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Locoregional therapies in advanced and recurrent pleural mesothelioma: A systematic review 晚期和复发胸膜间皮瘤的局部治疗:一项系统综述
IF 4.4 2区 医学 Q1 ONCOLOGY Pub Date : 2025-12-17 DOI: 10.1016/j.lungcan.2025.108877
Paolo Ambrosini , Thierry Berghmans , Mario Occhipinti , Valérie Durieux , Paul Van Schil , Arnaud Scherpereel , Andrea Riccardo Filippi , Mariana Brandão

Background

Locoregional therapies, including radiotherapy, surgery and other ablative techniques, are occasionally used as strategies to manage oligorecurrent or oligoprogressive pleural mesothelioma. Yet, their real-world utilization, safety and efficacy remain poorly defined.

Methods

We conducted a systematic review in accordance with PRISMA guidelines. A search was conducted in MEDLINE, Scopus, Academic Search Premier and ProQuest Central up to June 2025 for retrospective and prospective studies of surgical cytoreduction, radiotherapy, or other local interventions in oligorecurrent or oligoprogressive pleural mesothelioma. Data on patient demographics, treatment protocols, local control (LC), progression-free survival (PFS), overall survival (OS) and toxicity were extracted and synthesized descriptively.

Results

A total of 22 studies, all retrospective, encompassing 234 patients, were included. Radiotherapy series (n = 142 patients) reported one-year LC rates ranging from 73.5 to 100 %, a median PFS of 5.1–8.0 months, a median OS of 26.9–38.0 months and grade 3–4 toxicities in ≤ 13 % of patients. Surgical series of oligorecurrences (n = 67 patients) demonstrated OS ranging from 14.5 to 44.6 months, with rare long-term survivors after distant resections. A single series of percutaneous cryoablation (n = 24 patients) achieved a 90.8 % local recurrence free-survival rate at one year with minimal toxicity; a single radiofrequency ablation case yielded a 24-month PFS.

Conclusions

Retrospective evidence suggests that locoregional interventions can achieve long-term local control and acceptable safety in selected pleural mesothelioma patients with oligorecurrent or oligoprogressive disease. Prospective trials are warranted to establish optimal patient selection and strategies integrating these approaches into standard care.
背景局部治疗,包括放疗、手术和其他消融技术,偶尔被用作治疗少复发或少进展胸膜间皮瘤的策略。然而,它们在现实世界中的应用、安全性和有效性仍不明确。方法按照PRISMA指南进行系统评价。截至2025年6月,MEDLINE、Scopus、Academic search Premier和ProQuest Central进行了一项关于手术细胞减少、放疗或其他局部干预治疗少复发或少进展胸膜间皮瘤的回顾性和前瞻性研究。提取并描述性地合成了患者人口统计学、治疗方案、局部控制(LC)、无进展生存(PFS)、总生存(OS)和毒性的数据。结果共纳入22项研究,均为回顾性研究,纳入234例患者。放疗系列(n = 142例)报告一年LC率为73.5%至100%,中位PFS为5.1-8.0个月,中位OS为26.9-38.0个月,≤13%的患者毒性为3-4级。手术系列的少复发(n = 67例)显示了14.5至44.6个月的OS,在远处切除后很少有长期存活。单一系列经皮冷冻消融(n = 24例)在一年内获得90.8%的局部无复发生存率,毒性最小;一个射频消融病例获得了24个月的PFS。结论回顾性证据表明,局部干预可以实现长期的局部控制和可接受的安全性,在选定的胸膜间皮瘤患者少复发或少进展。有必要进行前瞻性试验,以建立最佳的患者选择和策略,将这些方法整合到标准护理中。
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引用次数: 0
Neoadjuvant immunotherapy plus chemotherapy in locally advanced stage III NSCLC patients undergoing definitive chemo-radiotherapy---a real‑world multicenter retrospective study 新辅助免疫治疗加化疗在局部晚期III期NSCLC患者接受明确的化疗-放疗-一个真实世界的多中心回顾性研究
IF 4.4 2区 医学 Q1 ONCOLOGY Pub Date : 2025-12-17 DOI: 10.1016/j.lungcan.2025.108883
Guoyin Li , Chaoyuan Liu , Pan Xi , Liangxue Hou , Yaoxiong Xia , YunXiang Qi , Wenyan Pan , Wei Bai , Xiaoyan Li , Hao Zhou , Pengyi Li , Zewen Song , Huiyun Zhao , Xuewen Liu

Background

The optimal integration of immunotherapy with definitive chemoradiotherapy (CRT) for unresectable stage III non-small cell lung cancer (NSCLC) remains an area of active investigation. While consolidation immunotherapy is standard, the efficacy and safety of a neoadjuvant approach are not yet established by phase III trials. This real-world study compares outcomes between neoadjuvant immuno-chemotherapy followed by CRT (NEO) and CRT followed by adjuvant immunotherapy (ADJ, the PACIFIC regimen).

