Thoracic Cancer最新文献

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.

Introduction: This retrospective study describes contemporary patterns of care and outcomes for early-stage non-small cell lung cancer (NSCLC) in Queensland, Australia, with a focus on immunotherapy.

Methods: Population-based data for patients with NSCLC diagnosed at stages I-III between 2018 and 2022 were sourced from the Queensland Oncology Repository. Follow-up on treatment and mortality was available to 31 December 2024. Poisson models were used to determine patient and clinical characteristics associated with the treatments received. Differences in five-year observed survival were calculated from multivariable flexible parametric models.

Results: The study cohort comprised 4608 patients. Surgery alone was the most common treatment modality for stages I and II (55% and 27%, respectively), whereas 44% of patients with stage III disease had concurrent chemoradiotherapy without surgery. Just over half (53%) of this latter group were also treated with durvalumab. First Nations people were somewhat less likely to receive either surgery (relative likelihood = 0.95, 95% CI 0.91-1.00; p = 0.04) or chemotherapy (RL = 0.95, 95% CI 0.90-0.99; p = 0.03) compared to other Queensland residents. Five-year observed survival ranged from 17% (95% CI 11%-25%) for stage IIIC to 81% (95% CI 74%-87%) for stage IA1. Patients with unresected stage III disease who received concurrent chemoradiotherapy with subsequent durvalumab were 37% less likely to die from NSCLC within 5 years of diagnosis than chemoradiotherapy alone (hazard ratio = 0.63, 95% CI 0.51-0.78; p < 0.001).

Conclusions: Disparities in treatment for First Nation people with NSCLC require urgent attention. Durvalumab provides a survival advantage for unresectable stage III NSCLC within a real-world setting.

Purpose: Lung cancer remains the leading cause of cancer-related deaths in South Korea, yet a comprehensive evaluation that encompasses evolving patterns of operative choice and their impact on survival outcomes by pathological factors and surgery type is lacking.

Methods: We included 36 663 patients who underwent curative lung cancer resection between 2015 and 2019. Surgical procedures were categorized as pneumonectomy, lobectomy, segmentectomy, or wedge resection, and tumors were staged according to the Surveillance, Epidemiology, and End Results classification scheme. Temporal trends in procedure frequency and age-group distribution were assessed using trend analyses. Overall survival was estimated by Kaplan-Meier analysis, and independent prognostic factors were identified using multivariable Cox proportional hazards models.

Results: Lobectomy remained the most common operation (78.3%), while the use of segmentectomy and wedge resection increased and that of pneumonectomy declined significantly (all P for trend < 0.0001). The proportion of patients aged ≥ 76 years who received surgery rose (trend p < 0.0001). Survival was highest following segmentectomy and lobectomy across all age groups and stages. In age group-specific analyses, lobectomy conferred best survival outcomes in the 46-75-year group (adjusted hazard ratio [aHR], 0.789; 95% confidence interval [CI], 0.734-0.849), whereas segmentectomy yielded favorable survival in the ≥ 76-year group (aHR, 0.808; 95% CI, 0.676-0.967).

Conclusion: Between 2015 and 2019, the frequency of sublobar resections increased. Segmentectomy conferred the highest survival benefit in patients aged ≥ 76 years, whereas lobectomy was more favorable in patients aged ≤ 75 years, underscoring the importance of tailoring surgical choice to age group.

Targeted therapy is the standard treatment for driver-mutated lung cancer, but its efficacy in multiple primary lung cancers (MPLCs) remains limited due to significant inter-lesional molecular heterogeneity. We present a case of synchronous MPLC with 34 bilateral pulmonary nodules. The dominant right upper lobe lesion was an EGFR L858R-mutated adenocarcinoma that responded to osimertinib, while other nodules progressed. Switching to chemoimmunotherapy induced regression of all lesions, enabling surgical resection. Postoperative pathological analysis revealed two resected lesions with discordant molecular profiles-one EGFR-mutated and one driver-negative. Despite adjuvant therapy, the patient developed early recurrence as non-small cell lung carcinoma-not otherwise specified with no driver mutation and died within 6 months post-radiotherapy. This case highlights the limitations of single-agent targeted therapy in MPLC, challenges the assumption that driver-negative lesions typically follow an indolent course, and supports early chemotherapy-based systemic combination strategies to address the significant molecular heterogeneity in MPLC.

Background: Non-invasive lung adenocarcinoma may occasionally contain solid benign components, presenting challenges for making an accurate diagnosis using CT (computed tomography). Therefore, we investigated whether a three-dimensional (3D) volumetric analysis was more effective than CT in distinguishing the presence of invasive lesions in early-stage lung adenocarcinoma.

