Journal of thoracic disease最新文献

Background: Neuron-specific enolase (NSE) in pleural fluid has been proposed as a promising diagnostic biomarker. However, existing studies on the diagnostic accuracy of NSE have reported inconsistent results. This study aimed to assess the accuracy of NSE in differentiating malignant pleural effusion (MPE) from benign pleural effusion (BPE) and investigate potential sources of heterogeneity in the diagnostic performance of NSE reported in previous studies.

Methods: We prospectively enrolled patients with undiagnosed pleural effusion from two centers in China (Hohhot and Changshu) and blindly measured their pleural fluid NSE level using an electrochemiluminescence assay. The diagnostic accuracy of NSE was assessed using a receiver operating characteristic (ROC) curve and decision curve analysis (DCA). We used the published studies to analyze the association between the prevalence of heart failure (HF) in the studied cohort and the diagnostic accuracy of NSE.

Results: The Hohhot center enrolled 153 patients (66 MPEs, 87 BPEs), and the Changshu center enrolled 58 patients (26 MPEs, 32 BPEs). MPE patients exhibited significantly higher levels of NSE compared to BPE patients in the Hohhot cohort. The areas under the curve (AUCs) for NSE were 0.68 [95% confidence interval (CI): 0.59-0.77] for the Hohhot cohort and 0.65 (95% CI: 0.51-0.79) for the Changshu cohort. The sensitivity and specificity of NSE in the Hohhot cohort were 0.50 (95% CI: 0.38-0.62) and 0.79 (95% CI: 0.70-0.86), respectively, at the 13.92 ng/mL threshold. In the Changshu cohort, the sensitivity and specificity of NSE were 0.42 (95% CI: 0.26-0.61) and 0.84 (95% CI: 0.68-0.93), respectively, at the 62.50 ng/mL threshold. The DCA of NSE was near the reference lines in both cohorts. HF prevalence was positively correlated with AUC in published studies.

Conclusions: The current evidence does not support that NSE serves as a useful diagnostic marker for MPE. The prevalence of HF patients in the studied cohort affects the diagnostic accuracy of NSE.

Background: Airway epithelial cells (AECs) are crucial in respiratory tract. They are not only physical protective barriers, but also sensors of pathogens that release inflammatory mediators and chemokines that modulate the immune response. This study aims to explore global research trends on AECs-immune interactions via bibliometric analysis and provide immunology data to enhance understanding of AECs' role in respiratory disease immunity.

Methods: This study employed the Web of Science Core Collection (WOSCC) database to scan published data on AECs and immune responses from 2003 to 2023. The results were analyzed using bibliometric methods. Furthermore, statistical analysis was performed to assess the number of articles, publication years, distribution of author countries, and thematic areas.

Results: A total of 1,146 relevant articles were acquired. It was revealed that over the past two decades, there was a significant increase in studies focused on the relationship between AECs and immune responses. Moreover, most research topics comprised immune regulation of AECs, pathophysiology, and respiratory infections. Furthermore, most studies were from the United States, China, and European countries with universities and medical research centers being the most active research institutions.

Conclusions: Research on the association between AECs and immune responses is rapidly increasing globally and further investigation will increase the understanding of airway immune system regulation and the pathogenesis of respiratory diseases, thereby providing theoretical support for the development of novel therapeutic approaches and drug design.

This article provides a systematic analysis and commentary on the North American Expert Consensus regarding the clinical role of ex vivo lung perfusion (EVLP) using acellular perfusate. The consensus outlines key recommendations, including general statements on EVLP, criteria for donor lung selection, critical assessment parameters during perfusion, and a decision-making framework for transplantation. It emphasizes that current clinical practice relies heavily on small-scale, non-randomized, single-center studies, which often require substantial reliance on clinical judgment and institutional experience. As a result, the consensus calls for further, more rigorous research to establish evidence-based guidelines for EVLP-related decisions. By integrating the consensus recommendations with recent advancements in both basic and clinical EVLP research, this article examines the clinical relevance of various decision-making criteria and evaluation frameworks. It also explores EVLP management strategies within specific clinical contexts identified in the consensus. Additionally, the article discusses the inherent logistical and economic challenges associated with implementing EVLP in clinical settings. By clarifying both established principles and ongoing controversies, this review aims to bridge the gap between theoretical consensus and clinical practice, and to provide a useful reference for standardizing EVLP protocols, improving donor lung quality, expanding the donor pool, and enhancing transplant outcomes.

Background: The benefit of adjuvant chemotherapy (ACT) in stage IB non-small cell lung cancer (NSCLC) remains controversial, particularly for patients with high-risk features [visceral pleural invasion (VPI), lymphovascular invasion (LVI), poor differentiation]. This study aimed to evaluate the efficacy of ACT in this cohort.

Methods: We retrospectively analyzed 356 patients with stage IB [American Joint Committee on Cancer (AJCC) 9th edition] lung adenocarcinoma treated from 2016 to 2019, of whom 276 with at least one high-risk factor were included in the study. Propensity score matching (PSM) was used to balance baseline characteristics (n=106 per group). Disease-free survival (DFS) and overall survival (OS) were compared between the ACT and non-ACT groups.

Results: ACT significantly improved DFS [hazard ratio (HR) =0.471, P=0.001] and OS (HR =0.519, P=0.03). Subgroup analysis revealed that the benefit was grade-dependent: patients with poorly differentiated (G3) tumors had a 66.5% lower risk of recurrence with ACT (HR =0.335, P=0.001), while those with moderately differentiated (G2) tumors derived no significant benefit (HR =1.041, P=0.91). High-grade histologic patterns (solid, micropapillary, and complex glandular), LVI, and tumor size were independent predictors of poor survival. VPI status did not significantly influence ACT efficacy (P=0.95).