Methods

In this multicenter retrospective analysis, we reviewed data from patients with stage III NSCLC who received radical thoracic radiotherapy and peri-radiotherapy immunotherapy between January 2020 and December 2023. Patients were classified into NEO (n = 321) or ADJ (n = 142) groups. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Secondary endpoints included treatment patterns, recurrence modes, and incidence of pneumonitis. Propensity score matching (PSM) and robust statistical analyses were used to minimize confounding.

Results

The median PFS was significantly longer in the NEO group than in the ADJ group (25.0 months vs. 16.3 months; HR = 0.57, 95 % CI: 0.43–0.74; p < 0.001). Median OS was not reached (NR) in the NEO group compared to 41.1 months in the ADJ group (HR = 0.54, 95 % CI: 0.37–0.78; p = 0.001). The survival benefit for the NEO group remained consistent after PSM and multivariable adjustment. The objective response rate to neoadjuvant therapy was 68.4 %. Patterns of recurrence were similar between groups, with distant metastasis being the most common site of first progression. The incidence of grade ≥2 radiation pneumonitis was comparable (31.8 % NEO vs. 30.8 % ADJ, p = 0.925), though a non-significant trend towards higher grade ≥3 radiation pneumonitis was observed in the NEO group (14.0 % vs. 7.5 %, p = 0.071). Rates of checkpoint inhibitor pneumonitis were low and similar between groups.

Conclusion

In this large real-world cohort, a treatment sequence incorporating neoadjuvant immuno-chemotherapy prior to definitive CRT was associated with significantly improved PFS and OS compared to the standard adjuvant immunotherapy approach, without a definitive increase in severe pneumonitis. These findings support the further investigation of neoadjuvant immunotherapy strategies in phase III randomized trials for stage III NSCLC.
背景:对于不可切除的III期非小细胞肺癌(NSCLC),免疫治疗与放化疗(CRT)的最佳结合仍然是一个积极研究的领域。虽然巩固免疫治疗是标准的,但新辅助方法的有效性和安全性尚未通过III期试验确定。这项现实世界的研究比较了新辅助免疫化疗后CRT (NEO)和CRT后辅助免疫治疗(ADJ, PACIFIC方案)的结果。方法在这项多中心回顾性分析中,我们回顾了2020年1月至2023年12月期间接受根治性胸部放疗和放疗期免疫治疗的III期NSCLC患者的数据。患者分为NEO组(n = 321)和ADJ组(n = 142)。主要终点为无进展生存期(PFS)和总生存期(OS)。次要终点包括治疗方式、复发方式和肺炎发病率。倾向评分匹配(PSM)和稳健的统计分析,以尽量减少混淆。结果NEO组的中位PFS明显长于ADJ组(25.0个月比16.3个月;HR = 0.57, 95% CI: 0.43-0.74; p < 0.001)。NEO组未达到中位生存期(NR),而ADJ组为41.1个月(HR = 0.54, 95% CI: 0.37-0.78; p = 0.001)。经PSM和多变量调整后,NEO组的生存获益保持一致。新辅助治疗的客观有效率为68.4%。两组之间的复发模式相似,远处转移是最常见的首次进展部位。≥2级放射性肺炎的发生率相当(NEO组为31.8%,ADJ为30.8%,p = 0.925),但在NEO组中观察到更高级别≥3级放射性肺炎的无显著趋势(14.0%,p = 0.071)。检查点抑制剂肺炎的发生率在两组之间很低且相似。结论:在这个庞大的现实世界队列中,与标准辅助免疫治疗方法相比,在最终CRT之前结合新辅助免疫化疗的治疗序列与显著改善的PFS和OS相关,而没有明显增加严重肺炎的发生率。这些发现支持在III期非小细胞肺癌的III期随机试验中进一步研究新辅助免疫治疗策略。
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引用次数: 0
Corrigendum to "Treatment and outcomes of limited stage small cell lung cancer in the Canadian small cell lung cancer database (CASCADE)" [Lung Cancer 210 (2025) 108840]. “加拿大小细胞肺癌数据库(CASCADE)中有限期小细胞肺癌的治疗和结果”[肺癌210(2025)108840]的更正。
IF 4.4 2区 医学 Q1 ONCOLOGY Pub Date : 2025-12-16 DOI: 10.1016/j.lungcan.2025.108875
William J Phillips, Luna Jia Zhan, Deepro Chowdhury, Jeniszka Gill, Alexander Sun, Rebekah Rittberg, Victor Cohen, Amanda J W Gibson, Michael Yan, Daniel Liwski, Saritha Surapaneni, Marie Frederique D'Amours, Fabian P S Yu, YongJin Kim, Rana A Qadeer, David E Dawe, Jason Agulnik, Vishal Navani, Andrea S Fung, Stephanie Snow, Sara Kuruvilla, Cheryl Ho, Benjamin H Lok, Geoffrey Liu, Paul Wheatley-Price, Sara Moore
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引用次数: 0
A pathomics model for predicting response to chemo-immunotherapy in lung squamous cell carcinoma: A multicenter study 预测肺鳞状细胞癌化疗免疫治疗反应的病理模型:一项多中心研究
IF 4.4 2区 医学 Q1 ONCOLOGY Pub Date : 2025-12-16 DOI: 10.1016/j.lungcan.2025.108881
Dongying Wang , Shuai Mu , Minghui Zhang , Guangyu Tao , Shuyuan Wang , Yinchen Shen , Guanxi Xiao , Xueyan Zhang , Baohui Han , Lei Cheng , Hua Zhong , Wei Nie

