Journal of thoracic disease最新文献

Background: Robot-assisted thoracic surgery has been shown to have several advantages over conventional surgery. As mobile communication technology and surgical robotic devices in China continue to progress rapidly, the conditions for performing remote surgery have been optimized. Consequently, informatized and remote advanced medical cooperation is becoming a new direction for supporting the medical development of border regions and promoting the equitable distribution of medical resources in China.

Case description: In this case, a 53-year-old female patient in Kashi was admitted with a mixed ground-glass lesion in the right upper lobe. The size and density of the lesion were found to be increasing progressively. After a comprehensive multidisciplinary team consultation, the patient was clinically diagnosed with early stage lung cancer. The patient gave informed consent to undergo remote robot-assisted right upper lobectomy and lymph node dissection, which was performed on July 13, 2024 between Shanghai and Kashi using a dedicated network and 5G mobile communication. The procedure was successfully conducted with an average delay of 100 ms and no connection interruptions. Pathology and immunohistochemistry confirmed invasive mucinous adenocarcinoma (T1aN0M0). Postoperative imaging showed good lung re-expansion; the patient had an ideal recovery and was discharged smoothly.

Conclusions: We reported the first case in which a remote robot-assisted lobectomy was performed using a robotic surgical system, 5G technology, and corresponding procedures. More cohorts or clinical studies need to be conducted to further clarify the guidelines and promote the application of remote thoracic surgery.

Background: There is a clear correlation between accurate postoperative lymph node staging and the survival prognosis of patients. This study aimed to explore the application and value of indocyanine green (ICG) fluorescence real-time imaging technology in lymph node sorting during radical esophagectomy for esophageal cancer.

Methods: From August 2022 to June 2023, the specimens of 66 patients who underwent esophageal cancer resection with lymph node dissection were examined. Among them, 12 cases of ex vivo esophageal specimens underwent secondary lymph node sorting using ICG fluorescence real-time imaging technology after conventional lymph node sorting, while the remaining 54 cases underwent conventional lymph node sorting.

Results: A total of 329 lymph nodes were detected in the 12 patients with an average of 29.75±9.19 nodes per patient. Lymph node metastasis was detected in five patients, of whom, three were diagnosed as N1 (N refers to regional lymph nodes, N1: involves 1 to 2 regional lymph node metastases), and two were diagnosed as N2 (N refers to regional lymph nodes, N2: involves 3-6 regional lymph node metastases). Following the ICG injection of 12 patient specimens, lymph nodes were re-detected in 6 patients of them (above we stated 12 patients), yielding a detection rate of 50%. In total, 17 lymph nodes were detected. There was a statistically significant difference in the total number of lymph nodes detected before and after the injection of ICG (P=0.02). Among the other 54 patients, an average of 34.06±15.66 lymph nodes were detected. There was no statistically significant difference in the total number of lymph nodes detected between the two groups (P=0.21).

Conclusions: The use of ICG fluorescence real-time imaging technology facilitate lymph node identification in resected specimens and will become a powerful technique for precise staging in esophageal cancer treatment.

Background: Pulmonary function assessment is mandatory before oncological lung resection surgery. To do so, subjects undergo a pulmonary function test (PFT) and the calculation of predicted postoperative (PPO) values to estimate the residual lung function after surgery. The aim of this study is to evaluate the use of anatomical formulae in estimating postoperative pulmonary function in patients undergoing minimally invasive surgery (MIS).

Methods: This is a retrospective study. Patients affected by lung cancer who underwent pulmonary lobectomy or segmentectomy with MIS or thoracotomy approach at our center from June 2020 to May 2021 were considered. Exclusion criteria were: subjects who underwent atypical pulmonary resection surgery or pneumonectomy; and patients who underwent adjuvant therapy (chemotherapy or immunotherapy). PFT data measured before and 1 year after surgery were collected. In particular, postoperative PFT data, especially forced expiratory volume in the first second (FEV1) and diffusing capacity for carbon monoxide (DLCO), and PPO values calculated by the anatomical formulae were compared. Secondary endpoints were: analysis of the postoperative pulmonary function in patients who underwent lung resection with the standard approach (thoracotomy) and evaluation of the anatomical formulae accuracy in subjects operated through thoracotomy.

