Thoracic Cancer最新文献

Background: The distress thermometer (DT) is an effective tool for identifying distress among cancer patients worldwide. Our study objective is to evaluate the prevalence and severity of distress in lung cancer patients by using DT.

Methods: A total of 153 lung cancer patients were retrospective enrolled at the Lung Cancer Center of Peking Union Medical College Hospital. Participants completed three assessments: the clinical characteristics, the associated problem list (PL) scale and the DT.

Results: At a DT cut-off score of ≥ 4, 56.2% of lung cancer patients had significant distress, which was related to the number of PL items symptoms. Sleep (55.6%), fatigue (51.0%), and pain (47.7%) were the most commonly reported issues. Univariate logistic regression analysis revealed that a DT score ≥ 4 was significantly associated with most of the PL items, such as housing, child care, insurance, transportation, dealing with children and relatives, loneliness, depression, nervousness, sadness, worry, loss of interest in usual activities, sleep, memory/concentration, bathing, appearance, change in urination, fatigue, breathing, diarrhea, indigestion, constipation, eating, dizziness, pain, mouth sores, nausea, sexual issues, dry nose, tingling in hands/feet, and physical activity restrictions. However, multivariate regression analysis identified only the following as independent predictors of significant distress in patients with lung cancer: insurance, transportation, depression, sleep, mouth sores, and dry nose.

Conclusion: This study recommends using the DT for screening lung cancer patients, and the involvement of the social services and psycho-oncology at the time of initial diagnosis and treatment.

Background: Intentional pulmonary segmentectomy via minimally invasive surgery is now commonly used to treat early stage non-small cell lung cancers smaller than 2 cm. The main challenge of this procedure lies in identifying the intersegmental plane (ISP). Two primary methods are used: the method of inflation-deflation (MID) and indocyanine green (ICG) fluorescence.

Methods: This prospective, single-center study included 196 patients who underwent minimally invasive segmentectomy between January 2022 and December 2024. The ISP was identified using both MID and ICG injection. Patients were divided into two groups based on whether the discrepancy between the two methods was ≤ 10 mm or > 10 mm, in order to identify factors associated with discordance.

Results: A discrepancy > 10 mm was observed in 41.3% of cases (n = 81). Factors significantly associated with this discordance included pleuropulmonary adhesions (OR = 4.61; p = 0.032), complex segmentectomies (OR = 2.36; p = 0.027), and bronchial variations (OR = 3.72; p = 0.011). ICG visualization of the ISP was rated satisfactory or very satisfactory (score ≥ 2) in 88.8% of cases. No significant differences were observed in postoperative outcomes, complications, or resection margin quality.

Conclusion: ICG proves to be a reliable and reproducible method for ISP visualization, though it has limitations in certain clinical situations. It remains a valuable tool, especially during the learning phase or in cases of anatomical uncertainty, and should be adapted to each patient's anatomy, the type of segmentectomy, and the surgeon's experience.

Background: This study evaluated the safety, long-term survival, and prognostic factors associated with salvage pulmonary surgery following systemic therapy for initially unresectable non-small cell lung cancer (NSCLC).

Methods: Between 2014 and 2024, this single-center retrospective review identified 32 patients (median age: 61.0 years) with NSCLC initially considered unresectable who subsequently underwent curative-intent pulmonary resection after chemotherapy, targeted therapy, and/or immunotherapy. The primary endpoint was overall survival (OS); secondary endpoints included recurrence-free survival (RFS), major morbidity (Clavien-Dindo grade ≥ IIIa), and R0 resection rate. The Kaplan-Meier method and log-rank test were employed.

Results: Reasons for unresectability at initial diagnosis were distant metastasis (n = 20; 62.5%), N3 nodal disease (n = 6; 18.8%), bulky N2 nodal disease (n = 3; 9.4%), and tumor or nodal extension requiring pneumonectomy (n = 3; 9.4%). Overall, 65.6% patients underwent lobectomy, with R0 resection achieved in 81.3% and pathological complete or major response observed in 15.6%. Overall complication and major morbidity rates were 12.5% and 3.1%, respectively; no 90-day mortality was observed. After a median follow-up of 40.1 months, median OS was not reached, whereas median RFS was 49.9 months; 5-year OS and RFS were 75.0% (95% CI 51.6-88.3) and 46.3% (95% CI 26.3-64.2), respectively. Notably, adenocarcinoma histology was significantly more prevalent in the good-prognosis group (88.9% vs. 35.7%, p = 0.003).

