Treatment Of Early Lung Cancer Research Articles

Preoperative localization of pulmonary nodules by electromagnetic navigation bronchoscopy combined with methylene blue injection.

Electromagnetic navigation bronchoscopy (ENB) can help to accurately locate pulmonary nodules using a minimally invasive approach. This study sought to evaluate the clinical efficacy and safety of dye marking localization under the guidance of ENB followed by surgery. A retrospective analysis was performed of 61 patients who underwent ENB localization using methylene blue dye marking before surgery at Shanghai General Hospital from October 2021 to February 2022. The clinical efficacy and safety of ENB localization and the related factors affecting the navigation time of ENB location were analyzed. ENB was performed on 170 pulmonary nodules in 61 patients with a median age of 60 [interquartile range (IQR), 18] years. The majority of patients (70.69%) had more than two pulmonary nodules. The median maximum nodule diameter was 10 (IQR, 8) mm, and 48.21% of the nodules were mixed ground-glass nodules. Median time for ENB navigation was 10.5 (IQR, 6) min. The navigation success rate was 92.96%, and the ENB location success rate was 95.89%. The rate of complications related to ENB localization was 1.64% (there was only one case of pulmonary hemorrhage). The multivariate analysis showed that the factors related to the navigation time included the node location (P=0.001) and location mode (P=0.04). ENB-guided methylene blue injection is an effective and safe tool for localizing and marking pulmonary nodules, and can be used to assist the diagnosis and treatment of early lung cancer. The node location and location mode had significant effects on navigation time.

Evaluation of the efficacy and safety of robot-assisted and video assisted thoracic surgery for early non-small cell lung cancer: A meta-analysis.

Radical resection of lung cancer and chemotherapy are the main methods for the treatment of early lung cancer, but surgical treatment is still the key and preferred method. To evaluate the efficacy and safety of robotic-assisted thoracic surgery (RATS) and video assisted thoracic surgery (VATS) for non-small cell lung cancer (NSCLC). The clinical cohort studies on the comparison of the effects of RATS and VATS in the treatment of NSCLC published in Web of Science, PubMed, The National Library of Medicine (NLM), China National Knowledge Infrastructure (CNKI) and Wanfang database from January 1, 2015 to December 31, 2022 were searched. Two researchers independently screened the literature, extracted the data, such as operation time, intraoperative conversion rate, intraoperative blood loss, number of lymph nodes dissected, and evaluated the quality of the included literature based on the Newcastle-Ottawa Scale (NOS). RevMan 5.3 software was used for Meat analysis. A total of 18 articles and 21,802 subjects were included. The results of the meta-analysis showed that the intraoperative blood loss of RATS was significantly less than that of VAS, and the difference was statistically significant [MD =-38.43 (95% CI: -57.71, -19.15, P< 0.001)]. Compared with VATS, the number of lymph nodes dissected in RATS was significantly higher [MD = 2.61 (95% CI: 0.47, 4.76, P= 0.02)]. The rate of conversion to thoracotomy in RATS was lower, and the difference was statistically significant [OR = 0.59 (95% CI: 0.50, 0.70, P< 0.001)]. There was no significant difference between RATS and VATS in operation time [MD =-9.34 (95% CI: -28.72, 10.04, P= 0.34)], postoperative thoracic drainage time [MD =-0.08 (95% CI: -0.42, 0.26, P= 0.64)], postoperative hospital stay [MD =-0.05 (95% CI: -0.19, 0.08, P= 0.42)], postoperative mortality [OR = 0.88 (95% CI: 0.56, 1.36, P= 0.56)] and postoperative complications [OR = 1.03 (95% CI: 0.93, 1.13, P= 0.57)]. Compared with VATS, the number of lymph nodes dissected in RATS was significantly more, and the removal of lesions and lymph nodes was more thorough and accurate. More flexible and precise operation avoids the injury of important blood vessels during operation, effectively reduces the amount of blood loss during operation, shortens the indwelling time of thoracic drainage tube, and is conducive to postoperative rehabilitation of patients.

