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BACKGROUND: Patients with lung adenocarcinoma (LUAD) have a low response rate to immune checkpoint blockade. It is highly important to explore the tumor immune escape mechanism of LUAD patients and expand the population of patients who may benefit from immunotherapy. METHODS: Based on 954 bulk RNA-seq data of LUAD patients and 15 single-cell RNA-seq data, the relationships between tumor immune dysfunction and exclusion (TIDE) scores and survival prognosis in each patient were calculated and evaluated, and the immune escape mechanism affecting the independent prognosis of LUAD patients was identified. Functional enrichment analysis explored the antitumour immune response and biological behavior of tumor cells among different LUAD groups. Single-cell annotation and pseudotemporal analysis were used to explore the target molecules and immune escape mechanisms of LUAD. RESULTS: Myeloid-derived suppressor cells (MDSCs) and IRF8 were identified as risk and protective factors for the independent prognosis of LUAD patients, respectively. In the tumor microenvironment of patients with high infiltration of MDSCs, the antitumor immune response is significantly suppressed, while tumor cell division, proliferation, and distant metastasis are significantly enhanced. Single-cell RNA-seq analysis revealed that IRF8 is an important regulator of MDSC differentiation in LUAD myeloid cells. In addition, IRF8 may regulate the differentiation of MDSCs through the IL6-JAK-STAT3 signalling pathway. CONCLUSIONS: IRF8 deficiency impairs the normal development of LUAD myeloid cells and induces their differentiation into MDSCs, thereby accelerating the immune escape of LUAD cells. IRF8-targeted activation to inhibit the formation of MDSCs may be a new target for immunotherapy in LUAD.
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Adenocarcinoma de Pulmão , Fatores Reguladores de Interferon , Neoplasias Pulmonares , Células Supressoras Mieloides , Microambiente Tumoral , Humanos , Células Supressoras Mieloides/imunologia , Adenocarcinoma de Pulmão/imunologia , Adenocarcinoma de Pulmão/genética , Adenocarcinoma de Pulmão/patologia , Fatores Reguladores de Interferon/metabolismo , Fatores Reguladores de Interferon/genética , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/genética , Microambiente Tumoral/imunologia , Prognóstico , Feminino , Regulação Neoplásica da Expressão Gênica , Transdução de Sinais , Masculino , Evasão Tumoral , Evasão da Resposta Imune , Análise de Célula Única , Diferenciação CelularRESUMO
BACKGROUND: Micropapillary (MP) and solid(S) pattern adenocarcinoma are highly malignant subtypes of lung adenocarcinoma. In today's era of increasingly conservative surgery for small lung cancer, effective preoperative identification of these subtypes is greatly important for surgical planning and long term survival of patients. METHODS: For this retrospective study, the presence of MP and/or S was evaluated in 2167 consecutive patients who underwent surgical resection for clinical stage IA1-2 lung adenocarcinoma. MP and/or S pattern-positive patients and negative-pattern patients were matched at a ratio of 1:3. The Lasso regression model was used for data dimension reduction and imaging signature building. Multivariate logistic regression was used to establish the predictive model, presented as an imaging nomogram. The performance of the nomogram was assessed based on calibration, identification, and clinical usefulness, and internal and external validation of the model was conducted. RESULTS: The proportion of solid components (PSC), Sphericity, entropy, Shape, bronchial honeycomb, nodule shape, sex, and smoking were independent factors in the prediction model of MP and/or S lung adenocarcinoma. The model showed good discrimination with an area under the ROC curve of 0.85. DCA demonstrated that the model could achieve good benefits for patients. RCS analysis suggested a significant increase in the proportion of MP and/or S from 11% to 48% when the PSC value was 68%. CONCLUSION: Small MP and/or S adenocarcinoma can be effectively identified preoperatively by their typical 3D and 2D imaging features.