Background

The identification of lung squamous cell carcinoma (LUSC) patients who may benefit from first-line chemo-immunotherapy (CIT) remains a challenge. This study aimed to develop a pathomics model to predict the T cell-inflamed gene-expression profile (GEP) status and validate its utility in identifying patients who derive survival benefit from CIT.

Methods

The pathomics model was developed using whole-slide images and RNA-sequencing data from The Cancer Genome Atlas (TCGA) LUSC cohort (n = 334) to predict the GEP status and generate a pathomics score (PS). The predictive value of PS was validated in a prospective, multicenter trial (AK105-302, n = 267) by assessing its interaction with treatment (CIT vs. chemotherapy) for progression-free survival (PFS) and overall survival (OS). Two additional independent cohorts (n = 82 and n = 50) were used for external validation.

Results

The pathomics model accurately predicted GEP status, achieving area under the curve (AUC) values of 0.80 and 0.71 in the TCGA training and validation sets, respectively. In the AK105-302 cohort, significant interactions were identified between PS and treatment modalities for both PFS (interaction p = 0.011) and OS (interaction p < 0.001). Patients with high PS who received CIT exhibited significantly prolonged PFS (hazard ratio [HR]: 0.31, 95 % confidence interval [CI]: 0.21–0.48, p < 0.001) and OS (HR: 0.30, 95 % CI: 0.18–0.50, p < 0.001) compared to high PS patients receiving chemotherapy. However, this survival benefit was not observed in the low-PS patients. These findings were corroborated in two independent clinical cohorts. Furthermore, biological assessments revealed a significant association between high PS and an immune-hot tumor microenvironment.