Application of the patient-reported outcome-based postoperative symptom management model in lung cancer: a multicenter randomized controlled trial protocol

IntroductionLung cancer is the most common cancer in China, with the highest mortality rate. Surgery is the primary treatment for early lung cancer. However, patients with lung cancer have a heavy burden of symptoms within 3 months after surgery, which seriously affects their quality of life (QOL). The symptom management model based on the patient-reported outcome (PRO) is considered the best caregiving model. The clinical evidence about the symptom management of lung cancer within 3 months after the operation is very limited. Herein, we propose a randomized controlled trial to evaluate the PRO score-based monitoring and alert system for follow-up on psychological and physiological symptoms of lung cancer patients within 3 months after surgery and further investigate the effect of intervention measures based on this PRO score-based system.Methods and analysisThis multicenter, open-label, randomized, parallel superiority trial will be conducted at four hospitals in China. A total of 440 lung cancer patients will be recruited in this study, who will be randomly assigned to the intervention group or the control group in a ratio of 1:1. Any of the target symptoms reaches the preset threshold (score ≥ 4), the patients will accept the symptom management advices based on the PRO. The patients in the control group will follow the current standard procedure of symptom management. The symptom management system is an electronic management system based on WeChat mini programs. All patients will be evaluated for symptoms through the lung cancer module of the MDASI lung cancer-specific scale on the day before surgery, days 1, 3, 5, and 7 after surgery, and once a week during the 12-week post-discharge period. Simultaneously, the EORTC QLQ-C30 scale will be used to evaluate patients’ quality of life at baseline and the fourth and twelfth week after the surgery. The mean number of symptom threshold events of the intervention and the control groups were compared by t-test, and the changes of PRO were compared by a mixed effect model. The primary endpoint has been set as the 12-week post-discharge period.DiscussionThis study will test the feasibility of the symptom management system based on the mobile social media applet in postoperative caregiving and the efficacy of psychiatrist-assisted treatment and provide evidence in managing the symptoms of patients in the medium and long term.Trials registrationTrials registration number: ChiCTR 2200058876, Registered 18 April 2022

A clinical–radiological predictive model for solitary pulmonary nodules and the relationship between radiological features and pathological subtype

To develop a clinical-radiological model to predict the malignancy of solitary pulmonary nodules (SPNs) and to evaluate the accuracy of chest computed tomography imaging characteristics of SPN in diagnosing pathological type. The predictive model was developed using a retrospective cohort of 601 SPN patients (Group A) between July 2015 and July 2020. The established model was tested using a second retrospective cohort of 124 patients between August 2020 and August 2021 (Group B). The radiological characteristics of all adenocarcinomas in two groups were analysed to determine the correlation between radiological and pathological characteristics. Malignant nodules were found in 78.87% of cases and benign in 21.13%. Two clinical characteristics (age and gender) and four radiological characteristics (calcification, vascular convergence, pleural retraction sign, and density) were identified as independent predictors of malignancy in patients with SPN using logistic regression analysis. The area under the receiver operating characteristic curve (0.748) of the present model was greater than the other two reported models. Diameter, spiculation, lobulation, vascular convergence, and pleural retraction signs differed significantly among pre-invasive lesions, minimally invasive adenocarcinoma, and invasive adenocarcinoma. Only diameter and density were significantly different among invasive adenocarcinoma subtypes. Older age, male gender, no calcification, vascular convergence, pleural contraction sign, and lower density were independent malignancy predictors of SPNs. Furthermore, the pathological classification can be clarified based on the radiological characteristics of SPN, providing a new option for the prevention and treatment of early lung cancer.

Application of computed tomography-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm)