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The Taitema Lake Basin serves as an ecological barrier in the south of the Tarim Basin, connecting with the Qiemo, Ruoqiang, and Milan oases, collectively preventing the expansion and merging of the desert, specifically inhibiting the convergence of the Taklamakan Desert and Lop Nur. In recent years, with changes in the natural environment and an increase in water usage, the downstream flow of the Tarim River has decreased, leading to the gradual drying up of Taitema Lake and exacerbating desertification, resulting in frequent sandstorms. Subsequently, under the influence of ecological water transfer projects, Taitema Lake has gradually recovered, and the ecological environment has improved. This study focuses on Taitema Lake and its nearby regions, constructing the Regional Landscape Ecological Risk Index (ERI) to assess landscape ecological risks before and after ecological engineering and determine ecological benefits. The results indicate that the EWC (Ecological Water Conveyance) project effectively supplements water in the intermediate and lower courses of the Tarim River and the terminal lakes, significantly bolstering ecological conditions in the lake basin and reducing risks. However, the current EWC project is relatively extensive, and the water reaching the Tarim River and Taitema Lake depends entirely on the surplus water from upstream production and daily life. Additionally, the distribution of downstream water depends entirely on natural topography, leading to uneven spatiotemporal distribution of water resources and significant evaporation losses. Rational hydraulic engineering measures should be taken to re-plan the distribution of rivers and lakes, achieving the maximum ecological benefits of the EWC project.
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Introduction: Solid adenocarcinoma represents a notably aggressive subtype of lung adenocarcinoma. Amidst the prevailing inclination towards conservative surgical interventions for diminutive lung cancer lesions, the critical evaluation of this subtype's malignancy and heterogeneity stands as imperative for the formulation of surgical approaches and the prognostication of long-term patient survival. Methods: A retrospective dataset, encompassing 2406 instances of non-solid adenocarcinoma (comprising lepidic, acinar, and papillary adenocarcinoma) and 326 instances of solid adenocarcinoma, was analyzed to ascertain the risk factors concomitant with diverse histological variants of lung adenocarcinoma. Concurrently, RNA-sequencing data delineating explicit pathological subtypes were extracted from 261 cases in the TCGA database and 188 cases in the OncoSG database. This data served to illuminate the heterogeneity across lung adenocarcinoma (LUAD) specimens characterized by differential histological features. Results: Solid adenocarcinoma is associated with an elevated incidence of pleural invasion, microscopic vessel invasion, and lymph node metastasis, relative to other subtypes of lung adenocarcinoma. Furthermore, the tumor microenvironment (TME) in solid pattern adenocarcinoma displayed suboptimal oxygenation and acidic conditions, concomitant with augmented tumor cell proliferation and invasion capacities. Energy and metabolic activities were significantly upregulated in tumor cells of the solid pattern subtype. This subtype manifested robust immune tolerance and capabilities for immune evasion. Conclusion: This present investigation identifies multiple potential metrics for evaluating the invasive propensity, metastatic likelihood, and immune resistance of solid pattern adenocarcinoma. These insights may prove instrumental in devising surgical interventions that are tailored to patients diagnosed with disparate histological subtypes of LUAD, thereby offering valuable directional guidance.
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BACKGROUND: Minimally invasive lobectomy is the standard treatment for early stage non-small cell lung cancer (NSCLC). The aim of this study is to investigate postoperative recovery in a prospective trial of discharged patients with early stage non-small cell lung cancer undergoing robot-assisted thoracic surgery (RATS) versus uniportal video-assisted thoracic surgery (UVATS). PATIENTS AND METHODS: This is a prospective and observational study. From 9 September 2022 to 1 July 2023, 178 patients diagnosed with NSCLC admitted to the Department of Thoracic Surgery of Shandong Provincial Hospital signed informed consent and underwent lobectomy by RATS and UVATS. The functional recovery index included MD Anderson Symptom Inventory, Christensen Fatigue Scale, EORTC QLQ-C30, and Leicester Cough Questionnaire. RESULTS: After propensity score-matched analysis, each group included 42 cases. For the baseline characteristics of patients, operation time (p = 0.01) and length of stay (p = 0.04) were shorter in the RATS group. The number of lymph nodes resected in the RATS group was much more than in the UVATS group. According to our investigation, appetite loss, nausea, diarrhea, and cough severity after RATS were better than after UVATS. After the first week, pain severity degree of the RATS group was higher than UVATS, while there was no difference during the second and third week. The physical score of the RATS group was higher than the UVATS group (p = 0.04), according to the Leicester Cough Questionnaire. CONCLUSION: RATS was associated with severe short-term postoperative pain but less postoperative complications.