Conclusion

We developed a GEP-based pathomics model that provides a practical, cost-effective strategy to identify patients most likely to derive superior survival benefit from first-line CIT over chemotherapy alone.
背景:鉴别可能受益于一线化学免疫治疗(CIT)的肺鳞状细胞癌(LUSC)患者仍然是一个挑战。本研究旨在建立一种病理模型来预测T细胞炎症基因表达谱(GEP)状态,并验证其在识别从cit中获得生存益处的患者中的应用。方法利用来自癌症基因组图谱(TCGA) LUSC队列(n = 334)的全切片图像和rna测序数据建立病理模型,预测GEP状态并生成病理评分(PS)。一项前瞻性多中心试验(AK105-302, n = 267)通过评估其与治疗(CIT vs.化疗)对无进展生存期(PFS)和总生存期(OS)的相互作用,验证了PS的预测价值。另外两个独立队列(n = 82和n = 50)用于外部验证。结果病理模型准确预测GEP状态,TCGA训练集和验证集的曲线下面积(AUC)分别为0.80和0.71。在AK105-302队列中,在PFS(相互作用p = 0.011)和OS(相互作用p <; 0.001)中,发现PS和治疗方式之间存在显著的相互作用。与接受化疗的高PS患者相比,接受CIT的高PS患者表现出明显延长的PFS(风险比[HR]: 0.31, 95%可信区间[CI]: 0.21-0.48, p < 0.001)和OS (HR: 0.30, 95% CI: 0.18-0.50, p < 0.001)。然而,在低ps患者中没有观察到这种生存获益。这些发现在两个独立的临床队列中得到了证实。此外,生物学评估显示高PS与免疫热肿瘤微环境之间存在显著关联。结论:我们开发了一种基于gep的病理模型,该模型提供了一种实用的、具有成本效益的策略,以确定最有可能从一线CIT中获得优于单独化疗的生存获益的患者。
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引用次数: 0
Identifying eligible patients for the Australian national lung cancer screening program in primary care: A cross-sectional study using clinical decision support systems and evaluating PLCOm2012 data quality 确定澳大利亚国家初级保健肺癌筛查项目的合格患者:一项使用临床决策支持系统和评估PLCOm2012数据质量的横断面研究
IF 4.4 2区 医学 Q1 ONCOLOGY Pub Date : 2025-12-14 DOI: 10.1016/j.lungcan.2025.108880
Lucas De Mendonça , Shakira Onwuka , Sarah York , Javiera Martinez-Gutierrez , Jon Emery , Christine Paul , Jo-Anne Manski-Nankervis , Nicole M. Rankin
Primary care is pivotal in identifying eligible participants for Australia’s National Lung Cancer Screening Program (NLCSP). Clinical Decision Support Systems (CDSS) can assist by flagging potentially eligible individuals using Electronic Medical Record (EMR) data. We developed a CDSS to identify people aged 50–70 who currently or formerly smoked cigarettes (with an unknown quit date or cessation within the past 10 years) for use in Australian general practice EMRs. This study aimed to: (1) assess the algorithm’s accuracy in identifying eligible patients, (2) estimate NLCSP eligibility based on audited EMR smoking data, and (3) evaluate EMR data quality for applying the PLCOm2012 risk prediction tool.
A cross-sectional EMR audit was conducted across five Victorian general practices. Of 4,186 records flagged by the CDSS, 1,315 (31.4 %) were manually audited. The algorithm correctly identified all patients according to its rules (age and smoking status). Pack-year could be calculated for 226 patients (17.2 %), with 91 (6.9 %) meeting NLCSP eligibility. Eligibility was higher among people who currently smoke (9.2 %) than those who formerly smoked (3.6 %). A subset of 933 records was assessed for PLCOm2012 variables, revealing substantial data gaps (% missing): education level (100 %), ethnicity (58 %), BMI (57 %), and daily cigarette consumption (33 %).
CDSS algorithms can identify potential NLCSP participants, but confirmation of smoking history remains essential due to sub-optimal smoking data quality. Significant data limitations currently hinder PLCOm2012 implementation via CDSS in general practice EMRs.
初级保健在确定澳大利亚国家肺癌筛查计划(NLCSP)的合格参与者方面至关重要。临床决策支持系统(CDSS)可以通过使用电子病历(EMR)数据标记潜在的合格个人来提供帮助。我们开发了一个CDSS来识别50-70岁目前或曾经吸烟的人(戒烟日期未知或在过去10年内戒烟),用于澳大利亚全科医生的电子病历。本研究旨在:(1)评估算法识别合格患者的准确性;(2)基于审计的EMR吸烟数据估计NLCSP的资格;(3)评估应用PLCOm2012风险预测工具的EMR数据质量。横断面电子病历审计进行了五个维多利亚一般做法。在CDSS标记的4186条记录中,1315条(31.4%)是手工审计的。该算法根据其规则(年龄和吸烟状况)正确识别所有患者。226例患者(17.2%)可以计算出包年,其中91例(6.9%)符合NLCSP资格。目前吸烟者(9.2%)比以前吸烟者(3.6%)的适格性更高。对933份记录的PLCOm2012变量进行了评估,发现了大量的数据缺口(缺失%):教育水平(100%)、种族(58%)、BMI(57%)和每日香烟消费(33%)。CDSS算法可以识别潜在的NLCSP参与者,但由于吸烟数据质量不理想,确认吸烟史仍然是必要的。目前,严重的数据限制阻碍了PLCOm2012通过CDSS在常规emr中实施。
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引用次数: 0
Multiomic analysis of treatment-naïve NSCLC before the era of neoadjuvant immunotherapy reveals contrasting immune phenotypes in stage IIIA: node-dominant (T1N2) exhibiting hot versus tumor-dominant (T4N0) cold features 新辅助免疫治疗时代之前treatment-naïve NSCLC的多组学分析揭示了IIIA期的不同免疫表型:淋巴结优势(T1N2)表现为热特征与肿瘤优势(T4N0)表现为冷特征
IF 4.4 2区 医学 Q1 ONCOLOGY Pub Date : 2025-12-13 DOI: 10.1016/j.lungcan.2025.108879
Duk Ki Kim , Yooyoung Chong , Min-Kyung Yeo , Da Hyun Kang , Joo-Eun Lee , Hyun-Yi Kim , Min-Woong Kang , Chaeuk Chung

Background

Non-small cell lung cancer (NSCLC) exhibits substantial heterogeneity in its tumor immune microenvironment, which critically influences therapeutic outcomes. Recently, immune checkpoint inhibitors (ICIs) have been increasingly incorporated not only in metastatic settings but also into neoadjuvant, adjuvant, and perioperative treatments. Pathologic complete remission (pCR) following neoadjuvant immunotherapy is strongly associated with reduced recurrence and favorable survival outcomes. However, reliable biomarkers for predicting preoperative immunotherapy response remain limited. The dichotomy between “hot” and “cold” tumors provides a useful framework to explain differential immunotherapy responsiveness, yet how these immune phenotypes manifest across specific tumor stages remains poorly defined.

Methods

We performed integrative analyses combining bulk RNA sequencing and immunohistochemistry (IHC) on tumor specimens from patients with stage T1N2 and T4N0 NSCLC. Frozen samples were used for RNA sequencing and formalin-fixed paraffin-embedded (FFPE) tissues for IHC, obtained from surgeries performed between 2009 and 2018—prior to the widespread introduction of immunotherapy. Differentially expressed genes (DEGs) were identified, and Gene Ontology (GO) enrichment analyses were conducted to characterize biological pathways. Immune cell infiltration and spatial distribution were assessed by IHC staining for CD3+, CD4+, CD8+, CD56+, FOXP3+, CD68+, and CD163+ markers. Statistical analyses were performed using the Mann–Whitney U test.