ObjectiveThis study aimed to investigate the safety and efficacy of the computed tomography (CT)-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm) and to identify the risk factors for localization-related complications.MethodsThe medical records of 150 patients with small pulmonary nodules treated from January 2018 to June 2021 were retrospectively analyzed. According to preoperative hook-wire positioning status, they were divided into the localization group (50 cases) or the control group (100 cases). The operation time, intraoperative blood loss, hospital stay, and conversion rate to thoracotomy were recorded and compared between groups. Uni- and multivariate binary logistic regression analysis was used to identify the risk factors for localization-related complications.ResultsA total of 58 nodules were localized in 50 patients in the localization group, and the localization success rate was 98.3% (57/58). In one case, the positioning pin fell off before wedge resection was performed. The mean nodule diameter was 7.05 mm (range, 2.8–10.0 mm), while the mean depth from the pleura was 22.40 mm (range, 5.47–79.47 mm). There were 8 cases (16%) of asymptomatic pneumothorax, 2 (4%) of intrapulmonary hemorrhage, and 1 (2%) of pleural reaction.The mean operation time of the localization group (103.88 ± 41.74 min) was significantly shorter than that of the control group (133.30 ± 45.42 min) (P < 0.05). The mean intraoperative blood loss of the localization group (44.20 ± 34.17 mL) was significantly lower than that of the control group (112.30 ± 219.90 mL) (P < 0.05). The mean hospital stay of the localization group (7.96 ± 2.34 days) was significantly shorter than that of the control group (9.21 ± 3.25 days).Multivariate binary logistic analysis showed that localization times of small pulmonary nodules in the localization group was an independent risk factor for localization-related pneumothorax.ConclusionsOur results suggest that the CT-guided hook-wire localization technique is beneficial for localizing small pulmonary nodules. Specifically, it is helpful for the diagnosis and treatment of early lung cancer because it can accurately remove lesions, decrease intraoperative blood loss, shorten operation time and hospitalization stay, and reduce thoracotomy conversion rate. Simultaneous positioning of multiple nodules can easily lead to positioning-related pneumothorax.

Abstract 2883: Gut microbiome dysbiosis promotes immune suppression and lung cancer development

Abstract Mounting evidence supports synergistic roles for the gut microbiome in cancer progression. Yet, the interplay between the gut microbiome and immune responses in cancer is still poorly understood. We recently showed that gut microbiome changes are closely associated with development of Kras-mutant lung adenocarcinoma (KM-LUAD) in a human-relevant, tobacco-associated mouse model (Gprc5a-/-; G). Knockout of the antimicrobial protein Lcn2 in these mice (Gprc5a-/-/Lcn2-/-; GL) further reduced microbial diversity while enhancing inflammation and tumor development. We thus hypothesized that microbial dysbiosis in the gut, such as that incurred by loss of Lcn2, may exacerbate LUAD development. Here, we investigated the effects of gut microbiome modulation on LUAD pathogenesis using fecal microbiota transfer (FMT) in both syngeneic and tobacco carcinogenesis models. Syngeneic G mice (transplant of G LUAD cells) that received FMT from GL donors (G &amp;lt; GL) exhibited significantly increased tumor growth relative to littermates with FMT from G mice (G &amp;lt; G). These effects were recapitulated in an independent syngeneic model (KrasG12D LKR13 cells in wild type mice). Tobacco carcinogen-exposed G &amp;lt; GL mice also exhibited increased lung tumor development compared with similarly exposed G &amp;lt; G littermates. 16S rDNA-Seq analysis of fecal pellets revealed significant differences in gut beta diversity between syngeneic G &amp;lt; G and G &amp;lt; GL mice. G &amp;lt; GL mice additionally displayed elevated relative abundance of tumor-promoting Alistipes, while Ruminoccocus and Akkermansia, taxa associated with favorable response to immunotherapy, were reduced. We next performed single-cell RNA-sequencing to comprehensively probe the tumor immune microenvironment (TIME) and the immune milieu near the gut of tumors and mesenteric lymph nodes (MLNs), respectively. The TIME in G &amp;lt; GL mice displayed an overall enhanced immunosuppressive phenotype evidenced by prominently increased fractions of T regulatory and Cd4+ Izumo1r+ exhausted T cells and, conversely, reduced levels of activated Isg15+ Cd8a+ T cells. MLNs from G &amp;lt; GL mice showed markedly increased fractions of memory B cells expressing the immunosuppressor Bank1 and reduced levels of follicular B cells and Cd8a+ Clec9a+ class 1 dendritic cells (cDC1). Flow cytometry further showed enhanced immunosuppression in G &amp;lt; GL relative to G &amp;lt; G mice, including increased fractions of myeloid-derived suppressor cells in the TIME of the former group. Our findings show that gut microbiome dysbiosis fosters lung cancer development by promoting immunosuppression, perhaps via a local and systemic gut microbiota-immune system crosstalk. Modulating the gut microbiome may be a promising strategy for interception or early treatment of lung cancer. Citation Format: Zahraa Rahal, Fuduan Peng, Yuejiang Liu, Matthew C. Ross, Ansam Sinjab, Ke Liang, Jiping Feng, Chidera O. Chukwuocha, Manvi Sharma, Elizabeth Tang, Camille Abaya, Joseph Petrosino, Junya Fujimoto, Seyed Javad Moghaddam, Linghua Wang, Kristi L. Hoffman, Humam Kadara. Gut microbiome dysbiosis promotes immune suppression and lung cancer development [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2883.

