Wedge Resection of Pulmonary Nodules (≤2 cm): A Consensus Statement by Specialists of Thoracic Surgery (2023 Edition) / 中国肺癌杂志

Lung cancer is the highest cancer-related mortality rate in the world, and is one of the most common malignancies. The standard treatment for early-stage non-small cell lung cancer (NSCLC) is radical lobectomy, while recent studies have found that sub-lobectomy of pulmonary nodules (≤2 cm) is not inferior to lobectomy and even improve the prognosis of the patients. These important findings will effectively and positively promote the formation of consensus and principles of wedge resection of pulmonary nodules (≤2 cm) in the field of thoracic surgery. The purpose of this study is to present a national expert consensus on wedge resection of pulmonary nodules (≤2 cm) in the field of thoracic surgery. The experts from Editorial Committee of Consensus on Wedge Resection of Lung Nodules (≤2 cm) (2023 Edition) jointly participated in the revision work. According to the clinical progress about the wedge resection of pulmonary nodules (≤2 cm) at home and abroad during recent years, experts jointly wrote Wedge Resection of Pulmonary Nodules (≤2 cm): a Consensus Statement by Specialists of Thoracic Surgery (2023 Edition), in combination with the homogeneous treatment principles of wedge resection in the field of thoracic surgery in China. This consensus was summarized from the following aspects: (1) Indications of wedge resection of pulmonary nodules (≤2 cm); (2) Resection range of pulmonary nodules (≤2 cm) required for wedge resection; (3) Excisable pulmonary nodules (≤2 cm) for wedge resection. This consensus finally put forward 8 recommended opinions, and sorted out 5 opinions which were still controversial and needed more evidence. The integrated opinions were generated through the discussion held among the experts of thoracic surgery from all over the country, making wedge resection of pulmonary nodules (≤2 cm) more appropriate for China and more standardized and homogeneous for clinical practice. In the future, more relevant researches should be accumulated based on the characteristics of lung cancer and its diagnosis and treatment in China, optimizing the treatment of pulmonary nodules (≤2 cm).

Clinical Recommendations for Perioperative Immunotherapy-induced Adverse Events in Patients with Non-small Cell Lung Cancer / 中国肺癌杂志

BACKGROUND@#Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE).@*METHODS@#This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE.@*RESULTS@#This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively.@*CONCLUSIONS@#Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.

Combination of Radiation Therapy and Immunotherapy for Non-small Cell Lung Cancer: Peer Exchange on Frontier Academic Topics / 中国肺癌杂志

Lung cancer is the leading cause of cancer death worldwide as well as in China. For many years, conventional oncologic treatments such as surgery, chemotherapy, and radiotherapy (RT) have dominated the field of non-small cell lung cancer (NSCLC). The recent introduction of immunotherapy in clinical practice, led to a paradigm shift in lung cancer as in many other solid tumors. Recent pre-clinical and clinical data have shown RT may also modify antitumor immune responses through induction of immunogenic cell death and reprogramming of the tumor microenvironment. This has led many to reexamine RT as a partner therapy to immuno-oncology treatments and investigate their potential synergy in an exponentially growing number of clinical trials. Clinical trials combining radiotherapy and immunotherapy are attracting major attention, experts were invited to discuss frontier and controversial academic topics: (1) Recent developments of clinical synergy between radiation and immune checkpoint inhibitors (ICIs) in the treatment of NSCLC; (2) Will immunotherapy and radiotherapy increase the toxicity risk for cancer patients; (3) How to cope the mixed responses/disassociated responses phenomenon in checkpoint inhibition therapy to NSCLC with local ablative therapy; (4) Combining radiotherapy and immunotherapy in the treatment of NSCLC brain metastases.

