Thoracic Cancer最新文献

Background: With advancements in medical devices, more hospitals are incorporating the digital chest drainage (DCD) system into postoperative care. Although some studies have suggested that the DCD system provides accurate information and shortens hospital stays compared with the traditional chest drainage (TCD) system, the effect of the DCD system on quality of life remains unclear. This study investigated whether the digital chest drainage system improves postoperative outcomes and quality of life.

Methods: This single-center, prospective, randomized controlled trial initially included 362 patients. After exclusion and randomization, 128 and 125 patients were included in the DCD and TCD groups, respectively. Wearable devices were used to measure sleep duration and walking distance after surgery. Primary outcomes included postoperative recovery and quality of sleep and rehabilitation.

Results: Both groups had similar baseline characteristics. In terms of postoperative outcomes, the DCG group had shorter durations of chest tube insertion and hospital stays than the TCD group did. We noted no significant differences in postoperative pulmonary complications or extended hospitalizations exceeding 1 week between the groups. Regarding physiological changes, the DCD group had a longer sleep duration during the first 2 days after surgery. Furthermore, the number of walking steps after surgery was higher in the DCD group.

Conclusion: The DCD system provides precise information that can help surgeons in decision-making, potentially shortening the postoperative course and reducing the need for postoperative chest x-rays. Furthermore, the DCD system can enhance postoperative recovery by improving sleep quality and ambulation.

Background: Although smoking cessation remains the most effective preventive measure against lung cancer, the implementation of low-dose computed tomography screening has facilitated early tumor detection, increasing the need for less invasive surgical approaches. This study evaluated the efficacy of segmentectomy vs. lobectomy for early-stage non-small cell lung cancer (NSCLC) in northern Italy.

Material and methods: The analysis included 200 patients with stage I NSCLC, selected from a cancer registry. Of these, 100 underwent lobectomy and 100 underwent segmentectomy. We calculated loco-regional and distant recurrences, overall survival, and disease-free survival (DFS).

Results: Over a median follow-up of 6.3 years, segmentectomy was associated with a lower recurrence rate (28%) compared to lobectomy (35%) and a lower incidence of distant metastases (39.6% vs. 60.4%). Multivariable analysis showed a greater risk of recurrence in patients undergoing lobectomy [OR 1.32; 95% CI: 0.71-2.45] and in females [OR 1.69; 95% CI: 0.89-3.18], while a decreased risk was observed among elderly patients over 70 years [OR 0.72; 95% CI: 0.39-1.32] and those with adenocarcinoma histology [OR 0.82; 95% CI: 0.41-1.64]. Five-year survival was higher in the segmentectomy group (67%; 95% CI: 57-76) compared to the lobectomy group (55%; 95% CI: 45-65); a similar result was observed for DFS: 59% (95% CI: 48-68) versus 47% (95% CI 37-57). The risk of death appeared lower in the segmentectomy group [HR 0.85; 95% CI: 0.59-1.22].

Discussion: The outcomes appear to favor segmentectomy, as previously demonstrated in clinical trials. The observed effects are less pronounced, due to the absence of patient selection in this real-world setting.

Main problem: The efficacy and safety of platinum-based chemotherapy with programmed death-1 (PD-1) blockade after chemoradiotherapy (CRT) for the treatment of limited disease (LD) small cell lung cancer (SCLC) is unknown. This study aimed to assess the effectiveness and tolerability of platinum-based chemotherapy with PD-1 blockade in patients with recurrent LD-SCLC after CRT.

Methods: This retrospective study analyzed 66 patients who experienced recurrence after CRT for LD-SCLC and received platinum-based chemotherapy with PD-1 blockade therapy between August 2019 and September 2020 at 19 Japanese institutions. Clinical efficacy was assessed according to response rate, survival, and toxicity.

Results: The overall response rate was 53.0% (95% confidence interval [CI], 48.9-65.0), and the disease control rate was 78.7% (95% CI, 68.9-88.5). The median progression-free survival and overall survival periods were 5.9 (95% CI, 4.7-7.3) months and 24.9 (95% CI, 16.8-28.1) months, respectively. The frequencies of grade ≥ 3 hematological adverse events were as follows: leukopenia, 47.0%; neutropenia, 65.2%; and febrile neutropenia, 8.3%. There was no treatment-related death.

Conclusions: Chemoimmunotherapy is a feasible and effective treatment for recurrent disease after CRT in patients with LD-SCLC, providing a new potential option for the pharmacological management of these patients.

Thymomas and thymic carcinomas represent rare epithelial-derived thoracic neoplasms that, despite their low incidence, pose significant clinical challenges and impact patient survival. Through collaborative efforts among experts across the Beijing-Tianjin-Hebei region, this consensus seeks to provide guidance for the challenging management of advanced-stage thymic epithelial tumors (Stages IIb-IV). Advanced thymic tumors frequently present with local invasion or distant metastases, necessitating multimodal therapeutic approaches incorporating surgery, radiotherapy, chemotherapy, and emerging immunotherapies. Treatment individualization remains paramount given tumor heterogeneity and variable clinical presentations. This regional consensus framework endeavors to offer evidence-based guidance for thymic tumor management, promoting coordinated care through multidisciplinary teams that may help improve therapeutic outcomes and patient survival. Through collaborative efforts, we hope to foster greater consistency in treatment approaches across participating institutions, potentially contributing to enhanced regional oncological care via the careful integration of contemporary therapeutic strategies for patients with advanced thymic epithelial neoplasms.

