Journal of thoracic disease最新文献

Background: Traditional diagnostic methods have limited efficacy in predicting the prognosis of lung adenocarcinoma (LUAD), T cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) is a new biomarker. This study aimed to evaluate TIGIT expression as a LUAD biomarker and predict patient prognosis using a pathological feature model.

Methods: Clinical data and pathological images from The Cancer Genome Atlas (TCGA) were analyzed. The prognostic value of TIGIT was verified by genetic prognostic analysis and gene set enrichment analysis (GSEA). The OTSU algorithm was used to segment LUAD pathological images, and features were extracted using the PyRadiomics package and standardized with z-scores. Feature selection was performed using min-redundancy, recursive feature elimination (RFE) and stepwise regression algorithms, and a logistic regression algorithm was used to establish the pathomics model. Receiver operating characteristics, calibration, and decision curves were used for model evaluation. The pathomics score (PS) was used to predict TIGIT gene expression and analyze prognostic value and pathological mechanisms through Spearman correlation.

Results: The study included 443 clinical samples and 327 pathological images. Prognostic analysis showed significantly higher TIGIT expression in tumor tissues (P<0.001), with TIGIT being a protective factor for overall survival (OS) in LUAD [hazard ratio (HR) =0.65; 95% confidence interval (CI): 0.44-0.95; P=0.03]. GSEA revealed significant enrichment of differentially expressed genes in the TGF-β and MAPK signaling pathways. From 465 pathological features, the four best features were selected to construct a pathomics model with good predictive performance. Higher PS values were observed in the TIGIT high-expression group, correlating with improved OS (P=0.009). PS was positively correlated with the epithelial-mesenchymal transition related (EMT-related) genes (WIPF1, GLIPR1, IL15) and immune checkpoints (ICOS, CTLA4, LAG3) (P<0.001). Increased abundance of G2/M checkpoint-related genes (MARCKS, CASP8AP2) and infiltration of CD8⁺ T cells and M2 macrophages were noted in the high PS group (P<0.05).

Conclusions: TIGIT expression is significantly correlated with LUAD prognosis and can effectively predict patient outcomes.

Background: Cardiac surgery during pregnancy is complex and has significant risks for mothers and infants. The clinical outcomes and risk factors for complications are largely unknown. This study aimed to analyse the outcomes of cardiac surgeries during pregnancy and to investigate the risk factors for maternal postoperative outcomes from the two largest referral centres for pregnant patients with complex cardiac disease in northern and southern China.

Methods: Retrospective data review and analysis were conducted on patients who underwent cardiac surgery during pregnancy at Beijing Anzhen Hospital, Capital Medical University, and Guangdong Provincial People's Hospital from January 2010 to June 2023.

Results: In total, 140 pregnant women underwent cardiac surgery. The maternal and foetal mortality rates were 4.3% and 35.7%, respectively. Multivariate logistic regression analysis identified preoperative left ventricular ejection fraction (LVEF), pulmonary hypertension (PH), and intraoperative blood loss as independent risk factors for postoperative new-onset cardiovascular complications or death. The combined use of these three factors yielded the highest predictive value, with the area under the curve of 0.803. A preoperative LVEF below 61.5%, PH, and intraoperative blood loss exceeding 1,150 mL can be used to predict new cardiovascular complications or death after surgery.

Conclusions: Cardiac surgery during pregnancy is associated with high maternal and foetal risks. Combining preoperative LVEF, PH, and intraoperative blood loss can predict postoperative cardiovascular complications and mortality reliably.

Background: The morbidity and mortality of chronic pulmonary aspergillosis (CPA) are very high. We aimed to investigate the prognostic factors of patients with CPA, especially focusing on the underlying pulmonary disease and the probable co-infection of bacterial.

Methods: We retrospectively analyzed 106 CPA patients from November 2019 to August 2023. We collected the patient's clinical medical records. Kaplan-Meier survival curves were used to analyze patient survival; log-rank tests were utilized to compare survival among groups. Univariate and multivariate Cox proportional hazards regression analyses were applied for identification of potential prognostic factors.

Results: The mean age at the time of diagnosis was 60.3±14.8 years; 74 (69.8%) patients were male. There was significant difference between patients with and without lung cancer (P<0.001), and with and without emphysema (P=0.02). Other prognosis factors associated with mortality were as follows: smoking (P=0.04), cough (P=0.01), simultaneous discovery with Gram-negative bacteria (P=0.02), and hypoalbuminemia (P=0.001) in log-rank tests. Multivariate Cox regression analyses showed that emphysema [hazard ratio (HR), 4.107; 95% confidence interval (CI): 1.414-11.933; P=0.009] and lung cancer (HR, 8.511; 95% CI: 2.494-29.047; P<0.001) were identified as independent predictors of mortality. The 1- and 3-year survival rates with emphysema were 75.2% and 64.9%, respectively, whereas those for patients without emphysema were 92.6% and 85.9%, respectively.

Conclusions: In the current study, emphysema and lung cancer were independent predictors of mortality. Therefore, we should pay attention to the patients with these underlying lung diseases in order to improve the prognosis.

