Uniportal video-assisted anatomical segmentectomy: an analysis of the learning curve.

BACKGROUND: This study aimed to demonstrate the learning curve of anatomical segmentectomy performed by uniportal video-assisted thoracoscopic surgery (U-VATS). METHOD: We conducted a retrospective study of U-VATS segmentectomies performed by the same surgeon between September 2019 and August 2022. The learning curve was demonstrated using risk-adjusted cumulative sum (RA-CUSUM) analysis in terms of perioperative complications, which reflected surgical quality and technique proficiency. The surgical outcomes were also compared between different phases. RESULT: The complication-based learning curve of U-VATS segmentectomy could be divided into two phases based on RA-CUSUM analysis: phase I, the initial learning phase (cases 1-50) and phase II, the proficiency phase (cases 51-141). Significantly higher complication rates (24.0 vs. 8.8%, p=0.013), longer surgical times (119.8±31.9 vs. 106.2±23.8 min, p=0.005), and more blood loss (20 [IQR, 20-30] vs. 20 [IQR, 10-20] ml, p=0.003) were observed in phase I than in phase II. CONCLUSION: The learning curve of U-VATS segmentectomy consists of two phases, and at least 50 cases were required to gain technique proficiency and achieve high-quality surgical outcomes.

Real-world surgical treatment patterns and clinical outcomes in patients with stages IA-IIIA non-small cell lung cancer: a retrospective multicentric observational study involving 11,958 patients.

PURPOSE: Surgical resection is cornerstone treatment for early-stage non-small cell lung cancer (NSCLC) and offers a chance for cure. This study was conducted to determine current surgical treatment patterns and outcomes of Chinese patients with NSCLC. METHODS: Data of patients with histologically confirmed NSCLC of stages IA-IIIA and who underwent surgery between July 2014 and July 2020 were retrospectively collected from 9 tertiary hospitals in China. Cox model was used for multivariate analyses. RESULTS: This study included 11,958 patients, among whom 59.1%, 19.2%, and 21.7% were in stages I, II, and IIIA, respectively. Lobectomy was the most common operation method (78.4%), followed by wedge resection (8.2%), segmentectomy (5.4%), pneumonectomy (5.2%), and bronchial sleeve lobectomy (2.8%). Among patients who underwent wedge resection and segmentectomy, majority had stage I NSCLC (87.2% and 93.3%, respectively), and sublobectomy accounted for 20.7% of stage I operations. With a median follow-up time of 30.2 months, disease-free survival (DFS) and overall survival (OS) rates of entire population were 88.9% and 96.1% at 1 year, 75.2% and 85.1% at 3 years, and 65.3% and 77.0% at 5 years, respectively. The 5-year OS rates for stages IA, IB, IIA, IIB, and IIIA disease were 93.2%, 82.7%, 70.3%, 67.0%, and 52.1%, respectively. CONCLUSION: This is the largest real-world cohort study of patients with NSCLC who underwent surgery in China, where we described characteristics of surgical treatment and survival outcomes. The results of our study provide insights into real-world surgical treatment status for surgeons and clinicians.

The Clinical Outcomes of Thoracoscopic Versus Open Lobectomy for Non-Small-Cell Lung Cancer After Neoadjuvant Therapy: A Multi-Center Retrospective Cohort Study.

BACKGROUND: The safety and efficacy of video-assisted thoracic surgical (VATS) versus open lobectomy for non-small-cell lung cancer (NSCLC) following neoadjuvant therapy remained controversial. The aim of this study was to compare the outcomes of VATS with those of open lobectomy for NSCLC after neoadjuvant therapy. METHODS: Patients who had undergone VATS or open lobectomy for NSCLC following neoadjuvant therapy in nine hospitals in China from July 2014 to July 2020 were retrospectively reviewed. The clinical characteristics and overall survival (OS) of patients were analyzed using Cox regression models and propensity score matching. RESULTS: We identified 685 patients, 436 (63.6%) who had undergone VATS lobectomy and 249 (36.4%) who had undergone open lobectomy. Patients who had undergone VATS lobectomy tended to have had fewer nodes removed than those who had undergone open lobectomy. However, compared with open group, the VATS group had a better perioperative outcome, such as smaller blood loss volumes and shorter postoperative stays. The groups had a similar operation durations and postoperative complications, and there was a nonsignificant difference between their 30-day mortality rates. After propensity score matching, there was no significant different between the OS of the groups, and only postoperative adjuvant therapy was associated with worse OS. CONCLUSION: This multi-center analysis of patients with NSCLC who had undergone surgery subsequent to neoadjuvant therapy reveals that VATS lobectomy tended to have a better perioperative outcome, and have a similar OS compared to open lobectomy. These findings suggest that VATS lobectomy is appropriate for NSCLC following neoadjuvant therapy.

