Thoracic Cancer最新文献

Background: Thymoma is a rare thymic epithelial tumor, and its prognostic factors remain not fully elucidated. This study aimed to identify simple, practical preoperative predictors of prognosis, focusing on tumor dimensions assessed by computed tomography (CT).

Methods: We retrospectively analyzed 181 patients who underwent complete or partial resection for thymoma between 2004 and 2022. Tumor size was assessed by measuring the maximum transverse and craniocaudal dimensions on preoperative CT. Freedom from recurrence (FFR) and overall survival (OS) were estimated using the Kaplan-Meier method. Cox proportional hazards models were constructed: Model A included only preoperative variables, while Model B additionally incorporated postoperative factors (e.g., TNM stage classification and histology).

Results: During a median follow-up of 96 months, the 5- and 10-year FFR rates were 78.4% and 71.4%, and the corresponding OS rates were 96.5% and 87.3%, respectively. In multivariate analysis, TNM stage classification and preoperative steroid pulse therapy were significantly associated with FFR, whereas no variables were significantly associated with OS. Model A demonstrated good discriminatory ability (C-index = 0.839), which improved only modestly after including postoperative factors in Model B (C-index = 0.867). In the steroid-excluded cohort (N = 148), the craniocaudal tumor dimension emerged as a significant predictor of FFR (p = 0.027).

Conclusions: The craniocaudal tumor dimension measured on preoperative CT was consistently associated with recurrence and may reflect prognostic information embedded within the pathological TNM classification. This easily measurable parameter could complement TNM-based evaluation in preoperative risk assessment and surgical decision-making for thymoma.

Objective: To evaluate the effect of postoperative adjuvant immune checkpoint inhibitor (ICI) therapy on survival outcomes in resectable non-small cell lung cancer (NSCLC) patients who received neoadjuvant chemoimmunotherapy.

Methods: A retrospective cohort study was conducted at Zhongshan Hospital, Fudan University, from January 2019 to June 2024, including resectable NSCLC patients treated with neoadjuvant chemotherapy combined with ICIs. Pathological responses were assessed, and event-free survival (EFS) and overall survival (OS) were compared between patients who received postoperative adjuvant ICI therapy and those who did not.

Results: Among the 186 patients included, 106 received adjuvant ICI therapy, while 80 did not. No significant differences in EFS or OS were observed between the two groups in patients who achieved pathological complete response (pCR) or major pathological response (MPR) (EFS: p = 0.282, OS: p = 0.330). In contrast, patients who did not achieve pCR or MPR experienced a significant improvement in EFS with adjuvant ICI therapy (p = 0.004). An AI-based decision tree model developed to predict the need for postoperative adjuvant immunotherapy demonstrated strong performance, with an accuracy of 85% and an area under the curve (AUC) of 0.82. Key predictors identified by the model included pathological response, age, clinical stage, and PD-L1 expression.

Conclusions: Postoperative adjuvant ICI therapy significantly improves EFS in resectable NSCLC patients, especially in those without pCR or MPR. However, its effect on OS remains uncertain. These findings highlight the importance of personalized treatment strategies, with adjuvant ICI offering greater benefits for patients with incomplete pathological responses.

Thymoma is a rare malignant tumor originating from the thymus epithelium. In recent years, immune checkpoint inhibitors have become an indispensable treatment for cancer. However, the efficacy and adverse events of immunotherapy for thymoma have not been widely evaluated. A 53-year-old Chinese man who was diagnosed with metastatic B2 thymomas since March 2023. He received chemotherapy plus anlotinib for four cycles since May 5, 2023, and underwent radiotherapy from May 23, 2023 to June 30, 2023. However, the treatment was not satisfactory. Thus, we detected PD-L1 expression in tumors; immunohistochemical examination on the tumor revealed a high PD-L1 expression in 60% of tumor cells. He presented symptoms of palpitation, gasping, fatigue, diplopia, and eyelid ptosis. Additionally, he was found to have significantly elevated levels of serum cardiac troponin, creatine kinase, creatine kinase isoenzymes, N-terminal pro brain natriuretic peptide, and anti-acetylcholine receptor antibody. He was eventually diagnosed with immune-related myocarditis and myasthenia gravis. Finally, the patient was discharged after treatment with glucocorticoids, immunoglobulin, and pyridostigmine. Although immune checkpoint inhibitors have achieved similar anti-tumor effects in thymomas as in other solid tumors, they may be closely associated with serious immune-related adverse events, so special caution is required when using immune checkpoint inhibitors in thymoma patients.

