Thoracic Cancer最新文献

Objective: This study aims to conduct a comprehensive meta-analysis of the effects of postoperative complications (PCs) on survival following esophagectomy using the restricted mean survival time (RMST) analysis.

Methods: A systematic literature search was performed in PubMed, Embase, Web of Science, Cochrane, and Medline, including articles published up to July 2024. Data were reconstructed from Kaplan-Meier curves, and the difference in RMST (RMSTD) and the RMST/restricted mean time loss (RMTL) ratios were calculated to examine the effects of PCs on overall survival.

Results: A total of 12 articles, including 7925 patients, met the inclusion criteria. RMSTD estimates indicate that patients with overall PCs survived an average of 0.04 years shorter (RMSTD = -0.04, 95% CI: -0.06, -0.03) than those without PCs at the 1-year follow-up and 0.39 years shorter (RMSTD = -0.39, 95% CI: -0.55, -0.22) at the 5-year follow-up. Patients with anastomotic leaks survived an average of 0.34 years shorter (RMSTD = -0.34, 95% CI: -0.49, -0.19), and patients with pulmonary complications survived an average of 0.63 years shorter (RMSTD = -0.63, 95% CI: -0.81, -0.45) at the 5-year follow-up. Additionally, RMTL ratios were estimated to be 1.21 (95% CI: 1.12, 1.31) for overall PCs, 1.19 (95% CI: 1.11, 1.28) for anastomotic leaks, and 1.53 (95% CI: 1.36, 1.73) for pulmonary complications at the 5-year follow-up, respectively.

Conclusions: Our findings quantified the annual negative impact of PCs of esophageal cancer on overall patient survival following esophagectomy. Increased efforts are needed to enhance prevention, early screening, and timely treatment for complications, particularly for patients with pulmonary complications.

Tracheal obstruction can arise from multiple conditions, including chronic obstructive pulmonary disease, asthma, foreign bodies, tumors, and acute heart failure. We report a case of a 43-year-old man with cervical liposarcoma who, following surgical excision, chemotherapy, and radiation, presented with severe dyspnea and was admitted to our hospital. A CT scan detected an endotracheal mass causing significant obstruction, suspected to be malignant. The patient required intensive care due to respiratory distress. Bronchoscopy revealed a red polypoid lesion causing nearly 90% tracheal narrowing, which was successfully resected using high-frequency electrotrap and argon coagulation, confirming it as a metastasis from the previously treated liposarcoma. Remarkably, there were no significant recurrences after 6 months. While lung metastases are frequent, intratracheal metastasis is rare; this case is the first documenting bronchial and tracheal metastasis of liposarcoma. It highlights the dangers of airway obstruction and the need for timely intervention. Although CT scans are helpful in identifying intrabronchial tumors, bronchoscopy remains the gold standard for diagnosis and treatment, with several options available for urgent cases.

Background: Metastasis to the thyroid gland from lung adenocarcinoma is rare and challenging to diagnose due to similar histopathological features. This study aimed to analyze the clinicopathological characteristics of and treatment strategies for lung adenocarcinoma metastasis to the thyroid based on 11 years of institutional experience.

Methods: A retrospective study included patients with lung adenocarcinoma metastasis to the thyroid at our center from 2010 to 2023. Clinicopathological features and clinical outcomes were analyzed.

Results: Among 9714 lung adenocarcinoma patients, nine patients (five females, 55.6%) were diagnosed with thyroid metastasis, presenting primarily with cough symptoms. Most patients (88.9%) had synchronous tumors, whereas a minority (11.1%) had metachronous tumors. The median time from primary tumor diagnosis to metastasis was 4.8 months. Most patients developed bilateral thyroid metastases (88.9%). Diagnosis of thyroid metastasis was primarily through fine-needle aspiration (FNA), with one case misdiagnosed as papillary thyroid carcinoma. Immunohistochemical staining revealed thyroid transcription factor-1 (TTF-1) and novel aspartic proteinase of pepsin family A (Napsin-A) positivity and paired box 8 (PAX8) negativity. Genetic testing found epidermal growth factor receptor mutations in 71.4% of patients. The individualized comprehensive therapy included surgery, chemotherapy, immunotherapy, and targeted and supportive therapy. The median overall survival was 56.0 months, with a progression-free survival of 12.7 months. Kaplan-Meier (K-M) analysis suggested improved survival with no advanced symptoms (p = 0.03) and targeted therapies (p = 0.05).

Conclusions: Lung adenocarcinoma metastasis to the thyroid is a rare disease, with an incidence of 0.1% among lung adenocarcinoma patients. Early treatment after symptom onset and personalized targeted therapies may improve prognosis. Despite rapid disease progression, favorable outcomes can be achieved with comprehensive treatment.

Background: Cancer is a severe threat to human health, and surgery is a major method of cancer treatment. This study aimed to develop an optical sensor for fast cancer tissue.