Abstract 5104: Targeting IL-1B synergizes with PD-1 blockade for enhanced T and B cell immune responses and inhibition of early lung cancer development

Abstract Early immunotherapy with inhibitors of immune checkpoints such as PD-1 has revolutionized lung adenocarcinoma (LUAD) treatment. Still, many patients do not respond or relapse following PD-1 blockade. Tumor-promoting inflammation, such as that mediated by the pleiotropic cytokine interleukin 1 beta (IL-1B), fosters immunosuppression in the tumor immune microenvironment (TIME). Our group and others showed that IL-1B blockade inhibits lung cancer development. We thus hypothesized that addition of IL-1B blockade to anti-PD-1 treatment may enhance outcomes against LUAD. Using a human-relevant, tobacco-associated, mouse model of LUAD development, we compared the effects of combined PD-1 and IL-1B blockade relative to treatment with single-agents (anti-IL-1B or anti-PD-1) and control antibody on early lung tumor development and the TIME. Drugs (anti-PD-1 + anti-IL-1B, anti-PD-1, anti-IL-1B, control IgG) were administered at end of exposure to the tobacco-specific carcinogen NNK, to evaluate effects on formation of early lesions (preventive), or at 3 months post-NNK (prophylactic) to interrogate LUAD development (8 groups). Comprehensive interrogation of the lung ecosystem and the TIME was performed using deep single-cell RNA-sequencing (scRNA-seq) analysis in a subset of the mice (n = 3 to 4) from each of the 8 groups (n = 31 total; 143,897 cells after stringent quality control). Mice treated with combined PD-1 and IL-1B blockade displayed reduced development of lung tumors when compared to animals treated with anti-IL-1B, anti-PD-1, or control antibodies. Fractions of cytotoxic Cd8+ T cells were conspicuously higher and those of tumor cells and exhausted Cd8+ T cells evidently lower in lungs of mice treated with combined PD-1 and IL-1B blockade relative to monotherapy- or control antibody-treated animals. Igha+ plasma cells were strikingly highest in lungs of mice treated with combined PD-1 and IL-1B blockade and nearly absent in monotherapy- and control-treated groups. Lungs of mice treated with combined PD-1 and IL-1B blockade showed higher fractions of Cd80+/Cd86+ memory B cells and, consistently, T follicular helper T cells, while exhibiting reduced fractions of naïve B and Cd24a+/Tgfb1+ B cells suggestive of enhanced activation of B cell responses by the combinatorial treatment. These effects were, overall, present, or much more pronounced, in animals that were prophylactically treated. Flow cytometry analysis of lung tissues and immune profiling of bronchioalveolar lavage fluid overall confirmed augmented immune cell responses by combined PD-1 and IL-1B blockade. Our findings show that blocking IL-1B synergizes with anti-PD-1 in regression of early tumor cells and reversal of immunosuppression. Combined blockade of PD-1 and IL-1B may be a promising strategy for early treatment of lung cancer that warrants further clinical studies. Citation Format: Warapen Treekitkarnmongkol, Guangchun Han, Zahraa Rahal, Jiping Feng, Ansam Sinjab, Tina Cascone, Christopher S. Stevenson, Cheryl Sweeney, Matt Edwards, Avrum Spira, Junya Fujimoto, Seyed Javad Moghaddam, Linghua Wang, Humam Kadara. Targeting IL-1B synergizes with PD-1 blockade for enhanced T and B cell immune responses and inhibition of early lung cancer development. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5104.

MSANet: Multiscale Aggregation Network Integrating Spatial and Channel Information for Lung Nodule Detection.