Results

Transcriptomic and histologic analyses revealed distinct molecular and immune profiles between T1N2 and T4N0 tumors. T1N2 tumors were enriched for immune activation pathways and displayed dense, evenly distributed infiltration of CD3+, CD4+, and CD8+ T cells. In contrast, T4N0 tumors showed upregulation of extracellular matrix organization and adhesion-related pathways, accompanied by reduced intratumoral CD4+ and CD8+ T-cell density, accumulation of FOXP3+ regulatory T cells, and increased CD163+ M2 macrophages, consistent with an immune-excluded phenotype.

Conclusion

Our integrative multiomic analysis delineates node-dominant (T1N2) NSCLC as “hot” tumors with active immune engagement, whereas tumor-dominant (T4N0) NSCLC exhibit “cold” features characterized by stromal remodeling, immune exclusion, and immunosuppression. These findings suggest that the balance between tumor invasiveness and nodal spread may shape immune contexture and potentially modulate responsiveness to neoadjuvant immunotherapy, highlighting the clinical value of immune landscape profiling in personalized NSCLC treatment.
背景:非小细胞肺癌(NSCLC)的肿瘤免疫微环境具有很大的异质性,这对治疗结果有重要影响。最近,免疫检查点抑制剂(ICIs)不仅越来越多地应用于转移性肿瘤,而且还应用于新辅助、辅助和围手术期治疗。新辅助免疫治疗后的病理完全缓解(pCR)与减少复发和有利的生存结果密切相关。然而,预测术前免疫治疗反应的可靠生物标志物仍然有限。“热”和“冷”肿瘤之间的二分法提供了一个有用的框架来解释不同的免疫治疗反应性,然而这些免疫表型如何在特定的肿瘤阶段表现出来仍然不清楚。方法对T1N2期和T4N0期非小细胞肺癌患者的肿瘤标本进行大量RNA测序和免疫组化(IHC)综合分析。冷冻样本用于RNA测序和福尔马林固定石蜡包埋(FFPE)组织用于免疫组化,这些样本来自于2009年至2018年间进行的手术——在广泛引入免疫疗法之前。鉴定差异表达基因(DEGs),并进行基因本体(GO)富集分析以表征生物学途径。免疫组化染色检测免疫细胞CD3+、CD4+、CD8+、CD56+、FOXP3+、CD68+、CD163+标志物的浸润及空间分布。采用Mann-Whitney U检验进行统计分析。结果转录组学和组织学分析显示T1N2和T4N0肿瘤具有不同的分子和免疫特征。T1N2肿瘤免疫激活途径丰富,CD3+、CD4+、CD8+ T细胞浸润密集、分布均匀。相反,T4N0肿瘤表现出细胞外基质组织和黏附相关通路的上调,并伴有瘤内CD4+和CD8+ T细胞密度的降低,FOXP3+调节性T细胞的积累,CD163+ M2巨噬细胞的增加,符合免疫排斥表型。我们的综合多组学分析表明,淋巴结显性(T1N2)非小细胞肺癌是具有主动免疫参与的“热”肿瘤,而肿瘤显性(T4N0)非小细胞肺癌表现出以基质重塑、免疫排斥和免疫抑制为特征的“冷”特征。这些发现表明,肿瘤侵袭性和淋巴结扩散之间的平衡可能塑造免疫环境,并可能调节对新辅助免疫治疗的反应性,突出了免疫景观分析在个性化非小细胞肺癌治疗中的临床价值。
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引用次数: 0
Prognostic comparison of lymph node metastasis subtypes in lung adenocarcinoma: clinical implications of intranodal metastasis versus extranodal extension for optimizing R classification 肺腺癌淋巴结转移亚型的预后比较:结内转移与结外转移对优化R分级的临床意义。
IF 4.4 2区 医学 Q1 ONCOLOGY Pub Date : 2025-12-11 DOI: 10.1016/j.lungcan.2025.108876
Jia-Yong Wu , Guo-Zhong Liang , Tian-Qing Chen , Hai-Ping Qiu , Cai-Biao Huang , Xiao-Ping Xie

Background

Lung adenocarcinoma (LUAD) prognosis is strongly influenced by lymph node (LN) status. While extranodal extension (ENE) is a recognized negative prognostic factor, the International Association for the Study of Lung Cancer (IASLC) has proposed reclassifying ENE from R0 (complete resection) to R1 (incomplete resection). The prognostic significance of intranodal metastasis (INM) remains less defined. This study aims to compare the prognosis of LUAD patients with INM versus ENE to inform potential refinements to the R classification system.