Methods: The tissue autofluorescence spectrum and diffuse reflectance spectrum were obtained by using a laboratory-developed optical sensor system. A total of 151 lung tissue samples were used in this ex vivo study.

Results: Experimental results demonstrate that tissue autofluorescence spectroscopy with a 365-nm excitation has better performance than diffuse reflectance spectroscopy, and 63 of 64 test samples (98.4% accuracy) were correctly classified with tissue autofluorescence spectroscopy and our developed data analysis method.

Conclusions: Our promising ex vivo study results show that the developed optical sensor system has great promise for future clinical translation for intraoperative lung cancer detection and other applications.

Background: Testing for targeting programmed death ligand 1 (PD-L1) is standard of care for patients with newly diagnosed non-small cell lung cancer (NSCLC) but is only approved for use with core biopsy specimens. Endobronchial ultrasound guided miniforceps biopsy (EBUS-MFB) is an approach to obtain core biopsy material but data assessing the ability of EBUS-MFB to adequately test for PD-L1 is lacking. We evaluate the feasibility of EBUS-MFB to acquire adequate tissue for PD-L1 testing and look to compare the quality of specimens between EBUS-MFB and endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) using a standard method of tissue analysis.

Methods: Twenty patients with suspected non-small cell lung cancer undergoing bronchoscopy were recruited for enrollment. For each patient with NSCLC diagnosed on rapid onsite pathology with EBUS-TBNA, EBUS-MFB was performed. PD-L1 immunostaining was completed to assess for adequacy. A comparison of tissue collection was performed using the total surface area measured by digital imaging.

Results: Among 20 patients, 65% were male with a mean age of 66 years with a total procedure time of 50 min and an average of 14 biopsy passes per procedure. 15 (75%) patients were diagnosed with NSCLC, and PD-L1 analysis was successfully performed in 12 of the 15 (80%). The mean total tissue area obtained by the MFB technique was 9.757 mm² compared to 6.941 mm² with TBNA (p = 0.427).

Conclusion: In this feasibility study, EBUS-MFB was successful in performing PD-L1 testing in 80% of patients with NSCLC.

We herein describe a patient with non-small-cell lung cancer who achieved pCR with a single dose of pembrolizumab-based chemoimmunotherapy followed by surgery. A 61-year-old man was referred to our hospital with wheezing and an abnormal chest shadow. Squamous cell carcinoma of the left lower lobe, cT2aN1M0 stage IIB, was diagnosed and pembrolizumab-based chemoimmunotherapy was initiated at the patient's request. One month later, chest CT revealed new ground-glass opacities of the lungs, which were judged to be a CTCAE grade 2 pneumonitis due to an immune-related adverse event (irAE). Therefore, steroid therapy was initiated. Prednisolone was tapered and discontinued as symptoms improved. A sleeve resection of the left lower lobe was performed, and a pathological complete response (pCR) was confirmed in a resected specimen. There has been no recurrence for 1 year and 7 months without treatment. This is the first case report of pCR to a single dose of chemoimmunotherapy followed by surgery for lung cancer. The present results suggest the potential of a single dose of chemoimmunotherapy to achieve pCR and cause irAEs in some patients.

Background: Esophageal squamous cell carcinoma (ESCC) is a lethal malignancy, and the molecular underpinnings of its aggressive behavior are not fully understood. FYN proto-oncogene, Src family tyrosine kinase (FYN) has been linked to cancer progression, yet its role in ESCC remains elusive. This study investigated the influence of FYN on ESCC malignancy.

Methods: Quantitative real-time polymerase chain reaction was used to assess the mRNA expression of FYN, while western blotting and immunohistochemistry (IHC) assays were performed to detect the protein expression of FYN, ubiquitin specific peptidase 8 (USP8) and protein tyrosine kinase 2 (PTK2). Cell viability was measured with a cell counting kit-8 assay, and cell apoptosis was evaluated using flow cytometry.

Results: FYN expression was increased in ESCC tissues and cells when compared with normal esophageal tissues and normal esophageal epithelial cells. Knockdown of FYN inhibited cell invasion, migration, stem-like traits, and glycolysis, while promoting apoptosis. USP8 was shown to stabilize FYN protein expression through its deubiquitinating activity in ESCC cells. Overexpression of FYN reversed the effects of USP8 silencing on the malignant phenotypes of ESCC cells in vitro and in vivo. FYN upregulated PTK2 expression in both TE1 and KYSE150 cell lines. Furthermore, PTK2 overexpression reversed the effects of FYN silencing on the malignant phenotypes of ESCC cells. Further, USP8 silencing-induced inhibitory effect on PTK2 protein expression was counteracted after FYN overexpression.

Conclusion: USP8-dependent FYN contributed to the malignant progression of ESCC by interacting with PTK2. Targeting this pathway may offer a novel therapeutic strategy for ESCC treatment.

