ABSTRACTImmunotherapy has transformed the therapeutic landscape of breast cancer. Nevertheless, an exhaustive overview of the treatment‐related adverse events (TRAEs) and immune‐related adverse events (irAEs) spectrum of immune checkpoint inhibitor (ICI)‐based combination therapies remains lacking. We performed a comprehensive systematic review and meta‐analysis comparing chemotherapy, antibody–drug conjugate (ADC) therapy, targeted therapy, immunotherapy, endocrine therapy, radiotherapy, and dual therapy combined with ICIs. The primary outcomes were overall incidence rates and profiles for all‐grade and grade 3 or higher TRAEs and irAEs according to random effects models. We identified 8236 records, 100 of which (9192 patients) met the inclusion criteria. For grade ≥ 3 TRAEs, the ICI‐based chemotherapy and ICI‐based ADC regimens demonstrated equivalent incidence rates, marginally exceeding those observed in the ICI‐based targeted therapy group. Analysis of irAEs revealed that ICI‐based chemotherapy combinations had a significantly lower incidence than other dual‐agent regimens did. In triplet regimens that combined ICIs with chemotherapy plus additional immunotherapy, irAEs rates remained nearly comparable to those of dual therapies. Among the therapeutic regimens analyzed, ICIs combined with multitarget tyrosine kinase inhibitors (mTKIs) presented the highest incidence rates of both all‐grade and grade ≥ 3 irAEs. Conversely, combination regimens of ICIs with poly ADP–ribose polymerase (PARP) inhibitors or HER2‐targeted monotherapy demonstrated markedly lower risks of irAEs. Our study provides comprehensive data on the TRAEs and irAEs associated with ICI‐based combination therapies. These results offer direct and practical references for clinicians to evaluate toxicity profiles and optimize treatment decisions in routine breast cancer care.

In robot-assisted thoracoscopic (RATS) bronchial sleeve lobectomy, despite the continuous suturing (CS) technique's widespread adoption, the safety and advantages of the semi-continuous suturing (SCS) technique remain inconclusive. Patients undergoing RATS bronchial sleeve lobectomy for central Non-Small Cell Lung Cancer (NSCLC) between January 2020 and December 2024 were retrospectively enrolled and stratified into two cohorts based on anastomotic technique: the CS group and the SCS group. Perioperative outcomes were compared between the two groups. The SCS group (n = 18) demonstrated significantly shorter anastomotic time than the CS group (n = 14) (median 28 min [24-33] vs. 45 min [32-52]; p < 0.001), with a 21-min reduction in operative time (median 135 min [110-185] vs. 156 min [138-212]; p = 0.040). No statistically significant differences were observed in: overall complication rates (anastomosis-specific: 11.1% vs. 21.4%, p = 0.425; systemic: 22.2% vs. 42.9%, p = 0.212); 90-day mortality (0% vs. 7.1%, p = 0.467); late stenosis rate (0% vs. 7.1%, p = 0.249) or reoperation rate (5.6% vs. 14.3%, p = 0.401); postoperative recovery metrics (extubation time and hospital stay, p > 0.05). SCS can safely reduce bronchial anastomosis time in RATS sleeve resection and is recommended as the preferred technique for optimizing operative efficiency.

Radiation recall dermatitis (RRD) is an inflammatory skin reaction confined to areas previously exposed to radiation, triggered by subsequent systemic therapy. This case report describes a female patient with hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer. She received 6 cycles of neoadjuvant chemotherapy, followed by mastectomy with immediate tissue expander implantation and axillary lymph node dissection. Adjuvant radiotherapy and intensive endocrine therapy (endocrine therapy and abemaciclib) were administered postoperatively. After radiotherapy, the patient developed small, coin-sized skin flap necrosis. Two months after completing radiotherapy, she initiated abemaciclib treatment, which was followed by rapid progression of flap necrosis and increased exposure of the tissue expander. This flap necrosis was suggestive of RRD. This report details the clinical course, management strategies, and a review of relevant literature, aiming to provide valuable insights for clinicians in handling similar cases and enhance awareness of potential risks associated with this treatment combination.

