Thoracic Cancer最新文献

Hypertrophic pulmonary osteoarthropathy is a rare paraneoplastic syndrome affecting < 1% of patients with non-small cell lung cancer, characterized by clubbed fingers, periosteal proliferation, and arthritis. Although symptoms improve after treatment, objective functional recovery has not previously been reported. We present a 52-year-old male heavy smoker with right upper lobe adenocarcinoma and hypertrophic pulmonary osteoarthropathy causing profound grip strength impairment (5/2 right/left kilogram-force (kgf)). Genetic testing identified the KRAS G12C mutation. The patient underwent right upper lobectomy after which his arthralgia resolved immediately and grip strength recovered progressively (16/12 kgf, postoperative day 3; 40.9/32.9 kgf, 3 months), reaching normal adult levels. Periosteal changes initially persisted but resolved by 1 year. This case provides the first objective documentation of functional recovery in a patient with hypertrophic pulmonary osteoarthropathy, suggesting that impaired grip strength may be caused by joint inflammation and edema affecting bone-tendon attachments, rather than by muscle weakness alone. The KRAS G12C mutation may contribute to the development of hypertrophic pulmonary osteoarthropathy through upregulation of vascular endothelial growth factor via the Raf pathway. This case provides valuable insights into the pathophysiology of hypertrophic pulmonary osteoarthropathy and confirms that functional impairment is reversible with appropriate treatment.

Background: Second-generation anaplastic lymphoma kinase (ALK) inhibitors, including alectinib and brigatinib, are widely used in patients with ALK-positive non-small cell lung cancer (NSCLC) who develop resistance or progress on crizotinib. However, real-world data comparing their efficacy and safety remain limited. This multicenter, prospective cohort study compared the clinical outcomes of alectinib and brigatinib in this setting.

Methods: Patients with stage IV ALK-positive NSCLC who progressed on crizotinib were enrolled and treated with either brigatinib or alectinib. The primary endpoint was the progression-free survival (PFS) rate.

Results: Sixty patients were included (brigatinib, n = 34; alectinib, n = 26). Median follow-up durations were 26.5 and 30.0 months. Disease progression or death occurred in 50.0% (brigatinib) and 46.2% (alectinib), respectively. The 3-year PFS was 51.5% (brigatinib) vs. 62.1% (alectinib), with no significant difference at 5 years (40.0% vs. 42.5%; p = 0.260). Overall response rates were similar (58.8% vs. 46.2%; p = 0.475). However, intracranial outcomes appeared more favorable with alectinib: the 3-year intracranial PFS was 70.5% vs. 31.7% (p = 0.023), and intracranial ORR was 94.4% vs. 64.3% (p = 0.028). More patients in the brigatinib group had prior whole-brain radiotherapy (21.4% vs. 5.6%), while radiosurgery was more frequent in the alectinib group (55.6% vs. 35.7%). Treatment discontinuation rates due to adverse events were comparable between the two groups.

Conclusions: In crizotinib-refractory ALK-positive NSCLC, systemic efficacy was not significantly different between brigatinib and alectinib; however, alectinib was associated with more favorable intracranial PFS and ORR, which may be partly explained by differences in prior brain-directed local treatments.

Objective: Although uniportal video-assisted thoracoscopic surgery (uVATS) is increasingly adopted for early-stage lung cancer, long-term survival data comparing different forms of anatomic resection remain limited. This study aimed to evaluate the long-term oncologic outcomes-specifically, 5-year disease-free survival (DFS) and overall survival (OS)-of patients with clinical stage I non-small cell lung cancer (NSCLC) who underwent uVATS segmentectomy or lobectomy. Secondary outcomes included perioperative parameters and complication rates.

Method: We conducted a retrospective analysis of patients with clinical stage I NSCLC who underwent uVATS anatomical resection (lobectomy or segmentectomy) between January 2014 and December 2020. The primary endpoints were 5-year DFS and OS, while the secondary endpoints included operative time, drainage duration, hospital stay, conversion rates, and postoperative complications.