Conclusions: Salvage pulmonary surgery following systemic therapy is safe, yielding a 5-year OS rate of 75% in carefully selected patients with advanced NSCLC. Prevalent adenocarcinoma histology in the good-prognosis cohort is associated with superior outcomes.

Entrectinib, a first-generation TRK inhibitor, is effective in NTRK fusion-positive non-small cell lung cancer (NSCLC) but commonly induces significant weight gain. We describe the case of a 42-year-old patient with metastatic NTRK-positive NSCLC undergoing entrectinib who participated in a two-year, supervised exercise program. The intervention included twice-weekly aerobic and resistance training aligned with international exercise-oncology guidelines. Adherence was high (91.6%), and no exercise-related adverse events occurred. Despite an initial 13 kg weight gain over 9 months, split between fat and lean mass, subsequent fat loss (~3.5 kg) occurred while lean mass was preserved. This case suggests that prolonged, structured exercise is a safe and feasible strategy to attenuate entrectinib-associated metabolic effects and support physical function during targeted therapy in advanced NSCLC.

Background: Immune checkpoint inhibitors (ICIs) significantly impact advanced non-small cell lung cancer (NSCLC) management, but predictive biomarkers for elderly patients remain controversial. This study aimed to assess peripheral immune cells as biomarkers for predicting ICI efficacy in elderly NSCLC patients.

Methods: This was an ambispective, observational study enrolling patients aged ≥ 65 years with advanced NSCLC treated with first-line ICI ± chemotherapy from January 2023 to August 2024 at Beijing Chest Hospital. Peripheral immune cell subsets were analyzed by flow cytometry at baseline and dynamically during treatment. Associations between clinical characteristics, immune cell profiles, and outcomes were assessed using Kaplan-Meier analysis, Cox regression, and Wilcoxon tests.

Results: A total of 34 patients were included in this study. Objective response rate and disease control rate were 41.2% and 97.1%, respectively. Median progression-free survival (PFS) was 10.3 months, while median overall survival (OS) was not reached. Patients responding to ICIs had significantly higher baseline percentages of CD3⁺ T cells, CD3⁺CD8⁺Perforin⁺ T cells, and CD3⁺CD8⁺Granzyme B⁺ T cells. Higher baseline absolute counts of CD3⁺ T cells and CD3⁺CD8⁺ T cells were also significantly associated with longer OS. Post-treatment increases in the percentage of CD3⁺Perforin⁺ T cells were associated with significantly longer OS (up vs. down: not reached vs. 15.1 months, p = 0.034).

Conclusions: Peripheral cytotoxic T cell subsets may serve as promising biomarkers for predicting the efficacy of ICIs in elderly NSCLC patients. Dynamic monitoring of immune cell profiles could further enhance prognostic accuracy.

Background: Lung cancer, representing a predominant form of pulmonary malignancy, demonstrates significant disease burden and poor clinical outcomes. Circular RNAs (circRNAs) have emerged as critical regulators in various cancers, including lung cancer. However, the specific roles and mechanisms of circRNAs in lung cancer remain largely unexplored.

Methods: Differential circRNA expression was analyzed using GEO datasets GSE101586 and GSE112214. CircFUT8 was prioritized for its upregulation in lung cancer tissues. In vitro and in vivo functional experiments evaluated its effects on cell proliferation, apoptosis, migration, and invasion. RNA pull-down, immunofluorescence, and western blotting assessed interactions with ENO1. Macrophage polarization was examined via cocultures and flow cytometry.

Results: CircFUT8 (hsa_circ_0003028) was significantly upregulated in lung cancer tissues, correlating with advanced stages and poor prognosis. It enhanced lung cancer cell proliferation, migration, and invasion while inhibiting apoptosis in cellular and animal models. Mechanistically, circFUT8 directly binds ENO1 to form an RNA-protein complex, promoting M2 macrophage polarization. Silencing circFUT8 reversed these effects by suppressing ENO1 and M2 polarization, inhibiting tumor progression. Moreover, ENO1 promotes TNF signaling through glycolytic metabolites.

Conclusions: Our findings highlight the critical role of circFUT8 in lung cancer progression through its regulation of M2 macrophage polarization via interaction with ENO1. The findings suggest that circFUT8 may serve as both a diagnostic marker and a promising therapeutic target in lung cancer management. This study first identified the regulating oncogenic role of circFUT8 in lung cancer progression and the microenvironment.