ABSTRACTBackgroundLobectomy, a cornerstone in the treatment of various thoracic tumors, often requires postoperative chest drainage to prevent complications such as pneumothorax and pleural effusion. Traditional water‐seal drainage systems have limitations, including inconvenience and restricted patient mobility.MethodsThis study investigated the safety and efficiency of a disposable dry seal chest drainage system compared to the traditional water‐seal system in lobectomy patients. An open‐label randomized controlled trial with trial registration number NCTO6410716 was conducted, including 82 patients undergoing elective three‐port thoracoscopic lobectomy. The study assessed postoperative pain, functional recovery, complications such as DVT, and nursing workload.ResultsThe results showed that the disposable dry seal chest drainage system significantly reduced nursing workload (p < 0.001) and improved patient mobility, with patients in the experimental group having significantly higher finger oxygen saturation levels on postoperative day 1 (p = 0.01) and day 2 (p < 0.001) compared to the control group. The incidence of DVT during the hospital stay was also lower in the experimental group (p = 0.032). Although no significant improvement in postoperative pain scores was observed, the improved functionality and reduced nursing workload suggest potential benefits for patient care and resource management.ConclusionsThis study provides valuable insights into the potential advantages of the new drainage system and its alignment with enhanced recovery after surgery (ERAS) protocols, supporting its use as a superior option in postoperative chest drainage management for lobectomy patients.

Sleeve right lower lobectomy (SRLL) is an uncommon procedure for right lower lobe lung cancer involving the intermediate bronchus, mainly because it is more technically demanding than lower bilobectomy (LBL), particularly due to challenges such as bronchial caliber mismatch and anastomotic tension. We retrospectively reviewed four chronic obstructive pulmonary disease (COPD) patients who underwent SRLL at Akita University Hospital (2020-2023). All cases had squamous cell carcinoma pStage IB-IIB. Postoperative respiratory function exceeded the predicted postoperative values for LBL and even for right lower lobectomy, suggesting preservation of pulmonary function beyond initial estimates. One bronchopleural fistula occurred, but it healed with conservative treatment. No recurrences were observed. SRLL with middle lobe preservation may improve outcomes by reducing complications and preserving pulmonary function, especially in COPD patients.

Anatomical sublobar resection (ASR) is non-inferior to lobectomy for peripheral small-sized lung cancer. However, for nodules located in complex locations, ASR is usually challenging. This study aimed to compare the outcomes of ASR and lobectomy for multi-intersegmental pulmonary nodules. Patients with pulmonary nodules (≤ 2 cm) who underwent ASR or lobectomy between 2012 and 2023 were retrospectively screened. The 3D multiplanar reconstruction software was used to determine the precise tumor localization. Demographic, radiomic, histopathologic, and perioperative characteristics between ASR and lobectomy were compared. The log rank test was adopted for prognostic evaluation. Propensity score-matching (PSM) analysis was conducted to yield matched patients. In total, 93 patients undergoing ASR and 118 subjects undergoing lobectomy were included. Patients with ASR were younger and had a smaller tumor size, fewer solid nodules, and more central nodules than those with lobectomy. ASR achieved a median surgical margin of 2.0 cm, removed fewer lymph nodes, and preserved seven more subsegments than lobectomy (5 vs. 12, p < 0.001), without increasing air leak or postoperative hospital stay. During a median follow-up of 32 months, four patients in the lobectomy group encountered tumor recurrence, whereas no recurrence occurred in the ASR group. The 5-year recurrence-free survival (RFS) after lobectomy and ASR was 95.4% and 100%, respectively. After PSM, 34 matched patients remained in each group, and the RFS was 100% in both groups. ASR is feasible for multi-intersegmental nodules and can preserve more pulmonary parenchyma with no compromise in perioperative and oncological outcomes compared to lobectomy.