Comprehensive Analysis of a Novel Immune-Related Gene Signature in Lung Adenocarcinoma.

Lung cancer is the major cause of cancer-related deaths around the world. Lung adenocarcinoma (LUAD), the most common subtype of lung cancer, contributed to the majority of mortalities and showed different clinical outcomes in prognosis. Tumor-infiltrated immune cells at the tumor site are associated with better survival and immunotherapy response. Thus, it is essential to further investigate the molecular mechanisms and new prognostic biomarkers of lung adenocarcinoma development and progression. In this study, a six-gene signature (CR2, FGF5, INSL4, RAET1L, AGER, and TNFRSF13C) was established to predict the prognosis of LUAD patients, as well as predictive value. The prognostic risk model was also significantly associated with the infiltration of immune cells in LUAD microenvironments. To sum up, a novel immune-related six-gene signature (CR2, FGF5, INSL4, RAET1L, AGER, and TNFRSF13C) was identified that could predict LUAD survival and is highly related to B cells and dendritic cells, which may provide a theoretical basis of personalized treatment for targeted immunotherapy.

The Predictive Value of Stair Climbing Test on Postoperative Complications in Lung Cancer Patients with Limited Pulmonary Function.

PURPOSE: To evaluate the predictive value of stair climbing test (SCT) on postoperative complications in lung cancer patients with limited pulmonary function. METHODS: A total of 727 hospitalized lung cancer patients with limited pulmonary function were retrospectively reviewed. Included in the cohort were 424 patients who underwent SCT preoperatively. Patients were grouped according to general condition, past medical history, surgical approach, pulmonary function test, and SCT results. Comparison of the postoperative cardiopulmonary complication rates was made and independent risk factors were identified. RESULTS: A total of 89 cardiopulmonary-related complications occurred in 69 cases, accounting for 16.3% of the entire cohort. The postoperative cardiopulmonary complication rates were significantly different between groups stratified by smoking index, percentage of forced expiratory volume in one second, percentage of diffusion capacity for carbon monoxide, SCT results, excision extension, and anesthetic duration (p <0.05). Multivariate analysis showed that only height achieved (p <0.001), changes in heart rate (∆HR; p <0.001), and excision extension (p = 0.006) were independent risk factors for postoperative cardiopulmonary complications. CONCLUSIONS: The SCT could be used as a preoperative screening method for lung cancer patients with limited pulmonary function. For those patients who could only climb less than 6 floors or had ∆HR >30 bpm in the test, sublobar resection should be selected to reduce the postoperative cardiopulmonary complication rate.

E2F1-activated LINC01224 drives esophageal squamous cell carcinoma cell malignant behaviors via targeting miR-6884-5p/DVL3 axis and activating Wnt/ß-catenin signaling pathway.

Current evidence has unveiled that long non-coding RNAs (lncRNAs) are pivotal regulators in the development of cancers. This study aimed to investigate the potential mechanisms of LINC01224 in esophageal squamous cell carcinoma (ESCC) cells. RT-qPCR analysis was done to test LINC01224 expression in ESCC cells. Functional assays were conducted to assess the influences of LINC01224 on ESCC cell functions. Mechanism assays were carried out to detect the regulatory mechanisms of LINC01224 at post-transcriptional and transcriptional levels. Briefly, LINC01224 expression was remarkably high in ESCC cells. LINC01224 silence restricted the proliferative, migratory, and invasive capabilities of ESCC cells. Moreover, LINC01224 could combine with miR-6884-5p by acting as a ceRNA. Further, DVL3 was proved to be targeted by miR-6884-5p. Importantly, LINC01224 could switch on Wnt/ß-catenin signaling pathway by via enhancing DVL3 expression. Additionally, E2F1 could serve as a transcription factor to stimulate LINC01224 transcription. In summary, our study elucidated that E2F1-activated LINC01224 regulated miR-6884-5p/DVL3 to actuate the Wnt/ß-catenin signaling pathway, which facilitates multiple phenotype of ESCC cells, including proliferation, migration, and invasion. Our findings might offer potential therapeutic targets for ESCC treatment.