Improving the detection accuracy of pulmonary nodules plays an important role in the diagnosis and early treatment of lung cancer. In this paper, a multiscale aggregation network (MSANet), which integrates spatial and channel information, is proposed for 3D pulmonary nodule detection. MSANet is designed to improve the network's ability to extract information and realize multiscale information fusion. First, multiscale aggregation interaction strategies are used to extract multilevel features and avoid feature fusion interference caused by large resolution differences. These strategies can effectively integrate the contextual information of adjacent resolutions and help to detect different sized nodules. Second, the feature extraction module is designed for efficient channel attention and self-calibrated convolutions (ECA-SC) to enhance the interchannel and local spatial information. ECA-SC also recalibrates the features in the feature extraction process, which can realize adaptive learning of feature weights and enhance the information extraction ability of features. Third, the distribution ranking (DR) loss is introduced as the classification loss function to solve the problem of imbalanced data between positive and negative samples. The proposed MSANet is comprehensively compared with other pulmonary nodule detection networks on the LUNA16 dataset, and a CPM score of 0.920 is obtained. The results show that the sensitivity for detecting pulmonary nodules is improved and that the average number of false-positives is effectively reduced. The proposed method has advantages in pulmonary nodule detection and can effectively assist radiologists in pulmonary nodule detection.

SC-Dynamic R-CNN: A Self-Calibrated Dynamic R-CNN Model for Lung Cancer Lesion Detection.

Lung cancer has complex biological characteristics and a high degree of malignancy. It has always been the number one “killer” in cancer, threatening human life and health. The diagnosis and early treatment of lung cancer still require improvement and further development. With high morbidity and mortality, there is an urgent need for an accurate diagnosis method. However, the existing computer-aided detection system has a complicated process and low detection accuracy. To solve this problem, this paper proposed a two-stage detection method based on the dynamic region-based convolutional neural network (Dynamic R-CNN). We divide lung cancer into squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. By adding the self-calibrated convolution module into the feature network, we extracted more abundant lung cancer features and proposed a new regression loss function to further improve the detection performance of lung cancer. After experimental verification, the mAP (mean average precision) of the model can reach 88.1% on the lung cancer dataset and it performed particularly well with a high IoU (intersection over union) threshold. This method has a good performance in the detection of lung cancer and can improve the efficiency of doctors' diagnoses. It can avoid false detection and miss detection to a certain extent.

Bilan fonctionnel pré-opératoire du cancer bronchique: Preoperative functional assessment of bronchial cancer

Surgery is the best treatment for early lung cancer but requires a preoperative functional evaluation to identify patients who may be at a high risk of complications or death. Minimal preoperative assessment includes a cardiological evaluation and lung function tests. Lung function values allow calculating the predicted residual lung function, and identifying patients needing exercise testing to complete the evaluation. According to most expert opinion, exercise tests have a high predictive value of complications. These recommendations are designed to select patients before major lung resection (lobectomy-pneumonectomy) performed by thoracotomy. However, since the publication of these guidelines, minimally-invasive surgery, sublobar resections, prehabilitation and enhanced recovery after surgery (ERAS) programmes have been implemented and are associated with a decrease in post-operative mortality and complications. It is recognized that the published selection criteria may be too stringent to select patients who will benefit from modern modalities of lung surgery, justifying the need to redefine functional criteria.© 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Melatonin enhances radiofrequency-induced NK antitumor immunity, causing cancer metabolism reprogramming and inhibition of multiple pulmonary tumor development

Surgery is the common treatment for early lung cancer with multiple pulmonary nodules, but it is often accompanied by the problem of significant malignancy of other nodules in non-therapeutic areas. In this study, we found that a combined treatment of local radiofrequency ablation (RFA) and melatonin (MLT) greatly improved clinical outcomes for early lung cancer patients with multiple pulmonary nodules by minimizing lung function injury and reducing the probability of malignant transformation or enlargement of nodules in non-ablated areas. Mechanically, as demonstrated in an associated mouse lung tumor model, RFA not only effectively remove treated tumors but also stimulate antitumor immunity, which could inhibit tumor growth in non-ablated areas. MLT enhanced RFA-stimulated NK activity and exerted synergistic antitumor effects with RFA. Transcriptomics and proteomics analyses of residual tumor tissues revealed enhanced oxidative phosphorylation and reduced acidification as well as hypoxia in the tumor microenvironment, which suggests reprogrammed tumor metabolism after combined treatment with RFA and MLT. Analysis of residual tumor further revealed the depressed activity of MAPK, NF-kappa B, Wnt, and Hedgehog pathways and upregulated P53 pathway in tumors, which was in line with the inhibited tumor growth. Combined RFA and MLT treatment also reversed the Warburg effect and decreased tumor malignancy. These findings thus demonstrated that combined treatment of RFA and MLT effectively inhibited the malignancy of non-ablated nodules and provided an innovative non-invasive strategy for treating early lung tumors with multiple pulmonary nodules. Trial registration: www.chictr.org.cn, identifier ChiCTR2100042695, http://www.chictr.org.cn/showproj.aspx?proj=120931.