Herein, we reported the damage of the B6 bronchial segment following apical segmentectomy of the left lower lobe for management of a typical carcinoid tumor. The defect was localized distally to the B6 origin and was successfully repaired by re-stapling the proximal side of the B6 bronchus. Before firing, the intraoperative bronchoscopy confirmed the closure of the B6 bronchus alone and the normal patency of the bronchial pyramid basal. Then, the bronchial stump was covered by a collagen patch to reduce the risk of fistula. The postoperative course was uneventful, and the patient was discharged 3 days later.

Intravascular papillary endothelial hyperplasia (IPEH) or Masson tumor is a relatively rare benign tumor of vascular origin. While surgical resection is considered standard management, there is limited information regarding its natural history. Given the benign clinical behavior of IPEH, observation may be a viable option, particularly if surgery could incur significant morbidity. We present the case of a patient with a Masson tumor by the chest wall who opted for observation with significant spontaneous decrease in size of his tumor followed by complete resolution over an 18-month surveillance period. This case suggests an alternative approach to surgical resection.

Lung cancer remains one of the leading causes of cancer-related deaths worldwide, underscoring the urgent need for transformative therapeutic strategies. Conventional treatments face critical limitations, including poor targeting efficiency, systemic toxicity, and resistance to targeted therapies. Nanotechnology offers promising solutions by enabling enhanced drug stability, bioavailability, and targeting precision. This review integrates recent advancements in nanotechnology-driven drug delivery systems with a particular focus on computational tools that optimize nanocarrier design. Molecular simulations, quantum mechanics, and AI-driven models have emerged as powerful approaches to streamline development, accelerate innovation, and enable personalized therapies. Clinically, several nanocarrier-based formulations have been associated with favorable therapeutic outcomes in lung cancer patients, including extended progression-free survival and reduced treatment-related toxicity. Despite these advancements, challenges remain in scaling production, ensuring regulatory compliance, and achieving broad clinical adoption. By addressing these barriers through interdisciplinary collaboration, nanotechnology holds the potential to revolutionize lung cancer therapy and set new standards for precision oncology.

Background: Efficient and affordable diagnosis, coupled with a clear understanding of driver gene prevalence, distribution, and clinicopathological features of driver genes, is crucial for lung cancer treatment and prevention. This study developed a cost-effective targeted sequencing assay for actionable driver mutation and investigated EGFR, KRAS, NRAS, BRAF, PIK3CA, MET, and HER2 in a southern Taiwanese lung cancer population.

Materials and methods: Two hundred and twenty-three lung cancer specimens from Chang Gung Memorial Hospital, Chiayi (2009-2020), were retrospectively analyzed.

Results: Among the 223 patients, the mutation frequencies detected by the optimized targeted sequencing assay were: EGFR 48.88%, KRAS 6.28%, PIK3CA 5.83%, NRAS and BRAF both 1.79%, MET 0.90%, and HER2 0.45%. While EGFR mutations in this cohort generally correlated with female sex, never-smoking status, and adenocarcinoma histology, some mutation subtypes deviated from this trend. Conversely, KRAS mutations showed no preference for gender, smoking, or histology, with G12C (42.86%) and G12D (28.57%) being predominant. PIK3CA mutations were more often observed in males and smokers. Concomitant driver mutations were common-except in KRAS and HER2-with prevalence rates of EGFR 5.50%, PIK3CA 61.54%, NRAS 25%, BRAF 50%, and MET 50%.

Discussion: The established actionable driver mutation targeted sequencing assay can cost-effectively facilitate treatment stratification for over 60% of lung cancer patients. The distinct features caused by mutations in the same gene or genes within similar pathways, coupled with the frequent occurrence of concomitant driver mutations, underscore the importance of economic molecular testing for both patient care and trial stratification.

Background: Although neoadjuvant chemoimmunotherapy has emerged as a promising approach for resectable non-small cell lung cancer (NSCLC), comparative real-world data on different PD-1 inhibitors are limited. This study compared the clinical efficacy, pathological response, survival, and safety of four PD-1 inhibitors-pembrolizumab, tislelizumab, camrelizumab, and sintilimab-in patients with Stage II-IIIa NSCLC.

Methods: We retrospectively reviewed 199 patients with resectable Stage II-IIIa NSCLC treated with neoadjuvant PD-1 inhibitors plus platinum-based chemotherapy from January 2018 to December 2024. After excluding 50 non-surgical cases, 149 patients were included. Outcomes compared included pathological response (pathological complete response, pCR; major pathological response, MPR), recurrence, disease-free survival (DFS), overall survival (OS), and adverse events.

Results: pCR and MPR rates were 52.2% and 58.0% (pembrolizumab), 67.6% and 75.7% (tislelizumab), 71.4% and 71.4% (camrelizumab), and 47.2% and 61.1% (sintilimab), respectively. Differences in pCR/MPR were not statistically significant. However, OS differed significantly across groups (p < 0.05), favoring pembrolizumab and tislelizumab. No significant differences were observed in progression-free survival (PFS) or recurrence among patients with pCR. Grade ≥ 3 treatment-related adverse events occurred in 27.0%-42.9% of patients, lowest in the tislelizumab group.

Conclusion: All treatment regimens elicited substantial pathological responses and exhibited acceptable safety profiles. Pembrolizumab and tislelizumab were associated with better OS and lower toxicity, supporting their preferential use in neoadjuvant therapy for resectable NSCLC.