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Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Robótica , Carcinoma de Pequenas Células do Pulmão , Humanos , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/patologia , Estudos Prospectivos , Pontuação de Propensão , Pneumonectomia/métodos , Carcinoma de Pequenas Células do Pulmão/cirurgia , Tosse/cirurgia , Cirurgia Torácica Vídeoassistida/métodosRESUMO
BACKGROUND: RNA modification, a major component of post-transcriptional modification, plays an essential role in tumor initiation and progression. N4-acetylcytidine (ac4C) present in different species as a highly conserved RNA modification. ac4C on mRNA increases the stability of mRNA and the efficiency of protein translation. However, the mRNA profiling of ac4C in lung adenocarcinoma (LUAD) is unknown. METHODS: NAT10 expression was tested using immunohistochemistry in tissue microarray (TMA). The ac4C peaks on mRNA were identified through acetylated RNA immunoprecipitation sequencing in both human LUAD tissues and adjacent non-tumor tissues, and differences of acetylation and mRNA between the two groups were analyzed. Furthermore, the function of AC4C-specific acetylated transcripts was analyzed bioinformatically. And a ac-RIP-PCR was used to verify the ac4C acetylation sites of TFAP2A. RESULTS: The expression of acetylated key enzyme NAT10 was obviously increased in LUAD group. Then we found noticeable differences in ac4C mRNA modification between LUAD and adjacent non-tumor tissues. In addition, bioinformatics analysis showed that the distinctive distribution pattern of mRNA ac4C in LUAD affects a variety of cellular functions, such as protein sumoylation and transmembrane transporter activity. Importantly, we verified the ac4C level of TFAP2A was up-regulated in LUAD. CONCLUSIONS: Our study revealed that the degree of ac4C in mRNA in LUAD was significantly higher than in adjacent tissues and was concentrated mainly in the coding sequences with a implications in a wide range of cellular functions. The ac4C may become a new molecular marker and treatment target for lung cancer.
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Adenocarcinoma de Pulmão , Neoplasias Pulmonares , Humanos , Adenocarcinoma de Pulmão/genética , Neoplasias Pulmonares/genética , Citidina , RNARESUMO
BACKGROUND: The aim of this study was to investigate the imaging features, lymph node metastasis, and genetic mutations in micropapillary lung adenocarcinoma (imaging with mixed ground-glass nodules) ≤2 cm, to provide a more precise and refined basis for the selection of lung segment resection. METHODS: A retrospective analysis of 162 patients with surgically resected pathologically confirmed cancers ≤2.0 cm in diameter (50 cases of micropapillary mixed ground-glass nodules [mGGNs], 50 cases of nonmicropapillary mGGNs, and 62 cases of micropapillary SNs [solid nodules]) was performed. mGGNs were classified into five categories according to imaging features. The distribution of these five morphologies in micropapillary with mGGN and nonmicropapillary with mGGN was analyzed. The postoperative pathology and prognosis of lymph node metastasis were also compared between micropapillary mGGNs and micropapillary with SNs. After searching the TCGA database, we demonstrated heterogeneity, high malignancy and high risk of microcapillary lung cancer cancers. RESULTS: Different pathological subtypes of mGGN differed in morphological features (p < 0.05). The rate of lymph node metastasis was significantly higher in micropapillary mGGNs than in nonmicropapillary mGGNs. In the TCGA database samples, lactate transmembrane protein activity, collagen transcription score, and fibroblast EMT score were remarkably higher in micropapillary adenocarcinoma. Other pathological subtypes had a better survival prognosis and longer disease-free survival compared with micropapillary adenocarcinoma. CONCLUSION: mGGNs ≤2 cm with a micropapillary pattern have a higher risk of lymph node metastasis compared with SNs, and computed tomography (CT) imaging features can assist in their diagnosis.
