Postoperative Pulmonary Metastasis Research Articles

Boosting Theranostic Performance of AIEgens Using Nanocatalyzer for Robust Cancer Immunotherapy

AbstractHigh‐performance theranostic systems are of paramount importance for achieving precise image‐guided cancer immunotherapy. Here, a novel nanoplatform is presented that integrates aggregation‐induced emission luminogen (AIEgen) with prussian blue (PB) nanocatalyzer for robust cancer immunotherapy. The AIEgen with dimethylamine substitution demonstrates compelling near‐infrared (NIR) light‐induced photothermal conversion and photodynamic therapy (PDT) capabilities. By incorporating AIEgen into porous PBNPs, and further enveloped within M1 macrophage membrane, a tumor‐specific theranostic nanoagent is constructed. This strategic integration effectively constrains the molecular motion of AIEgen, leading to amplified NIR‐II fluorescence brightness and PDT attributes. Moreover, PBNPs can catalyze tumor‐overexpressed H2O2 to generate oxygen to boost PDT efficacy, and PB's NIR absorption also intensifies photoacoustic imaging and photothermal effect. The integration of NIR‐II fluorescence and photoacoustic imaging provides comprehensive information for photoimmunotherapy in orthotopic breast cancer‐bearing mice. Leveraging its potent immunogenic cell death effect, the nanoagent not only significantly inhibits cancer growth, but also generates a whole‐cell therapeutic cancer vaccine to protect mice from tumor rechallenge. In highly malignant post‐surgery breast cancer models, the nanoagent enables both accurate identification of residual tumors and efficient inhibition of postoperative tumor recurrence and pulmonary metastasis. This study will offer valuable insights for creating highly efficacious and multifaceted photoimmunotherapy protocols.

Nomogram for Predicting Postoperative Pulmonary Metastasis in Hepatocellular Carcinoma Based on Inflammatory Markers.

Uncertainty surrounds the usefulness of inflammatory markers in hepatocellular carcinoma (HCC) patients for predicting postoperative pulmonary metastasis (PM). The purpose of this study was to assess the predictive value of inflammatory markers as well as to create a new nomogram model for predicting PM. Cox regression was utilized to identify independent prognostic variables and to create a nomogram that predicted PM for comparison with a validation cohort and other prediction systems. We retrospectively analyzed a total of 1109 cases with HCC were included. The systemic inflammatory response index (SIRI) and aspartate aminotransferase-to-platelet ratio index (APRI) were independent risk factors for PM, with a concordance index of .78 (95% CI: .74-.81) for the nomogram. The areas under the curve of the nomograms for PM predicted at 1-, 3-, and 5-year were .82 (95% CI: .77-.87), .82 (95% CI: .78-.87) and .81 (95% CI: .75-.86), respectively, which were better than those of Barcelona Clinic Liver Cancer and China liver cancer stage. Decision curve analyses demonstrated a broader range of nomogram threshold probabilities. A nomogram based on SIRI and APRI can accurately predict postoperative PM in HCC.

Micellar nanoparticles inhibit the postoperative inflammation, recurrence and pulmonary metastasis of 4T1 breast cancer by blocking NF-κB pathway and promoting MDSCs depletion

The progression of breast cancer can stimulate the production of myeloid-derived suppressor cells (MDSCs). These cells with significant immunosuppressive activity play a key role in promoting the formation of pulmonary inflammatory and immunosuppressive microenvironment, namely pre-metastatic niche (PMN). Surgical resection of tumors often leads to strong inflammatory reactions, and the produced circulating tumor cells (CTCs) can implant into PMN to promote the recurrence and pulmonary metastasis of breast cancer. Therefore, we developed a hyaluronic acid (HA)-coated chitosan oligosaccharide-all-trans-retinoic-acid (COS-ATRA) micellar nanoparticle loaded with chemotherapeutic drug doxorubicin (DOX) (HA@CA/DOX NPs). The hydrophilic segment COS and hydrophobic segment ATRA both blocked NF-κB inflammatory signaling pathway in 4T1 tumor cells and MDSCs and alleviated the inflammation after resection. Besides, ATRA also significantly depleted MDSCs in lungs and tumors, thereby regulating the inflammatory and immunosuppressive microenvironment and inhibiting the formation of PMN. HA coated on the surface of nanoparticles shielded the excessive positive charge and achieved tumor targeting through CD44 on the surface of tumor cells. This drug delivery system combined with anti-inflammation and chemotherapy significantly inhibited the postoperative recurrence and pulmonary metastasis of breast cancer.