Results: The sample consisted of 48 patients operated on MIS (video-assisted thoracoscopic surgery and robotic-assisted thoracoscopic surgery) and 20 subjects who underwent thoracotomy for stage I-IIA and I-IIB lung cancer in both groups. The anatomical formula seemed to underestimate the postoperative FEV1% by 8.65% [interquartile range (IQR), 0.5-17.28%; P<0.001]. Furthermore, when comparing postoperative PPO_DLCO% and post-operative DLCO%, a significant difference was shown with an underestimation of the actual postoperative value of 2.78% (IQR, -3.63% to 10.47%; P=0.045).

Conclusions: Our results confirmed that the anatomical formulae currently used to predict postoperative pulmonary function are reliable in the case of the standard approach (thoracotomy), while they tend to overestimate the loss of FEV1 and DLCO in the postoperative period in patients who were operated on MIS, thus excluding some subjects from the operation.

Background: Empyema, characterized by the accumulation of pus in the pleural cavity, poses significant treatment challenges. While intrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) therapy is effective for many patients, a substantial proportion require surgical intervention, such as video-assisted thoracoscopic surgery (VATS), following treatment failure. Identifying tPA/DNase treatment failure-associated predictors is crucial for optimizing patient management and improving outcomes. This study aims to identify clinical and biochemical predictors of tPA/DNase treatment failure in empyema patients, facilitating early and targeted interventions.

Methods: We conducted a retrospective analysis of 223 empyema patients treated with tPA/DNase at Northeast Georgia Medical Center between January 2018 and December 2023. Data were collected on demographics, comorbidities, pleural fluid analysis, radiological findings, and laboratory results. Multivariable logistic regression was used to identify predictors of treatment failure, with statistical significance set at a P value <0.05.

Results: Of the 223 patients, 28 (12.6%) experienced treatment failure and required VATS. Several predictors of treatment failure were identified. Younger age was associated with a higher likelihood of treatment failure [odds ratio (OR) =0.97; 95% confidence interval (CI): 0.94-0.99; P=0.03]. The presence of Staphylococcus aureus (S. aureus) infection significantly predicted treatment failure (OR =4.1; 95% CI: 1.2-14.5; P=0.03). Biochemical markers in pleural fluid, such as pH, lactate dehydrogenase (LDH), and protein levels, were not associated with tPA/DNase failure.

Conclusions: Key predictors of tPA/DNase treatment failure in empyema patients include younger age (median age of 60.5 vs. 67 years old) and S. aureus infection. Recognizing these predictors can guide clinicians in identifying high-risk patients and considering early surgical intervention. Future studies should aim to validate these findings in diverse populations to refine and confirm these predictive models.

Background: Tyrosine kinase inhibitors (TKIs) are the first-line therapy for patients with non-small cell lung cancer (NSCLC) with sensitized mutations in the epidermal growth factor receptor (EGFR). However, resistance to TKIs is a major clinical issue that affects the survival and prognosis of the patients, with the mechanisms underlying this resistance remaining elusive. Circular RNAs (circRNAs) are a class of single-stranded, covalently closed RNA molecules, which are generated from pre-messenger RNAs (mRNAs) through back splicing. The aim of this study was to investigate the role of cRNA SPECC1 in promoting resistance to TKIs in NSCLC and to explore its potential involvement in tumorigenesis and metastasis of lung adenocarcinoma (LUAD).

Methods: In this study, we identified differentially expressed genes through RNA sequencing from three tumor samples obtained from patients with poor postoperative TKI treatment outcomes. Validation was performed using quantitative real-time polymerase chain reaction (qRT-PCR) and cell function experiments. We further constructed a competing endogenous RNA (ceRNA) network and performed Gene Ontology (GO) analysis to explore the underlying mechanisms of circRNA.

Results: SPECC1 circular RNA (circSPECC1) was found to be significantly upregulated in tumors as compared to adjacent tissues. Knockdown of circSPECC1 in NSCLC cell lines resulted in decreased proliferation, migration, and invasion. Additionally, apoptosis was increased in cell lines with TKI-sensitive EGFR mutations when treated with osimertinib.

Conclusions: circSPECC1 may promote TKI resistance and contribute to the tumorigenesis and metastasis of NSCLC. This study offers a novel perspective on TKI resistance research at the RNA level.

Background: To expand the donor pool, medical centers worldwide are applying marginal donor lungs in clinical settings. We carried out this research to reveal the short-term and long-term outcomes of marginal lung donor transplantation.