Results: A total of 386 patients with clinical stage I NSCLC underwent uVATS anatomical resection, with 280 receiving lobectomy and 106 undergoing segmentectomy. The 5-year DFS and OS rates did not significantly differ between segmentectomy and lobectomy for patients with pathological stage IA tumors. Segmentectomy was associated with a shorter drainage duration. The overall conversion rate to multiple-port VATS or thoracotomy was 1.8%, with no 30-day surgical mortality observed. Prolonged air leaks were the most common complication.

Conclusion: uVATS anatomical resection is an effective treatment option for clinical stage I NSCLC, offering comparable long-term survival outcomes for segmentectomy and lobectomy in selected patients. Further prospective studies are warranted to confirm these findings and optimize patient selection.

Background: Uncommon EGFR mutations, including G719X, L861Q, S768I, and compound mutations, present therapeutic challenges due to limited prospective evidence and variable drug sensitivity. Although later-generation (i.e., second- and third-) EGFR-TKIs have shown benefit in some subtypes, real-world data is limited.

Methods: We retrospectively analyzed patients with advanced or recurrent NSCLC harboring uncommon EGFR mutations diagnosed between 2014 and 2019 at Keio University Hospital and affiliated hospitals. Clinical data were updated through May 2023. EGFR mutations were detected using commercial assays. Common mutations and exon 20 insertions were excluded unless coexisting as compound mutations. Survival outcomes were estimated using the Kaplan-Meier method and compared by log-rank test; hazard ratios were calculated using the Cox proportional hazards model. Swimmer plots depicted treatment duration by subtype and EGFR-TKI agents.

Results: Among 35 patients, G719X was the most frequently detected mutation, followed by L861Q and S768I. In addition to these single mutations, various compound mutations involving combinations of G719X, L861Q, S768I, and other rare variants were also observed. While first-generation EGFR-TKIs were frequently used initially, 71% of patients eventually received a later-generation EGFR-TKI. These patients had significantly longer OS (47.7 vs. 15.5 months; p = 0.0177). Multivariate analysis identified non-use of later-generation EGFR-TKIs, liver metastases, and poor performance status as independent poor prognostic factors. Afatinib showed favorable treatment duration in G719X and compound mutations.

Conclusions: Later-generation EGFR-TKIs were associated with improved outcomes in patients with uncommon EGFR mutations, with afatinib showing favorable treatment duration in G719X and compound subtypes.

This case highlights acquired MTAP loss during disease progression in ROS1-rearranged NSCLC. Despite persistent CD74-ROS1 fusion and absence of known resistance mutations, the patient developed CNS progression after entrectinib, underscoring the value of longitudinal genomic profiling in guiding treatment decisions.

Persistent air leaks due to alveolar pleural fistula following lung resection were a frustrating clinical condition for patients and clinicians, associated with a prolonged hospital stay and increased morbidity. Several surgical strategies have been reported over the years for the closure of alveolar fistula, but the best treatment was still debated. Herein, we reported the clinical case of a patient who experienced a persistent air leak due to alveolar-pleural fistula following thoracoscopic right upper lobectomy for the management of early lung cancer. The fistula was successfully closed by thoracoscopic application of a pleural flap and polymeric sealant. Our new strategy could turn out to be useful for surgeons when standard procedures for management of APF were unfeasible or difficult to perform. Obviously, our impression should be validated by future large studies in a prospective manner.

Background: The IMpower150 trial demonstrated the efficacy of atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP) therapy in epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC). However, its efficacy in patients with NSCLC harboring other genetic alterations in real-world settings remains unclear. This study aimed to retrospectively evaluate the efficacy of ABCP therapy in patients with NSCLC harboring other genetic alterations.

Methods: We retrospectively analyzed 61 patients with advanced NSCLC (33 with EGFR mutations: EGFR group and 28 with other genetic alterations: other group) who received ABCP therapy between January 2019 and December 2023 at a single institution in Japan, and evaluated efficacy and toxicities.