VATS Versus Open Lobectomy in Pathological T1 SCLC: A Multi-Center Retrospective Analysis.

BACKGROUND: Video-assisted thoracic surgery (VATS) has been widely used in the surgical treatment of thoracic diseases, and it suggested surgical and oncological advantages compared with open surgery. However, reports on the application of VATS in surgery of small cell lung cancer (SCLC) are scarce. This study aimed to explore the advantages and disadvantages of different surgical approaches in the treatment of pathological stage T1(pT1) SCLC in terms of safety, clinical outcomes, and lymph node dissection. PATIENTS AND METHODS: Patients who underwent lobectomy for pT1 SCLC between January 2014 and September 2017 were identified from the National Collaborative Lung Cancer Database (LinkDoc Database). The patients were stratified based on the surgery approach (VATS or open lobectomy). Perioperative outcomes and long-term survival were analyzed using SPSS software. RESULTS: A total of 169 patients with pT1 SCLC met the criteria and were enrolled for this study, including 110 cases of VATS lobectomies and 59 cases of open lobectomies. VATS lobectomy was associated with less blood loss than open surgery (168.1 ± 237.4 vs. 340.0 ± 509.8 mL, P = .002). Open lobectomy harvested more N2 LNs (11.8 ± 8.2 vs. 8.4 ± 5.8, P = .048) and identified more metastasis positive LNs (3.1 ± 6.0 vs. 1.4 ± 3.0, P = .050). Open lobectomy associated with longer overall survival (OS) but has no statistical difference (23.4 ± 13.2 vs. 20.2 ± 10.9, P = .070). CONCLUSION: Open lobectomy had better lymph node dissection results, and comparable postoperative complications, postoperative hospital stay, and OS to VATS lobectomy. Further studies may still be needed to confirm the recommendation of thoracoscopic approach as a routine surgical procedure for operable SCLC, and until then, open surgery should still be considered.

The prognostic role of the Transducin-like Enhancer of split protein family in lung adenocarcinoma.

BACKGROUND: Lung cancer claims more lives than any other cancer worldwide. Lung adenocarcinoma (LUAD) accounts for approximately 40% of all lung cancers. Members of the Transducin-like Enhancer of split (TLE) protein family repress transcription through multiple mechanisms; however, their prognostic value in LUAD is still unclear. METHODS: A dataset from The Cancer Genome Atlas was used to analyze the relationship between the expression of TLE family members and outcomes of LUAD. The expression of TLE family members in 59 normal and 513 tumor samples in the TCGA dataset was selected. For paired analysis, 57 normal and 57 tumor paired tissues were selected. Gene Ontology (GO) term and Reactome pathway enrichment analyses of the TLE family members were performed. Progression-free survival (PFS) and overall survival (OS) served as endpoints in this study. All statistical analyses were performed with R 3.6.0. RESULTS: The expression levels of TLE family proteins differed between 59 normal and 513 tumor samples. High TLE1 and low TLE2 levels were associated with poor progression-free and OS (all P<0.050). Multivariate analysis demonstrated that high TLE1 expression and low TLE2 expression were independent risk factors for a poor outcome in LUAD. Moreover, the combined expression of these two proteins was a good tool for prognostication. CONCLUSIONS: High TLE1 expression and low TLE2 are independent adverse prognostic factors in LUAD and can serve as prognostic biomarkers.

[Clinical Recommendations for Perioperative Immunotherapy-induced Adverse Events in Patients with Non-small Cell Lung Cancer].

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.

A randomized trial of who is better at treating the incomplete pulmonary fissure between stapler and thulium laser.