Methods: We performed retrospective research using data from patients who underwent lung transplantation (LT) in The Affiliated Wuxi People's Hospital of Nanjing Medical University, Jiangsu Province, China, between 2018 and 2022 to compare the short-term and long-term outcomes of standard donors and marginal donors.

Results: A total of 553 cases were incorporated in this study. The perioperative mortality of recipients who received marginal donor lungs was around 20.8%, compared with 13.4% in the standard donor recipients (P=0.03). There were no significant differences between the two groups in terms of mechanical ventilation or extracorporeal membrane oxygenation (ECMO), length of intensive care unit and hospital stay, occurrence of primary graft dysfunction, and prevalence of acute rejection. The 1-year survival rate for recipients in the standard group and marginal group was 71.7% and 54.2% (P<0.001), respectively. There was a worse survival rate in the subgroups of age >55 years, smoking ≥20 pack-years, and abnormal chest radiographs; however, the 1-year survival rate in the subgroup analysis of donors with ratio of arterial oxygen partial pressure to fraction of inspired oxygen (PaO₂/FiO₂) <300 mmHg and purulent secretions on bronchoscopy was not significantly different.

Conclusions: Our findings suggest that marginal donor recipients can expect to have a lower survival rate than standard donor recipients. However, marginal lung transplant recipients could also gain benefit equivalent to that provided by standard donor LTs in both the short- and long-term when proper assessment and management strategies are implemented.

Background: Pleural mesothelioma is mainly caused by (occupational) asbestos exposure. Since 1990, the import and use of asbestos is prohibited in Switzerland. However, due to the long latency time between exposure and the development of disease, incidence in Switzerland was expected to further increase for years after the ban. The aim of the present study was to analyse incidence, mortality, and survival of patients diagnosed with malignant pleural mesothelioma in the canton of Zurich in Switzerland.

Methods: Population-based cancer registry data and cause of death statistics of the canton of Zurich from 1981 to 2019 were used to calculate age-standardized incidence and mortality rates. Time trends were investigated with joinpoint regression and net survival was computed using the Pohar-Perme method.

Results: In men, the incidence rate increased from 1981 to 2002 {annual percentage change (APC) 4.7 [95% confidence interval (CI): 2.6 to 6.8]} and then decreased until 2019 [APC: -2.3 (95% CI: -4.2 to -0.3)], while in women it increased over the whole period [APC 6.2 (95% CI: -1.3 to 14.4)]. Mortality rates were stable in men and women. Three-year net survival was 9.7% (95% CI: 7.8% to 12.2%) for men and 22.1% (95% CI: 15.3% to 32.1%) for women. Men with stage I or II pleural mesothelioma had a net survival of 25.4% (95% CI: 17.2% to 37.5%) after three years whereas men with stage III or IV experienced a net survival of 7.4% (95% CI: 3.9% to 13.8%) after three years.

Conclusions: Malignant pleural mesothelioma incidence seems to have reached the peak in the canton of Zurich in men, but not yet in women. Mortality rates were stable in men and women, and net survival was poor for both sexes, particularly in men.

Background: Although multimodality treatment, including chemoradiotherapy and surgery has significantly improved the prognosis of patients with esophageal squamous cell carcinoma (ESCC), a valid predictor is crucial for individualized treatment. As acyl-CoA synthetase long-chain family member 4 (ACSL4) and glutathione peroxidase 4 (GPX4) are key genes with radiation responses and constituents of the ferroptosis signaling pathway, the present study adopted ACSL4 and GPX4 protein expression to explore their predictive and prognostic value in patients with ESCC receiving adjuvant radiotherapy.

Methods: A total of 108 patients with thoracic ESCC who had undergone radical surgery and adjuvant radiotherapy were enrolled in the present retrospectively study. ACSL4 and GPX4 immunohistochemistry experiments were performed on paraffin-embedded tumor samples. The prognostic value of ACSL4 and GPX4 was examined using survival analysis, and the predictive value of ACSL4 and GPX4 for long-term survival was examined using univariate and multivariate Cox regression analyses, and verified by receiver operating characteristic (ROC) analysis.

Results: The survival analysis revealed that overall survival (OS) and disease-free survival (DFS) were significantly longer in the high ACSL4 expression group, and the DFS was significantly shorter in the high GPX4 expression group. The results of univariate and multivariate Cox regression analyses revealed that the ACSL4 expression level was an independent predictor for OS and DFS, and that the GPX4 expression level was an independent predictor for DFS. ROC analysis verified the predictive role of ACSL4 expression for DFS and OS, with an area under the curve (AUC) of 0.713 and 0.663.

