Malignant Lung Research Articles

Outcome of Primary Lung Salivary Gland-Type Carcinoma: A Population-Based Study.

Introduction. Primary pulmonary salivary gland-type carcinomas are rare malignancies arising from minor salivary gland tissue in the lower respiratory tract. Given their rarity, constituting <1% of all primary lung malignancies, their epidemiological features and outcomes remain poorly documented. This study analyzed data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database to identify primary pulmonary salivary gland carcinomas, including the most prevalent tumor types. Methods. All patients diagnosed with mucoepidermoid carcinoma, adenoid cystic carcinoma, and epithelial-myoepithelial carcinoma, with the lung designated as the primary site between 1975 and 2019, were subject to analysis. Overall and disease-specific survival were calculated using Kaplan-Meier curves and Cox proportional hazards models. Results. The study identified 323 mucoepidermoid carcinoma, 284 adenoid cystic carcinoma, and 6 epithelial-myoepithelial carcinoma diagnosed as pulmonary salivary gland-type carcinoma. An analysis of age distribution revealed a unimodal pattern for both mucoepidermoid carcinoma and adenoid cystic carcinoma, with most patients diagnosed after age 40. Most patients were Caucasians (77% for mucoepidermoid carcinoma and 83% for adenoid cystic carcinoma). Both disease-specific and overall survival were worse for patients diagnosed at the age of 60 years or above. Race or sex did not significantly impact patient survival. High-grade mucoepidermoid carcinoma demonstrated a significantly worse prognosis than low or intermediate-grade mucoepidermoid carcinoma. Conclusion. A comprehensive review of clinical and epidemiological features of pulmonary salivary gland-type carcinomas reveals that the age of diagnosis and tumor grade are the most significant factors in determining patient survival.

Atrial flutter in a patient population with cancer: Comparison of incidence, mortality, and readmission rates.

e23079 Background: Cardiac tachyarrhythmias are common in cancer patients. Much has been studied regarding atrial fibrillation, but the impact of atrial flutter (AFL) in different malignancies is under-studied. We aim to compare the occurrence of atrial flutter (AFL), its mortality, and readmission rates in cancer patients stratified by different types. Methods: The National Readmission Database (2016-2020) was queried to identify all-cause admissions for patients with active malignancy of any origin. The study population was divided into six subgroups based on the type of cancer (colorectal, renal, lung, breast, prostate, and hematological). Multivariate regression analysis was utilized for adjusted odds of mortality. A propensity score matching (PSM) model matched malignancy of interest with other malignancies to obtain incidence rates. Results: Among 10.6 million all-cause cancer-related hospitalizations, about 0.4% developed AFL. After propensity matching, when compared to other malignancies, AFL had the highest incidence in hospitalizations associated with lung malignancies (0.75%), followed by hematological (0.66%), prostrate (0.57%), renal (0.49%), colorectal (0.38%) and breast (0.31%) malignancies [p &lt; 0.05]. Moreover, cancer hospitalizations complicated by AFL were associated with higher mortality. AFL was associated with the highest odds of mortality in colorectal malignancies (aOR:2.80), followed by hematological (aOR:2.67), renal (aOR:2.66), lung (aOR:2.22), breast (aOR:2.12), &amp; prostate (aOR:1.76) malignancies [p &lt; 0.001]. AFL was also associated with frequent readmissions in cancer patients. The rates of 30-day AFL-related recurrent admission were highest in lung malignancies (18.3%), followed by hematological (18%), renal (16.6%), prostate (15.1%), colorectal (14.7%) &amp; breast (14.2%) malignancies [p &lt; 0.05]. Conclusions: The incidence of AFL in nationwide hospitalizations among cancer patients was ~ 0.4%. AFL was found to have the highest incidence and readmission rates in lung malignancies, while AFL-related mortality was highest in colorectal malignancies.

A single institution review of immunotherapy use, adverse events, and outcomes in early-onset cancer.