A study on the relationship between muscle mass loss and severe postoperative pulmonary complications in elderly patients with non-small cell lung cancer / 中华老年医学杂志

Objective:To investigate the correlation between the muscle mass loss and severe postoperative pulmonary complications(PPC)in elderly patients with non-small cell lung cancer(NSCLC).Methods:Elderly patients with NSCLC undergoing lobectomy at the Lung Cancer Institute and the Department of Thoracic Surgery of Guangdong Provincial People's Hospital were recruited from Feb.2019 to Dec.2019.Data of the body composition, lung function, respiratory muscle strength test, cardiopulmonary exercise test were collected before operation.All patients were grouped into two groups: with versus without severe PPC at 30 d after operation.The differences of the above parameters were compared between the two groups.A multiple logistic regression analysis was used to analyze the risk factors for severe PPC.Results:In this study, 120 elderly NSCLC patients undergoing lobectomy were recruited, All evaluations were completed in 113 patients(aged 68.13±7.01 years)in whom, 21(18.58%, 21/113)patients had serious PPC.Compared with patients without PPC, patients with severe PPC had a lower appendicular skeletal muscle mass index(ASMI)(5.67±0.90 kg/m 2vs.7.71±1.40 kg/m 2, t=3.900, P=0.001), a lower forced expiratory volume in 1 second(FEV 1)(1.85±0.40 L vs.2.12±0.57 L, t=2.412, P=0.027), a lower maximal mid-expiratory flow(MMF)(1.40±0.69 L/s vs.2.11±1.09 L/s, t=2.502, P=0.021), a lower maximum inspiratory pressure(Pimax)(55.13±32.52 cmH 2O vs.64.71±20.60, t=0.778, P=0.047, 1 cmH 2O=0.098 kPa), a lower maximal oxygen consumption(Vo 2max)(1.14±0.41 L/min vs.1.40±0.34 L/min, t=0.779, P=0.046), a lower peak O 2 consumption(Vo 2max@kg)(20.00±1.91 L·min -1·kg -1vs.22.33±2.37 L·min -1·kg -1, t=0.813, P=0.041). Multiple logistic regression analysis showed that in addition to FEV 1( OR=2.824, 95% CI: 1.127-5.158, P=0.001)and Vo 2max@kg( OR=3.149, 95%CI: 1.829-6.592, P<0.001), ASMI was also an independent risk factor for serious PPC( OR=1.919, 95% CI: 1.604-3.466, P=0.006), in which the best cut-off value was 6.295 kg/m 2, the sensitivity and specificity were 0.816 and 0.818 respectively, and the area under the receiver operating characteristic(ROC)curve(AUC)was 0.887(95% CI: 0.793-0.981, P<0.0001). Conclusions:Muscle mass loss can increase the risk for the occurrence of severe PPC within 30 days after lobectomy in elderly patients with NSCLC.

Observation - An Favorable Option Forthoracic Dissemination Patients with Lung Adenocarcinoma or Squamous Carcinoma / 中国肺癌杂志

BACKGROUND@#Surgery was not standard-of-care of patients with advanced lung cancer. However, a serial of retrospective studies demonstrated that thoracic dissemination (M1a) patients could benefit from contraindicated surgery. After non-standard treatment, how should these patients choose following treatment approaches? Herein, we conducted this retrospective study to explore subsequent optimal treatment approaches.@*METHODS@#Different therapeutic approaches were evaluated by comparing progression-free survival (PFS), overall survival (OS), time to treatment interval (TTI) using the Kaplan-Meier method and Log-rank test. A Cox proportional hazards regression model was used for multivariate analysis.@*RESULTS@#141 eligible were enrolled. The median PFS of chemotherapy group, targeted therapy group and observation group were 14.7, 41.0 and 31.0 months, respectively (95%CI: 19.01-26.01; P<0.001). There was no significantly statistically difference between median PFS of targeted group and observation group (P=0.006). The median OS were 39.0, 42.6 and 38.1 months (95%CI: 32.47-45.33; P=0.478). The median PFS and OS of TTI<3 months and TTI ≥3 months were 15.2 months versus 31.0 months (95%CI: 19.01-26.06; P<0.001) and 41.7 months versus 38.7 months (95%CI: 32.47-45.33; P=0.714). Multivariate analyses revealed gender (P=0.027), lymph node status (P=0.036) and initial therapy (P<0.001) were independent prognostic factors for PFS.@*CONCLUSIONS@#Observation did not shorten survival of thoracic dissemination patients with lung adenocarcinoma or squamous carcinoma, therefore, it could be an favorable option. But prospective randomized controlled study was needed to confirm its validity.