Methods

This retrospective study enrolled 357 patients with pT1-3N0-1M0 LUAD who underwent lobectomy with systematic lymph node dissection between 2015 and 2021. Patients were stratified into three groups based on postoperative pathology: no LN metastasis (N0, n = 180), INM (n = 124), and ENE (n = 53). Overall survival (OS) and disease-free survival (DFS) were compared using Kaplan-Meier and Cox regression analyses.

Results

Among 177N1-stage patients, no significant difference in OS or DFS was observed between the INM and ENE groups (p > 0.05). However, both the INM and ENE groups showed significantly worse OS and DFS compared to the N0 group (p < 0.05). Multivariate analysis confirmed LN metastasis as an independent adverse prognostic factor for both DFS (HR = 2.95, 95 % CI: 1.32–6.61, P = 0.008) and OS (HR = 3.11, 95 % CI: 1.52–6.38, P = 0.002). Patients with nodal metastasis also had a significantly higher risk of recurrence.

Conclusion

In N1-stage LUAD, the prognosis of patients with INM is comparable to that of patients with ENE, with both groups exhibiting significantly poorer outcomes than node-negative patients. These findings suggest that the presence of nodal metastasis, regardless of extracapsular extension, may represent occult residual disease. We propose that INM, alongside ENE, should be considered for classification as incomplete resection (R1) to better guide adjuvant therapy strategies.
背景:肺腺癌(LUAD)的预后受淋巴结(LN)状态的强烈影响。虽然结外延伸(ENE)是公认的不良预后因素,但国际肺癌研究协会(IASLC)已提议将ENE从R0(完全切除)重新分类为R1(不完全切除)。结内转移(INM)的预后意义仍不明确。本研究旨在比较INM和ENE LUAD患者的预后,为R分类系统的潜在改进提供信息。方法:本回顾性研究纳入了357例2015年至2021年间接受肺叶切除术并系统性淋巴结清扫的pT1-3N0-1M0 LUAD患者。根据术后病理情况将患者分为3组:无LN转移(n = 180)、INM (n = 124)和ENE (n = 53)。采用Kaplan-Meier和Cox回归分析比较总生存期(OS)和无病生存期(DFS)。结果:177n1期患者中,INM组与ENE组OS、DFS比较差异无统计学意义(p < 0.05)。然而,INM组和ENE组的OS和DFS均较N0组明显差(p)。结论:在n1期LUAD中,INM患者的预后与ENE患者相当,两组预后均明显差于淋巴结阴性患者。这些发现提示淋巴结转移的存在,无论囊外延伸,都可能代表隐匿性残留疾病。我们建议INM和ENE应考虑归类为不完全切除(R1),以更好地指导辅助治疗策略。
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引用次数: 0
Global patterns and trends in mesothelioma incidence: A retrospective cross-sectional study 间皮瘤发病率的全球模式和趋势:一项回顾性横断面研究。
IF 4.4 2区 医学 Q1 ONCOLOGY Pub Date : 2025-12-11 DOI: 10.1016/j.lungcan.2025.108878
Leiwen Fu , Ke Liu , Yang Liu , Yanxiao Gao , Bingyi Wang , Yuxian Sun , Wei Shu , Yujia Ning , Minyi Zhang , Jian Du , Liang Li

Background

Mesothelioma is a rare and aggressive malignancy primarily caused by asbestos exposure; it predominantly affects older adults with a history of occupational contact.

Methods

This population-based study used the GLOBOCAN 2022 database to estimate mesothelioma incidence and mortality across 185 countries in 2022. Long-term trends were assessed using the Cancer Incidence in Five Continents (CI5) Volume XII and CI5 plus databases. Age-standardised incidence rates (ASIRs) were calculated, and Joinpoint regression analysis was employed to assess trends in mesothelioma ASIRs by estimating the average annual percentage change (AAPC).

Results

In 2022, there were an estimated 30,633 new mesothelioma cases globally, with an ASIR of 0.28 per 100,000. Europe bore the highest burden, accounting for 48.1% of global cases and 48.4% of deaths. A significant positive correlation was observed between the ASIR or age-standardised mortality rate (ASMR) and the Human Development Index. From 2003 to 2017, while mesothelioma incidence decreased in many regions, significant increases were observed among male in Croatia (AAPC: 2.5, 95% CI: 0.3 to 4.8), the Republic of Korea (2.5, 1.2 to 3.7), and Slovenia (1.2, 0.1 to 2.2), as well as in female in Canada (4.5, 1.3 to 7.9). Mesothelioma incidence declined significantly in males in Australia, Belarus, Germany, Israel, the Netherlands, New Zealand, Norway, Turkey, the UK, and in the White population of the USA, as well as in females in Belarus, Germany, and Turkey.