Effects of Anesthetic Technique on Postoperative Pulmonary Metastasis in Patients Undergoing Laryngectomy.

BackgroundWhether laryngeal cancer is directly implanted into the lungs during orotracheal intubation is still unclear. Therefore, this study aimed to find whether orotracheal intubation is an independent risk factor for postoperative pulmonary metastasis in patients undergoing laryngectomy.Patients and MethodsMedical records from January 1, 2006, to December 31, 2016, were reviewed. According to similar propensity scores, patients who received orotracheal intubation (tracheal intubation group, n = 515) were matched 1:1 with those who received tracheotomy (tracheotomy group, n = 326) in the induction of general anesthesia. The primary outcome was postoperative pulmonary metastasis. Secondary outcomes included local recurrence, lymphatic metastasis, tracheostomal recurrence and overall survival.ResultsBetween the two groups, there was no significant difference in postoperative pulmonary metastasis (P = 0.688), local recurrence (P = 0.215), lymphatic metastasis (P = 0.480), tracheostomal recurrence (P = 0.246) or all-cause death (P = 0.299). The primary site of cancer was an independent risk factor for pulmonary metastasis [HR 0.29, 95% CI 0.13–0.68; P = 0.013] and local recurrence (HR 2.69, 95% CI 1.39–5.21; P = 0.003). Type of surgery (HR 3.13, 95% CI 2.03–4.84; P < 0.001) and N classification of TNM (HR 0.27, 95% CI 0.10–0.75; P = 0.012) were risk factors for local recurrence. Postoperative chemotherapy was an independent risk factor for lung metastasis (HR 7.58, 95% CI 3.11–18.47; P < 0.001) and lymphatic metastasis (HR 5.18, 95% CI 2.57–11.91; P < 0.001), and 5-year overall survival was associated with age (P = 0.028), clinical stage (P < 0.001) and postoperative chemotherapy (P = 0.003) but not with anesthetic technique (P = 0.473).ConclusionThis retrospective study suggests that orotracheal intubation in laryngectomy is not a risk factor for postoperative pulmonary metastasis, local recurrence, lymphatic metastasis or overall survival.

MON-508 Clinicopathological Features of Papillary Thyroid Cancer After Fukushima and Chernobyl Accidents

The phenomenon of a sharp increase in the incidence of thyroid cancer worldwide is now under debate. Screening activity, diagnostic improvements or real rise in incidence as a result of unknown carcinogens are discussed. Studies in Belarus after Chernobyl showed that the synergistic influence of radiation and nitrates might lead to an increased thyroid cancer (TC) risk in children. For better understanding of the etiology, we compared the published clinical data of pediatric TC patients after the nuclear emergency of Fukushima with the observations we made after the Chernobyl accident.In a large-scale survey after the Fukushima accident, 300,476 subjects were screened and by September 2018, 191 subjects were diagnosed with thyroid malignancy or suspected malignancy by fine needle aspiration. Mean age of TC patients was 17.8 years at presentation. Mean tumor size was 14.9 mm. Postoperative lymph node metastasis, extra-thyroidal invasion, and pulmonary metastasis were detected in 79%, 45%, and 2.1% of all cases, respectively. Only 4.8% TC cases were staged as low risk pT1aN0M0 (Suzuki et al. 2018). For comparison, in Belarus patients mean age was 13.0 years at presentation (1078 cases), mean tumor size 14.4 mm. Lymph node metastases were observed in 74%, pulmonary metastasis in 11% and extra-thyroidal extension in 48.5 - 64.1% (with respect to latency period). The low risk (pT1aN0M0) TC patients were diagnosed in 19.2% cases.The most of TC cases from Japan and Belarus were clinically significant, not “overdiagnosed” and screened on time. Given that the accidental thyroid doses were very low in Japanese cases, it would be very important to evaluate and compare the exposure to endocrine disruptors as e.g. nitrates and low radiation doses from diagnostic procedures (dental X-ray examination and computed tomography).Referece:Suzuki S, Matsumoto Y, Ookouchi C, Nakano K, Iwadate M, Suzuki S, Nakamura I, Fukushima T, Mizunuma H, Yamashita S, Takenoshita S. The clinicopathological features of childhood and adolescent thyroid cancer in Fukushima after the Fukushima Daiichi nuclear power plant accident. Thyroid. 2018; Supplement 1, (Poster 136).