Pericardial metastases are common in advanced cancers but often remain undetected due to subtle symptoms. Photon-counting CT (PCT) offers improved spatial resolution and contrast-to-noise ratio (CNR) compared with conventional CT (CCT), potentially enhancing diagnostic performance. In this retrospective single-center study, patients diagnosed with pericardial metastases by transthoracic echocardiography (TTE) between April and September 2025, who underwent both unenhanced and contrast-enhanced chest CT were included. After Propensity Score Matching (PSM), two groups were established: the PCT group (n = 11; reconstructions at 0.4 and 1 mm) and the CCT group (n = 22). Diagnostic sensitivity, image quality, and radiation dose were assessed, with TTE as the reference standard. PCT-0.4 mm demonstrated the highest overall sensitivity (91.5%) and small-lesion sensitivity (88.9%), followed by PCT-1 mm (87.2% and 83.3%) and CCT-1 mm (86.1% and 78.6%). Although not statistically significant, PCT showed consistently better lesion detection. The PCT-0.4 mm group showed higher standardized CNR versus CCT-1 mm (Tukey-Kramer p = 0.021) but not versus PCT-1 mm (p = 0.641); overall one-way ANOVA p = 0.020, whereas SNR did not differ among groups (ANOVA p = 0.18). Radiation exposure was significantly lower with PCT than CCT (ED: 11.7 ± 3.9 vs. 20.6 ± 6.6 mSv; p < 0.001). Compared with the 1-mm CCT reconstruction, the 0.4-mm PCT showed a trend toward improved detection of both overall and small pericardial metastases, enhanced image quality, and reduced radiation dose, highlighting its potential clinical value in managing pericardial metastases.

Objective: To compare the predictive value of the estimated dose of radiation to immune cells (EDRIC) with conventional dosimetric parameters for survival in elderly patients with stage III unresectable NSCLC after chemoimmunotherapy and radiotherapy.

Methods: We conducted a retrospective study of elderly patients (≥ 65 years) treated at two institutions. Patients were stratified by median EDRIC, mean lung dose (MLD), mean heart dose (MHD), and mean body dose (MBD). Survival was analyzed using Kaplan-Meier, Cox regression, and ROC curves.

Results: Baseline characteristics were well-balanced across dosimetric parameter subgroups (all p > 0.05). The median progression-free survival (PFS) and overall survival (OS) for the entire cohort were 23.9 months and 46.0 months, respectively. EDRIC ≥ 6.4 Gy was associated with worse PFS (p = 0.019) and OS (p = 0.011), while MLD, MHD, and MBD showed no prognostic significance (all p > 0.05). Multivariate analysis identified EDRIC ≥ 6.4 Gy as an independent predictor of worse PFS (HR = 1.852, p = 0.049) and OS (HR = 2.289, p = 0.048). Age ≥ 70 years was also independently associated with poorer OS (HR = 2.870, p = 0.011). ROC analysis demonstrated superior predictive performance of EDRIC over conventional parameters for 1-, 2-, and 3-year PFS and OS, with particularly outstanding discrimination for 12-month OS (AUC = 0.93).

Conclusion: EDRIC shows potential in predicting survival for elderly stage III unresectable NSCLC patients, with 6.4 Gy as a potential threshold for personalized radiotherapy optimization. These findings require prospective validation.

Background: The molecular landscape of thymic epithelial tumors has been partially elucidated. GTF2I mutation drives the pathogenesis in approximately 50% of tumors; however, the key molecular aberrations in the other cases remain unclear.

Methods: We designed a panel including the most frequently mutated genes in thymic epithelial tumors and sequenced tumor and normal DNA from 70 patients prospectively accrued at a single institution in the Thymogene trial. Moreover, 19 neoplastic samples were dissociated to isolate tumor cells using flow cytometry.

Results: GTF2I mutations were the most common, being present in 41% of patients. GTF2I mutations were prevalent in type A and AB thymomas, in Stage I-II tumors, and in patients without myasthenia gravis. The unique pattern of mutually exclusive and co-occurring mutations suggests a distinct pathogenesis for thymomas with and without GTF2I mutation. In 39% of patients, no mutations were found in the 77 genes evaluated. The absence of epithelial cells in some dissociated tumors highlights the challenge of identifying mutations in a subset of thymic epithelial tumors that lack the GTF2I mutation. Mutational signatures, including COSMIC 1, 19, and 25, were enriched, possibly linked to 5'-methylcytosine deamination and the effects of chemotherapy.

Conclusions: GTF2I mutations drive the growth of a significant portion of thymic epithelial tumors, often in conjunction with other gene mutations. Somatic mutations are not commonly found in many GTF2I wild-type tumors, where the underlying genomic abnormalities remain elusive, even when using a dedicated tool for sequencing thymic epithelial tumors.