ABSTRACTRobot‐assisted thoracoscopic surgery facilitates the execution of intrathoracic hand‐sewn layered anastomosis during minimally invasive esophagectomy. However, challenges persist due to the complex technical demands inherent in this procedure. Patients who received robot‐assisted Ivor‐Lewis esophagectomy with intrathoracic hand‐sewn layered anastomosis for esophageal cancer were enrolled. A novel irrigation‐drainage auxiliary system designed for robot‐assisted thoracoscopic esophagectomy was introduced to optimize the execution of intrathoracic hand‐sewn layered anastomosis. The anastomosis time, operation time, postoperative complications, and postoperative hospital stay were evaluated. A total of 30 patients were enrolled, and the application of this system resulted in a median anastomosis time of 37 min (range: 28–65). None of the patients experienced postoperative anastomotic leakage or pleural cavity infection, indicating satisfactory short‐term safety and efficacy. The device improved operative efficiency by providing better exposure of the anastomotic region, enabling complete abdominal and thoracic drainage and freeing the assistant's hands for other tasks.

ABSTRACTBackgroundThymoma is associated with diverse immune abnormalities, yet immune‐mediated multilineage cytopenias are exceedingly rare and poorly defined. Their clinical features, immunologic patterns, and treatment outcomes remain unclear.MethodsWe retrospectively reviewed four adult patients with histologically confirmed thymoma and immune‐mediated cytopenias affecting ≥ 2 hematopoietic lineages at a tertiary hematology center. Clinical data, bone marrow morphology, immunologic studies, T‐cell receptor (TCR) clonality, cytogenetics, next‐generation sequencing (NGS), treatments, and outcomes were collected. Responses were assessed using standardized criteria for immune thrombocytopenia (ITP), autoimmune hemolytic anemia (AIHA), and autoimmune neutropenia (AIN).ResultsThe four patients (aged 44–75 years) showed heterogeneous temporal patterns, with cytopenias occurring either before thymoma diagnosis or years after thymectomy. Three had trilineage cytopenia and one had bicytopenia, with combinations of AIHA, ITP, AIN, and pure red cell aplasia. Bone marrow findings ranged from normal cellularity to erythroid aplasia. Two patients demonstrated clonal TCR rearrangement consistent with T‐LGL leukemia, and NGS identified mutations including TET1, EP300, and BCORL1. All received immunosuppressive therapy. Neutrophil and platelet counts responded earlier (1–2 months), whereas erythroid recovery was slower. Despite initial responses (2 CR, 2 PR), three patients relapsed and required additional therapy. After 10–84 months of follow‐up, one patient remained in CR and three in PR.ConclusionsThymoma‐associated multilineage cytopenias are heterogeneous, frequently relapsing, and driven by complex T‐cell–mediated immune dysregulation. Comprehensive evaluation and individualized immunosuppressive therapy are essential for management.

ABSTRACTMain ProblemThe treatment and prognosis of lung adenocarcinoma (LUAD) remain challenging. The study aimed to identify prognostic genes and construct a prognostic model for LUAD.MethodsAfter identifying malignant alveolar type II (AT2) cells using InferCNV, we applied CytoTRACE, pseudo‐time analysis, Mendelian randomization (MR), and univariate Cox regression analysis to identify prognostic genes. A prognostic model was then developed using an optimized subset of these genes, selected through the least absolute shrinkage and selection operator (LASSO) algorithm. Further analyses included Gene Ontology enrichment analysis and the construction of a protein–protein interaction (PPI) network.ResultsPseudo‐time analysis identified 3526 dynamically expressed genes during malignant AT2 cell dedifferentiation. Subsequent multi‐omics integration refined the gene selection, yielding four prognostic genes for the final predictive model. The resulting model achieved area under the receiver operating characteristic (ROC) curve (AUC) values of 0.649, 0.675, and 0.654 for predicting 1, 2, and 3‐year overall survival (OS) in the training set, respectively, and was successfully validated in two external cohorts at the corresponding time points. Moreover, survival analysis demonstrated that patients in the high‐risk group had significantly poorer OS than those in the low‐risk group, both in the training set and the validation sets (p < 0.01).ConclusionsThe study developed a novel signature based on genes dynamically expressed during malignant AT2 cell dedifferentiation, capable of predicting the prognosis of LUAD patients, and offered four accurate prognostic biomarkers (ADM, MARK4, PARVA, and RPS6KA1).