e23320 Background: A significant portion of cancer patients are treated with immune checkpoint inhibitors (ICI) and many experience immune related adverse events (irAE) which impact treatment and outcomes. A paucity of data exists related to use of ICIs in Early Onset Cancers (EOC), their irAE, and its correlation to outcomes. Methods: A single institution database of immunotherapy use from an NCI-designated cancer center (NCI-CC) was reviewed with patients treated from 2010-2019. Two cohorts were examined: EOC (age ≤50 at diagnosis), and age &gt; 50. Clinically significant irAEs were defined as those requiring hospitalization (≥grade 3). Pearson's Chi-squared test and Fisher's exact test were used for analysis. Significance was defined as p &lt; 0.05. Results: A total of 1067 patients were identified, 173 were EOC. Race and ethnicity were similar between groups, the EOC group had significantly higher proportion of females, private insurance, working, single, treated at main campus, and ECOG 0. Main cancer types in EOCs were skin cancers (38.2%), lung (16.2%), and heme malignancies (11.6%); those &gt; 50 were lung (46.6%), skin cancer (21.6%), and GU malignancies (11.2%). Stages of cancer were not statistically different nor was type or doses of ICI. EOCs were more likely to get a greater number of ICIs. IrAE requiring hospitalization were similar between groups; 20 (11.6%) in EOC vs 95 (10.6%) in &gt; 50. There was no difference in the incidence of specific irAEs. Further stratification of EOC cohort by age group 13-30, 31-40, and 41-50 demonstrated no difference in experience of an irAE. Ipilimumab had the highest incidence of irAE in EOC; 12 (75.0%) vs 52 (33.1%), as did receiving 2+ ICIs: 11 (68.8%). The number of doses of a specific ICI was not correlated to irAE in EOC. EOC patients without an irAE were more likely to have a disease response; either stable disease, partial response, or a complete response: 21 (70.0%) vs 1 (12.5%); there was no difference in mortality. Conclusions: In a single NCI-CC review of ICI use, EOC had no difference in ≥grade 3 irAEs or in specific irAEs relative to older adults. Within EOCs, those who experienced a significant irAE were more likely to have received Ipilimumab or 2+ ICIs and were less likely to obtain a response to treatment, although mortality was not different. [Table: see text]

In-hospital outcomes of patients with lung cancer with and without superior vena cava thrombosis: A nationwide analysis.

e23322 Background: Malignant superior vena cava syndrome (SVCS) is a clinical problem that results from the obstruction of blood flow in the superior vena cava by an underlying malignancy. It may be caused by external compression or internal obstruction due to a thrombus or direct invasion by tumor cells. Though lung malignancy is the most common cause of SVCS, there is a lack of data on in-hospital outcomes in these patients. Methods: We queried the National Inpatient Sample 2018-2020 to identify hospitalizations with lung cancer including both small cell and non small cell lung cancer. Hospitalizations with diagnosis of acute SVC thrombosis were determined by using ICD-10 codes.Demographics and mortality rates were compared between two groups using chi square for categorical variables and t test for continuous variables. Multivariate regression analysis was further performed to study the impact of SVC thrombosis on mortality, LOS and total hospitalization cost. Results: A total of 2011620 hospitalizations with lung cancer were identified. Of these, 2855 (0.0014%) had acute SVC thrombosis. These patients were younger with a mean age of 63 years. African-Americans and Hispanics were in a higher proportion in the cohort of hospitalizations with SVC thrombus as compared to those without. (Table 1). Multivariate regression analysis revealed higher odds of mortality (OR-1.94; C.I: 1.53-2.47; P &lt; 0.001), LOS (OR 1.66; C.I:1.20- 2.31; P &lt; 0.005) and total hospitalization cost (26211.15; C.I:22183.56- 30238.74; P &lt; 0.001) in lung cancer hospitalizations. Conclusions: Our study shows that SVCT, has higher odds of mortality, length of stay and total hospital cost. Though the general recommendation is to continue anticoagulation, sometimes patients may require endovascular stent placement with/without thrombectomy. Though rare, SCVT can be life threatening and requires prompt attention.[Table: see text]

Characterization of social determinants of health in patients considered for participation in treatment clinical trials at a community cancer center serving the Great Plains.

e13704 Background: Avera Cancer Institute, a community-based cancer network comprised of six rural cancer centers in SD and MN, provides care to a five-state region in the upper mid-west covering 72,000 square miles and offers several clinical trials to patients to offer access to advanced treatment for malignancies. Malignances are known to disproportionally affect patients that are older, rural, minorities, and have lower socioeconomic status, which are all less likely to enroll into clinical trials. Methods: Patients evaluated for participation in clinical trials from 2018-2022 were identified in an institutional database. Trial type was designated as either a treatment or nontreatment trial. Status of trial involvement was designated between enrolled or screened. Their demographic information was obtained from the electronic health record (EHR). Demographic information obtained from the EHR includes race, ethnicity, language spoken, gender, employment status, insurance type, and if they live in an urban or rural area as defined by the US Census Bureau. Clinical trial portfolio during this time includes trials for breast, gynecological, gastrointestinal, lung, and hematologic malignancies. Results: 4,397 patients were considered for participation in a clinical trial at our institution in the studied timeframe. Of these patients, 1887 were screened for treatment trials and of that group, 773 were enrolled. 35% of participants considered for clinical trials were from urban areas while 65% considered were rural. 48% of the urban population ultimately were enrolled on a clinical trial while 44% of rural population participated. Participants who lived in an urban area 25-50 miles from our study site had an enrollment rate of 49% compared to rural enrollment of 33%, from 50-100 miles rates of 53% and 37%, from 100-250 miles rates of 29% and 41%, and from greater than 250 miles rates of 44% and 33%, respectively. 99.5% of the population was non-Hispanic, 97% were White, and 99% were English speaking. 74% of the total population were female and 26% were male. Females had an enrollment rate of 51% while males had an enrollment of 29%. Patients with no insurance enrolled in trial 62% compared to 36% of those with commercial insurance The average national Area Deprivation Index percentile for screened patients was 57 vs 59 for enrolled patients. Conclusions: This retrospective study demonstrates a greater likelihood for females, urban patients, and white, English-speaking patients to enroll into clinical trials. Our data also demonstrate a preference for uninsured patients to enroll into clinical trials, possibly due to the financial benefits they may provide. Further directions include comparing our patients considered for clinical trials to all patients treated at our institution to identify potential disparities in care.