Exploration of clinicopathologic factors associated with postoperative pulmonary metastasis in elderly patients with rectal cancer

Objective To investigate the incidence rate, timing and risk factors of metachronous pulmonary metastasis after curative resection in patients with rectal cancer. Methods A total of 198 patients with rectal cancer undergoing curative resection in gastroenterology surgery department of Beijing Hospital from 2007 to 2012 were enrolled in this retrospective study.The metachronous metastasis and recurrence were observed.Clinicopathologic factors which might be associated with postoperative pulmonary metastasis were analyzed by the univariate and multivariate analysis. Results The 5-year disease-free survival was 76.8% in a total of 198 patients cohort.The most frequent metastatic sites were the lung(incidence of 11.6%)followed by liver(7.6%). Median interval from rectal surgery to diagnosis of pulmonary metastasis was much longer than that of hepatic metastasis(19 vs.11 months, P=0.002). Tumor location, current tumor-node-metastasis(TNM)stage, and a positive circumferential resection margin(CRM)were identified as the independent risk factors for pulmonary metastasis.The most common metachronous metastasis site for rectal cancer after curative surgery was the lung in elderly patients. Conclusions The lung is the most common metachronous metastatic site after curative surgery of rectal cancer in elderly patients.For patients with unfavorable risk profiles, a more intensive surveillance program is needed for the early detection of metachronous metastasis and recurrence. Key words: Pulmonary metastasis; Rectal cancer; Postoperative follow-up

The impact of pulmnary emphysema evaluated by CT on lung metastasis in rectal cancer.

582 Background: Our previous study suggested that smoking history could be a risk factor for pulmonary metastasis following rectal cancer surgery. Smoking causes emphysematous change in the lung, however, it remains unclear how much impact of pulmonary emphysema (PE) on the pathogenesis of pulmonary metastasis in rectal cancer. The objective of this study is to clarify the influence of PE on the pulmonary metastasis. Methods: Patients with rectal cancer who underwent curative resection from September 2005 to May 2014 in our institution were enrolled and their medical records were reviewed including the percentage volume of low attenuation area in the whole lung (LAA%), which were calculated from their preoperative chest CT by using AZE virtual place. PE was defined as more than 10% in LAA% and statistically evaluated the correlation with relapse free survival for pulmonary metastasis (RFSP). Results: A total of 286 patients, who consists of 7 in stage0,102 in StageⅠ, 75 in StageⅡ, and 102 in stageⅢ, were enrolled. The median LAA% was 3.16±3.78% and 14 patients (4.9%) were diagnosed PE by LAA%. Postoperative pulmonary metastasis was observed in 22 patients, including 3 patients in PE. Five-year RFSP rate in PE was significantly poorer than non-PE (25.4% vs 7.7%, p=0.02) by log-rank test. Multivariate survival analysis using Cox’s regression model revealed that PE was an independent risk factor for RFSP (Hazard Ratio = 19.14 [3.18 – 115.20], p &lt; 0.001). Conclusions: Pulmonary emphysema may have a robust impact on pulmonary relapse after curative surgical resection of rectal cancer.

Analysis of risk factors of pulmonary metastasis and prognosis of patients after anterior resection of rectal cancer