BACKGROUND: The role of thulium laser in the treatment of interlobar fissures in lobectomy is not clear. We aimed to evaluate the safety, effectiveness and economy of thulium laser in the treatment of incomplete interlobar fissure during lobectomy. METHODS: A total of 76 patients were randomly divided into two groups: laser group and stapler group. The laser group was treated with thulium laser and the stapler group with stapler. RESULTS: Compared with stapler group, the laser group had a longer operation time, more postoperative drainage and lower operation cost, while there was no significant difference in hospitalization time, postoperative air leakage time and chest tube duration. CONCLUSIONS: Thulium laser is safe and effective in the treatment of incomplete interlobar fissure during lobectomy and can reduce the cost.

Clinical recommendations for perioperative immunotherapy-induced adverse events in patients with non-small cell lung cancer.

Perioperative adjuvant treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). In particular, the success of immune checkpoint inhibitors, such as antibodies against PD-1 and PD-L1, in patients with lung cancer has increased our expectations for the success of these therapeutics as neoadjuvant immunotherapy. Neoadjuvant therapy is widely used in patients with resectable stage IIIA NSCLC and can reduce primary tumor and lymph node stage, improve the complete resection rate, and eliminate microsatellite foci; however, complete pathological response is rare. Moreover, because the clinical benefit of neoadjuvant therapy is not obvious and may complicate surgery, it has not yet entered the mainstream of clinical treatment. 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 cancellation of surgery, additional illness, and even death, and have therefore attracted much attention. In this article, we draw on several sources of information, including (i) guidelines on adverse reactions related to immune checkpoint inhibitors, (ii) published data from large-scale clinical studies in thoracic surgery, and (iii) practical experience and published cases, to provide clinical recommendations on adverse events in NSCLC patients induced by perioperative immunotherapy.

Perioperative comparison of video-assisted thoracic surgery and open lobectomy for pT1-stage non-small cell lung cancer patients in China: a multi-center propensity score-matched analysis.

BACKGROUND: Compared with open surgery, video-assisted thoracic surgery (VATS) has innovated the concept of the minimally invasive approach for non-small cell lung cancer (NSCLC) patients in past decades. This present study aimed to compare the perioperative and lymph node dissection outcomes between VATS lobectomy and open lobectomy for pathological stage T1 (pT1) NSCLC patients from both surgical and oncologic perspectives. METHODS: This was a retrospective multicenter study. Patients who underwent surgical resection for pT1 NSCLC between January 2014 and September 2017 were retrospectively reviewed from 10 thoracic surgery centers in China. Perioperative and lymph node dissection outcomes of pT1 NSCLC patients who accepted VATS or open lobectomies were compared by propensity score matching (PSM) analysis. RESULTS: Of the 11,360 patients who underwent surgery for pT1 NSCLC, 7,726 were enrolled based on the selection criteria, including 1,222 cases of open lobectomies and 6,504 cases of VATS lobectomies. PSM resulted in 1,184 cases of open lobectomies and 1,184 cases of VATS lobectomies being well matched by common prognostic variables, including age, sex, and surgical side. VATS lobectomy led to better perioperative outcomes, including less blood loss (133.5±200.1 vs. 233.3±318.4, P<0.001), lower blood transfusion rate (2.4% vs. 6.4%, P<0.001), shorter postoperative hospital stay (8.6±5.7 vs. 10.1±5.1, P<0.001), less chest drainage volume (1,109.5±854.0 vs. 1,324.1±948.8, P<0.001), and less postoperative complications (4.9% vs. 8.2%, P<0.001). However, open lobectomy had better lymph node dissection outcomes than VATS, with increased lymph node dissection numbers (16.1±9.4 vs. 13.7±7.7, P<0.001) and more positive lymph nodes being dissected (1.5±3.9 vs. 1.1±2.5, P=0.002). Compared with VATS, open lobectomy harvested more lymph node stations (5.5±1.9 vs. 5.2±1.8, P=0.001), including more pathological N2 (pN2) lymph node stations (3.4±1.4 vs. 3.1±1.3, P<0.001). CONCLUSIONS: VATS lobectomy was associated with better perioperative outcomes, such as less blood loss, lower blood transfusion rate, shorter postoperative hospital stay, less chest drainage volume and less postoperative complications. Open lobectomy has improved lymph node dissection outcomes, as more lymph nodes and positive lymph nodes were dissected for pT1 NSCLC patients during surgery.

