observed in one patient out of 18 at 1 month after surgery. Ten patients experienced postoperative neuropathic pain, with six receiving gabapentin.

Conclusions: This minimally invasive posterior approach technique appears to be feasible and safe for the first rib resection in patients with TOS. The appropriate identification of the "culprit" part of the first rib allows for excellent results with enhanced three-dimensional (3D) vision and a reduction in perioperative neurovascular complications.

Background and objective: The historical management of resectable non-small cell lung cancer (NSCLC) has relied on surgical resection and adjuvant chemotherapy, an approach with unsatisfactory long-term survival due to high rates of recurrence and micrometastasis. This narrative review synthesizes the evidence for a paradigm shift to neoadjuvant immunotherapy, which administers systemic therapy prior to surgery to address both the primary tumor and subclinical micrometastatic disease.

Methods: A comprehensive review was conducted on PubMed, Embase, and Scopus, limited to English-language articles from 2018 to the present to ensure a focus on recent, pivotal Phase II and III randomized clinical trials. The search used keywords such as 'neoadjuvant immunotherapy', 'resectable NSCLC', and 'biomarkers' to identify relevant studies.

Key content and findings: Initial immune checkpoint inhibitor (ICI) monotherapy trials established feasibility and efficacy. Large-scale phase III trials like CheckMate 816 and AEGEAN have since established neoadjuvant chemo-immunotherapy as the new standard of care, demonstrating significant improvements in pathological complete response (pCR), event-free survival (EFS), and overall survival (OS). This has validated pathological response as a surrogate endpoint for long-term survival, which accelerates drug development. The review also highlights novel combinations like antibody-drug conjugates (ADCs) in trials such as NeoCOAST-2, which have shown high pathological response rates, and discusses the evolution of biomarkers from programmed death-ligand 1 (PD-L1) to the more dynamic circulating tumor DNA (ctDNA).

Conclusions: Neoadjuvant immunotherapy has fundamentally transformed the treatment landscape for resectable NSCLC, establishing a definitive paradigm shift from conventional surgery-first approaches and becoming a foundational component of modern multidisciplinary care with a promising trajectory toward improved long-term outcomes and the realization of minimal residual disease (MRD) guided therapy. Challenges remain, including the need for better predictive biomarkers, optimized regimens, and management of surgical complexities.

Background: Third-generation tyrosine kinase inhibitor (TKI) agents have become the preferred option for the first-line treatment of patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) due to their exceptional efficacy and favorable safety profile. However, resistance to third-generation TKIs is inevitable. Subsequent treatment options are limited and confer only modest survival benefit. This retrospective study examined patients receiving flumonertinib after prior third-generation EGFR-TKI therapy following resistance to third-generation TKIs, with the aim to assess a potential therapeutic approach for this challenging patient population.

Methods: This retrospective study included a cohort of 40 patients who received flumonertinib after prior third-generation EGFR-TKI therapy following resistance to other third-generation TKIs. Kaplan-Meier analysis, Cox proportional hazards regression analysis, and Cox subgroup analysis were employed to examine factors influencing patient survival.

Results: The median progression-free survival (PFS) for the overall cohort was 8.95 months, and the median overall survival (OS) was 18.03 months. Patients who received flumonertinib after prior third-generation EGFR-TKI therapy (80 or 160 mg) as first- to third-line therapy (≤3 prior lines of therapy) demonstrated significantly improved survival outcomes [hazard ratio (HR) =0.43, 95% confidence interval (CI): 0.20-0.89; P=0.02]. Cox subgroup analysis further revealed that patients receiving flumonertinib monotherapy derived a significant survival benefit (HR =0.24, 95% CI: 0.07-0.85, P=0.02; P for interaction =0.04).

Conclusions: For patients with EGFR-mutated NSCLC who develop resistance after treatment with third-generation EGFR TKIs, flumonertinib monotherapy during rechallenge treatment is a viable therapeutic option. Initiating treatment with flumonertinib earlier may lead to better survival outcomes, and thus further investigation of this strategy is warranted.