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Adenocarcinoma de Pulmão , Neoplasias Pulmonares , Nódulos Pulmonares Múltiplos , Humanos , Estudos Retrospectivos , Metástase Linfática , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/genética , Adenocarcinoma de Pulmão/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/cirurgia , Tomografia Computadorizada por Raios X/métodos , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/genética , Nódulos Pulmonares Múltiplos/cirurgia , Estadiamento de NeoplasiasRESUMO
Background: The intraoperative localization of nonpalpable pulmonary nodules for thoracoscopic wedge resection is technically challenging. Current preoperative image-guided localization techniques require additional time, costs, procedural risks, advanced facilities, and well-trained operators. In this study, we explored a cost-effective method of well-matched interaction between virtuality and reality for accurate intraoperative localization. Methods: Through the integration of techniques involving preoperative 3-dimensional (3D) reconstruction, temporary clamping of target vessel and the modified inflation-deflation method, the segment on the 3D virtual model and the segment under the thoracoscopic monitor were well matched in the inflated state. Then the spatial relationships of target nodule to the virtual segment could be applied to the actual segment. The well-matched interaction between virtuality and reality would facilitate nodule localization. Results: A total of 53 nodules were successfully localized. The median maximum diameter of the nodules was 9.0 mm (interquartile range [IQR], 7.0-12.5 mm). The median depthmin and depthmax were 10.0 mm and 18.2 mm, respectively. The median macroscopic resection margin was 16 mm (IQR, 7.0-12.5 mm). The median duration of chest tube drainage was 27 hours, with a median total drainage of 170 mL. The median postoperative length of hospital stay was 2 days. Conclusions: The well-matched interaction between virtuality and reality is safe and feasible for intraoperative localization of nonpalpable pulmonary nodules. It may be proposed as a preferred alternative to traditional localization methods.
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Aims: To find out a better propaganda and education plan for the popularization of the ground-glass opacities-related (GGO-related) lung cancer screening. Methods and Material: The control group took a lung cancer screening knowledge test directly before receiving the health education. By contrast, the experimental group took the same knowledge test after receiving health education. This study designed unimodal and multimodal materials about GGO-related lung cancer. The text and graph were considered unimodal information, while the video was multimodal information. According to the different information forms they were exposed to, the experimental group was further divided into text, graphic, and video groups. An eye-tracking system was performed to record eye-tracking data synchronously. Results: Compared with the control group, the knowledge test scores of each experimental group were remarkably improved. Furthermore, the graphic group had a significantly higher correct rate on the No. 7 question, while the video group had the lowest. In terms of saccades, the video group had significantly higher speed and amplitude of saccades than the other two groups. In terms of fixation, the interval duration, total duration of whole fixations, and a number of whole fixations of the graphic group were significantly lower than those of the other two groups, while the video group had the highest values for these variables. Conclusions: It was on the unimodal information, such as text and graphics, that people can spend less time and cost to achieve effective acquisition of GGO-related lung cancer screening knowledge.
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Comunicação em Saúde , Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirurgia , Tecnologia de Rastreamento Ocular , Detecção Precoce de CâncerRESUMO
Blood vessel passage on CT exerts a vital part in early diagnosis as well as treatment of carcinoma of the lungs. Intratumoral microvascular density (iMVD) has gradually become the focus of research on biological behavior, appearance, and evolution of malignant tumors nowadays. The aim of this paper was to verify whether there is a correlation between the iMVD and the vascular morphology of ground glass nodules (GGNs). A total of 109 patients with pulmonary GGN were classified into three groups (I,II, and III) according to the vascular morphology on CT, and their expression of CD31-, CD34-, and CD105-labeled iMVD was detected by the streptoavidin-biotin method, statistically analyzing the iMVD values of each group. The expression of CD31, CD34, and CD105 in different lung tissues was significantly different, with remarkably higher iMVD in lung cancer tissues than in adjacent normal lung tissues. In the imaging sort of types I, II, and III according to the means of vascular passage, the iMVD expression of CD31, CD34, and CD105 was significantly different between groups. These data suggest that the presence and the abnormal morphology of vessels seen within GGNs indicate the occurrence and progression of lung cancer in pathology. It offers a strong theoretical foundation for early diagnosis of carcinoma of the lungs, thus providing a more precise clinical diagnosis and prognosis of early-stage lung cancer.
