Archivos De Bronconeumologia最新文献

英文中文

Challenges in the Management of Lung Cancer in ILD ILD 肺癌治疗面临的挑战

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.05.013

引用次数: 0

Effect of CPAP Treatment on Cardiovascular Outcomes CPAP 治疗对心血管结果的影响。

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.05.029

Introduction

Randomized controlled trials (RCT) have not demonstrated a role for continuous positive airway pressure (CPAP) on the secondary prevention of major cardiovascular events in obstructive sleep apnea (OSA) patients. However, participants in RCTs are substantially different from real-world patients. Therefore, we aimed to assess the effect of CPAP treatment on major cardiovascular events in real-world OSA patients.

Methods

Population-based longitudinal observational study including all OSA patients with an active CPAP prescription at the beginning of 2011 in Catalonia, Spain, that terminated CPAP treatment during 2011 and did not have CPAP prescriptions between 2012-2015; and propensity-score-matched OSA patients that continued CPAP treatment until the end of 2015 or death. Adjusted hazard ratios were used to assess the association between CPAP treatment and overall and cardiovascular mortality, cardiovascular hospitalizations, or major adverse cardiovascular events (MACEs).

Results

3638 CPAP terminators and 10,914 propensity-score-matched continuators were included (median age 67 [57–77] years, 71.4% male). During a median follow-up of 47.9 months CPAP continuators showed a lower risk of cardiovascular death than terminators (hazard ratio [HR]: 0.61; 95% confidence interval [CI]: 0.50–0.75) after adjusting by age, sex and key comorbidities. Similar results were found for cardiovascular hospitalizations (HR: 0.87; 95% CI: 0.76–0.99) and MACEs (HR: 0.84; 95% CI: 0.75–0.95).

Conclusion

CPAP treatment continuation could be associated with a significantly lower risk of major cardiovascular events in real-world OSA patients. This result highlights the importance of including real-world patients in studies on OSA.

导言：随机对照试验（RCT）并未证明持续气道正压（CPAP）对阻塞性睡眠呼吸暂停（OSA）患者重大心血管事件的二级预防有作用。然而，RCT 的参与者与现实世界中的患者有很大不同。因此，我们旨在评估 CPAP 治疗对现实世界中 OSA 患者主要心血管事件的影响：方法：基于人群的纵向观察研究，包括西班牙加泰罗尼亚地区所有在 2011 年初拥有有效 CPAP 处方的 OSA 患者，这些患者在 2011 年期间终止了 CPAP 治疗，并且在 2012-2015 年期间没有 CPAP 处方；以及倾向分数匹配的 OSA 患者，这些患者继续接受 CPAP 治疗直至 2015 年底或死亡。调整后的危险比用于评估 CPAP 治疗与总死亡率和心血管死亡率、心血管住院率或主要不良心血管事件 (MACE) 之间的关系：共纳入了 3638 名 CPAP 终止者和 10,914 名倾向分数匹配的继续治疗者（中位年龄 67 [57-77] 岁，71.4% 为男性）。经年龄、性别和主要合并症调整后，在中位随访 47.9 个月期间，CPAP 持续使用者的心血管死亡风险低于终止使用者（危险比 [HR]：0.61；95% 置信区间 [CI]：0.50-0.75）。心血管住院治疗（HR：0.87；95% CI：0.76-0.99）和MACEs（HR：0.84；95% CI：0.75-0.95）的结果与此相似：结论：在现实世界中，继续使用 CPAP 治疗可显著降低 OSA 患者发生重大心血管事件的风险。这一结果凸显了将现实世界中的患者纳入 OSA 研究的重要性。

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引用次数: 0

New Indicators of Exercise Capacity and Respiratory Function in COPD Patients: The Role of Gastrocnemius Muscle Oxygenation and Elastography Levels 慢性阻塞性肺病患者运动能力和呼吸功能的新指标：腓肠肌氧合和弹性成像水平的作用。