A nationwide analysis of demographic and treatment patterns in admissions for malignant pleural effusions from 2016-2020.

1618 Background: Malignant pleural effusions are an indicator of metastatic malignancy, with poor survival and need for palliative procedures to alleviate symptoms. Our study aims to identify the disparities in the utilization of these procedures and their effects on hospitalization outcomes. Methods: The Nationwide Inpatient Sample (NIS) was used to identify all adult hospitalizations with malignant pleural effusion (MPL) between the years 2016-2020. We studied patient demographics and treatment modalities during admission. The study's primary outcome measure was to identify the difference in the total length of stay (LOS) and total healthcare cost (THC)incurred during admission. The secondary outcome was mortality rates among patients undergoing these procedures. Statistical analysis was done using multivariate linear and logistic regression models. Results: A total of 439,245 admissions for MPL were identified, constituting 0.2% of all U.S. admissions. Among these, 59.6% were females and mean age was 67.3 years. There were 68% Whites, 15% Blacks, 8% Hispanics, 4% Asians or Pacific Islanders, 0.4% Native Americans, and 2.9% others. About 61% had Medicare, 11.2% Medicaid, 25.7% Private insurance, and 1.9% Self-pay. Most admissions occurred in teaching hospitals (76.3%), urban settings (94.5%), and hospitals with larger bed strength (56.1%). The most common primary admission diagnosis was sepsis (8.3%). The most common primary malignancies were Lung (39.9%), breast (27.9%), gastrointestinal (9%), and hematopoietic malignancies (7.1%). We studied rates of thoracocentesis, Pleurodesis, Decortication, and intrapleural chemotherapy. The mean LOS and THC increased in admissions where procedures were performed, highest for decortication (12.1 days, p&lt;0.01). However, the odds of death in hospitals significantly reduced. When compared to primary lung cancer causing malignant effusions, primary G.I., renal, urinary, and upper aerodigestive malignancies with MPL had significantly higher mortality rates (p&lt;0.05). Disparities were observed in procedures performed, with women having 29% lower odds of undergoing decortication (p&lt;0.001). African Americans had lower odds of undergoing any procedures for MPL when adjusted for age, sex insurance status, compared to whites. Teaching hospitals had 10.9 times higher odds of performing thoracocentesis but lower odds of performing pleurodesis and decortication (p&lt;0.05). Conclusions: This investigation provides insights into the favorable impact of invasive procedures on in-hospital mortality for malignant pleural effusions, suggesting a possibility that patients with better performance status underwent such interventions. We also noted racial and sex-based disparities in the performance of these procedures. Further studies are essential to identify the reasons for this disparity to help promote equitable care.

Comparing ventricular tachycardia across the nation: Stratification by different malignancies.

e23151 Background: Cardiac arrhythmias and cancer are prevalent conditions and share common predisposing factors. No studies have assessed VT rates and their outcomes stratified by cancer types. We aim to compare the occurrence of ventricular tachycardia (VT) and its outcomes in different malignancies. Methods: The national readmission database (2016-2020) was queried to identify all-cause admissions for patients with active malignancy of any origin. The study population was divided into six subgroups based on the type of cancer (colorectal, renal, lung, breast, prostate, and hematological). Multivariate regression analysis was utilized for adjusted odds of mortality. A propensity score matching (PSM) model matched malignancy of interest with other malignancies to obtain incidence rates. Results: Among 10.6 million all-cause cancer-related hospitalizations, about 0.8% developed VT. On a propensity-matched analysis &amp; compared to other malignancies, VT had the highest incidence in hospitalizations associated with hematological malignancies (1%), followed by prostate (0.95%), lung (0.9%), renal (0.76%), colorectal (0.75%) &amp; breast (0.50%) malignancies [p &lt; 0.05]. Moreover, cancer hospitalizations complicated by VT were associated with higher mortality. VT was associated with the highest adjusted odds of mortality in renal malignancies (aOR:4.62), followed by breast (aOR:4.60), hematological (aOR:4.44), colorectal (aOR:3.75), prostrate (aOR:3.44), &amp; lung (aOR:3.11) malignancies [p &lt; 0.001]. The rates of 30-day VT-related readmission were highest in hematological malignancies (16.8%), followed by renal (15.9%), lung (15.7%), prostrate (15%), colorectal (14%) &amp; breast (13.9%) malignancies [p &lt; 0.05]. Conclusions: The rate of VT in nationwide hospitalizations among cancer patients was ~ 0.8 %. VT was found to have the highest incidence &amp; readmissions in hematological malignancies, while VT-related mortality was highest in renal malignancies.