Application Value of Single-hole and Three-hole Thoracoscopy in Surgical Treatment of Early Lung Cancer

Application Value of Single-hole and Three-hole Thoracoscopy in Surgical Treatment of Early Lung Cancer

Application of logistic regression and convolutional neural network in prediction and diagnosis of high-risk populations of lung cancer.

The early detection, early diagnosis, and early treatment of lung cancer are the best strategies to improve the 5-year survival rate. Logistic regression analysis can be a helpful tool in the early detection of high-risk groups of lung cancer. Convolutional neural network (CNN) could distinguish benign from malignant pulmonary nodules, which is critical for early precise diagnosis and treatment. Here, we developed a risk assessment model of lung cancer and a high-precision classification diagnostic model using these technologies so as to provide a basis for early screening of lung cancer and for intelligent differential diagnosis. A total of 355 lung cancer patients, 444 patients with benign lung disease and 472 healthy people from The First Affiliated Hospital of Zhengzhou University were included in this study. Moreover, the dataset of 607 lung computed tomography images was collected from the above patients. The logistic regression method was employed to screen the high-risk groups of lung cancer, and the CNN model was designed to classify pulmonary nodules into benign or malignant nodules. The area under the curve of the lung cancer risk assessment model in the training set and the testing set were 0.823 and 0.710, respectively. After finely optimizing the settings of the CNN, the area under the curve could reach 0.984. This performance demonstrated that the lung cancer risk assessment model could be used to screen for high-risk individuals with lung cancer and the CNN framework was suitable for the differential diagnosis of pulmonary nodules.

A narrative review of invasive diagnostics and treatment of early lung cancer.

The diagnosis and treatment of early-stage lung cancer remains a clinical challenge. The broadening implementation of lung cancer screening has resulted in positive findings in numerous patients that are mostly non-malignant. Many other patients have indeterminate nodules that are difficult to assess through simple observation. The critical interpretation of such screening results remains a challenge for radiologists and multidisciplinary teams involved in screening for lung cancer. The evaluation and diagnosis of each participant suspected for malignancy should be based on the basic clinical principles such as a carefully collected medical history, physical examination, and detailed analysis of all imaging tests performed. Indeed, the decision to go ahead with more invasive diagnostics requires consideration of the both the risks and benefits, with reflection upon the complete clinical and radiological picture. Although transthoracic needle aspiration biopsy remains the first-choice method of diagnosis, several newer technologies have slowly begun to emerge as potential replacements. The guiding strategy for method selection is to choose the least harmful approach that offers the most relevant potential insights. Transthoracic biopsy is an effective method that allows the collection of cytological and tissue material from small, peripheral tumors, but it carries a moderate risk of complications. Bronchofiberoscopy, especially in combination with electromagnetic navigation, fluoroscopy or radial EBUS, also allows effective diagnosis of the peripheral pulmonary nodules. One of the most important diagnostic methods is the EBUS examination, which allows determining of staging in addition to diagnosis. Anatomical lung lobe resection and lymphadenectomy or sampling of the hilar and mediastinal lymph nodes is currently the treatment of choice for patients with stage I and II non-small cell lung cancer (NSCLC), but sublobar resections are recommended when a patient has limited pulmonary function or other significant comorbidities. Notably, several studies have highlighted the potential utility of more limited resections in small malignant lesions less than 2cm in diameter, with pure AIS histology, when more than 50% of the diameter of pulmonary nodule has ground-glass opacity (GGO) attenuation on CT, or long volume doubling time (VDT). Videothoracoscopy is the preferred surgical approach for resection of early-stage lung cancer. Patients who are not candidates for surgery or do not agree to surgery can be offered radical radiotherapy. Stereotactic body radiation therapy (SBRT) is a type of radical radiotherapy with proven effectiveness, a high rate of local control and an acceptable risk of the development of later complications. Future trials are expected to define the role of SBRT in the treatment of early lung cancer in healthy subjects.