Results: Most baseline characteristics were similar except treatment timing (p < 0.001) in both groups. The median progression-free survival (PFS) was 4.5 vs. 5.1 months (p = 0.663), and the objective response rate (ORR) was 45.5% vs. 50.0% (p = 0.77) between the EGFR and other groups. In multivariate analysis, PD-L1 expression ≥ 50% was independently associated with longer PFS (HR 0.23, p < 0.001). Grade ≥ 3 adverse events were manageable and occurred at similar rates (51.5% vs. 53.6%) between the EGFR and other groups, and discontinuation was low (9.8%). Subgroup analysis for patients with KRAS mutation (n = 14) and anaplastic lymphoma kinase (ALK) fusion (n = 6) showed trends consistent with the overall cohort.

Conclusions: ABCP therapy demonstrated efficacy and manageable toxicity in NSCLC patients in both groups. Notably, those with high PD-L1 expression (≥ 50%) may derive greater PFS benefit. Further confirmation in larger prospective trials is warranted.

Objective: This study evaluates the effectiveness and safety of C-arm cone beam CT (CBCT)-guided microcoil localization combined with uniportal video-assisted thoracoscopic surgery (VATS) for the management of small, difficult-to-localize ground-glass opacities (GGOs) and sub-solid nodules in the lungs.

Methods: We retrospectively analyzed data from 13 patients with single, small, peripheral, non-subpleural GGOs or SSN. All patients underwent successful microcoil localization using CB-CT guidance followed by uniportal VATS resection. A microcoil was positioned partly in the lung parenchyma and partly in the extra-pleural space to assist in intraoperative localization. We evaluated the rate of correct microcoil placement and the technical success of the resection.

Results: Microcoil placement was successfully performed in all patients, with an average procedure time of 28.8 ± 10.8 min. The mean nodule size was 9.9 ± 5.4 mm, and 76.9% of the nodules were classified as ground-glass opacities. No intraparenchymal bleeding was observed, and four patients (30.8%) experienced pneumothorax, all of which were self-limited and required no intervention or coil repositioning. The uniVATS resection success rate was 100%.

Conclusion: CBCT-guided microcoil localization, with partial placement of the coil in the extra-pleural space, proved to be a highly effective technique for the localization and resection of small pulmonary nodules. The procedure demonstrated high accuracy, minimal complications, reduction of procedural time, and short hospital stays. Intraoperative fluoroscopy was never necessary, with a high reduction in radiation exposure for the patient and the operator. Further studies with larger populations and longer follow-ups are needed to validate these findings.

Introduction: Lung cancer accounts for 9% of all cancer diagnoses in Australia with a 5-year survival rate of 26%. Small cell lung cancer (SCLC) is a more aggressive subtype of lung cancer, representing 15% of all lung cancer cases and a 5-year survival of 11.1%. This study aims to assess the extent of guideline concordant treatment (GCT) delivery for SCLC in Victoria, identify patient, clinical, and hospital factors influencing GCT receipt, and evaluate its impact on survival.

Methods: Data were obtained from the Victorian Lung Cancer Registry (VLCR) in Victoria, Australia (n = 1769). Descriptive statistics were used to summarie patient and disease characteristics by treatment type, including GCT, non-GCT, and no/declined treatment. Statistical analyses included multiple logistic regression, Cox regression, and Kaplan-Meier survival estimates.

Results: 78.1% received GCT, 10.5% received non-GCT, and 11.5% had no treatment. Older age, poor performance status, and advanced cancer stage were associated with a lower likelihood of receiving GCT. Patients who received stage-specific GCT had a 60% lower mortality risk compared to those who received non-GCT treatment.

Conclusion: This study highlights significant variation in the receipt of guideline concordant treatment for SCLC, with older age, poorer performance status, and advanced cancer stage reducing the likelihood of GCT. Given the survival benefits associated with GCT, addressing barriers to its delivery is essential to improving outcomes for SCLC patients in Victoria.