Establishing palliative care in tribal and rural Indian setting: A participatory action research approach.

e24085 Background: We established a palliative care center in the tribal area of Santhal Pargana, India, under a tertiary care facility, as a crucial step in addressing the palliative needs of oncology patients. This study assesses the center's inaugural year, focusing on referral patterns, morphine consumption, and pain management. Methods: Data from all patients visiting the palliative care outpatient department (OPD) in 2023 were prospectively collected and analyzed. The study focused on key palliative care indicators, including morphine consumption, patient referrals, and the mean Numeric Rating Scale (NRS) pain score after initial consultation. The PAR approach was utilized to tailor services to the community's needs. Results: The center observed an increase in patient referrals, from 8 new patients in January to 19 by December. The patient demographic primarily comprised individuals with head and neck cancer (43%), followed by breast cancer (28%) and gall bladder cancer (12%), alongside other types such as cervix, sarcomas, lung, and adult hematolymphoid malignancies. Bone metastasis was present in 46 (55.4%) patients at initial presentation. Morphine consumption demonstrated a notable rise, from 840 mg in May to 2860 mg in December, totaling 9800 mg for the year. The mean NRS pain score improved significantly from 6.5 in January to 4.3 post-initial consultation. The center maintained an overall median of 3 consultations per patient, and bereavement support was provided to 13 (15.7%) patients. Conclusions: The integration of the Participatory Action Research approach, specifically the CTC-5, was instrumental in the successful initiation and expansion of palliative care services within the center. The structured training, mentorship, and organizational restructuring, facilitated by the program, were crucial in establishing a modest palliative care infrastructure. This comprehensive approach not only enhanced care delivery but also ensured the sustainability and adaptability of palliative services, effectively addressing the gap in palliative care in rural, tribal settings.

Incidence and outcomes of atrial fibrillation in different cancer subtypes: A propensity-matched analysis of Nationwide Readmissions Database.

e23324 Background: Significant concern exists over the cardiotoxic effects of chemo &amp; radiation therapy used in the management of cancer patients. With different cancers requiring different chemo-radiotherapy regimens, cardiotoxicity risk is quite variable. We aim to evaluate the rates of atrial fibrillation (AF) in various cancers. Methods: The national readmission database (2016-2020) was queried to identify all-cause admissions for patients with active malignancy of any origin. The study population was divided into six subgroups based on the type of cancer (colorectal, renal, lung, breast, prostate, and hematological). Multivariate regression analysis was utilized for adjusted odds of mortality. A propensity score matching (PSM) model matched malignancy of interest with other malignancies to obtain incidence rates. Results: Among 10.6 million all-cause cancer-related hospitalizations, about 1.5 million (14%) developed atrial fibrillation (AF). On propensity-matched cohorts, AF had its highest incidence in hospitalizations associated with hematological malignancies (17%), followed by prostate (16.5%), lung (15.9%), renal (12.5%), colorectal (11.5%) &amp; breast (10.5%) malignancies [p &lt; 0.05]. Moreover, cancer hospitalizations complicated by AF were associated with higher mortality. AF was associated with the highest odds of mortality in breast cancer (aOR:1.60), followed by colorectal (aOR:1.59), hematological (aOR:1.55), prostrate (aOR:1.52), renal (aOR:1.51) &amp; lung (aOR:1.51) malignancies [p &lt; 0.001]. The rates of 30-day AF-related readmission were highest in hematological malignancies (21%), followed by lung (18.8%), colorectal (17.1%), breast (16.1%), prostate (15.7%) &amp; renal (12.5%) malignancies [p &lt; 0.05]. Conclusions: The rate of AF in nationwide hospitalizations among cancer patients was ~ 14%. AF was found to have the highest incidence &amp; readmission in hematological malignancies, while AF-related mortality was highest among breast cancer.