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.06.001

引用次数: 0

How to Protect Radon Exposed Workers? Advocating for a Specific Health Surveillance Protocol 如何保护接触氡的工人？倡导特定的健康监测协议。

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.06.014

引用次数: 0

NRF2 Signaling Pathway in Chemo/Radio/Immuno-Therapy Resistance of Lung Cancer: Looking Beyond the Tip of the Iceberg 肺癌化疗/放疗/免疫治疗耐药性中的 NRF2 信号通路：超越冰山一角

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.06.021

Sri Vidya Ramisetti , Tapas Patra , Vinayak Munirathnam , Jyothi Venkat Sainath , Durgadevi Veeraiyan , Akhileshwar Namani

Lung cancer is one of the most common causes of cancer death in men and women worldwide. Various combinations of surgery, chemotherapy, radiation therapy and immunotherapy are currently used to treat lung cancer. However, the prognosis remains relatively poor due to the higher frequency of tumor mutational burden (TMB). Nuclear factor E2-related factor 2 (NFE2L2/NRF2) is often considered a primary regulator of the expression of antioxidant enzymes and detoxification proteins and is involved in cytoprotection. On the contrary, NRF2 is even known to induce metastasis and support tumor progression. Kelch-like ECH-associated protein 1 (KEAP1) plays an important role in negatively regulating NRF2 activity via CUL3-mediated ubiquitinylation and successive proteasomal degradation. Extensive research has shown that the genetic alterations of KEAP1/NFE2L2/CUL3 genes lead to increased expression of NRF2 and its target genes in lung cancer. Thus, these studies provide ample evidence for the dual role of NRF2 in lung cancer. In this review, we discussed the mechanistic insights into the role of NRF2 signaling in therapy resistance by focusing on cell lines, mouse models, and translational studies in lung cancer. Finally, we highlighted the potential therapeutic strategies targeting NRF2 inhibition, followed by the discussion of biomarkers related to NRF2 activity in lung cancer. Overall, our article exclusively discusses in detail the NRF2 signaling pathway in resistance to therapy, especially immunotherapy, and its therapeutic avenue in the treatment of lung cancer.

肺癌是全球男性和女性最常见的癌症死因之一。目前治疗肺癌的方法有手术、化疗、放疗和免疫疗法等多种组合。然而，由于肿瘤突变负荷（TMB）频率较高，预后仍然相对较差。核因子 E2 相关因子 2（NFE2L2/NRF2）通常被认为是抗氧化酶和解毒蛋白表达的主要调节因子，并参与细胞保护。相反，NRF2 甚至被认为会诱导肿瘤转移和支持肿瘤进展。Kelch-like ECH-associated protein 1（KEAP1）通过 CUL3 介导的泛素化和蛋白酶体的连续降解，在负向调节 NRF2 活性方面发挥着重要作用。大量研究表明，KEAP1/NFE2L2/CUL3 基因的遗传改变会导致肺癌中 NRF2 及其靶基因的表达增加。因此，这些研究充分证明了 NRF2 在肺癌中的双重作用。在这篇综述中，我们通过关注肺癌的细胞系、小鼠模型和转化研究，探讨了 NRF2 信号在耐药性中的作用机制。最后，我们强调了针对 NRF2 抑制的潜在治疗策略，并讨论了肺癌中与 NRF2 活性相关的生物标志物。总之，我们的文章专门详细讨论了 NRF2 信号通路在治疗（尤其是免疫疗法）耐药性中的作用及其在肺癌治疗中的治疗途径。

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引用次数: 0

Non-Tuberculous Mycobacterial Pulmonary Disease—Where are we Now? 非结核分枝杆菌肺病--我们现在在哪里？

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.07.001

Kartik Kumar , Michael R. Loebinger

引用次数: 0

Tertiary Lymphoid Structure in Tumor Microenvironment and Immunotherapy of Lung Cancer 肿瘤微环境中的三级淋巴结构与肺癌免疫疗法

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.07.020

Mei Xie , Xuwen Lin , Xinyu Bao , Yiran Liang , Hui Deng , Jialin Song , Xidong Ma , Xin Zhang , Jie Yao , Lei Pan , Xinying Xue

