Journal of thoracic disease最新文献

Background: The expression of programmed death-ligand 1 (PD-L1) has an impact on survival outcomes in non-small cell lung cancer (NSCLC) patients, but preoperative diagnosis is challenging. This study aimed to construct and validate a non-invasive model for predicting PD-L1 expression in early-stage resected NSCLC based on computed tomography (CT) features and clinicopathological characteristics.

Methods: In this retrospective study, the clinical, pathological, and CT data were obtained from consecutive NSCLC patients who had undergone resection from January 2016 to March 2018. The clinicopathologic, CT, and clinicopathologic-CT models were constructed after univariate and multivariate logistic regression analyses. The Kaplan-Meier analysis and log-rank test were used for survival analysis.

Results: A total of 679 consecutive patients with 695 early-stage NSCLC nodules were included, and there were 243 {median age 57 [interquartile range (IQR), 48-63] years; 152 females} in the positive PD-L1 group and 452 [median age 58 (IQR, 50-65) years; 315 females] in the negative PD-L1 group. Smoking history, spread through air spaces (STAS), average CT value, lobulation, and cytokeratin 7 (CK7) were independent predictors of positive PD-L1 NSCLC. In validation set, the area under the curve (AUC) value of clinicopathologic model, CT model and clinicopathologic-CT model were 0.630 [95% confidence interval (CI): 0.621-0.702; sensitivity =0.701; specificity =0.542], 0.629 (95% CI: 0.574-0.638; sensitivity =0.624; specificity =0.615), and 0.819 (95% CI: 0.740-0.837; sensitivity =0.763; specificity =0.760), respectively. The clinicopathologic-CT model had higher predictive performance than the other two models by DeLong test, both in the training and validation sets.

Conclusions: Smoking history, STAS, average CT value, lobulation, and CK7 might be helpful in the diagnosis of PD-L1 expression in patients with early-stage NSCLC. The clinicopathologic-CT model had higher predictive performance than the clinicopathologic and CT models.

Background: Postoperative acute exacerbation of interstitial pneumonia (IP-AE) is highly lethal after lung resection. Whether a symptom-free, routine computed tomography (rCT) can detect IP-AE early enough to justify pre-emptive steroids is unknown. We therefore aimed to assess the diagnostic accuracy of early postoperative rCT for detecting clinical IP-AE (cIP-AE) and to identify a high-specificity rCT score threshold that could support pre-emptive steroid treatment.

Methods: This single-center, retrospective diagnostic-accuracy study analyzed 120 consecutive lung-cancer patients with underlying interstitial pneumonia (IP) who underwent high-resolution rCT within 7 days after surgery. Eligibility was based on preoperative high-resolution computed tomography (HRCT) demonstrating IP, irrespective of postoperative pathological confirmation. Two thoracic radiologists independently graded each scan on a five-point likelihood scale; a summed 10-point score (range, 2-10) was defined as the sum of the two readers' five-point ratings, assigned retrospectively. Diagnostic accuracy was expressed as sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve (AUC). The ROC analysis assessed the ability of the rCT score to detect cIP-AE. For analysis, the proposed treatment threshold was the lowest score, giving 100% specificity.

Results: IP-AE developed in 14 patients (11.6%). The ROC for cIP-AE detection yielded an AUC of 0.956. A summed score ≥9 achieved 100% specificity and detected 36% of presymptomatic events, whereas ≥6 increased sensitivity (86%) but lowered specificity (89%). Five patients received steroid pulse therapy solely on the basis of rCT; four of the five scans scored ≥9 and one scored 8. Thirty- and 90-day mortality were 0.8% and 3.3%, respectively, and no grade ≥3 steroid-related toxicity occurred.

Conclusions: A single rCT obtained within 1 week of lung resection can reveal radiological IP-AE (rIP-AE) before clinical decline. Using a score ≥9 confines early steroid treatment to patients with near-certain disease, avoiding unnecessary exposure. Prospective studies should confirm whether this high-specificity strategy improves survival and resource utilization.