Impact of pneumocystis pneumonia on clinical outcomes in patients with lung malignancy compared to other malignancies.

e20001 Background: Pneumocystis pneumonia (PCP) is an opportunistic infection that causes significant morbidity and mortality in cancer patients. Although infrequent in solid malignancies, limited studies suggest that PCP portends a worse outcome in patients with lung cancer. We examined hospitalization outcomes for PCP among patients with lung cancer relative to other malignancies. Methods: A retrospective cohort analysis using the Nationwide Inpatient Sample (NIS) database (2010-2019) was conducted. Using ICD-9 and ICD-10 codes, cancer patients admitted for PCP were identified and stratified based on their diagnosis of lung cancer versus other cancer types. Primary outcomes were inpatient mortality, length of stay (LOS), and total hospital charges (THC). Secondary outcomes included odds of mechanical ventilation, ICU care, bronchoscopy, and palliative care. Statistical analyses were performed using t-tests, univariate and multivariate logistic regression. Results: Among 5,408 hospitalizations for PCP in cancer patients, 10.6% had a diagnosis of lung cancer and 89.4% had other cancer types. Lung cancer patients were older (mean age: 66 vs 62 years; p = 0.001) and had a higher Charlson comorbidity burden (&gt;2) compared to those with other cancers (69.8 vs 34.2%; p&lt;0.001). 31% of lung cancer patients admitted for PCP died compared to 16% of patients with other cancer types ( p&lt;0.001). Multivariate regression analysis showed that hospitalized PCP patients with lung cancer had two-fold higher odds of hospital-associated mortality relative to those with other cancer types (adjusted odds ratio (aOR): 2.2; 95% confidence interval (CI): 1.39-3.37; p = 0.001). Both cohorts had similar LOS (aOR: 0.86; P=0.61; 95% CI: 0.5-1.5) and THC (β -15,377; p=0.113; 95% CI= -34,407-3,653). Among secondary outcomes, lung cancer patients admitted for PCP had higher odds of mechanical ventilation (25.3 vs 17.7%; aOR: 1.61; p = 0.046) and palliative care utilization (24 vs 13%; p=0.002). Conclusions: Pneumocystis pneumonia is associated with significantly higher inpatient mortality among patients with lung cancer compared to other cancers. These patients also had higher rates of mechanical ventilation and palliative care utilization. Health care providers need to maintain a high index of suspicion to facilitate early diagnosis and intervention in order to mitigate adverse outcomes.[Table: see text]

Relationship between immune-inflammatory markers and clinical features and deepness of tumor response and prognosis of patients with PD-L1 ≥50% metastatic NSCLC receiving first-line immunotherapy.

e14547 Background: Patients with programmed cell death-ligand 1 (PD-L1) ≥50% metastatic non-small cell lung cancer (NSCLC) treated with first-line immunotherapy have heterogeneous clinical assessment and outcomes. In this study, we sought to identify features of patients with metastatic NSCLC who achieved high deepness of response (HDPR) to first-line immunotherapy, and how these might differ from features predictive of non-high deepness of response (NHDPR). The influence of clinical features on prognosis of patients with PD-L1 ≥50% were further clarified. Methods: This retrospective study analyzed patients with PD-L1≥50% metastatic NSCLC treated with first-line immunotherapy at Beijing Tiantan Hospital between July 2020 and December 2023. All the patients had at least one measurable lesion in lung according to the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. HDPR was defined as deepness of lung tumor response ≥50%, while NHDPR was defined as deepness of lung tumor response &lt;50% or tumor enlargement. Tumor PD-L1 expression, target mutation, neutrophil-to-lymphocyte ratio (NLR), lactic dehydrogenase (LDH) level, and other prognostic variables were analyzed to identify characteristics enriched in patients achieving HDPR compared to NHDPR. We also investigated the effects of these variables on first-line progression-free survival (PFS) and overall survival (OS) of the patients. Results: A total of 17 patients were included in our retrospective analysis. Seven (41.2%) patients achieved HDPR (range: -50%, -72%) and ten (58.8%) patients achieved NHDPR (range: -13%, -45%). Seven (41.2%) patients had central nervous system (CNS) metastases at the first diagnosis of lung malignancy, and their CNS target lesions shrinkages were observed after therapy (range: -32%, -100%). Lower Th/Ts ratio ( P=0.01) and drug resistance mutations (TP53/KRAS/EGFR) ( P=0.001) were found enriched for NHDPR compared to HDPR. However, no differences were found in tumor PD-L1 expression, NLR, LDH, B lymphocyte subset, NK cell subset, pathological type, T-stage, smoking index, ECOG score, immunotherapeutic schemes, or CNS metastases between the two groups ( P&gt;0.05). With a median follow-up of 26.0 months (range: 17.2-34.8 months), the median first-line PFS and OS were 9.0 months (95% CI: 5.0-13.0) and not reached (NR), respectively. The NLR was identified as an independent prognostic factor on first-line PFS. Patients with an NLR≥4 exhibited a worse median PFS (7.0 months vs. NR; P=0.033; 95%CI: 1.2-80.2) than those with an NLR&lt;4 following first-line immunotherapy. Conclusions: Among patients with PD-L1≥50% metastatic NSCLC who received first-line immunotherapy, lower Th/Ts ratio and drug resistance mutations showed a diminished tumor response and higher NLR ratio exhibited a worse median PFS.

Mucinous epidermoid carcinoma of the lung with ALK mutation: Case report and literature review.

