Thoracic Cancer最新文献

Background: Tracheal, bronchial, and lung cancers (TBL cancers) pose a significant global health challenge, with rising incidence and mortality rates, particularly in China. Studies from the Global Burden of Disease (GBD), 2021, can guide screening and prevention strategies for TBL cancer. This study aims to provide a comprehensive analysis of the burden of TBL cancers in China compared to global data.

Methods: We conducted an analysis of incidence, prevalence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021. We also performed Joinpoint regression analysis and Bayesian age-period-cohort (BAPC) modeling to project future trends.

Results: From 1990 to 2021, there was a substantial increase in TBL cancer indicators for all sexes in China, with the most significant rise observed in females. The female population showed alarming increases in age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR). While global efforts have managed to stabilize these rates, China's figures remain high, suggesting the impact of persistent risk factors such as smoking and air pollution, coupled with an aging population. Furthermore, we utilized the projection model in China to estimate that these indicators of TBL cancers in females will likely follow continuous and rapid upward trends, while the burden of TBL cancers among males is expected to have a steady trend.

Conclusion: Although global efforts have been effective in reducing the burden of TBL cancers over the past three decades, there still remains strong regional and gender heterogeneity. TBL cancers need more screening strategies and medical attention in China and in the female population.

Background: Ipsilateral shoulder pain (ISP) is a common complication following video-assisted thoracoscopic surgery (VATS), significantly affecting postoperative recovery and quality of life. This study aimed to evaluate the relationship between intraoperative upper limb positioning, and the occurrence of ISP, with the goal of optimizing positioning to reduce postoperative complications.

Methods: This prospective cohort study included 252 patients undergoing VATS for lung resection. The A angle (shoulder flexion) and B angle (shoulder abduction) were measured intraoperatively. ISP was assessed using the Visual Analog Scale (VAS) on the first postoperative day and 1 week after surgery. Univariate and multivariate logistic regression analyses were performed to identify predictors of ISP, and receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic accuracy of shoulder positioning in predicting ISP.

Results: The incidence of ISP was 26.2% (66/252). Multivariate analysis revealed that larger A angles (OR: 1.061, 95% CI: 1.009-1.115, p = 0.021) were associated with a higher risk of ISP, while larger B angles (OR: 0.798, 95% CI: 0.744-0.856, p < 0.001) were protective against ISP. ROC curve analysis demonstrated a strong predictive value for the combined influence of A and B angles, with an area under the curve (AUC) of 0.822.

Conclusion: Intraoperative upper limb positioning, specifically decreasing the A angle (shoulder flexion) and increasing the B angle (shoulder abduction), plays a critical role in reducing the incidence of ISP following VATS. These findings suggest that adopting an optimal shoulder posture during surgery can improve patient outcomes.

Lung cancer (LC) is a malignant tumor with high morbidity and mortality. Nearly 50% of patients with primary LC have distant metastases at the time of initial diagnosis. LC usually metastasizes from the lungs to the liver, adrenal glands, brain, and bone, but rarely to the gastrointestinal (GI) tract. Most gastrointestinal metastases (GIM) from LC are found on the basis of primary LC. GIM of LC with GI symptoms as the initial symptom is extremely rare. Moreover, the overall survival time of lung cancer patients developing intestinal metastases is from 5 weeks to 1 year, and most patients will die within the first 6 months. This report describes an uncommon case of lung adenocarcinoma that metastasized to the colon with initial symptoms involving the GI tract. After immunotherapy, the condition was stable for more than 2 years, and he is currently in good condition.

Background: Multiport robot-assisted thoracoscopic surgery (mRATS) has been comprehensively evaluated for its clinical efficacy in numerous studies. Nevertheless, the safety and feasibility of uniportal robotic lobectomy and lymphadenectomy require further validation.

Methods: The clinical data of 34 consecutive patients with lung cancer who underwent improved uniportal robotic-assisted thoracoscopic surgery (uRATS) at our hospital between November 2023 and June 2024 were reviewed retrospectively. Camera-centered uRATS was conducted using the da Vinci Surgical Xi system (Intuitive Surgical Inc., 1266 Kifer Road, Sunnyvale, CA 94086, USA). Descriptive statistics are expressed as numbers with percentages for categorical data or medians (ranges) or means with standard deviations for continuous data.

Results: Improved uRATS lobectomy and lymphadenectomy were conducted in 34 patients with postoperative pathology-diagnosed invasive lung cancer. Among the patients, the median number of lymph nodes dissected was 24.5 (range 10-42), and the median number of stations with lymph nodes dissected was 8 (range 6-11). The median durations of the operation and the uRATS procedure were 200 min (range, 142-330 min) and 140 min (range, 80-242 min), and the median intraoperative blood loss volume was 20 mL (range, 10-100 mL), respectively. All postoperative complications, including pneumonia (2/34, 5.8%), air leakage > 5 days (2/34, 5.8%), prolonged wound healing (1/34, 2.9%), and arrhythmia (1/34, 2.9%), were graded as Clavien-Dindo grades I-II. There were no cases of wound infection or postoperative 30-day mortality.