Background: Immune checkpoint inhibitors (ICIs) are emerging as important drugs for patients with locally advanced esophageal cancer (EC). Yet, immune-related adverse events (irAEs) may be a major obstacle for these population. Multidisciplinary team (MDT) is an efficient way to deal with such conditions. The aim of this study is to report a case of a stage III esophageal squamous cell carcinoma (ESCC) patient who achieved long-term survival through comprehensive treatment and MDT management, despite multiple irAEs.

Case description: A 67-year-old man was diagnosed with stage III ESCC (cT4N1M0) in January 2021. After 2 cycles of initial immuno-chemotherapy with good efficiency, he suffered from grade 3 immune-related hepatitis (IRH) and recovered after steroid therapy. Then radical radiotherapy began as planned. However, he got pneumonia and common antibiotics and steroid showed no effect. Finally, NGS-based pathogen detection identified cytomegalovirus (CMV) infection in his sputum. Ganciclovir was prescribed to him and his condition turned better soon. During a five-month period of anti-infectious therapy and follow-up, there was no anti-tumor treatment. However, the patient's esophageal lesion was evaluated as having a partial response (PR) on computed tomography (CT) scan and cancer cells transformed to high-grade intraepithelial neoplasia through gastroscopy. He underwent endoscopic submucosal dissection (ESD) and began a five-month follow-up period. When dysplasia recurred locally, the MDT members carefully restarted ICIs since he had fully recovered from previous irAEs and we believed he benefited from long-term responses to ICIs. Despite experiencing a third irAE, that is, adrenocortical insufficiency with mild symptoms, the patient still greatly benefited from ICIs. After being diagnosed as stage III EC for about 35 months, the patient's disease was still evaluated as clinical no evidence of disease (NED).

Conclusions: EC patients with irAEs who are well managed benefited from ICIs. MDT is crucial in the management of comprehensive treatment for EC.

Background: Several studies have documented the high prevalence of obstructive sleep apnea (OSA) among women with polycystic ovary syndrome (PCOS). However, causal relationships between the two conditions remain unconfirmed. This study aims to assess the causal relationships between OSA and PCOS.

Methods: We conducted a two-sample Mendelian randomization (MR) analysis utilizing instrumental variables (IVs) derived from large-scale genome-wide association studies (GWAS) to genetically estimate the causal effects of PCOS on OSA. To explore the impact of PCOS on OSA across different ethnicities, we analyzed GWAS data from European and East Asian participants. The inverse variance weighted (IVW) method was the primary statistical approach. A series of sensitivity analyses, including the weighted median, MR-Egger, weighted mode methods, and leave-one-out analysis, were performed to evaluate the robustness of our MR results.

Results: In the IVW analysis, the odds ratio (OR) for the association between PCOS and OSA was 1.133 [95% confidence interval (CI): 1.037-1.239, P=0.006], indicating that PCOS significantly increases the risk of OSA in the European population. No evidence of heterogeneity or directional pleiotropy was found using Cochran's Q test and the MR-Egger test. Conversely, the IVW analysis did not reveal a causal effect of PCOS on OSA in the East Asian population (OR =1.061, 95% CI: 0.888-1.268, P=0.51).

Conclusions: Our findings suggest that European women with PCOS are at an increased risk for OSA. However, no association was observed between PCOS and OSA in the East Asian population. Clinicians should maintain a high index of suspicion for OSA in women with PCOS, particularly among the European demographic.

Background: There is currently no widely accepted prognostic model specifically for elderly patients with esophageal squamous cell carcinoma (ESCC) undergoing radiotherapy. This study aimed to develop a nomogram incorporating metabolic imaging parameters from ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸F-FDG PET/CT) to predict overall survival (OS) in this patient population. The clinical need for such a prediction model is significant given the challenges of treatment planning in elderly patients with ESCC undergoing radiotherapy.

Methods: A retrospective analysis was conducted on 118 elderly patients with ESCC treated with radiotherapy. The patients were evaluated using ¹⁸F-FDG PET/CT imaging prior to treatment, and the spleen:liver ratio (SLR) and length of visual tumor (Lv) were identified as potential prognostic indicators. These variables, along with clinical tumor, node, metastasis (cTNM) staging, were used to develop a nomogram model. Key baseline clinical factors, PET variables, inclusion criteria, and follow-up procedures were documented. The model's predictive accuracy was assessed using time-dependent receiver operating characteristic (ROC) curves, the concordance index (C-index), and decision curve analysis (DCA). The patient cohort was stratified into three risk groups based on the total scores derived from the nomogram.

Results: SLR and Lv were found to be independent predictors of OS in elderly patients with ESCC. The nomogram developed by incorporating these factors, along with cTNM staging, showed superior predictive power compared to the traditional TNM staging system. ROC curve analysis demonstrated greater accuracy in predicting 1-, 2-, and 3-year OS rates, with area under the curve (AUC) values of 0.771, 0.763, and 0.815, respectively. DCA confirmed that the nomogram provided a greater clinical benefit. Patients were stratified into low-risk, intermediate-risk, and high-risk groups, with corresponding 3-year OS rates of 60.3%, 25.0%, and 3.6%, respectively.