Video-assisted thoracoscopic surgery lobectomy might be a feasible alternative for surgically resectable pathological N2 non-small cell lung cancer patients.

BACKGROUND: The majority of previous studies of the clinical outcome of video-assisted thoracoscopic surgery (VATS) versus open lobectomy for pathological N2 non-small cell lung cancer (pN2 NSCLC) have been single-center experiences with small patient numbers. The aim of this study was therefore to investigate these procedures but in a large cohort of Chinese patients with pathological N2 NSCLC in real-world conditions. METHODS: Patients who underwent lobectomy for pN2 NSCLC by either VATS or thoracotomy were retrospectively reviewed from 10 tertiary hospitals between January 2014 and September 2017. Perioperative outcomes and overall survival of the patients were analyzed. Cox regression analysis was performed to identify potential prognostic factors. Propensity-score analysis was performed to reduce cofounding biases and compare the clinical outcomes between both groups. RESULTS: Among 2144 pN2 NSCLC, 1244 patients were managed by VATS and 900 by open procedure. A total of 305 (24.5%) and 344 patients died during VATS and the thoracotomy group during a median follow-up of 16.7 and 15.6 months, respectively. VATS lobectomy patients had better overall survival when compared with those undergoing the open procedure (P < 0.0001). Multivariate COX regression analysis showed VATS lobectomy independently favored overall survival (HR = 0.75, 95% CI: 0.621-0.896, P = 0.0017). Better perioperative outcomes, including less blood loss, shorter drainage time and hospital stay, were also observed in patients undergoing VATS lobectomy (P < 0.05). After propensity-score matching, 169 patients in each group were analyzed, and no survival difference were found between the two groups. Less blood loss was observed in the VATS group, but there was a longer operation time. CONCLUSIONS: VATS lobectomy might be a feasible alternative to conventional open surgery for resectable pN2 NSCLC. KEY POINTS: Significant findings of the study: VATS lobectomy has comparative OS in pN2 NSCLC versus open procedure in resectable patients. WHAT THIS STUDY ADDS: VATS lobectomy might be feasible for pN2 NSCLC.

Decreased miR-940 expression can predict a negative prognosis in early-stage nonsmoking female lung adenocarcinoma.

BACKGROUND: Early-stage female lung adenocarcinoma is the most common type of lung cancer encountered in thoracic surgery departments. Tumor-node-metastasis (TNM) staging does not adequately explain a significant stratification phenomenon in the prognosis of patients with stage I lung adenocarcinoma. We aimed to investigate the contributory role of miR-940 in the prognosis prediction. METHODS: We analyzed the microRNA (miRNA) expression level in tumor tissues (high-risk group vs. low-risk group) from 12 non-smoking female patients with stage I lung adenocarcinoma using miRNA array. Bioinformatic analyses of miR-940 were also carried out based on the public database. Then, quantitative reverse-transcription polymerase chain reaction (qRT-PCR) tests of the tissue samples were further validated. And miR-940's function was analyzed and potential target genes were predicted. RESULTS: In all, 24 miRNAs were found to be significantly different between the high-risk group and low-risk group. The expression level of miR-940 was lower in tumor tissue (P=0.011), and the survival rate in the high miR-940 group was higher [hazard ratio (HR) =0.688; P=0.011]. Gene Ontology (GO) analysis showed that the assembly functions of targets regulated by miR-940 were mainly enriched in regulation of myeloid cell differentiation, G1/S transition of mitotic cell cycle, and cellular response to environmental stimulus. miR-940 is involved in transforming growth factor-beta (TGF-beta) signaling pathway; TNF signaling pathway; and estrogen signaling pathway. The number of lung adenocarcinoma cells (A549) was significantly decreased after miR-940 was transfected. Ten epithelial-to-mesenchymal-transition (EMT)-associated genes (MMP9, ZEB1, CDH1, KRT8, KRT18 KET19, TWIST1, VIM, SNAI1, and SNAI2) were found to be significantly related to miR-940. CONCLUSIONS: The present study showed that miR-940 might be a protective factor for positive prognosis in early stage nonsmoking female lung adenocarcinoma, with transforming growth factor-beta (TGF-beta) pathway, TNF pathway, and matrix metalloprotein (MMP9) being potential targets.