Bronchoscopic ablation is an emerging minimally invasive treatment option for patients with non-small cell lung cancer (NSCLC). Techniques including radiofrequency ablation (RFA), microwave ablation (MWA), pulsed electric field (PEF) ablation, and cryoablation have been evaluated in several feasibility and early clinical studies. These approaches demonstrate technical success with encouraging safety profiles and reduced complication rates compared to percutaneous methods. Bronchoscopic RFA and MWA have shown effective tumour ablation, though isolated mortality events underscore the need for further safety evaluation. PEF ablation has gained attention for its ability to preserve surrounding structures, with early signals of favourable immune activation. Cryoablation, though tested in small cohorts, has demonstrated feasibility with minimal major adverse events. Beyond local control, an emerging theme across modalities is the potential for these treatments to stimulate systemic anti-cancer immunity, with early evidence suggesting enhanced immune responses and possible synergy with immunotherapy. Despite these advances, most studies remain small, with limited follow-up and heterogeneous endpoints, leaving long-term efficacy and optimal technique unresolved. Larger prospective trials are needed to establish safety, durability of tumour control, and comparative outcomes versus established therapies. Nonetheless, the growing body of data highlights bronchoscopic ablation as a developing therapeutic option with the potential to expand lung-sparing treatment strategies and complement evolving immunotherapy paradigms.

Background: Malnutrition, a significant complication, triggers devastating consequences among patients with chronic obstructive pulmonary disease (COPD). Although previous studies have demonstrated the benefits of nutritional support in stable COPD, evidence in hospitalized patients with acute exacerbations remains limited. This study aimed to examine the short-term association between individualized nutritional support and changes in nutritional status and clinical symptoms among inpatients with acute COPD exacerbations.

Methods: Thirty male inpatients diagnosed with acute exacerbations of COPD were enrolled in a 40-day individualized nutritional intervention program. The intervention included tailored dietary counseling based on each patient's energy and protein requirements, alongside hospital-standard medical treatment. Anthropometric measurements, serum albumin levels, and Subjective Global Assessment (SGA) were assessed at the hospital admission (T0), 7 days (T7), and 40 days (T40) of intervention. Clinical symptoms, including fatigue, dyspnea, anorexia, dysphagia, and bloating, were also monitored. Statistical analyses were two-sided, and significance was set at P<0.05.

Results: Thirty COPD patients (mean age 68.4±8.6 years; 66.7% aged >65 years) completed the 40-day individualized nutritional intervention. At baseline, 70% had chronic energy deficiency (CED) and 83.3% were malnourished (SGA-B/C). After intervention, the proportion of well-nourished patients (SGA-A) increased from 16.7% to 80%. Serum albumin rose significantly from 36.4±0.7 to 38.3±0.7 g/L (P=0.005). Mean BMI increased from 17.7±2.2 to 18.1±2.3 kg/m², and CED prevalence declined from 70% to 53.3%. Fatigue, dyspnea, and anorexia markedly improved following intervention.

Conclusions: Individualized nutritional support was associated with notable improvements in nutritional status and clinical symptoms among patients hospitalized with acute exacerbations of COPD. These findings underscore the value of incorporating tailored nutritional care into routine COPD management. However, given the small, male-only sample and short follow-up duration, further large-scale and long-term studies are warranted to verify the durability and broader applicability of these outcomes.

Background: Pulmonary basal segmentectomy is more technically demanding than other segmental resections because of its anatomical complexity and frequent variations in vascular and bronchial structures. The purpose of this study was to explore the factors that affect operation time, postoperative complications and surgical costs during basal segment resection to provide reference value for clinical practice.

Methods: This study retrospectively enrolled 190 patients who underwent thoracoscopic single or combined basal segmentectomy at the Department of Thoracic Surgery of China-Japan Friendship Hospital. Basic clinical information and perioperative data were collected, and Spearman correlation analysis and non-parametric Mann-Whitney U test and multiple linear regression were performed to identify potential influencing factors. The learning curve was evaluated based on the operative time and the cumulative sum value of the operative time in all patients.

Results: Among the 190 patients, 70 patients underwent segment resection excluding S9/S10, and 120 patients underwent segmentectomy including S9/S10. The mean operative time was 2.18±0.76 hours, the average duration of chest drainage was 3.24 days, and the mean postoperative hospitalization time was 4.24 days. The final multiple linear regression analysis results show that surgical approach, surgical procedure and intraoperative bleeding will significantly affect the operation time, surgical procedure will significantly affect the total hospitalization cost, and poor development of lung fissure will prolong the postoperative tube time. In 119 cases, the surgeon was just beginning to perform segmentectomy; after 119 cases, the surgeon became quite proficient. Thus, surgery becomes more efficient.

Conclusions: The surgical choice of single-hole thoracoscopy may significantly shorten the operation time, and the intraoperative bleeding will significantly increase the total operation time. The operation time with S9/S10 is longer than that without S9 and S10, and the total cost of hospitalization is higher. The development of pulmonary fissures significantly reduces the possibility of postoperative lung leakage.