Materials and methods: We retrospectively classified 161 patients preoperatively diagnosed with clinical stage IA1 into two groups: the non-invasive lesion group (50 patients) and the invasive lesion group (111 patients). We conducted a comparative analysis concerning the predictive performance of CT and a 3D volumetric analysis to identify invasive lesions. In addition, a histological review of the pre-invasive lesion group was performed to assess the pathological characteristics of the solid component, as observed on preoperative CT.

Results: A univariate analysis demonstrated that the consolidation diameter, consolidation/tumor (C/T) ratio, consolidation volume, and three-dimensional (3D)-C/T ratio were significant predictors of the presence of invasive lesions. A multivariate analysis identified the consolidation volume as an independent predictor (p = 0.045). Analyses of the receiver operating characteristics showed that the areas under the curve for the consolidation diameter, consolidation volume, C/T ratio, and 3D-C/T ratio were 0.702, 0.634, 0.747, and 0.742, respectively. In addition, a histological review revealed alveolar collapse in 89.2% (25 of the 28) of the preinvasive lesion group.

Conclusions: Consolidation diameter, consolidation volume, and 3D-C/T ratio are more reliable predictors for distinguishing alveolar collapse from invasive lesions than the C/T ratio in early-stage lung adenocarcinoma.

Background: Locally advanced B-type thymomas frequently present technical challenges for R0 resection. Given the limitations of conventional neoadjuvant therapies, this study investigated glucocorticoids (GCs) as a potential downstaging strategy to improve surgical feasibility.

Methods: A propensity score-matched analysis was conducted in patients with Masaoka-Koga stage III-IV B-type thymomas (2017-2024). The intervention cohort (GC + Surgery, n = 36) received oral prednisone acetate (0.6 mg/kg/d, maximum dose 50 mg/d for 2-4 weeks) followed by surgery, while matched controls (Surgery, n = 36) underwent immediate resection. Outcomes included surgical parameters (operative time, blood loss, R0 rates), perioperative complications, and survival.

Results: Neoadjuvant GCs yielded an objective response rate of 64.8% (13.2% complete response, 51.6% partial response). The GC + Surgery cohort demonstrated reduced operative time (182.8 vs. 426.0 min; p < 0.001) and median blood loss (165 vs. 1285 mL; p < 0.001), along with increased utilization of VATS approaches (55.6% vs. 13.9%; p < 0.001). R0 resection rates were 97.2% versus 86.1% (p = 0.115), with no R2 resections observed in the GC group. Perioperative complication profiles appeared comparable between groups. At a median follow-up of 52 months, the GC + Surgery group showed higher 5-year progression-free survival (83.4% vs. 72.4%; p = 0.033), though overall survival differences did not reach statistical significance (94.1% vs. 85.9%; p = 0.272).

Conclusions: These findings suggest neoadjuvant glucocorticoids may enhance resectability in advanced B-type thymomas, potentially enabling less invasive procedures and improving intermediate-term disease control.

Background: Thymoma is associated with diverse immune abnormalities, yet immune-mediated multilineage cytopenias are exceedingly rare and poorly defined. Their clinical features, immunologic patterns, and treatment outcomes remain unclear.

Methods: We retrospectively reviewed four adult patients with histologically confirmed thymoma and immune-mediated cytopenias affecting ≥ 2 hematopoietic lineages at a tertiary hematology center. Clinical data, bone marrow morphology, immunologic studies, T-cell receptor (TCR) clonality, cytogenetics, next-generation sequencing (NGS), treatments, and outcomes were collected. Responses were assessed using standardized criteria for immune thrombocytopenia (ITP), autoimmune hemolytic anemia (AIHA), and autoimmune neutropenia (AIN).

Results: The four patients (aged 44-75 years) showed heterogeneous temporal patterns, with cytopenias occurring either before thymoma diagnosis or years after thymectomy. Three had trilineage cytopenia and one had bicytopenia, with combinations of AIHA, ITP, AIN, and pure red cell aplasia. Bone marrow findings ranged from normal cellularity to erythroid aplasia. Two patients demonstrated clonal TCR rearrangement consistent with T-LGL leukemia, and NGS identified mutations including TET1, EP300, and BCORL1. All received immunosuppressive therapy. Neutrophil and platelet counts responded earlier (1-2 months), whereas erythroid recovery was slower. Despite initial responses (2 CR, 2 PR), three patients relapsed and required additional therapy. After 10-84 months of follow-up, one patient remained in CR and three in PR.

