Thoracic Cancer最新文献

Sleeve right lower lobectomy (SRLL) is an uncommon procedure for right lower lobe lung cancer involving the intermediate bronchus, mainly because it is more technically demanding than lower bilobectomy (LBL), particularly due to challenges such as bronchial caliber mismatch and anastomotic tension. We retrospectively reviewed four chronic obstructive pulmonary disease (COPD) patients who underwent SRLL at Akita University Hospital (2020-2023). All cases had squamous cell carcinoma pStage IB-IIB. Postoperative respiratory function exceeded the predicted postoperative values for LBL and even for right lower lobectomy, suggesting preservation of pulmonary function beyond initial estimates. One bronchopleural fistula occurred, but it healed with conservative treatment. No recurrences were observed. SRLL with middle lobe preservation may improve outcomes by reducing complications and preserving pulmonary function, especially in COPD patients.

Background: In robot-assisted thoracoscopic (RATS) bronchial sleeve lobectomy, despite the continuous suturing (CS) technique's widespread adoption, the safety and advantages of the semi-continuous suturing (SCS) technique remain inconclusive.

Methods: Patients undergoing RATS bronchial sleeve lobectomy for central Non-Small Cell Lung Cancer (NSCLC) between January 2020 and December 2024 were retrospectively enrolled and stratified into two cohorts based on anastomotic technique: the CS group and the SCS group. Perioperative outcomes were compared between the two groups.

Results: The SCS group (n = 18) demonstrated significantly shorter anastomotic time than the CS group (n = 14) (median 28 min [24-33] vs. 45 min [32-52]; p < 0.001), with a 21-min reduction in operative time (median 135 min [110-185] vs. 156 min [138-212]; p = 0.040). No statistically significant differences were observed in: overall complication rates (anastomosis-specific: 11.1% vs. 21.4%, p = 0.425; systemic: 22.2% vs. 42.9%, p = 0.212); 90-day mortality (0% vs. 7.1%, p = 0.467); late stenosis rate (0% vs. 7.1%, p = 0.249) or reoperation rate (5.6% vs. 14.3%, p = 0.401); postoperative recovery metrics (extubation time and hospital stay, p > 0.05).

Conclusions: SCS can safely reduce bronchial anastomosis time in RATS sleeve resection and is recommended as the preferred technique for optimizing operative efficiency.

Radiation recall dermatitis (RRD) is an inflammatory skin reaction confined to areas previously exposed to radiation, triggered by subsequent systemic therapy. This case report describes a female patient with hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer. She received 6 cycles of neoadjuvant chemotherapy, followed by mastectomy with immediate tissue expander implantation and axillary lymph node dissection. Adjuvant radiotherapy and intensive endocrine therapy (endocrine therapy and abemaciclib) were administered postoperatively. After radiotherapy, the patient developed small, coin-sized skin flap necrosis. Two months after completing radiotherapy, she initiated abemaciclib treatment, which was followed by rapid progression of flap necrosis and increased exposure of the tissue expander. This flap necrosis was suggestive of RRD. This report details the clinical course, management strategies, and a review of relevant literature, aiming to provide valuable insights for clinicians in handling similar cases and enhance awareness of potential risks associated with this treatment combination.

Background: Lobectomy, a cornerstone in the treatment of various thoracic tumors, often requires postoperative chest drainage to prevent complications such as pneumothorax and pleural effusion. Traditional water-seal drainage systems have limitations, including inconvenience and restricted patient mobility.

Methods: This study investigated the safety and efficiency of a disposable dry seal chest drainage system compared to the traditional water-seal system in lobectomy patients. An open-label randomized controlled trial with trial registration number NCTO6410716 was conducted, including 82 patients undergoing elective three-port thoracoscopic lobectomy. The study assessed postoperative pain, functional recovery, complications such as DVT, and nursing workload.

Results: The results showed that the disposable dry seal chest drainage system significantly reduced nursing workload (p < 0.001) and improved patient mobility, with patients in the experimental group having significantly higher finger oxygen saturation levels on postoperative day 1 (p = 0.01) and day 2 (p < 0.001) compared to the control group. The incidence of DVT during the hospital stay was also lower in the experimental group (p = 0.032). Although no significant improvement in postoperative pain scores was observed, the improved functionality and reduced nursing workload suggest potential benefits for patient care and resource management.

Conclusions: This study provides valuable insights into the potential advantages of the new drainage system and its alignment with enhanced recovery after surgery (ERAS) protocols, supporting its use as a superior option in postoperative chest drainage management for lobectomy patients.

