Thoracic Cancer最新文献

Introduction: Improving patient-centered outcomes is a core aim of value-based healthcare (VBHC). Integrating patient-reported outcome and experience measures (PROMs/PREMs) into clinical quality registries may provide insight into health-related quality of life (HRQL) and variation in care. We piloted PROMs/PREMs collection in an Australian Lung Cancer Registry to evaluate associations between HRQL, clinical outcomes and treatment value.

Methods: Individuals newly diagnosed with lung cancer across five metropolitan health services were invited to complete electronic PROMs (EORTC QLQ-C30 and QLQ-LC29) and PREMs at baseline and follow-up. Preference-based utilities (QLU-C10D) and quality-adjusted life-years (QALYs) were derived and linked with registry clinical data. Stage-specific Australian health system cost estimates for guideline concordant treatment (GCT) provided context for value-based reporting. Multivariable regression examined associations between HRQL and clinical variables.

Results: Baseline PROMs/PREMs were completed by 241/490 (49%) participants. HRQL was associated with cancer stage, ECOG performance status ≥ 2, comorbidities, weight loss, and receipt of GCT (p = 0.041). HRQL remained stable among ongoing respondents over time. Estimated health system costs increased with advancing stage, while earlier stage disease was associated with better HRQL and survival. A registry-level VBHC dashboard integrating HRQL, patient experience, clinical quality indicators and cost context was developed to support health service performance review.

Conclusions: PROMs/PREMs linked with clinical and cost data provided meaningful insight into patient-centered outcomes and drivers of value in lung cancer care. This VBHC framework highlights the importance of early diagnosis and access to evidence-based treatment and offers a scalable approach to support patient-centered quality improvement at the health system level.

In lung cancer surgery, when tumors are present in the branches of the bronchus, it may be appropriate to perform suture closure by sharply separating the bronchus, rather than using an autosuture device to ensure adequate margins. While RATS simplifies needle handling compared to VATS, ligation remains challenging due to the lack of tactile feedback. To ensure closure of the bronchial segment by ligation in robotic surgery, we started a preliminary study to use dual barbed sutures that do not require ligation and clips for ligature fixation after the approval from the Ethics Committee of Mie University Hospital. We performed this procedure in five patients from January 2024 to present. Postoperative bronchoscopy, performed in four of the five patients, confirmed the bronchial stump was well closed in all cases, with no evidence of bronchopleural fistula (BPF). However, two patients experienced prolonged hospitalization due to midlobar torsion and prolonged air leakage requiring pleurodesis, respectively. The preliminary results suggest that this novel technique provides reliable bronchial stump closure in RATS. We plan to conduct a larger cohort study with long-term follow-up to further confirm the safety and long-term BPF rate.

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.

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.

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.

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.

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.