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BACKGROUND: The high false-positive rate for pulmonary nodules (PNs) from using low-dose computed tomography (LDCT) screening can lead to overuse of invasive procedures, overtreatment, and patient anxiety. Therefore, it is very important to develop new diagnostic methods. METHODS: A negative enrichment-fluorescence in situ hybridization (NE-FISH) approach was used to detect circulating tumor cells (CTCs) in patients with PNs. We evaluated whether or not the combination of CTC counts with serum tumor marker levels (CEA, CA 125, CYFRA 21-1, SCC) could improve the diagnostic ability for distinguishing patients with malignant pulmonary nodules (MPNs) from those with benign pulmonary nodules (BPNs). Moreover, the potential clinical application of this combination for the diagnosis of solitary pulmonary nodules (SPNs) with a diameter ≤2 cm was also investigated. RESULTS: The combination of CTC counts and tumor marker levels had a sensitivity of 80.12% and the area under the receiver operating characteristics curve (AUCROC ) of 0.853 (95% confidence interval [CI]: 0.800-0.897, p < 0.001) for the differential diagnosis of PNs. For early cancer stages, the sensitivity was 75.38% (AUCROC = 0.780, 95% CI: 0.713-0.838, p < 0.001). In addition, for SPNs within 2 cm the combination of CTC counts and tumor marker levels was still the most valuable diagnostic tool with a sensitivity of 78.95% and AUCROC of 0.888. CONCLUSION: The combination of CTC counts and serum tumor marker levels is helpful for improving the diagnosis of PNs, especially in the early stages of cancer and for SPNs within 2 cm.
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Neoplasias Pulmonares , Nódulos Pulmonares Múltiplos , Células Neoplásicas Circulantes , Nódulo Pulmonar Solitário , Humanos , Células Neoplásicas Circulantes/patologia , Hibridização in Situ Fluorescente , Neoplasias Pulmonares/patologia , Biomarcadores Tumorais , Nódulo Pulmonar Solitário/diagnóstico por imagemRESUMO
The main contents of the Clinical Practice Guidelines on Image-Guided Thermal Ablation (IGTA) of Primary and Metastatic Lung Tumors (2022 Edition) include the following: epidemiology of primary and metastatic lung tumors; the concepts of the IGTA and common technical features; procedures, indications, contraindications, outcomes evaluation, and related complications of IGTA on primary and metastatic lung tumors; and limitations and future development.
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Técnicas de Ablação , Ablação por Cateter , Hipertermia Induzida , Neoplasias Pulmonares , Cirurgia Assistida por Computador , Técnicas de Ablação/métodos , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Humanos , Hipertermia Induzida/métodos , Neoplasias Pulmonares/patologia , Guias de Prática Clínica como Assunto , Cirurgia Assistida por Computador/métodosRESUMO
BACKGROUND: The accurate and safe division of the intersegmental demarcation (ISD) is critical and challenging during thoracoscopic anatomical segmentectomy. Here, we provide an improved technique which emphasizes the application of an electric hook and blunt division of ISD. The technique is termed as the "modified hand-tearing method" (MHT method) with combined application of an electric hook and staplers. The study aimed to review the outcomes of patients who underwent thoracoscopic anatomical segmentectomy, with or without the MHT method in our institute and assess its feasibility and safety. In addition, we compared the feasibility between video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) using the MHT method. METHODS: From 2018 July to 2021 June, we retrospectively analyzed 701 patients who underwent segmentectomy. Using propensity score matching, data of two well-matched pairs of 276 cases in the MHT method and non-MHT method groups, and two well-matched pairs of 40 cases in the VATS and RATS subgroups were obtained. The clinical and perioperative characteristics of patients were compared between groups. RESULTS: Compared with the non-MHT method group, the MHT method group had shorter operation time and shorter postoperative hospital stay. Period of chest tube drainage and postoperative total drainage and postoperative complications had no between-group difference. Compared with VATS, the RATS subgroup had less intraoperative bleeding and shorter postoperative hospital stay. CONCLUSION: Division of ISD using the MHT method has advantages in precision and ease of operation, so it has the potential to become a feasible and effective method for thoracoscopic anatomical segmentectomy.