Conclusions: The present study demonstrates that ACSL4 and GPX4 may serve as valuable prognostic biomarkers for long-term survival, and play a key translational role in individualized therapy for patients with ESCC.

Background: An increasingly large proportion of patients undergoing curative surgery for lung cancer, are octogenarians. We evaluated our short and long-term survival and adverse outcomes after oncological lung resections.

Methods: Octogenarians undergoing anatomical resection for confirmed or suspected lung cancer at a single-centre between January 2016 and December 2021 were included. Retrospective analysis of demographic, clinical, and operative data was performed and correlated with mortality and long-term outcomes.

Results: Out of 214 patients, 189 were included in the final analysis. Median age was 82 years (range, 80-89 years). Most patients had lobectomies and minimally invasive approach. Ninety-day mortality was 3.2% with no intraoperative deaths. Chronic obstructive pulmonary disease (COPD) primarily conferred a greater likelihood of persistent air leak (PAL), chest infection, reintubation and intensive care admission (all P<0.01). Complications occurred more in those with high white cell counts (WCCs) (P=0.03) and squamous cell carcinoma subtype (P<0.01). Wedge resections conferred fewer complications (P=0.049). Hospital length of stay (LOS) was reduced by 1 day in sublobar resections (P=0.01) and halved in minimally invasive approaches compared to thoracotomy (P=0.02). The median overall survival (OS) was 3.5 years (1-, 3-, and 5-year survival was 82.5%, 57.1%, and 38.2%, respectively). Pathological tumour stage (P<0.01) and incomplete resection (R1 or R2) (P=0.02) conferred a worse OS and disease-free survival (DFS). Median DFS was 2.4 years. No significant difference was seen in OS or DFS from extent of resection or tumour subtype (P=0.78, P=0.97 and P=0.40, P=0.91).

Conclusions: Curative surgery is safe and feasible with good long-term outcomes in appropriately selected octogenarians. Predictors of specific complications can be identified and optimised in order to better counsel patients pre-operatively and offer surgery at an early pathological stage.

Background: Esophageal squamous cell carcinoma (ESCC) stands as the sixth most common cause of cancer-related mortality on a global scale, with a strikingly high proportion-over half-of these fatalities occurring within China. The emergence of radiation resistance in ESCC patients significantly diminishes overall survival rates, complicating treatment regimens and reducing clinical outcomes. There is an urgent need to explore the molecular mechanisms that underpin radiation resistance in ESCC, which could lead to the identification of new therapeutic targets aimed at overcoming this resistance. This study aims to elucidate the role of myeloid cell leukemia-1 (MCL1) in ESCC and its association with radioresistance, thereby providing a novel strategy for enhancing the efficacy of radiotherapy.

Methods: We used The Cancer Genome Atlas (TCGA) database, Genotype-Tissue Expression (GTEx) project and real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) of 10 pairs of fresh endoscopic biopsy samples from patients with ESCC to analyze the messenger RNA (mRNA) expression levels of MCL1 in esophageal cancer tissues as compared to normal tissues. Immunohistochemistry (IHC) staining and Western blotting were performed using an anti-MCL1 antibody to visualize protein expression. The mechanism of radioresistance of ESCC was examined by combining bioinformatics analysis, Western blotting, and clone formation and stemness sphere formation assays.

Results: The analysis of TCGA database and the results of RT-qPCR indicated that the mRNA level of MCL1 was overexpressed in esophageal cancer tissues. Subsequently, the results of IHC and Western blotting showed that the protein level of MCL1 expression in cancer tissues was significantly higher than that in adjacent normal tissues. Moreover, there was a significant upregulation of MCL1 in ESCC tissues and in radioresistant tissues and cells, with its overexpression correlating with the acquisition of stemness properties in ESCC. In terms of mechanism, MCL1 induced cell cycle arrest by regulating the expression of cyclin D3 and p21 through the JAK-STAT signaling pathway. G0/G1 phase arrest contributed to the stem cell-like phenotype. Blocking JAK-STAT signaling significantly improved the efficacy of radiotherapy for ESCC.

Conclusions: These findings indicate that MCL1 is a critical cell cycle regulator that drives the stemness and radioresistance of ESCC and may thus be a potential target in a combined therapeutic strategy aimed at overcoming radioresistance.