Coronary artery bypass grafting (CABG) remains the most frequently performed cardiac surgery, yet anatomically complex cases present unique technical challenges that significantly impact outcomes. This review focuses on high-risk CABG scenarios defined by patient-specific anatomical constraints, including porcelain aorta, poor conduits and targets, redo-CABG, spontaneous coronary artery dissection (SCAD), and coronary aneurysms. Unlike prior studies emphasizing physiological comorbidities, we highlight how structural complexities alter surgical planning, limit standard techniques, and demand tailored strategies. Perioperative imaging-including computed tomographic angiography and epiaortic scanning-plays a pivotal role in risk stratification and operative planning. For porcelain or atherosclerotic ascending aorta, "no-touch" techniques, axillary cannulation, or hypothermic circulatory arrest and aortic replacement can mitigate embolic risks. Poor conduits and targets necessitate creative revascularization approaches, including composite and sequential grafting and endarterectomy, while redo-CABG requires meticulous sternal re-entry and dissection to avoid injury to cardiovascular structures including patent grafts. SCAD management favors conservative therapy, but surgery is reserved for high-risk anatomies not amenable to percutaneous interventions with substantial myocardial territories at risk, whereas symptomatic and large coronary aneurysms often require complex surgical repair. Across all scenarios, a successful outcome necessitates proper preoperative planning, intraoperative adaptability, and expertise. In this clinical practice review, we shed light on anatomically high-risk CABG cases and present the latest evidence-based and expert-recommended surgical management strategies.

Background: Lung cancer is the most common cancer and the leading cause of cancer-related death. Post-translational modifications (PTMs) play a key role in tumor progression, but the functional mechanisms of many PTM-regulated genes remain unclear. In this study, we performed a bibliometric analysis to systematically evaluate the research trends of lung cancer PTMs worldwide.

Methods: Data of Web of Science Core Collection (WOSCC) from 2000 to March 2025 were used to analyze the publication trends, collaboration networks, and keyword networks. Then, the functions of these genes were investigated by constructing protein-protein interaction (PPI) networks and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Finally, unstudied genes were screened by constructing a differential gene set between the PTM database and genes retrieved from published articles. And their potential functions were explored by gene differential expression analysis, prognosis analysis, PTM pattern analysis, Gene Ontology (GO) analysis, and KEGG analysis.

Results: China was the main contributor, followed by the United States and South Korea. Phosphorylation and methylation were the most studied PTMs, with STAT3 being the most reported gene. GO and KEGG analysis linked PTM-related genes to pathways such as cell cycle regulation. A total of 7,523 unstudied PTM-related genes in lung cancer were screened based on the PTM database. Differential expression and survival analysis revealed 134 candidate genes with potential functional relevance, mainly related to nuclear division and mitosis.

Conclusions: This study highlights the growing interest in lung cancer PTM research and identifies a group of genes that have not been studied and may become novel therapeutic targets.

Background: Ultrasound-guided percutaneous core needle biopsy (UGNB) has been widely adopted in pre-treatment pathological diagnosis in mediastinal neoplasms, while the accuracy rates varied in previous reports. We analyzed the impacting factors of accuracy in this retrospective study, aiming to further improve the diagnostic yield.

Methods: Patients with mediastinal lesions who had undergone UGNB in Shanghai Chest Hospital between August 2013 and September 2022 were included in this study. All relevant medical information was retrieved from the database of our institution. The accuracy of biopsy was verified by post-surgery pathology or clinical outcome after long-term follow-up. Potential impacting factors, such as gender, age, tumor size, cystic necrosis, needle gauge and vascularity, were analyzed via binary logistic regression.

Results: A total of 622 patients were enrolled in this study. There were 366 males and 256 females with an average age of 45 years old. There were 585 (94.05%) patients who obtained a successful diagnosis after biopsy, with a complication (≥ grade 2) rate of 3.86%. Thymic epithelial tumor (n=295), lymphoma (n=190) and germ cell tumor (n=51) were the most common three types. Cystic necrosis and younger age (<40 years) were tested to be significant impacting factors that lead to unsuccessful diagnosis, with P=0.001 and P=0.02, respectively.

Conclusions: UGNB is an effective diagnostic approach for patients with mediastinal tumors with minor complications. Cystic necrosis and younger age were significant impacting factors for unsuccessful diagnosis. New techniques, such as contrast-enhanced ultrasound and rotational core needle, may probably increase diagnostic accuracy and reduce complications.