Conclusion: The safety and feasibility of uRATS lobectomy and lymphadenectomy using the da Vinci Surgical Xi system have been preliminarily validated.

Background: This study aims to investigate the factors influencing false-negative results in ultrasound-guided percutaneous transthoracic needle lung biopsy results (US-PTLB).

Materials and methods: This ambispective cohort study included patients with subpleural pulmonary lesions who underwent US-PTLB with benign pathological findings between April 2017 and June 2022 (retrospective cohort) and between July 2022 and October 2022 (prospective cohort). In the retrospective cohort, comparative and logistic regression analyses were performed to identify independent risk factors for false-negative biopsy results. Stratified analyses based on these risk factors were performed in the prospective cohort.

Results: The retrospective cohort included 1747 (true-negative: false-negative, 1321:426) patients with negative biopsy results, which were analyzed by comparative and logistic regression analyses, and the results demonstrated that advanced age (> 56 years) (OR = 1.08, 95% CI: 1.07-1.09), small-sized lesions (< 3 cm) (OR = 1.80, 95% CI: 1.38-2.34), lesions with necrosis (OR = 3.00, 95% CI: 2.29-3.92), contrast-enhanced ultrasound (CEUS) showing hyper-enhancement (OR = 5.87, 95% CI: 4.09-8.42) or iso-enhancement (OR = 2.81, 95% CI: 2.05-3.83), and the presence of hemoptysis (OR = 11.82, 95% CI: 5.16-27.08) or pneumothorax (OR = 7.90, 95% CI: 2.89-21.58) during the puncture were independent predictors of false-negative US-PTLB results. The results of stratified analyses in the prospective cohort were consistent with the retrospective cohort.

Conclusion: Risk factors associated with false-negative results included advanced age (> 56 years), small-sized lesion (< 3 cm), presence of necrosis in the lesion, CEUS showing hyper-enhancement or iso-enhancement of the lesion, and hemoptysis or pneumothorax during puncture.

Trial registration: Number: ChiCTR2000029749.

Purpose: As microwave ablation continues to be used in patients with inoperable stage I non-small cell lung cancer (NSCLC), it is particularly important to monitor efficacy. Whether plasma ctDNA detection can predict its efficacy should be illustrated.

Methods: We recruited 43 patients with inoperative stage I NSCLC, all of whom underwent biopsy-synchronous microwave ablation (MWA). Peripheral blood samples were collected at baseline (n = 43), within 1 h post-MWA (n = 28), and at the landmark time point (n = 26) for MRD detection. Clinical outcomes were analyzed using Kaplan-Meier survival analysis.

Results: Patients with undetectable ctDNA at baseline (p = 0.042) and within 1 h after MWA (p = 0.023) had better clinical outcomes. In particular, patients with undetectable ctDNA at the 1-h post-MWA time point did not experience recurrence. Detection of ctDNA at the landmark time point is considered an independent risk factor for prognosis and is strongly correlated with clinical outcomes (p = 0.001), the median time to recurrence indicated by ctDNA was 4.9 months earlier compared to imaging. The clinical outcomes of patients with ctDNA clearance were similar to those with no ctDNA (p = 0.570). Risk stratification indicated that patients with persistent ctDNA had worse clinical outcomes compared to those who never had detectable ctDNA (p = 0.004).

Conclusion: Our findings suggest that ctDNA monitoring can assist in predicting clinical outcomes in stage I NSCLC treated with microwave ablation. Patients with undetectable ctDNA within 1 h after MWA are determined to be clinically cured. Risk stratification based on ctDNA test results helps to differentiate high-risk patients.

Background: Multiplex genetic testing is recommended when treating nonsmall cell lung cancer. A certain percentage of test failures in RNA assays owing to poor surgical specimen quality have been documented, and fixation failure is a possible cause. At our institution, sheet-like fixation is performed to reduce fixation time. This study aimed to compare the quality of RNA from resected lung cancer specimens following different fixation methods.

Methods: Sheet-like fixation specimens (n = 15), conventional fixation specimens of the same resected lungs (n = 15), and other lung cancer specimens collected for conventional fixation and subjected to multiplex gene-panel testing (n = 22) were retrospectively examined. RNA was extracted from each specimen. RNA quality and quantity were compared, and the success rate of multiplex gene-panel testing was determined.

Results: The DV₂₀₀ value was significantly higher in RNA extracted from sheet-like fixation samples (median 47.5%, interquartile range [IQR]:40.3-51.5) compared with RNA extracted from conventionally fixed samples or conventionally fixed samples of other patient specimens (median 21%, IQR:5.3-29.8 and median 16.3%, IQR:9.5-27.1, respectively). No significant difference was observed in nucleic acid concentration. The multiplex genetic analysis success rate was 95% with conventional methods (one failure); however, it was 100% with the sheet-like fixation method.