Conclusion

Mesothelioma remains a significant global health challenge, characterised by notable geographic and socioeconomic disparities. Sustained public health efforts are required to eliminate asbestos exposure and reduce disease burden, particularly in regions with rising incidence.
背景:间皮瘤是一种罕见的侵袭性恶性肿瘤,主要由石棉暴露引起;它主要影响有职业接触史的老年人。方法:这项基于人群的研究使用GLOBOCAN 2022数据库来估计2022年185个国家的间皮瘤发病率和死亡率。使用五大洲癌症发病率(CI5)第十二卷和CI5 plus数据库评估长期趋势。计算年龄标准化发病率(asir),并通过估计平均年百分比变化(AAPC)采用Joinpoint回归分析来评估间皮瘤asir的趋势。结果:2022年,全球估计有30,633例间皮瘤新发病例,ASIR为0.28 / 10万。欧洲的负担最重,占全球病例的48.1%,死亡人数的48.4%。在ASIR或年龄标准化死亡率(ASMR)与人类发展指数之间观察到显著的正相关。从2003年到2017年,虽然许多地区的间皮瘤发病率下降,但克罗地亚(AAPC: 2.5, 95% CI: 0.3至4.8)、韩国(2.5,1.2至3.7)和斯洛文尼亚(1.2,0.1至2.2)的男性以及加拿大的女性(4.5,1.3至7.9)的间皮瘤发病率显著增加。间皮瘤发病率在澳大利亚、白俄罗斯、德国、以色列、荷兰、新西兰、挪威、土耳其、英国和美国白人人群中的男性以及白俄罗斯、德国和土耳其的女性中显著下降。结论:间皮瘤仍然是一个重大的全球健康挑战,其特征是显著的地理和社会经济差异。需要持续的公共卫生努力,以消除石棉接触和减轻疾病负担,特别是在发病率上升的区域。
{"title":"Global patterns and trends in mesothelioma incidence: A retrospective cross-sectional study","authors":"Leiwen Fu ,&nbsp;Ke Liu ,&nbsp;Yang Liu ,&nbsp;Yanxiao Gao ,&nbsp;Bingyi Wang ,&nbsp;Yuxian Sun ,&nbsp;Wei Shu ,&nbsp;Yujia Ning ,&nbsp;Minyi Zhang ,&nbsp;Jian Du ,&nbsp;Liang Li","doi":"10.1016/j.lungcan.2025.108878","DOIUrl":"10.1016/j.lungcan.2025.108878","url":null,"abstract":"<div><h3>Background</h3><div>Mesothelioma is a rare and aggressive malignancy primarily caused by asbestos exposure; it predominantly affects older adults with a history of occupational contact.</div></div><div><h3>Methods</h3><div>This population-based study used the GLOBOCAN 2022 database to estimate mesothelioma incidence and mortality across 185 countries in 2022. Long-term trends were assessed using the Cancer Incidence in Five Continents (CI5) Volume XII and CI5 <em>plus</em> databases. Age-standardised incidence rates (ASIRs) were calculated, and Joinpoint regression analysis was employed to assess trends in mesothelioma ASIRs by estimating the average annual percentage change (AAPC).</div></div><div><h3>Results</h3><div>In 2022, there were an estimated 30,633 new mesothelioma cases globally, with an ASIR of 0.28 per 100,000. Europe bore the highest burden, accounting for 48.1% of global cases and 48.4% of deaths. A significant positive correlation was observed between the ASIR or age-standardised mortality rate (ASMR) and the Human Development Index. From 2003 to 2017, while mesothelioma incidence decreased in many regions, significant increases were observed among male in Croatia (AAPC: 2.5, 95% CI: 0.3 to 4.8), the Republic of Korea (2.5, 1.2 to 3.7), and Slovenia (1.2, 0.1 to 2.2), as well as in female in Canada (4.5, 1.3 to 7.9). Mesothelioma incidence declined significantly in males in Australia, Belarus, Germany, Israel, the Netherlands, New Zealand, Norway, Turkey, the UK, and in the White population of the USA, as well as in females in Belarus, Germany, and Turkey.</div></div><div><h3>Conclusion</h3><div>Mesothelioma remains a significant global health challenge, characterised by notable geographic and socioeconomic disparities. Sustained public health efforts are required to eliminate asbestos exposure and reduce disease burden, particularly in regions with rising incidence.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"211 ","pages":"Article 108878"},"PeriodicalIF":4.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145757063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reply to letter to the editor “The effectiveness of pembrolizumab maintenance with or without pemetrexed after induction treatment for advanced non-squamous Non-Small-Cell lung cancer” 回复编辑的信“晚期非鳞状非小细胞肺癌诱导治疗后派姆单抗维持与培美曲塞或不培美曲塞的有效性”。
IF 4.4 2区 医学 Q1 ONCOLOGY Pub Date : 2025-12-06 DOI: 10.1016/j.lungcan.2025.108872
Bas J.M. Peters , Stefan Böhringer , Esmee van Geffen
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引用次数: 0
Informed choice for lung cancer screening: A randomised trial of three decision support tools 肺癌筛查的知情选择:三种决策支持工具的随机试验。
IF 4.4 2区 医学 Q1 ONCOLOGY Pub Date : 2025-12-06 DOI: 10.1016/j.lungcan.2025.108874
Rachael H Dodd , Marianne Weber , Kathleen McFadden , Nicole M Rankin
