Uniportal versus multiportal video-assisted thoracoscopic segmentectomy for non-small cell lung cancer: a systematic review and meta-analysis.

It remains controversial whether one-port video-assisted thoracoscopic surgery (VATS) or multiportal VATS is better for segmentectomy in patients with early non-small cell lung cancer (NSCLC). We conducted this meta-analysis of eight published studies to compare the clinical effectiveness and safety of the two surgical approaches. The uniportal group had a shorter postoperative hospital stay (mean difference (MD): - 0.40, 95% CI [- 0.71 to - 0.08] days, p = 0.01), lower postoperative pain scores on day 3 (MD: - 0.90, 95% CI [- 1.26 to - 0.54], p < 0.00001) and day 7 (MD: - 0.33, 95% CI [- 0.62 to - 0.04], p = 0.02), fewer days of chest tube drainage (MD: - 0.47, 95% CI [- 0.78 to - 0.15] days, p = 0.004), and a smaller wound (MD: - 0.73, 95% CI [- 1.00 to - 0.46] cm, p < 0.00001) than the multiportal group. However, there were no significant differences between the groups in complications, operative times, resected lymph nodes, resected lymph node stations, blood loss, postoperative pain scores on days 1, 2, 30, overall survival (OS), or disease-free survival (DFS). The most common complications were prolonged air leakage (10.29%), bleeding (8.82%), vascular injury (7.14%), empyema (5.88%), and arrhythmia (5.26%) in the uniportal group. Overall, uniportal VATS appears to be better than multiportal VATS for segmentectomy in patients with NSCLC, with better postoperative outcomes and similar survival rates.

The influence of different sequences of vessel ligation on long-term survival during video-assisted thoracoscopic lobectomy for non-small cell lung cancer: A matched cohort study.

In lobectomy of patients with lung cancer, the principle of operation is to cut off the pulmonary vein first, but it is often not taken seriously in clinical practice. We conducted this research to compare the impact of different sequences of pulmonary vessel ligation on the long-term survival of patients. This cohort study included 1239 patients treated surgically with video-assisted thoracoscopic lobectomy from January 2015 to December 2019 at The Second Affiliated Hospital of Nanchang University. Survival and perioperative indicators were compared between a Vein-first group (VF) and an artery-first group. After matching, 364 patients were included in each group for analysis. VF was associated with better overall survival (hazard ratio: 1.96 [1.4~2.74], P < .0001) and disease-free survival (hazard ratio: 1.65 [1.22~2.24], P = .0011). Meanwhile, the survival advantage of VF was achieved in almost all subgroups, particularly in the pathological tumor node metastasis stage I-II group and squamous cell carcinoma group. We obtained no significant differences in perioperative indications (operation time, hospital stay, etc) between VF and artery-first group. With better overall survival and disease-free survival, especially for pathological stage I-II squamous cell carcinoma, vein-first ligation should be strictly observed in lobectomy for patients with non-small cell lung cancer.

Use of Novel m6A Regulator-mediated Methylation Modification Patterns in Distinct Tumor Microenvironment Profiles to Identify and Predict Glioma Prognosis and Progression, T-cell Dysfunction, and Clinical Response to ICI Immunotherapy.

BACKGROUND: The specific functions of RNA N6-methyladenosine (m6A) modifications in the glioma tumor microenvironment (TME) and glioma patient prognosis and treatment have not been determined to date. OBJECTIVE: The objective of the study was to determine the role of m6A modifications in glioma TME. METHODS: Nonnegative matrix factorization (NMF) methods were used to determine m6A clusters and m6A gene signatures based on 21 genes relating to m6A modifications. TME characteristics for each m6A cluster and m6A gene signature were quantified by established m6A score. The utility of m6A score was validated in immunotherapy and other antiangiogenic treatment cohorts. RESULTS: Three m6A clusters were identified among 3,395 glioma samples, and they were linked to different biological activities and clinical outcomes. The m6A clusters were highly consistent with immune profiles known as immune-inflamed, immune-excluded, and immune-desert phenotypes. Clusters within individual tumors could predict glioma inflammation, molecular subtypes, TME stromal activity, genetic variation, alternative splicing, and prognosis. As for the m6A score and m6A gene signature, patients with low m6A scores exhibited an increased tumor mutation burden, immune activity, neoantigen load, and prolonged survival. A low m6A score indicated the potential for a low level of T-cell dysfunction, a considerably better treatment response, and durable clinical benefits from immunotherapy, bevacizumab and regorafenib. CONCLUSION: Glioma m6A clusters and gene signatures have distinctive TME features. The m6A gene signature may guide prognostic assessments and promote the use of effective strategies.

Prognostic factors and survival prediction for patients with metastatic lung adenocarcinoma: A population-based study.