Immunotherapy has transformed the therapeutic landscape of breast cancer. Nevertheless, an exhaustive overview of the treatment-related adverse events (TRAEs) and immune-related adverse events (irAEs) spectrum of immune checkpoint inhibitor (ICI)-based combination therapies remains lacking. We performed a comprehensive systematic review and meta-analysis comparing chemotherapy, antibody-drug conjugate (ADC) therapy, targeted therapy, immunotherapy, endocrine therapy, radiotherapy, and dual therapy combined with ICIs. The primary outcomes were overall incidence rates and profiles for all-grade and grade 3 or higher TRAEs and irAEs according to random effects models. We identified 8236 records, 100 of which (9192 patients) met the inclusion criteria. For grade ≥ 3 TRAEs, the ICI-based chemotherapy and ICI-based ADC regimens demonstrated equivalent incidence rates, marginally exceeding those observed in the ICI-based targeted therapy group. Analysis of irAEs revealed that ICI-based chemotherapy combinations had a significantly lower incidence than other dual-agent regimens did. In triplet regimens that combined ICIs with chemotherapy plus additional immunotherapy, irAEs rates remained nearly comparable to those of dual therapies. Among the therapeutic regimens analyzed, ICIs combined with multitarget tyrosine kinase inhibitors (mTKIs) presented the highest incidence rates of both all-grade and grade ≥ 3 irAEs. Conversely, combination regimens of ICIs with poly ADP-ribose polymerase (PARP) inhibitors or HER2-targeted monotherapy demonstrated markedly lower risks of irAEs. Our study provides comprehensive data on the TRAEs and irAEs associated with ICI-based combination therapies. These results offer direct and practical references for clinicians to evaluate toxicity profiles and optimize treatment decisions in routine breast cancer care.

Robot-assisted thoracoscopic surgery facilitates the execution of intrathoracic hand-sewn layered anastomosis during minimally invasive esophagectomy. However, challenges persist due to the complex technical demands inherent in this procedure. Patients who received robot-assisted Ivor-Lewis esophagectomy with intrathoracic hand-sewn layered anastomosis for esophageal cancer were enrolled. A novel irrigation-drainage auxiliary system designed for robot-assisted thoracoscopic esophagectomy was introduced to optimize the execution of intrathoracic hand-sewn layered anastomosis. The anastomosis time, operation time, postoperative complications, and postoperative hospital stay were evaluated. A total of 30 patients were enrolled, and the application of this system resulted in a median anastomosis time of 37 min (range: 28-65). None of the patients experienced postoperative anastomotic leakage or pleural cavity infection, indicating satisfactory short-term safety and efficacy. The device improved operative efficiency by providing better exposure of the anastomotic region, enabling complete abdominal and thoracic drainage and freeing the assistant's hands for other tasks.

Main problem: The treatment and prognosis of lung adenocarcinoma (LUAD) remain challenging. The study aimed to identify prognostic genes and construct a prognostic model for LUAD.

Methods: After identifying malignant alveolar type II (AT2) cells using InferCNV, we applied CytoTRACE, pseudo-time analysis, Mendelian randomization (MR), and univariate Cox regression analysis to identify prognostic genes. A prognostic model was then developed using an optimized subset of these genes, selected through the least absolute shrinkage and selection operator (LASSO) algorithm. Further analyses included Gene Ontology enrichment analysis and the construction of a protein-protein interaction (PPI) network.

Results: Pseudo-time analysis identified 3526 dynamically expressed genes during malignant AT2 cell dedifferentiation. Subsequent multi-omics integration refined the gene selection, yielding four prognostic genes for the final predictive model. The resulting model achieved area under the receiver operating characteristic (ROC) curve (AUC) values of 0.649, 0.675, and 0.654 for predicting 1, 2, and 3-year overall survival (OS) in the training set, respectively, and was successfully validated in two external cohorts at the corresponding time points. Moreover, survival analysis demonstrated that patients in the high-risk group had significantly poorer OS than those in the low-risk group, both in the training set and the validation sets (p < 0.01).

Conclusions: The study developed a novel signature based on genes dynamically expressed during malignant AT2 cell dedifferentiation, capable of predicting the prognosis of LUAD patients, and offered four accurate prognostic biomarkers (ADM, MARK4, PARVA, and RPS6KA1).

Background: While chemotherapy remains the treatment of choice for mesothelioma, it carries significant toxicities, especially hematological toxicity.