Shared decision-making in the Australian National Lung Cancer Screening Program (NLCSP) involves consultation between healthcare provider and individual to ensure participants make an informed choice about screening. Three decision support tools were co-designed: a 16-page A5 booklet (booklet), 2-page A4 leaflet (leaflet) and a 3-minute animated video (video). This randomised trial evaluated the tools’ ability to support informed choice, attitudes/intentions towards lung cancer screening, acceptability, comprehension, ease of understanding and balance of information of the tool. An online survey was conducted with people eligible for the Australian NLCSP. Participants were randomised to view one of the tools and completed a questionnaire. The primary outcome was informed choice (defined as adequate knowledge and congruency between attitudes and screening intentions). 715 participants completed the survey: booklet (n = 221), leaflet (n = 252) and video (n = 242). There was no statistically significant difference in informed choice between tools; informed choice was made by 148 (67 %) people who viewed the booklet, 167 (66.3 %) for the leaflet and 153 (63.2 %) for the video. Across all the tools, over 90 % found the information clear and easy to understand, around 85 % found the tool they viewed as helpful in deciding about screening, and around 80 % would recommend the viewed tool to others. Almost 80 % in each group intended to participate in lung cancer screening. Attitudes towards screening were significantly less positive for those viewing the leaflet than the booklet or video (p = 0.006). Each decision support tool was acceptable, supported informed choice, and could be adapted for use in the Australian NLCSP.
澳大利亚国家肺癌筛查计划(NLCSP)的共同决策包括医疗保健提供者和个人之间的咨询,以确保参与者对筛查做出知情的选择。共同设计了3种决策支持工具:16页的A5小册子(booklet)、2页的A4传单(传单)和3分钟的动画视频(video)。这项随机试验评估了工具支持知情选择的能力、对肺癌筛查的态度/意图、可接受性、理解性、易于理解性和工具信息的平衡。一项在线调查是针对有资格获得澳大利亚NLCSP的人进行的。参与者被随机分配观看其中一种工具,并完成一份调查问卷。主要结果是知情选择(定义为充分的知识和态度与筛查意图之间的一致性)。715名参与者完成了调查:小册子(n = 221),传单(n = 252)和视频(n = 242)。两种工具在知情选择方面没有统计学上的显著差异;有148人(67%)观看了宣传册,167人(66.3%)观看了宣传册,153人(63.2%)观看了宣传册。在所有工具中,超过90%的人认为信息清晰易懂,约85%的人认为他们认为该工具有助于决定筛选,约80%的人会向他人推荐该工具。每组中近80%的人打算参加肺癌筛查。看传单的人对筛查的态度明显不如看小册子或视频的人积极(p = 0.006)。每个决策支持工具都是可接受的,支持知情选择,并且可以适用于澳大利亚NLCSP。
{"title":"Informed choice for lung cancer screening: A randomised trial of three decision support tools","authors":"Rachael H Dodd ,&nbsp;Marianne Weber ,&nbsp;Kathleen McFadden ,&nbsp;Nicole M Rankin","doi":"10.1016/j.lungcan.2025.108874","DOIUrl":"10.1016/j.lungcan.2025.108874","url":null,"abstract":"<div><div>Shared decision-making in the Australian National Lung Cancer Screening Program (NLCSP) involves consultation between healthcare provider and individual to ensure participants make an informed choice about screening. Three decision support tools were co-designed: a 16-page A5 booklet (booklet), 2-page A4 leaflet (leaflet) and a 3-minute animated video (video). This randomised trial evaluated the tools’ ability to support informed choice, attitudes/intentions towards lung cancer screening, acceptability, comprehension, ease of understanding and balance of information of the tool. An online survey was conducted with people eligible for the Australian NLCSP. Participants were randomised to view one of the tools and completed a questionnaire. The primary outcome was informed choice (defined as adequate knowledge and congruency between attitudes and screening intentions). 715 participants completed the survey: booklet (n = 221), leaflet (n = 252) and video (n = 242). There was no statistically significant difference in informed choice between tools; informed choice was made by 148 (67 %) people who viewed the booklet, 167 (66.3 %) for the leaflet and 153 (63.2 %) for the video. Across all the tools, over 90 % found the information clear and easy to understand, around 85 % found the tool they viewed as helpful in deciding about screening, and around 80 % would recommend the viewed tool to others. Almost 80 % in each group intended to participate in lung cancer screening. Attitudes towards screening were significantly less positive for those viewing the leaflet than the booklet or video (p = 0.006). Each decision support tool was acceptable, supported informed choice, and could be adapted for use in the Australian NLCSP.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"211 ","pages":"Article 108874"},"PeriodicalIF":4.4,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145724446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Lung Cancer
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