Conclusions: The developed nomogram incorporating SLR, Lv, and cTNM staging offers a reliable tool for the risk stratification of elderly patients with ESCC undergoing radiotherapy. This model may serve as a reference for personalized treatment planning, potentially improving clinical outcomes in this patient population.

Thoracogastric airway fistula (TGAF) is a rare but devastating complication that may occur following esophagectomy. The most effective method for repairing the defect between the airway and digestive tract is the interposition of a pedicled soft tissue in situ. However, this approach is associated with a high risk and remains challenging for surgeons. Herein, we present a two-stage surgical approach using a pedicled myocutaneous flap for TGAF repair. In Stage I, an appropriate pedicled myocutaneous flap was selected and prepared based on the patient's surgical history. Then, the thoracostomach was removed transthoracically to expose the tracheal fistula, and the pedicled myocutaneous flap was used to repair the fistula by anastomosing it to the airway. At the same time, cervical esophagostomy and jejunostomy were performed. In Stage II, 3-6 months later, the ileocolon was freed in the abdomen and pulled up behind the sternum to the neck to complete the reconstruction of the digestive tract. The staged repair of TGAF using pedicled myocutaneous flaps appeared safe, with no intraoperative adverse events, including anesthesia accidents, massive bleeding, and severe arrhythmia. One patient developed a tracheal-myocutaneous flap anastomotic leakage 1 week after surgery, resulting in chronic empyema. After 1 month of conservative treatment, follow-up bronchoscopy revealed good healing of the anastomosis. No surgery-related complications occurred in the other patients. Four patients underwent successful repair of TGAF using this approach and were able to resume oral intake. Successful repair using a pedicled myocutaneous flap may provide a reference for treating this type of disease.

Background: Lung cancer is among the most common types of cancers worldwide, and surgery can be a curative treatment option for this condition. However, some patients experience postoperative recurrence. Hence, predicting early postoperative recurrence to improve patient prognosis is important. This study aimed to determine the usefulness of nutritional inflammation indexes in predicting the prognosis of early recurrence after lung cancer surgery.

Methods: A retrospective cohort study was conducted on 310 patients with primary lung cancer who underwent lung lobectomy at Jikei University Hospital from January 1, 2013, to December 31, 2017. The prognostic nutrition index (PNI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and modified Glasgow prognostic score (mGPS) were calculated. The patients were classified into the high and low groups based on the receiver operating characteristic (ROC) curves. Furthermore, the association between these indexes and postoperative recurrence was analyzed via univariate analysis and using the Kaplan-Meier method.

Results: The mean age of the patients was 67.0 years, and the male-to-female ratio was 199:111. The mean observation period was 30.6 months. Patients with a low NLR and mGPS had a significantly longer 5-year recurrence-free survival than those with a high NLR and mGPS (P=0.045 and 0.02, respectively). Patients with a low PNI had a significantly higher 1-year recurrence rate than those with a high PNI (P=0.007).

Conclusions: The PNI is associated with 1-year recurrence, and NLR and mGPS are considerably associated with 5-year postoperative recurrence in patients with lung cancer. Hence, these nutritional inflammatory indices can be useful in predicting postoperative recurrence.

Background: Intimal sarcomas are rare tumors that typically affect the major vessels, such as the pulmonary artery and aorta, and are associated with a particularly poor prognosis. Intimal sarcomas found in the aorta are most commonly located in the abdominal section between the celiac artery and the iliac bifurcation. The descending aorta is involved in 30% of cases, while involvement of the ascending aorta is rare. Additionally, the symptoms of intimal sarcomas are usually nonspecific, making preoperative diagnosis difficult. The majority of neoplasms can only be found by histological analysis of the surgical specimen.

Case description: A 69-year-old female patient was diagnosed with intimal sarcoma of the ascending aorta and aortic valve, which was initially thought to be nonbacterial thrombotic endocarditis. The patient complained of chest discomfort accompanied by reduced activity tolerance and had elevated serum levels of interleukin 6, lactic dehydrogenase, high-sensitivity troponin I, and brain natriuretic peptide, along with mild anemia. Echocardiography and computed tomography with contrast-enhanced angiography revealed a vegetation measuring 9.8 mm × 6.6 mm between the root of the aorta and aortic valve, suggesting an initial diagnosis of nonbacterial thrombotic endocarditis. However, an aortic intimal sarcoma was detected by immunohistochemistry and postoperative histology. Additionally, ¹⁸F-fluorodeoxyglucose positron emission tomography detected metastasis in the right adrenal gland and left humeral head.

Conclusions: Intimal sarcomas are an uncommon and extremely aggressive type of primary malignant aortic tumor. Diagnosis might be challenging and requires a high level of suspicion. Standard surgical treatment may include resection of the affected segment followed by interposition graft replacement. Given the poor prognosis even after complete resection, it is essential to rule out metastasis.