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Neoplasias Pulmonares , Pneumonectomia , Humanos , Neoplasias Pulmonares/complicações , Pneumonectomia/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/métodosRESUMO
BACKGROUND: Advances in chest computed tomography (CT) have resulted in more frequent detection of subcentimeter pulmonary nodules (SCPNs), some of which are non-benign and may represent invasive lung cancer. The present study aimed to explore the correlation between pathological diagnosis and the CT imaging manifestations of SCPNs. METHODS: This retrospective study included patients who underwent pulmonary resection for SCPNs at Shandong Provincial Hospital in China. Lesions were divided into five categories according to their morphological characteristics on CT: cotton ball, solid-filled with spiculation, solid-filled with smooth edges, mixed-density ground-glass, and vacuolar. We further analyzed lesion size, enhancement patterns, vascular aggregation, and SCPN traversing. Chi-square tests, Fisher's exact tests, and Welch's one-way analysis of variance were used to examine the correlation between CT imaging characteristics and pathological type. RESULTS: There were statistically significant differences in the morphological distributions of SCPNs with different pathological types, including benign lesions and malignant lesions at different stages (p < 0.01). The morphological distributions of the four subtypes of invasive lung adenocarcinoma also exhibited significant differences (p < 0.01). In addition, size and enhancement patterns differed significantly among different pathological types of SCPNs. CONCLUSION: Different pathological types of SCPNs exhibit significant differences based on their morphological category, size, and enhancement pattern on CT imaging. These CT characteristics may assist in the qualitative diagnosis of SCPNs.
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Adenocarcinoma de Pulmão , Neoplasias Pulmonares , Nódulos Pulmonares Múltiplos , Adenocarcinoma de Pulmão/patologia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/patologia , Nódulos Pulmonares Múltiplos/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodosRESUMO
The Expert Consensus reviews current literatures and provides clinical practice guidelines for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The main contents include the following: (1) clinical evaluation of GGN; (2) procedures, indications, contraindications, outcomes evaluation, and related complications of thermal ablation for GGN; and (3) future development directions.
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Hipertermia Induzida/métodos , Neoplasias Pulmonares/cirurgia , Nódulos Pulmonares Múltiplos/cirurgia , Lesões Pré-Cancerosas/cirurgia , Nódulo Pulmonar Solitário/cirurgia , Consenso , Prova Pericial , HumanosRESUMO
BACKGROUND: Despite recent improvements in treatment technologies, such as surgical resection and chemoradiotherapy, the prognosis of patients with esophagogastric junction adenocarcinoma (EJA) remains poor due to early lymph node metastasis. Since few studies have investigated genes associated with lymph node metastasis in EJA, we aimed to screen lymph node metastasis-associated genes and clarify their expression status and prognostic significance in EJA. METHODS: The differential frequency of mutations between carcinoma and para-carcinoma tissues from 199 cases with EJA was detected using targeted next-generation sequencing (tNGS). Following a stratified analysis to determine that gender has no effect on the frequency of gene mutations, lymph node metastasis-related genes, including CDK6, MET, NOTCH1, and LRP1B, were screened, and CDK6 and LRP1B were selected for further study as they displayed significant differences in mutation rates. Differences in their expression status were verified using immunohistochemical (IHC) staining in 18 CDK6- and 17 LRP1B-mutated samples and a randomly matched control group. RESULTS: tNGS revealed that CDK6 and LRP1B mutation frequencies were significantly different between EJA cases with (N ≥ 1) or without (N = 0) lymph node metastasis. In particular, CDK6 mutation frequency was expected less, whereas that of LRP1B was remarkably higher in cases with stage N0 than in those with stage N ≥ 1. IHC staining confirmed significant differences in CDK6 and LRP1B expression status between the study and control cohorts. Chi-square tests revealed that a high CDK6 expression status correlated significantly with smoking history (p = 0.044), T stage (p = 0.035), N stage (p = 0.000), and advanced TNM stage (p = 0.001) in EJA, whereas a high LRP1B expression status only correlated with BMI (p = 0.013) and N stage (p = 0.000). Furthermore, as confirmed by survival status investigation, a high LRP1B expression status predicted good prognosis, and a high CDK6 expression status was an independent predictor of poor prognosis in patients with EJA. CONCLUSIONS: Taken together, the findings of this study demonstrate that a high CDK6 and LRP1B expression status promotes and inhibits lymph node metastasis in patients with EJA, respectively, suggesting that both CDK6 and LRP1B are significantly potential predictors of lymph node metastasis and prognosis in EJA.