The prognosis of metastatic lung adenocarcinoma (MLUAD) varies greatly. At present, no studies have constructed a satisfactory prognostic model for MLUAD. We identified 44,878 patients with MLUAD. The patients were randomized into the training and validation cohorts. Cox regression models were performed to identify independent prognostic factors. Then, R software was employed to construct a new nomogram for predicting overall survival (OS) of patients with MLUAD. Accuracy was assessed by the concordance index (C-index), receiver operating characteristic curves and calibration plots. Finally, clinical practicability was examined via decision curve analysis. The OS time range for the included populations was 0 to 107 months, and the median OS was 7.00 months. Nineteen variables were significantly associated with the prognosis, and the top 5 prognostic factors were chemotherapy, grade, age, race and surgery. The nomogram has excellent predictive accuracy and clinical applicability compared to the TNM system (C-index: 0.723 vs 0.534). The C-index values were 0.723 (95% confidence interval: 0.719-0.726) and 0.723 (95% confidence interval: 0.718-0.729) in the training and validation cohorts, respectively. The area under the curve for 6-, 12-, and 18-month OS was 0.799, 0.764, and 0.750, respectively, in the training cohort and 0.799, 0.762, and 0.746, respectively, in the validation cohort. The calibration plots show good accuracy, and the decision curve analysis values indicate good clinical applicability and effectiveness. The nomogram model constructed with the above 19 prognostic factors is suitable for predicting the OS of MLUAD and has good predictive accuracy and clinical applicability.

Preoperative Three-Dimensional Lung Simulation Before Thoracoscopic Anatomical Segmentectomy for Lung Cancer: A Systematic Review and Meta-Analysis.

Background: Whether the utilization of preoperative three-dimensional (3D) lung simulation can improve the outcomes of segmentectomy for lung cancer (LC) is still controversial. Our meta-analysis was performed to compare preoperative 3D lung simulation with non-3D procedures in terms of perioperative outcomes. Methods: Seven databases (Embase, Ovid Medline, ScienceDirect, PubMed, Web of Science, Cochrane Library, and Scopus) were searched for eligible articles. Intraoperative outcomes (conversion, operative time, etc.), postoperative indicators (postoperative hospital stay, total number of complications, etc.) and postoperative complications were endpoints. Results: After applying predefined inclusion criteria, we included 8 studies and 989 patients (3D group: 552 patients; non-3D group: 437 patients) in our meta-analysis. The results of the meta-analysis showed that preoperative 3D lung simulation could significantly decrease the blood loss (mean difference [MD]: -16.21 [-24.95 to -7.47]ml, p = 0.0003), operative time (MD: -13.03 [-25.56 to -0.50]ml, p = 0.04), conversion rate (conversion from segmentectomy to thoracotomy or lobectomy) (MD: 0.12 [0.03-0.48], p = 0.003), postoperative hospital stay (MD: -0.25 [-0.46 to 0.04]days, p = 0.02) and total number of complications (MD: 0.59 [0.43-0.82], p = 0.001) compared with non-3D procedures. The number of resected lymph nodes (LNs), postoperative drainage time, postoperative forced expiratory volume in the first second (postoperative FEV1) and postoperative drainage volume were similar in the two groups. Arrhythmia (5.30%), pulmonary air leakage (2.72%), atrial fibrillation (2.20%), pulmonary infection (2.04%), and pneumonia (1.73%) were the top 5 postoperative complications in the 3D group. Conclusions: Preoperative 3D lung simulation was better than non-3D procedures in segmentectomy for LC, with better intraoperative and postoperative outcomes. However, our results should be confirmed in larger prospective randomized controlled trials. Systematic Review Registration: PROSPERO, identifier: CRD42021275020.

Lymph node ratio predicts overall survival in patients with stage II non-small cell lung cancer: a population-based SEER analysis.

BACKGROUND: In non-small-cell lung cancer (NSCLC), there are many factors that affect prognosis, and the lymph node ratio (LNR) may play a significant role. Our study aimed to confirm the value of the LNR in the prognosis of patients with stage II NSCLC. METHODS: Patient data were obtained from the Surveillance, Epidemiology and End Results (SEER) database. The classification for the LNR was best determined using the X-tile method. The correlation between the LNR and overall survival (OS) was validated after the Kaplan-Meier analysis was performed. To determine the correlation between the LNR and survival, stratification and the Cox regression analysis were used. RESULTS: In our study, 14,183 stage II NSCLC patients were included. Among them, 8303 patients had N1 disease. According to the X-tile analysis, the optimal critical points for the LNR in N1 patients with NSCLC was 0.21 and 0.38. We categorized the cohorts as low (LNR-L ≤ 0.21; n = 5158, 62.1%), medium (0.21 < LNR-M ≤ 0.38; n = 1736, 20.9%), and high (LNR-H > 0.38; n = 1409, 17.0%). According to the Kaplan-Meier analysis, the patients with a high LNR were considerably worse than those with a medium or low LNR (P < 0.001), which was also proven by stratified and multivariate analyses. The value of the LNR was reflected in all the subgroup analyses, especially in patients ages < 60 years. The multivariate competing risks regression analysis revealed that younger age, female sex, T1 disease, adenocarcinoma and N0 disease was associated with a better prognosis after controlling for potential confounders (P < 0.001). CONCLUSIONS: For patients with stage II NSCLC, the LNR is valuable for assessing prognosis. A higher LNR indicates a worse prognosis.