Pulmonary mucoepidermoid carcinoma (PMEC) is a rare lung malignancy, especially in combination with ALK mutations, whose clinical presentation lacks specificity and for which there are no standardized treatment guidelines. We report a case of a patient with PMEC-predominant primary lung cancer combined with an ALK mutation. One patient was diagnosed with PMEC combined with ALK mutation. After diagnosis by puncture pathology, the patient was treated with oral targeted drugs. The patient's cough and fever were controlled, her diet improved significantly, and she gained 20 pounds in 6 months. During this period, the primary and metastatic foci in the lungs were significantly reduced on repeat chest CT. PMEC combined with ALK mutation is an extremely rare primary lung cancer, and the diagnosis is mainly based on pathology, histology and immunohistochemistry. The application of molecularly targeted drugs to patients with mutations can significantly improve the prognosis of patients with PMEC, which is expected to be a new breakthrough in the treatment of PMEC.

Determination of predisposing factors for prolonged intensive care in patients with exacerbation of chronic obstructive pulmonary disease

Objective: To determine the predisposing factors for lengthy intensive care unit stay of chronic obstructive pulmonary disease patients with acute exacerbation. Method: The retrospective study was conducted after approval from the ethics review committee of Atatürk Sanatorium Training and Research Hospital, Turkey, and comprised data from January 1, 2017, to August 31, 2022, related to acute exacerbation chronic obstructive pulmonary disease patients receiving intensive care unite treatment. Demographics, comorbidities, treatment, length of stay in hospital and in intensive care unit, and nutritional status were evaluated. Data of patients who spent &lt;10 days in intensive care unit formed Group 1, while those having spent 10 days or more formed Group 2 for comparison purposes. Data was analysed using SPSS 22. Results: Of the 460 patients, 366(79.6%) were in Group 1; 224(61.2%) males and 64(38.8%) females with mean age 70.81±11.57 years. There were 94(20.4%) patients in Group 2; 62(66%) males and 32(34%) females with mean age 72.38±10.88 years (p&gt;0.05). Inotropic agent support, need for haemodialysis, timeframe of invasive mechanical ventilation, length of stay in hospital, 1-month mortality, antibiotic use, use of diuretic agent, acute physiology and chronic health evaluation-ii score, nutrition risk in the critically ill score, history of lung malignancy, and pneumonic infiltration on chest radiograph were significantly more frequenttly observed in Group 2 patients (p&lt;0.05). Age, timeframe of invasive mechanical ventilation, and length of stay in hospital were the factors prolonging intensive care unit stay (p&lt;0.05). Conclusion: Higher age, longer invasive mechanical ventilation timeframe and hospital stay with acute exacerbation chronic obstructive pulmonary disease caused a prolonged stay in intensive care unit. Key Words: Acute exacerbation of chronic obstructive pulmonary disease, Mechanical ventilation time, Prolonged intensive care stay, Prolonged hospitalisation.

A Multichannel CT and Radiomics-Guided CNN-ViT (RadCT-CNNViT) Ensemble Network for Diagnosis of Pulmonary Sarcoidosis.

Pulmonary sarcoidosis is a multisystem granulomatous interstitial lung disease (ILD) with a variable presentation and prognosis. The early accurate detection of pulmonary sarcoidosis may prevent progression to pulmonary fibrosis, a serious and potentially life-threatening form of the disease. However, the lack of a gold-standard diagnostic test and specific radiographic findings poses challenges in diagnosing pulmonary sarcoidosis. Chest computed tomography (CT) imaging is commonly used but requires expert, chest-trained radiologists to differentiate pulmonary sarcoidosis from lung malignancies, infections, and other ILDs. In this work, we develop a multichannel, CT and radiomics-guided ensemble network (RadCT-CNNViT) with visual explainability for pulmonary sarcoidosis vs. lung cancer (LCa) classification using chest CT images. We leverage CT and hand-crafted radiomics features as input channels, and a 3D convolutional neural network (CNN) and vision transformer (ViT) ensemble network for feature extraction and fusion before a classification head. The 3D CNN sub-network captures the localized spatial information of lesions, while the ViT sub-network captures long-range, global dependencies between features. Through multichannel input and feature fusion, our model achieves the highest performance with accuracy, sensitivity, specificity, precision, F1-score, and combined AUC of 0.93 ± 0.04, 0.94 ± 0.04, 0.93 ± 0.08, 0.95 ± 0.05, 0.94 ± 0.04, and 0.97, respectively, in a five-fold cross-validation study with pulmonary sarcoidosis (n = 126) and LCa (n = 93) cases. A detailed ablation study showing the impact of CNN + ViT compared to CNN or ViT alone, and CT + radiomics input, compared to CT or radiomics alone, is also presented in this work. Overall, the AI model developed in this work offers promising potential for triaging the pulmonary sarcoidosis patients for timely diagnosis and treatment from chest CT.