Background/objectives: Thoracostomy and pleurodesis are the mainstay of management for malignant pleural effusions (MPEs). However, pleurodesis may not be effective for patients with MPEs and non-expandable lungs. Intrapleural chemotherapeutic agents such as hypotonic cisplatin are reportedly useful for treating MPEs with expandable lungs; however, their efficacy in patients with non-expandable lungs remains unclear. We aimed to analyze the efficacy and safety of intrapleural administration of hypotonic cisplatin in patients with MPEs and non-expandable lungs.

Methods: We retrospectively analyzed patients with MPEs of thoracic malignancies who were administered intrapleural hypotonic cisplatin. We investigated the changes in drained fluid volume, radiological outcomes at 4 weeks, thoracentesis-free survival, and adverse events. Between June 2009 and September 2022, 62 patients with MPEs received 69 administrations of hypotonic cisplatin.

Results: The most frequent primary site was the lungs (90.3%), and the mean drained fluid volume per day decreased by 65% (95% confidence interval [CI] 58%-72%) after intrapleural hypotonic cisplatin administration. At 4 weeks post-administration, MPE volumes decreased in 33 (53.2%) patients, remained unchanged in 22 (35.4%), and increased in seven (11.3%), based on frontal plane chest radiographs. The median thoracentesis-free survival was 456 days (95% CI, 122-842 days), the 30-day thoracentesis-free survival rate was 86.1%, and the 90-day survival rate was 70.8%. In total, 37 patients (59.7%) were censored. The most frequent adverse event was pleural empyema, observed in four patients.

Conclusions: Intrapleural hypotonic cisplatin administration decreased or stabilized pleural effusion and may be useful for suppressing MPE with non-expandable lungs.

Clinicaltrials: gov identifier: E23-0003.

Background: Lung cancer remains a leading cause of cancer mortality globally, with particulate matter pollution (PMP) identified as a critical environmental risk. This study analyzes long-term trends in age-standardized mortality (ASMR) and disability-adjusted life-year rates (ASDR) for PMP-attributable lung cancer, with projections to 2030.

Method: Using Global Burden of Disease data, we evaluated temporal trends across age, sex, and Sociodemographic Index (SDI) regions through age-period-cohort and Bayesian models.

Result: Global Trends: PMP-related ASMR/ASDR declined significantly over the study period, while ambient PMP (APMP)-attributable rates increased, contrasting with household air pollution (HAP)-related declines. Age and Sex Disparities: Mortality burden shifted toward older populations, with APMP-related deaths rising sharply in the elderly. Males exhibited faster declines in PMP/HAP-related mortality, whereas females faced steeper increases in APMP-attributable risks. SDI variations: High-middle SDI regions consistently had the highest PMP-related mortality, with ASMR trends reflecting industrialization phases. Projections: PMP-related burdens are expected to rise globally, driven by aging populations and persistent pollution in middle-SDI regions.

Conclusion: The escalating burden in vulnerable populations demands urgent interventions, including air quality improvement, tobacco control, and enhanced screening, Notably, China consistently exhibited the world's highest PMP-attributable lung cancer ASMR (13.6 per 100 000 in 1990, declining to 10.1 per 100 000 in 2021). Future strategies must integrate gender-specific risk mitigation and environmental-genetic assessments to address disparities.

This review has been written with the intention of explaining to the patients with ALK-positive lung cancer, and to their families, friends, carers and medical teams, in simple terms, the fundamentals, and the current state of knowledge of this particular type of cancer. The review begins with basic facts about lung anatomy and lung cancer, then explains general principles of how cell proliferation is regulated at the molecular level. The coverage of the molecular events underlying the development of ALK-positive lung cancer and principles of targeted therapies then follows. The review concludes with an analysis of various therapeutic approaches to treat ALK-positive lung cancer. The Supporting Information section contains additional advanced information illustrating specific points of interest.

Objective: This study aimed to evaluate the short-term clinical outcomes of subxiphoid approach thoracoscopic surgery (SATS) versus lateral intercostal approach thoracoscopic surgery (LIATS) for anterior mediastinal tumors.

Methods: Clinical data from patients who underwent video-assisted thoracoscopic surgery for anterior mediastinal tumors between April 1, 2020 and December 31, 2023 were analyzed. Patients were stratified into two cohorts according to the surgical approach used: the SATS group (n = 679) and the LIATS group (n = 461). Intraoperative and postoperative outcomes were compared between the two groups.