Objective To investigate the risk factors of pulmonary metastasis and prognosis of patients with rectal cancer after anterior resection of rectal cancer. Methods The retrospective case-control study was adopted. The clinical data of 421 patients with rectal cancer who underwent anterior resection at the First Hospital of China Medical University from August 2010 to December 2014 were collected. The patients were followed up by outpatient examination and telephone interview once three months in the first postoperative year, once half a year in the second postoperative year, and then once a year. The follow-up included satuses of pulmonary metastasis and survival of patients after anterior resection of rectal cancer. The end point of follow-up was death of the patients or 31 December, 2014. The risk factors of pulmonary metastasis and prognosis in patients after anterior resection of rectal cancer were analyzed. Measurement data with normal distribution were presented as ±s and measurement data with skewed distribution were presented as M(range). The pulmonary metastasis rate/curve and survival rate/curve were calculated and drawn by the Kaplan-Meier method. The comparisons of pulmonary metastasis rate and survival rate were done using the Log-rank test.The univariate analysis was done using the chi-square test and Log-rank test. The multivariate analysis was done by Logistic regression model and COX regression model. Results Of the 421 patients, 389 patients were successfully followed up with a median time of 34 months (range, 11-53 months) and a follow-up rate of 92.40%(389/421). Ninety-four, 168 and 127 patients were detected in Ⅰ, Ⅱ and Ⅲ stages of TNM stage. There were 29 patients diagnosed with postoperative pulmonary metastasis with the diagnosis time of (21±9) months. The 3-year cumulative incidence of pulmonary metastasis after anterior resection of rectal cancer was 2.2% in patients of Ⅰ stage, 3.0% in patients of Ⅱ stage and 17.4% in patients of Ⅲ stage, showing significantly increase trend as the increase of the TNM stage (χ2=19.927, P 5 μg/L was an independent risk factor affecting the prognosis of patients (HR=13.489, 95% CI: 1.407-129.297, P<0.05). Conclusions Pulmonary metastasis after anterior resection of rectal cancer is common. Lymph node metastasis is a high risk factor affecting postoperative pulmonary metastasis, and preoperative CEA level>5 μg/L is an independent risk factor affecting the prognosis of patients with postoperative pulmonary metastasis. Key words: Rectal neoplasms; Pulmonary metastases; Risk factors; Prognosis

術後早期に多発肺肝転移を来した十二指腸乳頭部低分化型腺癌の1例

十二指腸乳頭部癌は他の胆・膵癌に比較して予後良好な症例が多いが，中には術後早期に全身転移を来す予後不良な症例も報告されている．我々はそのような1例を経験したので報告する．患者は64歳の男性で，黄疸を主訴とし入院した．腫瘤潰瘍型の十二指腸乳頭部癌で，#13a，#14dリンパ節転移陽性を疑った．術前生検で未分化癌組織を含む低分化型腺癌と診断されたが，根治手術可能と判定し幽門輪温存膵頭十二指腸切除を施行した．pT3，pN2，M（−），fStage IVaであった．術後7週目に多発性肺・肝転移を続発し，術後2か月で癌死した．病理組織学的検査では未分化癌組織を多く含む低分化管状腺癌と診断された．自験例を含む低分化型腺癌本邦報告8切除例中，3例が術後6か月以内に再発死亡していた．術後急速に遠隔転移を来し再発死亡する十二指腸乳頭部癌を術前に選別することができれば，不要な手術を回避できると思われた．

A clinicopathological study of postoperative pulmonary metastasis of uterine cervical carcinomas.

To investigate the clinicopathological backgrounds and prognostic factors of uterine cervical carcinomas metastatic to the lung. A total of 519 patients with invasive cervical carcinoma (Stage pTIb-IIb) treated by abdominal radical hysterectomy at the Saitama Cancer Center from January 1, 1976 to December 31, 1989 were analyzed clinicopathologically. The frequencies of pulmonary metastasis were 6.4% (24/377) and 11.3% (16/142) in patients with negative and positive pelvic lymph nodes, respectively. Among 24 negative lymph node patients, 15 had pulmonary metastasis only. The overall 5-year survival rate of these 15 patients was 36% after relapse. Of the 15, the prognosis of 12 patients with 1-3 pulmonary metastases only was better, that is, 46% after surgical resection (mean size of resectable tumor = 2.8 cm) and/or chemotherapy. But the other patients died within 3.3 years after relapse. The occurrence of pulmonary metastasis only, its number (1-3) and size (mean size = 2.8 cm), and no lymph node metastasis are important prognostic factors. For these patients, active surgical resection of the pulmonary lesion(s) and further chemotherapy are recommended in order to improve their prognosis.

An experimental study of triethylenethiophosphoramide (TSPA) in the prevention of postoperative pulmonary metastases.

An experimental study of triethylenethiophosphoramide (TSPA) in the prevention of postoperative pulmonary metastases.