The value of pulmonary nodule diameter and consolidation/tumor rate in the prediction of lymph node metastasis in early-stage (cT1N0M0) lung adenocarcinoma.

BACKGROUND: We aimed to determine whether the use of pulmonary nodule diameter and CTR predicts lymph nodes (LNs) metastasis for early-stage (cT1N0M0) lung adenocarcinoma. METHODS: We retrospectively analyzed 433 consecutive patients who underwent therapeutic surgical resection in our hospital. Information about age, sex, history of malignancy, smoking index, high-resolution computed tomography (HRCT) imaging information, pathologic findings, and status of LNs metastasis were collected. RESULTS: A total of 433 patients were included 277 women and 156 men, with a median age of 58.09±9.41 years. On univariate and multivariate analysis, visceral pleural invasion (VPI) (P=0.005), the diameter of nodule measured by postoperative pathology (DP) (P=0.011), the largest axial diameter of the lesion on the mediastinal window (DM) (P<0.001), the ratio of the maximum diameter of consolidation relative to the maximum tumor diameter from the lung window (CTR) (P=0.01), and total dissected LNs number (P=0.005) categories were independent facto for LNs metastasis. The receiver operating characteristic (ROC) curve showed that DM ≥11.81 cm, or CTR ≥79.50%, or VPI indicated LNs metastasis. LNs metastasis patients could be better predicted by a total dissected LNs number with a cutoff point of 13.5 for lung cancer. CONCLUSIONS: VPI, DP, DM, CTR, and total dissected LNs number categories were independent factors for LNs metastasis. If DM ≥11.81 cm, or CTR ≥79.50%, or VPI systemic lymphadenectomy was recommended. We suggested 14 LNs as the cut point for the evaluation LNs examination.

Clinicopathological characteristics of peripheral clinical stage IA lung adenocarcinoma with high Ki-67 expression.

BACKGROUND: High Ki-67 expression is associated with poor prognosis in early-stage lung adenocarcinoma (LUAD). However, there are few studies on the associations between clinicopathological features and Ki-67 proliferation index (PI). The study aimed to explore the clinicopathological characteristics of peripheral clinical stage IA LUAD with high Ki-67 expression. METHODS: A case-control study was carried out in China-Japan Friendship Hospital from January 2017 to December 2018. The clinicopathological features of patients were reviewed. Univariate and multivariate analyses were used to analyze the association between clinicopathological characteristics and high Ki-67 expression. RESULTS: Three hundred and seventy-six patients were finally enrolled in the study. Univariate and multivariate analyses showed that males sex (OR =2.23, 95% CI: 1.30-3.83, P=0.004), carcinoembryonic antigen (CEA) positivity (OR =3.25, 95% CI: 1.44-7.33, P=0.005), several imaging features such as notch positivity (OR =2.55, 95% CI: 1.18-5.51, P=0.017), vascular convergence (OR =3.04, 95% CI: 1.03-8.95, P=0.044), and consolidation/tumor ratio (CTR) (OR =1.03, 95% CI: 1.02-1.04, P<0.001) were significantly associated with high Ki-67 expression. The area under curve of receiver operating characteristic (ROC) curve for CTR was 0.813 (95% CI: 0.768-0.858, P<0.001). When cutoff value was 72.5%, the sensitivity and specificity were 80.5% and 76.3%, respectively. CONCLUSIONS: Male sex, CEA positivity, notch positivity, vascular convergence, and CTR were significantly associated with high Ki-67 expression in patients with peripheral clinical stage IA LUAD. These findings could be used to assist clinical decision-making and prognostic evaluation.

A novel nomogram to predict the overall survival of patients with colloid adenocarcinoma of the lung.