The preliminary results of a phase II randomized clinical trial of high-dose toremifene chemosensitization in stage IIIB/IV non-small cell lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>To investigate whether high-dose toremifene can enhance the efficacy of chemotherapy in non small cell lung cancer.</p><p><b>METHODS</b>Untreated stage IIIB/IV non-small cell lung cancer patients were randomly devided into group A (high-dose toremifene combined with the platinum-based chemotherapy) or group B (the same platinum-based chemotherapy alone).</p><p><b>RESULTS</b>A total of 30 eligible patients had been recruited. Hemotologic and nonhemotologic toxicities were similar with no statistic difference. The median survival for group A was 8 months, 95% CI (6.63-9.37) versus 7.5 months, 95% CI (4.75-10.25) for group B ( P =0.9). One year-survival rate was 31% for group A versus 28% for group B ( P =0.87). The response rate was 25% for group A versus 21% for group B ( P =0.99).</p><p><b>CONCLUSIONS</b>The results suggest that high-dose toremifene does not enhance the efficacy of platinum-based chemotherapy for IIIB/IV non-small cell lung cancer but toxicities are well tolerated.</p>

Mammographic and Pathologic Analyses of Mammary Hamartoma / 实用放射学杂志

Objective To investigate X-ray manifestations of mammary hamartoma and its pathologic basis.Methods 19 cases were proved by surgery and pathology,X-ray and pathologic manifestations were analyzed.All cases were examined with full digital mammography.Results X-ray manifestations of mammary hamartomas were divided into three types,including fat type were in 5 cases;dense type were in 4 cases and mixed type were in 10 cases.The lumps were surrounded by a true capsule in pathology,they were made up of different amount of rambling mammary ducts,lobules,adipose and fibrous tissue.Conclusion X-ray manifestations of mammary hamartoma are varied,depending on the proportion of the adipose tissue,gland and fibrous tissue.Mixed density lump is the characteristic sign of this disease.

Helical CT Scan:the Value in the Diagnosis of Small Renal Cell Carcinoma / 实用放射学杂志

Objective To evaluate the value of helical CT scan in the diagnosis of small renal cell carcinoma.Methods The helical CT features of small renal cell carcinoma proved by operation and pathology in 14 cases were studied retrospectively.Results CT showedisodense mass in 7 cases,slightly low density mass in 5 cases,slightly hyperdense mass in 1 case,cystic and solid mass in 1 case,and among them 2 cases showed punctural calcification.The lesions showed marked enhancement in cortical phase in 12 cases,slight to moderateenhancement in 2 cases,in parenchymal phase,the tumor density dropped promptly,and in the pelvic phase the tumor density droppedfurther. Conclusion Small renal cell carcinoma is of certain characteristic on multi-phasic spiral CT contrast-enhanced scan,it is a very valuable method in diangosis of small renal cell carcinoma.

CT Diagnosis of Pulmonary Sequestration / 实用放射学杂志

Objective　In order to improve diagnosis of the disease,CT appearances of pulmonary sequestration were studied.Methods　10 cases were proved by surgery and pathology.Lung inner type was in 9 and lung exterior type in 1.All cases were examined with plain CT scans and 5 of them were taken thin slice CT scan with contrast enhancement.Results　10 cases located in the posterior segment of right or left lower lobes,3 of them were cystic,3 were solid,4 were cystic and solid.The emphysema around the lesions were showed in 7 cases.Abnormal arterial supply could be seen in 7 cases.Conclusion　CT not only can demonstrate lesions and changes of tissue surrounding lesions,but also can manifest abnormal supplying blood vessels well.CT plays important role to diagnose pulmonary sequestration.