Results: A total of 1140 patients were included in the statistical analysis after screening and assessment. After propensity score matching, a total of 417 SATS patients were matched with 417 LIATS patients. In the analysis of the outcomes, the LIATS group had a shorter operation time than the SATS group (p < 0.001). There were no statistical differences in Numeric Rating Scale (NRS) pain scores on Postoperative Day 1 (p = 0.113), Day 2 (p = 0.189), or Day 3 (p = 0.462). Postoperative atelectasis was more common in the SATS group than in the LIATS group (p = 0.025). There were no perioperative deaths.

Conclusions: The SATS did not demonstrate significant improvements in postoperative pain compared with the LIATS. However, the LIATS was associated with shorter operative time in the overall cohort.

Cancer cachexia is a multifactorial syndrome characterized by progressive weight loss, muscle wasting, and systemic inflammation. Early identification of individuals at risk for cachexia is essential for timely intervention, yet a universally accepted definition of the "at risk" stage remains lacking. Building on the Asian Working Group for Cachexia (AWGC) framework, we propose that the presence of any one of the five components-low BMI (< 21 kg/m²), weight loss ≥ 2% over 3-6 months, anorexia, low handgrip strength, or elevated CRP levels-may indicate vulnerability to cachexia. We evaluated the prognostic value of this definition in a cohort of 364 patients with palliative cancer. The patients were categorized into three groups: non-cachectic, at risk, and cachectic. Survival analyses demonstrated significant differences across groups (p = 0.005), with the median overall survival not reached in the non-cachectic group, 381 days in the at-risk group, and 157 days in the cachectic group. While low BMI and weight loss were not associated with survival in patients with edema, they became evident in those without edema (HR = 1.54 and 1.58), highlighting the confounding role of fluid retention in anthropometric assessment. Anorexia, low handgrip strength, and elevated CRP levels independently predicted poor prognosis in both full and non-edematous cohorts. These findings support the clinical relevance of an "at risk" category based on AWGC components, especially in patients without edema. This simple and pragmatic definition may facilitate the early identification of patients who could benefit from supportive interventions before cachexia becomes refractory.

Objectives: The optimal staging system for thymic epithelial tumors (TETs) remains controversial. This study aimed to evaluate the clinical utility of the T component in the latest ninth edition of the TNM staging system.

Methods: A retrospective analysis was performed on patients diagnosed with TETs at our center from January 2001 to December 2022. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using Kaplan-Meier curves and Cox proportional hazards regression models. The predictive performance of the TNM staging systems was mainly assessed by the concordance index (C-index) and area under the receiver operating characteristic curve (AUC).

Results: Ultimately, 545 patients with TETs were included. The ninth edition TNM staging system demonstrated superior discrimination compared to the eighth edition TNM staging in RFS outcomes, particularly for T1b versus T2 patients (HR = 3.58, p = 0.014). Prognostic accuracy metrics also favored the ninth edition, with higher AUC values (RFS: 0.83 vs. 0.824; OS: 0.726 vs. 0.685) and C-index values (RFS: 0.823 vs. 0.816; OS: 0.743 vs. 0.685).

Conclusions: The ninth edition TNM staging system provides enhanced prognostic accuracy for RFS in patients with TETs compared to the eighth edition, although both editions have limitations in predicting OS. Further studies are warranted to refine staging approaches and improve patient management in TETs.

Background: In certain types of solid tumors, nuclear factor of activated T cell 5 (NFAT5) plays critical roles in tumor development and progression. However, the subtle regulatory mechanism of NFAT5 in particularly lung cancer has not been well characterized.

Methods: In this report, we measured the levels of interleukin-8 (IL8) in NSCLC cell lines. The target gene of IL8 was verified by ChIP assay and Luciferase reporter assay. Moreover, the function and regulatory mechanism of IL8 in the progression of cancer were further investigated.

Results: ELISA assay showed that IL8 was significantly downregulated in NFAT5 silencing PC9 cells and HCC827 cells. NFAT5 silencing caused inhibiting effects on proliferation, migration, and invasion in NSCLC cell lines. Further analysis indicated that IL8 was a direct target gene of NFAT5, evidenced by the direct binding of NFAT5 to the promoter of IL8. Elevated IL8 further enhanced the activation of the canonical NF-κB pathway.

Discussion: Our findings provide new insight into the mechanism of NSCLC progression. NFAT5 promotes cell growth and motility by regulating IL8 directly in NSCLC cell lines. Elevated IL8 expression causes enhancement of the NF-κB signaling pathway partially through autocrine or paracrine effects. These findings provide a possible mechanism of the inflammatory environment on lung cancer progression.