Conclusions: ACT provides survival benefits for stage IB NSCLC patients with high-risk features, especially in poorly differentiated (G3) tumors. Histologic grading might serve as a useful tool to guide ACT decisions and to avoid potential overtreatment in moderately differentiated (G2) subgroups.

Background: The validity and safety of simultaneously performing coronary artery bypass grafting (CABG) and lung cancer resection remain inconclusive. This study examined the clinical progression of patients undergone this surgery.

Methods: Fifty-seven patients who underwent concurrent off-pump CABG (OPCABG) and pulmonary lobectomy between May 2006 and December 2019 in Beijing Anzhen Hospital were retrospectively analyzed. Baseline characteristic and clinical data of patients were collected, and postoperative follow-up was performed to evaluate the prognosis.

Results: All procedures were performed with median or parasternal incision, and thoracoscope was used in 15 of them. No intraoperative deaths were reported. An average of 2.52±0.90 coronary vessels were grafted per procedure. One patient died in hospital due to postoperative low cardiac output, another due to respiratory failure. In Cox multivariate regression analysis, age >69 years [hazard ratio (HR): 1.223, 95% confidence interval (CI): 1.067-1.402, P=0.004, area under the curve (AUC) =0.657] and tumor stage >III (HR: 5.384, 95% CI: 1.917-15.125, P=0.001, AUC =0.715) emerged as significant predictors of adverse event risk for survival. During the 17-year follow-up, the mean survival time was 85.39±49.70 months, with a primary endpoint of death reached by 21.05% (12/57) of patients. All deaths were attributed to tumor progression, and there were no new myocardial infarction or heart failure readmissions.

Conclusions: OPCABG combined with pulmonary resection is safe and effective in the treatment of patients with concomitant coronary artery disease (CAD) and lung cancer. Age and tumor stage were significantly correlated with postoperative survival. The predictive value of tumor stage above III surpasses that of age in prognostic assessment. For patients aged 69 years and with tumors of stage III or higher, surgical decision-making requires careful consideration due to the potentially increased risk of adverse outcomes.

Background: There is no consensus on whether a thorough mediastinal lymph node dissection (MLND) is necessary for stage I lung adenocarcinoma (AD) patients who require lobectomy. This study aimed to evaluate the survival impact of MLND in patients with T1 stage lung AD undergoing lobectomy.

Methods: We conducted a retrospective cohort study of 5,398 patients diagnosed with lung AD (tumor diameter 1-29 mm) from 2004 to 2015, utilizing data from the Surveillance, Epidemiology, and End Results (SEER) program. Patients were treated with either lobectomy only or lobectomy with MLND. The primary endpoint was overall survival (OS), analyzed using Kaplan-Meier survival analysis, Chi-squared testing, and Cox regression analysis.

Results: At a median follow-up of 97 months, the median survival duration for patients with T1a lung AD who underwent lobectomy with MLND was significantly longer (143 months), compared to those who underwent lobectomy alone (79 months, P<0.001). Similar survival benefits were found for T1b and T1c lung AD. Multivariate analysis revealed that lobectomy with MLND was an independent prognostic factor for patients with T1 stage lung AD [hazard ratio (HR) =0.731; 95% confidence interval (CI): 0.639-0.837; P<0.001]. Other significant prognostic factors included gender, age, N stage, and treatment modalities.

Conclusions: Our findings suggest that MLND significantly improves survival in patients with T1 stage lung AD, highlighting its importance as a surgical strategy. Further prospective randomized controlled trials are needed to confirm these findings.

[This corrects the article DOI: 10.21037/jtd-23-1975.].

Background: Lung squamous cell carcinoma (LSCC) is a prevalent subtype of non-small cell lung cancer (NSCLC). While there have been some prognostic models for LSCC, models specifically addressing stage IIIA LSCC are still limited. The aim of this study is to develop a nomogram to predict the overall survival (OS) of patients with stage IIIA LSCC.

Methods: Patients diagnosed with LSCC between 2,010 and 2,015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database, and their basic clinical characteristics were analyzed. A 1:1 propensity score matching (PSM) analysis was performed to balance the baseline characteristics of the patients. The OS of patients was evaluated using Kaplan-Meier analysis and compared with the log-rank test. Clinical prognostic factors related to OS were analyzed using univariate and multivariate Cox regressions, and a visual nomogram model for predicting patient prognosis was developed and validated.

Results: This study included 4,268 patients with stage IIIA LSCC, comprising 1,157 cases in the cancer-directed surgery (CDS) group and 3,111 cases in the no-cancer-directed surgery (no-CDS) group. After PSM, 1,095 patients in the CDS group were matched with 1,095 patients in the no-CDS group. Kaplan-Meier survival analysis revealed the significant beneficial effect of surgery on OS in both the original and matched cohorts. Multivariate Cox analysis indicated that sex, age, marital status, surgery, and chemotherapy were independent prognostic factors for stage IIIA LSCC. Additionally, the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) curve demonstrated strong predictive performance in both the training and validation cohorts of the prognostic nomogram.

Conclusions: Through univariate and multivariate Cox regression analyses, sex, age, marital status, surgery, and chemotherapy were identified as independent prognostic risk factors for OS in patients with stage IIIA LSCC. A nomogram was successfully developed to assist clinicians in making more informed treatment decisions.