Objective: To search for a new biomarker that can predict the efficacy and prognosis of tumor immunotherapy.

Method: FOXK2 genes were analyzed using single-cell sequencing in pan-cancer bulk RNA-seq from the TCGA database. We used algorithms to predict their immune infiltration. Functional enrichment and ChIP-seq identified potential downstream gene, FBXO32. FBXO32's role in cancer immune response was explored through analysis.

Results: Significant up-regulation of FOXK2 was observed in prostate adenocarcinoma (PRAD), uterine corpus endometrial carcinoma (UCEC), bladder urothelial carcinoma (BLCA), colorectal cancer (CRC), pancreatic ductal adenocarcinoma (PDAC), and stomach adenocarcinoma (STAD), while no such increase was found in lung cancer (lung adenocarcinoma [LUAD], lung squamous cell carcinoma [LUSC]) or thyroid carcinoma (THCA) tumor and adjacent tissues. FOXK2 expression correlated with patient prognosis, with lower expression associated with better immune response and survival and higher expression of its downstream gene FBXO32 linked to worse overall survival (OS) and immune infiltration. FOXK2 has the potential to be used as a prognostic indicator and target for treatment in individuals with cancer.

Conclusion: Our research provides insights into the significance of FOXK2 in cancer and indicates its potential as both a prognostic indicator and target for treatment. The ribosome-associated pathways involving FOXK2 and FBXO32 could be pivotal in the advancement of tumors, offering possible avenues for targeted and individualized immunotherapy approaches. Additional research is required to completely understand the mechanisms that are responsible for the participation of FOXK2 and its subsequent gene FBXO32 in cancer, as well as to explore the possible advantages of focusing on FOXK2 for cancer treatment.

Background: Cachexia is a poor prognostic factor in many advanced cancers. Cachexia diagnostic criteria of the European Palliative Care Research Collaboration (EPCRC) may underestimate cachexia in Asians; therefore, new criteria have been proposed by the Asian Working Group for Cachexia (AWGC). We compared both criteria to determine differences in diagnostic rates and their association with lung cancer prognosis.

Patients and methods: This single-center, retrospective cohort study considered lung cancer outpatients receiving chemotherapy. Survival was analyzed using Kaplan-Meier curves and log-rank tests. The association between cachexia diagnosis and prognosis was examined for each set of criteria using a Cox proportional hazards model. C-statistic analysis was performed to compare the discriminative power for prognosis.

Results: Among the 106 participants analyzed (median age, 75 [71-79] years; 75 males [70.8%]; 91 [85.9%] with performance status [PS] 0-1), 58 (54.7%) and 77 (72.6%) cachexia cases were diagnosed using the EPCRC and AWGC criteria, respectively. The latter encompassed all but one patient diagnosed using the EPCRC criteria. Patients with cachexia had a significantly poorer prognosis according to both criteria (EPCRC, p = 0.002; AWGC, p = 0.001). Both criteria had almost equal discriminative power for prognosis (EPCRC, C-statistic = 0.658; AWGC, C-statistic = 0.658). CRP in the AWGC criteria was most strongly related to prognosis.

Conclusions: Cachexia was an independent poor prognostic factor in lung cancer patients receiving chemotherapy under the AWGC and EPCRC criteria, both of which had similar prognostic discriminatory power. Among CRP, anorexia, and grip strength, elevated CRP may be the most prognostically relevant parameter in the AWGC criteria.

Purpose: Lung cancer (LC) is a leading cause of death and presents a substantial societal burden. This article compares its disease burden and risk factors between China and Australia to support health policymakers for LC prevention and treatment.

Materials and methods: The data from the 2019 Global Burden of Disease Study were used to analyze disease temporal trends using Joinpoint regression model. The Bayesian age-period-cohort model was used for prediction. The population-attributable fraction (PAF) was used to analyze LC risk factors.

Results: In 2019, the age-standardized rates (ASR) of incidence and of mortality of LC in China were 41.71/100 000 and 38.70/100 000, while Australia's rates were 30.45/100 000 and 23.46/100 000. It showed an increasing trend in China but a decreasing trend in Australia. By 2030, the ASR of incidence and mortality are predicted to be 47.21/100 000 and 41.54/100 000 in China, while Australia's rates will reach 30.09/100 000 and 23.3/100 000, respectively. Smoking is the most common risk factor for LC, followed by particulate matter and occupational carcinogenesis. The PAF of smoking dropped in Australia (from 68.38% to 53.75% in females; 77.41% to 58.47% in males) but increased in China (from 19.56% to 26.58% in females; 80.45% to 82.03% in males) from 1990 to 2019.

Conclusions: The disease burden of LC in China is rising, whereas in Australia, it is declining. China still faces a heavy LC burden. Risk factor analysis supported for further improving the compliance and enforcement of polices on tobacco control and environmental management to reduce this disease burden.