Video-assisted versus open thoracotomy lobectomy: comparison on lymphadenectomy and survival in early stage of lung cancer.

BackgroundVideo-assisted thoracic surgery (VATS) is increasingly used in the surgical treatment of early lung cancer, but the oncological benefits are still controversial. We aimed to compare video-assisted lobectomy and open thoracotomy lobectomy in terms of lymphadenectomy and long-term survival depending on the location of lobectomy.MethodsA retrospective, multicenter study was based on the Polish Lung Cancer Study Group and included patients with stage I lung cancer who were surgically treated between 2007 and 2015. We included 1410 patients after video-assisted lobectomy and 4,855 after open thoracotomy.ResultsThe average number of lymph nodes removed in video-assisted lobectomy was 10.9 and in open thoracotomy lobectomy was 12.9 (P<0.001). The 5-year survival was better in the video-assisted lobectomy group (78.6%) compared to open thoracotomy (73.8%) (P=0.002). Significant differences were found in the case of left lower lobe and left upper lobe lobectomies. Multivariable analysis showed that the prognostic factors for open thoracotomy relative to video-assisted lobectomy are: age over 60 [HR (95% CI): 1.55 (1.17–2.05), P=0.002], female [HR (95% CI): 1.57 (1.07–2.29), P=0.02], squamous cell carcinoma [HR (95% CI): 1.63 (1.12–2.37), P=0.011], left lower lobe [HR (95% CI): 2.69 (1.37–5.27), P=0.004] and left upper lobe [HR (95% CI): 1.53 (1.01–2.33), P=0.047].ConclusionsThe study showed that the number of lymph nodes removed during video-assisted lobectomy is significantly lower than in the open thoracotomy group. The long-term video-assisted lobectomy results were significantly better compared to open thoracotomy. Better long-term results were achieved on the left side of lobectomy.

CT-guided percutaneous implantation of 125I particles in treatment of early lung cancer.

BackgroundTo analyze the efficacy of computed tomography (CT)-guided implantation of 125I radioactive particles in treatment of early lung cancer.MethodsSix patients were analyzed, including 4 squamous cell carcinoma, 1 adenocarcinoma, and 1 small cell lung cancer. TPS software was used to calculate the therapeutic dose amount of particles implanted, and the spacing and distribution of seeds in the target area and adjacent tissues. Under the guidance of CT, 20–55 particles were implanted at each site, with the total number of radioactive particles being 226, the particle spacing being 0.5–1.0 cm, and the implantation being performed in accordance with the principle of uniform implantation. The patients were each followed up with repeated pulmonary CT scans at 1, 3, 6, 12, 18, 24, 30 and 36 months after the procedure. In accordance with the response evaluation criteria in solid tumors (RECIST), the following definitions for responses were used: complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD).ResultsThere were 2 CRs and 4 PRs one month after procedure; six patients were followed up 3 months after procedure, including 2 CRs and 4 PRs; one patient was lost in follow-up, and 5 patients were followed up 6 months after procedure, including 3 CRs and 2 PRs; five patients were followed up 12 months after procedure, including 3 CRs, 1 PR and 1 PD. The single PD patient was again given CT-guided implantation of 125I radioactive particles for the treatment of recurrent lesions. The pulmonary CT was repeated 6 months after procedure, and the response was evaluated as SD. Four patients were followed up 18 months after procedure, including 3 CRs and 1 PR; one patient was lost in follow-up and 3 patients were followed up 24 months after the procedure with the response being evaluated as CR for all of them; one patient was followed up 36 months after procedure, and the response was evaluated as PD. During the follow-up, no serious complications occurred in any of the patients.ConclusionsThe preliminary clinical observation showed that 125I radioactive particle implantation was a safe, reliable and effective therapeutic method for early lung cancer.