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Adenocarcinoma/genética , Quinase 6 Dependente de Ciclina/genética , Junção Esofagogástrica , Metástase Linfática/genética , Receptores de LDL/genética , Neoplasias Gástricas/genética , Adenocarcinoma/mortalidade , Adenocarcinoma/secundário , Índice de Massa Corporal , Distribuição de Qui-Quadrado , Feminino , Expressão Gênica , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Pessoa de Meia-Idade , Taxa de Mutação , Estadiamento de Neoplasias , Proteínas Proto-Oncogênicas c-met/genética , Receptor Notch1/genética , Fumar/genética , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologiaRESUMO
"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions.â©.
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Neoplasias Pulmonares/cirurgia , Nódulo Pulmonar Solitário/cirurgia , Técnicas de Ablação , Tomografia Computadorizada Quadridimensional , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Nódulo Pulmonar Solitário/diagnóstico por imagemRESUMO
BACKGROUND: Even with the use of contrast-enhanced thin-layer chest computed tomography (CT) and endoscopic ultrasonography (EUS), the likelihood of cT2N0M0 squamous cell esophageal cancer correlating with the final pathologic outcome is exceedingly low. We therefore sought to investigate the associations between different risk factors and pathologic upstaging in stage T2N0M0 esophageal cancer patients who underwent esophagectomy. MATERIALS AND METHODS: We retrospectively reviewed the clinicopathological characteristics of 224 stage T2N0M0 squamous cell esophageal cancer patients who underwent complete resection over a 2-year period (October 2016-September 2018). The tumor volume (TV) was automatically measured from thin-layer chest CT scans using imaging software. Univariate and multivariate analyses were performed to identify the risk factors associated with upstaging. A receiver operating characteristic (ROC) curve was plotted, and its ability to identify pathological upstaging was assessed. RESULTS: A total of 224 patients with clinical stage T2N0M0 squamous cell esophageal carcinoma (SCEC) underwent esophagectomy; of these patients, 96 (42.86%) had a more advanced stage during the final pathologic review than during the initial diagnosis. The risk factors for pathologic upstaging included a large TV, high total cholesterol (TC), high triglycerides (TGs), high platelet-to-lymphocyte ratio (PLR), and high number of lymph nodes examined. The ROC analysis demonstrated an area under the curve of 0.845 (95% confidence interval 0.794-0.895). CONCLUSIONS: In SECC diagnosed as stage T2N0M0 by CT and EUS, the incidence of postoperative pathologic upstaging increases with a large TV, high TC, high TGs, high PLR, and high number of lymph nodes examined.
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Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/patologia , Linfonodos/patologia , Patologia Clínica/métodos , Tomografia Computadorizada por Raios X/métodos , Neoplasias Esofágicas/classificação , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/classificação , Carcinoma de Células Escamosas do Esôfago/diagnóstico por imagem , Carcinoma de Células Escamosas do Esôfago/cirurgia , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Carga TumoralRESUMO
BACKGROUND: As one of the most common malignant tumors of the digestive tract, esophageal squamous cell carcinoma (ESCC) is an advanced metastatic cancer with an extremely high mortality rate and the highest prevalence rate in China. Spindle- and kinetochore-associated protein 1 (SKA1), an essential member involved in chromosome separation during mitosis, has been indicated as a potential biomarker in the pathogenesis and development of various types of malignant tumors; however, the exact functions of SKA1 in ESCC are still unclear. PATIENTS AND METHODS: SKA1 expression was explored in stage IIA ESCC and corresponding healthy esophageal mucosa tissues through immunohistochemistry and reverse transcription-quantitative polymerase chain reaction and was further validated using The Cancer Genome Atlas (TCGA) database of the online tool UALCAN. Then, the clinicopathological correlations of SKA1 were analyzed based on the follow-up data. Furthermore, using the online tool LinkedOmics, the correlation test, gene ontology (GO), and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis of SKA1 were analyzed using high-throughput sequencing data of ESCC patients from TCGA dataset. RESULTS: The expression level of SKA1 was markedly upregulated in ESCC tissues. Upregulation of SKA1 significantly correlated with higher pathological T stage (P = 0.003) and poorer overall survival (P = 0.013). GO and pathway enrichment analyses of SKA1 in ESCC revealed that SKA1 was involved in a number of classical cell cycle-related pathways that contribute to special biological processes in tumorigenesis and development of ESCC. CONCLUSION: The results of this study demonstrate that SKA1 may act as a prognostic biomarker for stage IIA ESCC. Combined with the bioinformatic analysis, SKA1 could potentially serve as a therapeutic target for ESCC. CONCLUSION: The results coming from the present study demonstrated that SKA1 may act as a prognostic biomarker for stage IIA ESCC. Combined with the bioinformatic analysis, SKA1 could serve as a potential therapeutic target for ESCC.