Immune checkpoint inhibitors have opened an era of lung cancer therapy. However, a notable disparity exists in the efficacy of immunotherapy among individual patients. The tertiary lymphoid structure (TLS) is an ectopic lymphocyte aggregation that appears under pathological conditions and is the primary site of action for anti-tumor immunity. It is commonly reported that the presence of TLS within the tumor microenvironment (TME) relates to a favorable clinical prognosis and an excellent response to immunotherapy in lung cancer patients. A thorough understanding of TLS and its dynamic changes in TME has become an attractive focus for optimizing immunotherapy strategies for lung cancer. In this review, we comprehensively generalize the composition, formation, mechanism, detection methods of TLS, and summarize the role of TLS in lung cancer immunotherapy. Finally, induction of TLS is also discussed, which may provide more effective therapeutic strategies for lung cancer therapy.

免疫检查点抑制剂开启了肺癌治疗的新时代。然而，不同患者的免疫疗法疗效存在明显差异。三级淋巴结构（TLS）是病理条件下出现的异位淋巴细胞聚集，是抗肿瘤免疫的主要作用部位。据普遍报道，肿瘤微环境（TME）中存在 TLS 与肺癌患者良好的临床预后和对免疫疗法的良好反应有关。全面了解 TLS 及其在 TME 中的动态变化已成为优化肺癌免疫疗法策略的一个极具吸引力的焦点。在这篇综述中，我们全面归纳了TLS的组成、形成、机制、检测方法，并总结了TLS在肺癌免疫治疗中的作用。最后，我们还讨论了诱导 TLS 的问题，这可能会为肺癌治疗提供更有效的治疗策略。

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引用次数: 0

Sex-specific Difference for Small Cell Lung Cancer from Immunotherapy Advancement 免疫疗法的发展对小细胞肺癌的性别差异。

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.05.025

Background

The treatment of lung cancer has witnessed significant progress, leading to improved survival rates among patients. It is important to assess the individual contributions of non-small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) to overall lung-cancer incidence and mortality trends based population, especially sex difference.

Methods

We analyzed lung cancer mortality based on subtype, gender, and calendar year. The Joinpoint software was used to identify any changes in incidence and trends in mortality.

Results

Incidence and incidence-based mortality declined from 2001 to 2019 both NSCLC and SCLC annually. The most significant decrease occurred between 2016 and 2019 with annual percent change of 5.71%. From 2012 to 2016, the incidence-based mortality of SCLC in women changed by 2.7% in tandem with incidence decreased 2.84%. Remarkably, the incidence-based mortality for women declined notably by 5.23% between 2016 and 2019, even as the incidence showed a less extent of decreasing (-2.59%). The survival rate for women was 15.2% in 2001, 19.3% in 2016, it had increased to 21.3% in 2018 but similar trends not in men. The survival curve showed the change in survival outcomes over time among men and women (median overall survival: 13 vs 23months) receiving immunotherapy for SCLC.

Conclusion

Population-level mortality from NSCLC and SCLC in the United States fell sharply from 2016 to 2019 as incidence deceased, and survival improved substantially. Our analysis suggests that approval for and use of immunotherapy may explain the mortality reduction observed during this period, with significant benefits especially for SCLC patient in women.