MicroRNA genetic signature in non-small cell lung cancer (NSCLC) Egyptian patients

BackgroundCancer development is associated with deregulated microRNA (miRNA) in body fluids including serum, plasma, and bronchoalveolar lavage (BAL). Early diagnosis and early treatment of lung cancer improve survival and response to treatment. So, finding an easy detectable biomarker is crucially important to improve the disease outcome. So, we analyzed the differential expression of miRNA using microarray both in serum and BAL of 37 non-small cell lung cancer (NSCLC) patients and 30 healthy control subjects (15 non-smokers and 15 smokers).ResultsA total of 32 miRNAs were significantly differentially expressed in serum of NSCLC patients versus controls (13 up-regulated and 19 down-regulated), whereas 14 miRNAs were significantly differentially expressed in BAL of NSCLC patients relative to control (12 upregulated and 2 downregulated). The accuracy of MiRNAs to detect lung cancer patients versus control was 94.3% with a specificity of 97.8% and a sensitivity of 92.3%.ConclusionsExpression of miRNAs is specific in both serum and BAL of NSCLC patients, indicating that they might be considered easy diagnostic biomarkers for early lung cancer detection.

Diagnosis and treatment of early lung cancer.

Lung cancer is the leading cause of cancer death in Australia. Recently there have been unparalleled advances in the screening and management of lung cancer. The aim of this article is to discuss diagnosis and management of lung cancer, including advances that are likelyto translate into future practice. Screening with low-dose computed tomography scans has proven to be effective for detecting early curable disease, reducing mortality by ≥20% in randomised controlled trials. Implementation trials are underway within Australia and overseas, and a Commonwealth Inquiry is ongoing. Breath and blood biomarkers are less invasive alternatives that show potential but remain under investigation. Early diagnosis of lung cancer is key to improving survival - this includes familiarity with nodule screening recommendations and facilitating access to early tissue diagnosis via transthoracic needle aspiration or bronchoscopy. Treatment decisions can then be guided by staging with scans, molecular testing and multidisciplinary team consideration in the frame of patient factors/preferences. The therapeutic armamentarium is boosted by an increasing range of effective therapies including modern surgical and radiation techniques, and systemic treatments including targeted therapies and immunotherapy.

Expression and Clinical Significance of Galcetin-3 in the Serum of Non-small Cell Lung Cancer Patients

背景与目的肺癌是对人类健康威胁最大的疾病之一, 发病率高, 死亡率高。早期肺癌可以通过外科手术得到根治, 因此, 肺癌的早期发现及早期治疗尤其重要。血清肿瘤标志物是发现及诊断肺癌的一个重要手段。目前已知, 半乳糖凝集素3(Galectin-3)在多种恶性肿瘤中均有表达。该研究旨在探讨Galectin-3在非小细胞肺癌患者血清中的表达水平及其临床意义。方法采用酶联免疫吸附法检测并比较69例非小细胞肺癌患者与77例健康人群外周血血清Galectin-3浓度, 并分析其表达水平与肺癌临床特征之间的关系。结果Galectin-3在非小细胞肺癌患者外周血血清中的表达水平高于健康人群, 差异具有显著统计学意义(P < 0.01)；有淋巴结转移的非小细胞肺癌患者, Galectin-3表达水平显著高于无淋巴结转移患者, 差异有显著统计学意义(P < 0.01)；N2淋巴结转移的患者Galectin-3表达水平显著高于N1淋巴结转移的患者, 差异有显著统计学意义(P < 0.01)；临床Ⅲ期+Ⅳ期患者Galectin-3表达水平显著高于临床Ⅰ期+Ⅱ期患者, 差异有统计学意义(P < 0.05)。结论非小细胞肺癌患者血清Galectin-3水平呈现高表达, 与肺癌转移相关, 可能是一种潜在的肺癌肿瘤标志物。

Random Forest with Self-Paced Bootstrap Learning in Lung Cancer Prognosis

Training gene expression data with supervised learning approaches can provide an alarm sign for early treatment of lung cancer to decrease death rates. However, the samples of gene features involve lots of noises in a realistic environment. In this study, we present a random forest with self-paced learning bootstrap for improvement of lung cancer classification and prognosis based on gene expression data. To be specific, we propose an ensemble learning with random forest approach to improving the model classification performance by selecting multi-classifiers. Then, we investigate the sampling strategy by gradually embedding from high- to low-quality samples by self-paced learning. The experimental results based on five public lung cancer datasets show that our proposed method could select significant genes exactly, which improves classification performance compared to that of existing approaches. We believe that our proposed method has the potential to assist doctors in gene selections and lung cancer prognosis.