Background: Esophageal cancer (EC) is the eighth most prevalent malignancy worldwide and exhibits the sixth poorest prognosis. Esophageal squamous cell carcinoma (ESCC) is the predominant pathological subtype. Ferroptosis, an iron-dependent form of cell death, plays a critical role in cancer progression. Long non-coding RNAs (lncRNAs) have emerged as key regulators in the initiation and progression of EC. However, the role of lncRNAs in modulating ferroptosis within EC remains poorly understood. Therefore, this study aimed to identify key ferroptosis-related lncRNAs in ESCC and to investigate the role and mechanism of a specific lncRNA, long intergenic non-protein-coding RNA 92 (LINC00092).

Methods: Bioinformatics analysis was conducted to identify ferroptosis-related lncRNAs, transcription factors (TFs), and genes associated with ESCC. The expression, function, tumor microenvironment, immunotherapy, and downstream molecular pathways were also determined. The expression levels of LINC00092, MYC-associated zinc finger protein (MAZ), and NFE2 like bZIP transcription factor 2 (NFE2L2) were detected using quantitative real-time polymerase chain reaction (qRT-PCR), immunohistochemical analysis, and western blotting. Fluorescence in situ hybridization (FISH) was performed to determine the subcellular localization of LINC00092. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), colony formation, wound healing, Transwell, and flow cytometry apoptosis assays were performed to determine the phenotypes and functions of loss- and gain-of LINC00092. RNA immunoprecipitation (RIP) and luciferase reporter assays were used to evaluate interactions involving LINC00092. The expression of ferroptosis-related proteins was verified by western blotting.

Results: LINC00092 was found to be downregulated in ESCC datasets, cell lines, and tissue samples. Bioinformatics analysis revealed that LINC00092 was associated with ferroptosis and negatively correlated with NFE2L2 expression. Further investigations demonstrated that LINC00092 acted as a binder to the TF MAZ, modulating the expression of the ferroptosis-related gene NFE2L2. Overexpression of LINC00092 inhibited ESCC cell progression, whereas its downregulation promoted tumor progression. RIP and luciferase reporter assays confirmed that MAZ was a target of LINC00092, and NFE2L2 was a downstream target of MAZ. Western blot analysis showed that LINC00092 enhanced ferroptosis in ESCC cells. The LINC00092/MAZ/NFE2L2 axis appeared to inhibit cancer progression by promoting ferroptosis through the regulation of NFE2L2 and sequestration of the TF MAZ.

Conclusions: LINC00092 exerts tumor-suppressive effects in ESCC cells by inhibiting cancer progression through the LINC00092/MAZ/NFE2L2 axis and promoting ferroptosis. Therefore, LINC00092 may serve as a potential therapeutic target for ESCC.

Background and objective: Esophageal squamous cell carcinoma (ESCC) remains a major global health burden, with limited long-term survival despite advances in multimodal therapy. Neoadjuvant immunochemotherapy (NICT) has emerged as a promising preoperative strategy for operable locally advanced ESCC, demonstrating encouraging short-term efficacy and safety profiles. However, substantial interindividual variability in therapeutic response persists, underscoring the need for accurate predictive tools. Radiomics, which extracts high-dimensional quantitative features from medical images, offers a noninvasive means to characterize tumor heterogeneity and predict treatment outcomes. This review aims to synthesize current evidence on the application of radiomics in predicting NICT response for operable locally advanced ESCC, while discussing its biological interpretability and clinical translation potential.

Methods: A comprehensive literature search was conducted in PubMed from January 2020 to November 2025. Search terms included combinations of "esophageal squamous cell carcinoma", "neoadjuvant immunochemotherapy", and "radiomics". Only studies focusing on operable locally advanced ESCC that evaluated radiomics for predictive or analytical purposes were included. Articles lacking methodological rigor or full-text availability were excluded. Evidence was narratively synthesized to identify advances, limitations, and research gaps.

Key content and findings: NICT has shown comparable pathological complete response (pCR) and major pathological response (MPR) rates to conventional neoadjuvant chemoradiotherapy (NCRT). Radiomics-based models-particularly those integrating clinical and hematologic parameters-have achieved promising predictive performance for treatment response. Nevertheless, most studies remain single-center and lack external validation. Integrating molecular omics approaches, such as transcriptomics, could enhance biological interpretability and clinical applicability.