BACKGROUND: Colloid adenocarcinoma of the lung is one of rare subtypes of pulmonary adenocarcinoma. The purpose of our study is to establish a predictive model for the overall survival of colloid adenocarcinoma. METHODS: A total of 749 patients were separated from the Surveillance, Epidemiology, and End Results database between 2011 and 2015. Cox regression was performed to select the predictors of overall survival. The calibration curves, concordance index, the receiver operating characteristic curve, and the area under the curve were used to verify the nomogram. Kaplan-Meier curves were used to illustrate and compare the overall survival of patients in different surgical groups. RESULTS: Multivariate analyses demonstrated clinical characteristics such as age, sex, race, site, tumor stage, stage T, metastatic sites at diagnosis, surgical treatment were associated with prognosis. In the nomogram, we could predict the probability of overall survival for patients. The concordance index of the novel nomogram was 0.849, which meant that the model had a good discriminated ability. A good consistency was indicated by the calibration curves in the probability of 1-, 3-, and 5-year overall survival between the actual observation and the nomogram prediction. We plotted the receiver operating characteristic curve and the area under the curve was 0.905, 0.923, 0.885, respectively. The Kaplan-Meier curves indicated that overall survival was precisely distinguished by the different surgical status. The survival rate of patients in the surgery group was significantly higher than that of patients without surgery (P<0.0001). Segmentectomy had the highest survival rate than the lobectomy and wedge resection (P=0.0122). CONCLUSIONS: We constructed and validated a nomogram to help predict overall survival for colloid adenocarcinoma. Clinicians could predict individualized survival and give treatment recommendations.

Clinical characteristics and prediction model of long-term survival of patients with stage III non-small cell lung cancer.

BACKGROUND: The patients with stage III non-small cell lung cancer own a poor prognosis. We aimed to study the clinical characteristics of the patients with stage III non-small cell lung cancer and more than 5 years overall survival and establish a prognosis prediction model. METHODS: A total of 5792 patients were separated from the Surveillance, Epidemiology, and End Results database between 2011 and 2015. Cox regression was performed to select the predictors of overall survival. The validation of the nomogram was implemented by using the concordance index, calibration curves. Kaplan-Meier curves were used to illustrate and compare the overall survival of patients in different clinical characteristics. RESULTS: Multivariate analyses indicated factors such as age, sex, site, histology, grade, stage T, and N, surgical treatment were associated with prognosis. In the nomogram, we could predict the probability of overall survival for patients. The concordance index of the novel nomogram was 0.751. The calibration curves also showed good consistency in the probability of 5-year overall survival. The Kaplan-Meier curves showed that overall survival in the different age, sex, race, site, histology, grade, stage T and N, surgical treatment was accurately differentiated with a significantly statistical difference. CONCLUSIONS: Patients with a highly differentiated adenocarcinoma and early stages of T and N who are less than 70 years of age and have an opportunity for surgery to undergo surgery have a higher five-year survival rate in patients with stage III non-small cell lung cancer.

Clinical characteristics and prediction model of long time survival of patients with stage M1 Siewert type II esophagogastric junction adenocarcinoma.

BACKGROUND: We aimed to study the clinical manifestations of the patients with stage M1 Siewert type II esophagogastric junction adenocarcinoma and more than 1-year overall survival and establish a prognosis prediction model. METHODS: From the SEER database, 638 patients were chosen between 2011 and 2017. Patients were separated into two groups, including the long-time survival group (≥1 year), and the shorter time survival group (<1 year). The analysis of differences in clinical characteristics (age, race, sex, stage T, stage N, grade, surgery, distant metastasis, survival status and time) between the different groups was performed by using the chi-square test. The predictors of overall survival was selected by using the Cox regression. The calibration curves and C-index were used to verify the nomogram. RESULTS: The chi-square test showed that the proportion of patients with the age of ≥65 years in the long time survival group was lower than the short time survival group (P=0.008). The proportion of patients who received surgery was higher in the long time survival group (13.5% vs. 5.3%, P<0.001). There was a significantly lower proportions of bone metastasis in the long time survival group (P=0.036). Multivariate analyses indicated factors such as age, surgery, bone, liver, and lung metastasis were associated with prognosis. The C-index of the nomogram was 0.860. CONCLUSIONS: Age, surgery, bone, liver, and lung metastasis were related to the overall survival of a patient with stage M1 Siewert type II esophagogastric junction adenocarcinoma. We constructed a nomogram to help predict 1-year overall survival for a patient with stage M1 Siewert type II esophagogastric junction adenocarcinoma.