From Tumor to Bone: Growth Factor Receptors as Key Players in Cancer Metastasis.

This review article explores the intricate correlation between growth factors and bone metastases, which play a crucial role in the development of several types of malignancies, namely breast, prostate, lung, and renal cancers. The focal point of our discussion is on crucial receptors for growth factors, including Epidermal Growth Factor Receptor (EGFR), Transforming Growth Factor-β (TGFβ), Vascular Endothelial Growth Factor Receptor (VEGFR), and Fibroblast Growth Factor Receptor (FGFR). These receptors, which are essential for cellular activities including growth, differentiation, and survival, have important involvement in the spread of cancer and the interactions between tumors and the bone environment. We discuss the underlying mechanisms of bone metastases, with a specific emphasis on the interaction between growth factor receptors and the bone microenvironment. EGFR signaling specifically enhances the process of osteoclast development and the formation of osteolytic lesions, especially in breast and lung malignancies. TGFβ receptors have a role in both osteolytic and osteoblastic metastases by releasing TGFβ, which attracts cancer cells and promotes bone remodeling. This is a crucial element in the spread of prostate cancer to the bones. The functions of FGFR and VEGFR in the processes of bone formation and tumor angiogenesis, respectively, highlight the complex and diverse nature of these interactions. The review emphasizes the possibility of targeted therapeutics targeting these receptors to interrupt the cycle of tumor development and bone degradation. Therapeutic approaches include focusing on the VEGF/VEGFR, EGF/EGFR, FGF/FGFR, and TGFβ/TGFβR pathways. These include a variety of compounds, such as small molecule inhibitors and monoclonal antibodies, which have shown potential to interfere with tumor-induced alterations in bone. The text discusses clinical trials and preclinical models, offering insights into the effectiveness and constraints of various treatments. Ultimately, this study provides a succinct but thorough summary of the present knowledge and treatment strategies focused on growth factor receptors in bone metastases. This highlights the significance of comprehending the signaling of growth factor receptors in the microenvironment where tumors spread to the bones, as well as the possibility of using targeted therapies to enhance the results for cancer patients with bone metastases. The advancement of treating bone metastases hinges on the development of treatments that specifically target the intricate relationships between malignancies and bone.

A Rare Case of Recurrent Hemopneumothorax

Abstract Hemopneumothorax is most commonly encountered following trauma. Spontaneous hemopneumothorax is rare. Causes of spontaneous hemopneumothorax include congenital cystic lung diseases, bleeding disorders, collagen vascular diseases such as rheumatoid arthritis, systemic lupus erythematosus, and complications of lung malignancies. Vascular Ehlers–Danlos syndrome (vEDS) is a life-threatening rare genetic disorder with a high tendency of arterial and organ rupture. Pulmonary complications in vEDS are rare. This report is of a young male presenting with a history of recurrent hemopneumothorax. He was diagnosed with vEDS by identifying a COL3A1 gene mutation. This report emphasizes the importance of genetic studies when young patients present with unexplained and recurrent hemopneumothorax. Genetic counseling and close monitoring are imperative for the prevention of severe complications.

Role of Positron Emission Tomography/Computed Tomography (PET/CT) in Assessment and Follow-up of Gastrointestinal Tract Malignancies

Positron Emission Tomography/Computed Tomography (PET/CT) is a highly advanced imaging method that has several uses in oncology, such as determining the stage of cancer, evaluating the effectiveness of treatment, reevaluating the stage of cancer, and monitoring for the return of cancer over time. PET advancement has brought out a new capacity in medical diagnosis: being able to non-invasively examine the physiological condition of interior tissues. The integration of PET with simultaneous CT combines two procedures that enable the diagnosis of metabolic or receptor-specific abnormalities together with precise anatomical localization. In comparison to PET alone, the PET/CT combination is more effective in accurately identifying the location of abnormalities and distinguishing between normal and abnormal uptake of FDG along with additional tracers. PET/CT has become an essential component of management guidelines in many diseases such as lung, breast, and lymphoproliferative malignancies. The ability to image metabolic processes like glucose metabolism adds to the information provided by structural imaging, especially in the context of treatment monitoring, where metabolic changes can often precede structural changes.