Conclusions: Radiomics holds considerable promise for predicting NICT efficacy and advancing precision treatment in ESCC. Future research should prioritize multicenter validation and integration with molecular profiling to improve interpretability and clinical translation, ultimately guiding personalized therapy and informing future oncologic strategies.

Background: Predicting post-treatment lung function is critical in selecting curative-intent therapies like surgery or stereotactic ablative body radiotherapy (SABR) for early-stage lung cancer. Current guidelines estimate predicted post-operative (PPO) function using lobar volume, ignoring regional variation in ventilation and perfusion, especially in diseased lungs. We aimed to assess the feasibility of ventilation/perfusion single photon emission computed tomography/computed tomography (V/Q SPECT/CT) lobar quantification for improved prediction of post-treatment lung function.

Methods: We developed a novel index-Ventilation-Perfusion Capacity Differential Index (VQCDI)-using in-house software that quantifies lobar ventilation, perfusion and volume, reflecting each lobe's contribution to lung function. The software enables manual annotation of surgical margins and radiation fields, allowing regional quantification. Patients undergoing lobectomy, sub-lobar resection or SABR were prospectively enrolled. VQCDI and CT-based volumetric predictions (Vol%) of PPO forced expiratory volume in 1 second (FEV1), diffusing capacity of the lungs for carbon monoxide (DLCO) and haemoglobin-corrected DLCO (DLCOc) were compared to 6-month post-treatment measurements using Pearson correlation, intraclass coefficients (ICC) and Bland-Altman analysis.

Results: Fifty-three of 60 sequentially enrolled participants completed post-treatment lung function. VQCDI predicted post-treatment FEV1 in surgical participants with a strong correlation (R=0.920, ICC =0.908, mean difference: -0.096 L) outperforming Vol%. For DLCO and DLCOc, VQCDI also showed strong correlation in surgical participants (R=0.899, ICC =0.874, and R=0.921, ICC =0.899). Performance remained high across participants undergoing lobectomy and sub-lobar resection and in smokers and those with emphysema. VQCDI may also be useful in the quantification of lung function changes in acute radiation pneumonitis post-SABR using 100%, 75%, 50% and 25% radiation dose isocontour zones.

Conclusions: VQCDI is a feasible tool that appears to accurately predict post-treatment lung function, with novel capability in sub-lobar resection and post-SABR evaluation. Further multicentre studies with longer follow-up would be beneficial.

Background: Stroke is one of the most severe postoperative complications in patients with acute type A aortic dissection (ATAAD). This study aimed to develop a novel scoring system to supplement existing classification systems and evaluate its association with postoperative stroke and other complications.

Methods: A total of 257 patients were included in the study. The degree of involvement of the innominate artery (IA), left common carotid artery (LCCA), left subclavian artery (LSA), and right common carotid artery (RCCA) was assigned a score. These scores were then combined, and a grid search was used to determine the coefficient for each variable. The bootstrap method was applied to assess the performance of the scoring formula. The area under the curve (AUC) and odds ratio (OR) were used to evaluate the associations between the score and outcomes, such as stroke.

Results: The AUC of the scoring system was 0.811 [95% confidence interval (CI): 0.713-0.909], and the mean AUC from the bootstrap evaluation was 0.813 (95% CI: 0.721-0.903). The optimal cutoff score was found to be 15. The ORs for stroke associated with the score and cutoff score were 1.21 (95% CI: 1.14-1.29) and 10.13 (95% CI: 4.36-23.58), respectively. After adjusting for non-anatomical risk factors, the adjusted ORs were 1.22 (95% CI: 1.14-1.31) and 13.30 (95% CI: 5.21-33.93). The scoring system and its cutoff value were also identified as significant risk factors for postoperative death and delayed awakening.

Conclusions: The newly developed scoring system effectively evaluates the risk of postoperative stroke in patients with ATAAD and provides additional predictive value for postoperative death and delayed awakening.