Assuntos
Biomarcadores Tumorais/metabolismo , Proteínas Cromossômicas não Histona/metabolismo , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/patologia , Regulação Neoplásica da Expressão Gênica , Adulto , Idoso , Biomarcadores Tumorais/genética , Estudos de Casos e Controles , Proteínas Cromossômicas não Histona/genética , Biologia Computacional/métodos , Bases de Dados Genéticas , Progressão da Doença , Neoplasias Esofágicas/genética , Neoplasias Esofágicas/metabolismo , Carcinoma de Células Escamosas do Esôfago/genética , Carcinoma de Células Escamosas do Esôfago/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Taxa de SobrevidaRESUMO
BACKGROUND: Currently, methods for identifying the intersegmental plane during anatomical segmentectomy can be classified into 2 categories: the bronchial method and the vascular method. One of the vascular methods, the arterial-ligation-alone method, has not yet been validated or objectively evaluated in a large case series. We thus aimed to confirm that the arterial-ligation-alone method could effectively and accurately identify the intersegmental plane. METHODS: We retrospectively reviewed the records of 104 patients who were scheduled for thoracoscopic anatomic segmentectomy. Preoperative three-dimensional (3D) reconstruction was performed on all the affected lungs to distinguish the targeted segmental arteries, veins and bronchi. The procedure was as follows: first, based on the 3D reconstruction of the lung, the targeted segmental arteries were distinguished and ligated. Second, bilateral pulmonary ventilation was performed with pure oxygen. When the affected lung had completely inflated, contralateral pulmonary ventilation was performed. After waiting for some time, the first intersegmental plane could be obtained, and the time was recorded as T1, with an electric coagulation hook being used for marking. Thirdly, when the targeted segmental veins and bronchi had been ligated, the second intersegmental plane could be obtained by the inflation-deflation method as before, with the waiting time being recorded as T2. The differences between the 2 intersegmental planes were evaluated by 2 experienced chief thoracic surgeons. RESULT: In a total of 99 (95.2%) patients, the intersegmental planes were successfully and accurately identified by the arterial-ligation-alone method. Ultimately, 85 (81.7%) patients underwent thoracoscopic anatomic segmentectomy. The results for evaluating the differences between the 2 planes were as follows: completely consistent (94 cases, 94.9%), basically consistent (5 cases, 5.1%), and discrepant (0 cases, 0%). The mean T1 was 13.6±2.7 minutes (range, 8-25 minutes), and the mean T2 was 13.0±2.6 minutes (range, 8-23 minutes), with P=0.100 (95% CI). For 99 patients, the mean nodule size was 1.1±0.34 cm. In the 85 patients who underwent segmentectomy, the mean margin width was 2.84±0.51 cm, the mean operative duration was 165.6±18.3 minutes, the mean operative hemorrhage was 52.1±20.2 mL, and the mean duration of chest tube drainage was 3.9±1.3 days. Postoperative complications related to operative procedures occurred in 2 cases. CONCLUSIONS: The arterial-ligation-only method can effectively, accurately and inexpensively identify the intersegmental plane, and is especially suitable for the patients whose veins or bronchi are difficult to anatomize. Whether the target bronchus is ligated has no effect on the intersegmental plane.