背景：肺癌的治疗取得了重大进展，提高了患者的生存率。评估非小细胞肺癌（NSCLC）和小细胞肺癌（SCLC）对基于人群的整体肺癌发病率和死亡率趋势的贡献，尤其是性别差异，非常重要：我们根据亚型、性别和日历年分析了肺癌死亡率。结果：发病率和基于发病率的死亡率均有所下降：从 2001 年到 2019 年，NSCLC 和 SCLC 的发病率和基于发病率的死亡率逐年下降。最明显的下降发生在 2016 年至 2019 年，年变化百分比为 5.71%。从2012年到2016年，女性SCLC的发病死亡率下降了2.7%，与此同时，发病率也下降了2.84%。值得注意的是，在2016年至2019年期间，女性发病死亡率显著下降了5.23%，而发病率的下降幅度较小（-2.59%）。女性的存活率在 2001 年为 15.2%，2016 年为 19.3%，2018 年增至 21.3%，但男性的存活率却没有类似的趋势。生存曲线显示了接受免疫疗法治疗SCLC的男性和女性的生存结果随时间的变化（中位总生存期：13个月 vs 23个月）：2016年至2019年，随着发病率的下降，美国NSCLC和SCLC的人群死亡率急剧下降，生存率大幅提高。我们的分析表明，免疫疗法的批准和使用可能是在此期间观察到死亡率下降的原因，尤其是对女性SCLC患者有显著益处。

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引用次数: 0

Sleep Quality in Patients Receiving Long-term NIV: A Prospective Cohort Study 长期 NIV 患者的睡眠质量：前瞻性队列研究

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.05.030

引用次数: 0

Radiomics and Clinical Data for the Diagnosis of Incidental Pulmonary Nodules and Lung Cancer Screening: Radiolung Integrative Predictive Model 用于诊断偶发肺结节和肺癌筛查的放射组学和临床数据：放射肺综合预测模型。

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.05.027

Introduction

Early diagnosis of lung cancer (LC) is crucial to improve survival rates. Radiomics models hold promise for enhancing LC diagnosis. This study assesses the impact of integrating a clinical and a radiomic model based on deep learning to predict the malignancy of pulmonary nodules (PN).

Methodology

Prospective cross-sectional study of 97 PNs from 93 patients. Clinical data included epidemiological risk factors and pulmonary function tests. The region of interest of each chest CT containing the PN was analysed. The radiomic model employed a pre-trained convolutional network to extract visual features. From these features, 500 with a positive standard deviation were chosen as inputs for an optimised neural network. The clinical model was estimated by a logistic regression model using clinical data. The malignancy probability from the clinical model was used as the best estimate of the pre-test probability of disease to update the malignancy probability of the radiomic model using a nomogram for Bayes’ theorem.

Results

The radiomic model had a positive predictive value (PPV) of 86%, an accuracy of 79% and an AUC of 0.67. The clinical model identified DLCO, obstruction index and smoking status as the most consistent clinical predictors associated with outcome. Integrating the clinical features into the deep-learning radiomic model achieves a PPV of 94%, an accuracy of 76% and an AUC of 0.80.

Conclusions

Incorporating clinical data into a deep-learning radiomic model improved PN malignancy assessment, boosting predictive performance. This study supports the potential of combined image-based and clinical features to improve LC diagnosis.

简介肺癌的早期诊断对提高生存率至关重要。放射组学模型有望提高肺癌诊断率。本研究评估了基于深度学习的临床和放射组学模型对预测肺结节（PN）恶性程度的影响：方法：对 93 名患者的 97 个肺结节进行前瞻性横断面研究。临床数据包括流行病学风险因素和肺功能测试。对包含肺结节的每张胸部 CT 的感兴趣区进行分析。放射学模型采用预先训练好的卷积网络来提取视觉特征。从这些特征中选择 500 个标准偏差为正的特征作为优化神经网络的输入。临床模型通过使用临床数据的逻辑回归模型进行估算。临床模型中的恶性肿瘤概率被用作检测前疾病概率的最佳估计值，并利用贝叶斯定理的提名图更新放射线组学模型的恶性肿瘤概率：放射学模型的阳性预测值（PPV）为 86%，准确率为 79%，AUC 为 0.67。临床模型发现，DLCO、阻塞指数和吸烟状况是与预后相关的最一致的临床预测因素。将临床特征整合到深度学习放射学模型中，PPV 为 94%，准确率为 76%，AUC 为 0.80：将临床数据整合到深度学习放射学模型中可改善PN恶性肿瘤评估，提高预测性能。这项研究证明了基于图像和临床特征的组合在改善 LC 诊断方面的潜力。

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