Methods: We conducted this territory-wide retrospective study in Hong Kong to investigate the prevalence and risk factors of hematological toxicity associated with mesothelioma treatment.

Results: A total of 222 patients were included in the analysis. Lower baseline serum albumin level and more lines of cytotoxic chemotherapy received were risk factors for developing grade 3-4 hematological toxicity with aOR of 1.05 (95% CI, 1.02-1.09, p = 0.003) and 1.50 (95% CI, 1.03-2.19, p = 0.033) respectively. Risk factors for developing neutropenic fever included: diabetes mellitus (aOR = 9.44, 95% CI, 2.59-34.45, p < 0.001); the use of chemotherapy other than pemetrexed (aOR = 4.80, 95% CI, 1.05-21.89, p = 0.043); the presence of third-space fluid (aOR = 3.58, 95% CI, 1.16-11.05, p = 0.027), pleural effusion (aOR = 4.20, 95% CI, 1.34-13.17, p = 0.014) and pericardial effusion (aOR = 7.97, 95% CI, 1.18-53.93, p = 0.033). Number of lines of cytotoxic chemotherapy the patients received was the risk factor for pack cell transfusion with aOR of 2.35 (95% CI, 1.54-3.60, p < 0.001).

Conclusion: Hematological toxicities were commonly seen in the treatment course of mesothelioma. Risk factors include disease factors and treatment factors. Use of ICI could bring about hope in reducing the risk of hematological toxicities.

Pleomorphic carcinoma is a rare, aggressive subtype of non-small cell lung cancer (NSCLC). Invasion into the left atrium and dissemination to cerebral arteries are exceptionally uncommon, and the role of cardiopulmonary bypass (CPB)-assisted resection remains debated. We report two surgically treated cases with left atrial invasion. Case 1: A 57-year-old man underwent left lower lobectomy with partial atrial resection under CPB. One month later, he developed subarachnoid hemorrhage caused by rupture of a cerebral aneurysm secondary to metastasis; histology of the aneurysmal wall confirmed carcinoma. He remains recurrence-free at 21 months. Case 2: A 62-year-old woman underwent extended left upper lobectomy with partial atrial resection under CPB. Although adrenal metastasis was suspected radiologically, pathological confirmation was lacking preoperatively; surgery was pursued because of symptomatic disease and atrial involvement. She developed postoperative cerebral infarction and rapid adrenal progression and died at 4 months despite chemotherapy. These cases illustrate both the technical feasibility of CPB-assisted atrial resection and the aggressive biology of pleomorphic carcinoma, including atypical vascular metastasis to cerebral arteries. Careful staging, patient selection, and early multidisciplinary planning (thoracic surgery, cardiac surgery, neurosurgery, oncology, and radiology) are essential. Surgery can be justified in selected patients with atrial invasion; however, pleomorphic histology portends poor outcomes and unusual metastatic tropism. Vigilant postoperative surveillance and integration of systemic therapy are required.

Background: The role of wedge resection in the treatment of non-small cell lung cancer (NSCLC) with solid components ≤ 2 cm remains controversial. This study compared the efficacy of wedge resection with that of segmentectomy in these patients.

Materials and methods: This real-world retrospective study included NSCLC patients who underwent wedge resection or segmentectomy at Beijing Chao-Yang Hospital, Capital Medical University, from January 2018 to December 2020. Patient data were retrospectively reviewed. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were applied to minimize baseline disparities. Survival outcomes, including overall survival (OS), recurrence-free survival (RFS), and lung cancer-specific survival (LCSS), were examined via Cox proportional hazards modeling.

Results: A total of 640 patients were enrolled (wedge resection: 295; segmentectomy: 345). After IPTW, no difference in baseline characteristics was observed between the two groups. Additionally, long-term outcomes did not significantly differ between the groups. However, compared with segmentectomy, wedge resection was associated with a shorter operation duration (p < 0.001), less intraoperative blood loss (p < 0.001), fewer complications (p < 0.001), and shorter postoperative stay (p = 0.047). In the subgroup with a consolidation-to-tumor ratio (CTR) > 0.25, segmentectomy resulted in longer OS (p = 0.046), LCSS (p = 0.036) as well as higher 5-year OS (p = 0.045), 5-year RFS (p = 0.023), and 5-year LCSS (p = 0.015).

Conclusion: Wedge resection is an optimal choice for patients with NSCLC ≤ 2 cm, especially for patients with Ground-Glass Opacity (GGO) dominant tumors. However, segmentectomy is more appropriate when the CTR is > 0.25.