Conclusion: Sheet-like fixation preserved RNA extracted from lung cancer specimens, resulting in lesser degradation than with conventional fixation.

Background: Lung cancer continues to be the primary cause of cancer-related deaths globally, with the majority of cases identified at advanced stages. Genetic alterations, including mutations and gene fusions, are central to its molecular pathogenesis. The discovery of therapeutically targetable gene fusions, such as ALK, RET, ROS1, and NTRK1, has significantly advanced lung cancer management. Conventional methods, such as tissue biopsies, are invasive and unsuitable for continuous molecular monitoring. Consequently, noninvasive approaches, such as liquid biopsies and exhaled breath condensate (EBC), offer promising options for real-time molecular surveillance.

Methods: This study evaluates the feasibility of identifying fusion transcripts in 30 patients with lung adenocarcinoma by using next-generation sequencing (NGS) on formalin-fixed paraffin-embedded (FFPE) tissue, plasma, and EBC samples.

Results: Clinically significant fusion transcripts, including KIF5B-ALK, KIF5B-RET, and SQSTM1-ALK, were detected across different sample types. EBC samples showed strong concordance with tissue biopsy results, particularly in detecting ALK, ROS1, and RET fusions, and demonstrated greater sensitivity than plasma in detecting NTRK1 fusions. Additionally, 30 fusion transcripts of uncertain clinical significance were identified, highlighting the need for further research into their role in lung cancer pathogenesis.

Conclusion: In conclusion, EBC samples provide a valuable, noninvasive medium for detecting clinically relevant and previously uncharacterized fusion transcripts in non-small cell lung cancer (NSCLC). The high concordance between EBC and tissue biopsies suggests that EBC could complement tissue biopsy for effective diagnosis and monitoring of NSCLC. These findings underscore the importance of comprehensive molecular profiling using multiple sample types to enhance diagnostic precision and optimize therapeutic outcomes in lung cancer management.

Background: Primary pulmonary and bronchial adenoid cystic carcinoma (PACC) is a rare, low-grade malignant tumor of the lung. However, the relationship between its clinical features, surgical prognosis, and genetic phenotype has not been fully described.

Methods: PACC patient information was collected from the SEER, TCGA, and Zhongshan Hospital, Fudan University (FDZSH) databases. Overall survival (OS) was evaluated using the Kaplan-Meier method. Univariate and multivariate analyses through Cox proportional hazards regression identified risk factors that predicted OS. The limma and matfools packages from R were used to compare the differential genes and mutations between PACC and LUAD, respectively.

Results: Two hundred and ninety-two patients, 14 patients, and 12 patients with PACC were identified from the SEER, TCGA, and FDZSH databases, respectively. The 3-, 5-, and 10-year OS of the PACC patients were 91.7%, 88.6%, and 85.0%, respectively, compared to 95.8%, 93.9%, and 93.3% for patients who underwent surgery. Race, pathological grade, M stage, regional node examination, and regional node positive were independent prognostic factors for the OS of patients who underwent surgery. The gene map of PACC and lung adenocarcinoma (LUAD) shows significant differences. Common mutations found in lung cancer were almost undetectable in PACC patients, whereas mutations in the NOTCH pathway were more common. TMB levels and PD-1/PD-L1 expressions were also lower in PACC patients.

Conclusion: Our study analyzed the main factors that influence the prognosis of PACC patients undergoing surgery and discovered the unique genetic phenotype of PACC.

Background: This study aimed to compare long-term clinical outcomes of percutaneous needle biopsy (PCNB) versus surgical biopsy in patients with peripheral, small-sized clinical stage 1 non-small cell lung cancer (NSCLC) with computed tomography (CT)-defined visceral pleural invasion (VPI).

Methods: We retrospectively analyzed patients who underwent surgery for NSCLC with CT-defined VPI between 2010 and 2017. We excluded patients with non-peripheral NSCLC, or cancers > 3 cm. Propensity score matching was carried out to adjust for confounding variables. The primary endpoint was ipsilateral pleural recurrence-free survival, while secondary endpoints included overall survival and recurrence-free survival.

Results: Of the 1671 patients with peripheral, small-sized clinical stage 1 NSCLC with CT-defined VPI, 805 underwent PCNB, and 866 had a surgical biopsy. Propensity score matching assigned 562 patients to each group. Before matching, the PCNB group demonstrated worse baseline characteristics, including older age, higher smoking history, and more adverse pathological findings. After matching, the 5-year recurrence-free survival for ipsilateral pleural recurrence (98.6% vs. 96.0%, p = 0.002) and overall survival (93.8% vs. 90.2%, p = 0.003) were significantly higher in the surgical biopsy group compared with the PCNB group. Multivariable analysis revealed that PCNB significantly increased the risks of all-cause mortality and various recurrences before and after matching.

Conclusions: Compared with surgery biopsy, PCNB was associated with higher risks of all-cause mortality and recurrences, including ipsilateral pleural recurrence. PCNB should be considered with caution in cases of peripheral stage 1 NSCLC where CT-defined VPI is suspected.