Conclusions: Thymoma-associated multilineage cytopenias are heterogeneous, frequently relapsing, and driven by complex T-cell-mediated immune dysregulation. Comprehensive evaluation and individualized immunosuppressive therapy are essential for management.

Non-small cell lung cancer (NSCLC) remains the leading cause of cancer-related mortality worldwide. Although chemotherapy remains a cornerstone in the treatment of advanced NSCLC, local ablative strategies such as microwave ablation (MWA) have emerged as promising adjunctive therapies. However, the survival benefits of combining MWA with chemotherapy remain uncertain. This meta-analysis aims to evaluate the efficacy and safety of microwave ablation combined with chemotherapy compared to chemotherapy alone in patients with advanced NSCLC. A comprehensive search was conducted in MEDLINE, EMBASE, and Cochrane Library through January 2025. Eligible studies included randomized controlled trials or observational studies comparing MWA associated with chemotherapy versus chemotherapy alone in patients with advanced NSCLC. The primary outcome was progression-free survival (PFS); secondary outcomes included partial remission (PR) rate and adverse events (AE). Hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals (CI) were pooled using random-effects models. Individual patient data (IPD) were reconstructed from Kaplan-Meier curves to perform a one-stage survival meta-analysis. Four studies comprising 483 patients were included. MWA associated with chemotherapy significantly improved PFS (HR 0.408; 95% CI 0.24-0.49; p < 0.001; I² = 53.3%). No significant differences were found for PR (RR 0.74; 95% CI 0.37-1.50; p = 0.41) or AE (RR 1.08; 95% CI 0.86-1.36; p = 0.49). Sensitivity analyses confirmed the robustness of the findings. MWA combined with chemotherapy significantly improves PFS in advanced NSCLC without increasing toxicity.

Background: We previously reported the short-term real-world effectiveness and safety of first-line atezolizumab combined with chemotherapy in patients with extensive-stage small cell lung cancer (ES-SCLC). This study provides an updated analysis of the effectiveness, prognostic factors, and subsequent treatment patterns in first-line immunochemotherapy.

Methods: This prospective multicenter observational study enrolled patients with ES-SCLC, diagnosed at seven university hospitals throughout Korea, between June 2021 and August 2022. Primary outcomes were 1-year overall survival (OS) and progression-free survival (PFS), whereas secondary outcomes included OS, objective response rate, disease control rate, second progression-free survival, and safety, evaluated based on established clinical guidelines.

Results: A total of 100 ES-SCLC patients (median age, 69 years) were enrolled, with a median follow-up duration of 26.0 months. The median PFS and OS were 6.2 and 17.1 months, respectively, with a 1-year OS rate of 62.5%. Favorable prognostic factors for OS included partial response (PR) and stable disease (SD) as the best responses (SD: hazard ratio (HR), 0.79; PR: HR, 0.38) and a longer platinum-free interval (HR 0.84). Brain radiotherapy significantly improved OS in patients with brain metastases, whereas thoracic radiotherapy during first-line treatment tended to prolong survival in patients who responded to systemic treatment. Patients receiving second-line treatment after progression presented a significantly longer OS than did those receiving only best supportive care.

Conclusion: This study outlined the real-world effectiveness and safety of first-line atezolizumab immunochemotherapy for ES-SCLC patients over an extended follow-up, noting that local treatment and post-progression therapy were associated with improved survival.

The KRAS G12D mutation is a highly prevalent oncogenic driver in pancreatic ductal adenocarcinoma, colorectal cancer, and non-small cell lung cancer. Unlike other KRAS variants, G12D lacks a reactive site; therefore, it is considered "undruggable" and exhibits a propensity to activate the PI3K/AKT pathway while fostering an immunosuppressive microenvironment. This review summarizes recent breakthroughs in inhibitor design that are reshaping the therapeutic landscape for KRAS G12D. Significant progress has been made in the development of small-molecule inhibitors: non-covalent inhibitors (e.g., MRTX1133) exploit ionic interactions (salt bridges) with the mutant aspartic acid residue to achieve high affinity and selectivity; novel covalent strategies are emerging, including strain-release alkylation and tri-complex inhibitors (e.g., RMC-9805). Alternative modalities such as Proteolysis Targeting Chimeras (PROTACs), peptide inhibitors, and monobodies are also discussed. The article further evaluates the status of candidate drugs currently in clinical trials and addresses the critical challenges of acquired resistance, which may arise through secondary mutations or bypass signaling pathways. Finally, it emphasizes future directions, including the optimization of drug delivery via nanoparticles and the implementation of combination therapies to enhance efficacy and achieve durable clinical responses.