Neutrophil–Lymphocyte and Platelet–Lymphocyte Ratios are Predictors of Lung Malignancy

Neutrophil–Lymphocyte and Platelet–Lymphocyte Ratios are Predictors of Lung Malignancy

Abstract CT082: Phase I study of autologous CD8+ and CD4+ transgenic T cells expressing high-affinity KRAS G12V mutation-specific T cell receptors (FH-A11KRASG12V-TCR) in patients with metastatic pancreatic, colorectal and non-small cell lung cancers with KRAS G12V mutations

Abstract Background: KRAS, the most common driver oncogene in human malignancies, has predictable mutations. 85% of RAS mutations occur at the Glycine (G) 12 position with G12V being amongst the most common. Cancers driven by mutant KRAS include pancreatic (PDAC), colorectal (CRC), and non-small cell lung (NSCLC) malignancies. The prognosis of patients with activating KRAS mutations remains poor. Preliminary anti-tumor activity has been observed in the clinic with T cell receptor (TCR) T cell therapies targeting KRAS mutations, but durable clinical benefit is lacking. Rationale: FH-A11KRASG12V-TCR is an autologous CD8+ and CD4+ transgenic T cell product expressing (1) an HLA-A11-restricted, high affinity KRASG12V mutation-specific T cell receptor (TCR) and (2) the wildtype CD8α/β coreceptor enabling CD4+ T cell recognition of KRAS G12V presented on an MHC class I allele mediating helper T cell activity and cytotoxicity. The TCR sequence is derived from the peripheral blood of a healthy HLA-A11+ adult based on a strong pre-clinical dataset. Methods: This is an ongoing, investigator-initiated, Phase 1, first-in-human, single-center, open-label dose escalation study of FH-A11KRASG12V-TCR. The aims are to evaluate the safety, tolerability, maximum tolerated dose (MTD), and preliminary anti-tumor activity of FH-A11KRASG12V-TCR in patients with advanced PDAC, CRC, and NSCLC who express the HLA-A11-restricted KRAS G12V mutation. Dose modification will be guided by the Bayesian Optimal Interval design (BOIN). Patients will initially be treated in cohorts of 3 at each dose level (DL). BOIN will be used to identify the recommended dose for subsequent patients. The planned target doses are 5 x 109 transgenic TCR T cells in DL 1 with dose escalation up to 15 x 109 transgenic TCR T cells in DL 3. This study enrolls patients who are 18 years or older, HLA-A*11:01-positive, with KRAS G12V mutated metastatic PDAC, CRC, or NSCLC. Patients must have progressed on or be intolerant of at least two lines of prior therapies including any targeted therapies indicated for their current malignancy. Patients undergo leukapheresis prior to treatment and receive lymphodepleting chemotherapy with either cyclophosphamide intravenously (IV) and fludarabine IV on days -6, -5, -4, and -3 or bendamustine IV on days -4 and -3. FHA11KRASG12V-TCR is administered IV on day 0. The dose-limiting toxicity observation period is 28 days. Patients may receive an additional FHA11KRASG12V-TCR IV infusion at the same or lower dose as soon as 28 days or up to 1 year after the first infusion. One patient enrolled to date and the study is actively recruiting (NCT06043713). Citation Format: Elena Gabriela Chiorean, Andrew Coveler, Rachael Safyan, Stacey Cohen, Sylvia Lee, Cecilia Yeung, Mary Redman, Thomas Schmitt, Aude Chapuis, Philip D. Greenberg. Phase I study of autologous CD8+ and CD4+ transgenic T cells expressing high-affinity KRAS G12V mutation-specific T cell receptors (FH-A11KRASG12V-TCR) in patients with metastatic pancreatic, colorectal and non-small cell lung cancers with KRAS G12V mutations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT082.

Transbronchial Microwave Ablation of Peripheral Lung Tumors: The NAVABLATE Study.

Image-guided thermal ablation is a minimally invasive local therapy for lung malignancies. NAVABLATE characterized the safety and performance of transbronchial microwave ablation (MWA) in the lung. The prospective, single-arm, 2-center NAVABLATE study (NCT03569111) evaluated transbronchial MWA in patients with histologically confirmed lung malignancies ≤30mm in maximum diameter who were not candidates for, or who declined, both surgery and stereotactic body radiation therapy. Ablation of 1 nodule was allowed per subject. The nodule was reached with electromagnetic navigation bronchoscopy. Cone-beam computed tomography was used to verify the ablation catheter position and to evaluate the ablation zone postprocedure. The primary end point was composite adverse events related to the transbronchial MWA device through 1-month follow-up. Secondary end points included technical success (nodule reached and ablated according to the study protocol) and technique efficacy (satisfactory ablation based on 1-month follow-up imaging). Thirty subjects (30 nodules; 66.7% primary lung, 33.3% oligometastatic) were enrolled from February 2019 to September 2020. The pre-procedure median nodule size was 12.5mm (range 5 to 27mm). Procedure-day technical success was 100% (30/30), with a mean ablative margin of 9.9±2.7mm. One-month imaging showed 100% (30/30) technique efficacy. The composite adverse event rate related to the transbronchial MWA device through 1-month follow-up was 3.3% (1 subject, mild hemoptysis). No deaths or pneumothoraces occurred. Four subjects (13.3%) experienced grade 3 complications; none had grade 4 or 5. Transbronchial microwave ablation is an alternative treatment modality for malignant lung nodules ≤30mm. There were no deaths or pneumothorax. In all, 13.3% of patients developed grade 3 or above complications.