Overall clinical course of indeterminate dendritic cell tumor patients without skin lesions:A rare case report

BACKGROUND Indeterminate dendritic cell tumor(IDCT)is a rare tumor of immune cells,and IDCT patients without skin lesions are rarely reported.Therefore,the clinical course in this type of patient is unclear,and further research on the underlying pathological mechanisms and appropriate treatments is needed.CASE SUMMARY This study describes a female IDCT patient with bile duct lesions.The strong mimicry of IDCT lesions confused doctors,and consequently,this patient,who had no skin lesions,was first diagnosed with cholangiocarcinoma.Then,she presented with persistent abdominal distension without jaundice.Enlarged mesenteric lymph nodes along with massive ascites were observed in the subsequent imaging examination.However,no tumor cells or pathogens were found in the three subsequent ascites analyses.It took 2 years to reach the correct diagnosis,which was eventually obtained by performing surgery for biopsy of the patient’s abdominal lymph nodes.However,by then,she was already in a cachexic state.Finally,she received a cycle of cyclophosphamide therapy and was advised to visit a hospital specializing in rare diseases.CONCLUSION For IDCT patients without skin lesions,early biopsy is the key to obtaining a correct diagnosis.Moreover,the collective management of IDCT patients is important.Further histological and molecular biology studies based on human specimens are critical for understanding the pathological mechanism of dendritic cell tumors in the future.

Y–Z deformable magnetic ring for the treatment of rectal stricture: A case report and review of literature

BACKGROUND Treatment of postoperative anastomotic stenosis for colorectal cancer is often challenging,especially for patients who do not respond well to endoscopy.In cases where patients have undergone an enterostomy,the stenosis can be easily resolved through magnetic compression.However,common magnetic compre-ssion techniques cannot be performed on those without enterostomy.We design-ed a novel Y–Z deformable magnetic ring(Y–Z DMR)and successfully applied it to a patient with a stenosis rectal anastomosis and without enterostomy after rectal cancer surgery.CASE SUMMARY We here report the case of a 57-year-old woman who had undergone a laparo-scopic radical rectum resection(Dixon)for rectal cancer.However,she started facing difficulty in defecation 6 months after surgery.Her colonoscopy indicated stenosis of the rectal anastomosis.Endoscopic balloon dilation was performed six times on her.However,the stenosis still showed a trend of gradual aggravation.Because the patient did not undergo an enterostomy,the conventional endoscopic magnetic compression technique could not be performed.Hence,we imple-mented a Y–Z DMR implemented through the anus under single channel.The magnetic ring fell off nine days after the operation and the rectal stenosis was relieved.The patient was followed up for six months and reported good defeca-tion.CONCLUSION The Y–Z DMR deformable magnetic ring is an excellent treatment strategy for patients with rectal stenosis and without enterostomy.

Individualized anti-thrombotic therapy for acute myocardial infarction complicated with left ventricular thrombus: A case report

BACKGROUND Presently,there is no established standard anti-blood clot therapy for patients facing acute myocardial infarction(AMI)complicated by left ventricular thrombus(LVT).While vitamin K antagonists are the preferred choice for oral blood thinning,determining the best course of blood-thinning medication remains challenging.It is unclear if non-vitamin K antagonist oral blood thinners have different effectiveness in treating LVT.This study significantly contributes to the medical community.CASE SUMMARY The blood-thinning treatment of a patient with AMI and LVT was analyzed.Triple blood-thinning therapy included daily enteric-coated aspirin tablets at 0.1 g,daily clopidogrel hydrogen sulfate at 75 mg,and dabigatran etexilate at 110 mg twice daily.After 15 d,the patient’s LVT did not decrease but instead increased.Clinical pharmacists comprehensively analyzed the cases from the perspective of the patient’s disease status and drug interaction.The drug regimen was reformulated for the patient,replacing dabigatran etexilate with warfarin,and was administered for six months.The clinical pharmacist provided the patient with professional and standardized pharmaceutical services.The patient’s condition was discharged after meeting the international normalized ratio value(2-3)criteria.The patient fully complied with the follow-up,and the time in the therapeutic range was 78.57%,with no serious adverse effects during pharmaceutical monitoring.CONCLUSION Warfarin proves to be an effective drug for patients with AMI complicated by LVT,and its blood-thinning course lasts for six months.

Are case reports valuable?Exploring their role in evidence based medicine and patient care

Case reports,often overlooked in evidence-based medicine(EBM),play a pivotal role in healthcare research.They provide unique insights into rare conditions,novel treatments,and adverse effects,serving as valuable educational tools and generating new hypothesis.Despite their limitations in generalizability,case reports contribute significantly to evidence-based practice by offering detailed clinical information and fostering critical thinking among healthcare professionals.By acknowledging their limitations and adhering to reporting guidelines,case reports can contribute significantly to medical knowledge and patient care within the evolving landscape of EBM.This editorial explores the intrinsic value of case reports in EBM and patient care.

Rectus sheath hematoma combined with COVID-19:A case report

BACKGROUND Rectus sheath hematoma(RSH)is uncommon,and because people have limited knowledge about it,it is difficult to recognize the symptoms in time,often delaying optimal treatment.CASE SUMMARY Herein,we report a case of a 77-year-old female with RSH.The patient was treated at our hospital for coronavirus disease 2019.Anticoagulant treatment was administered during this period because of thrombosis.On the 8th d of treatment,the patient complained of abdominal pain.Ultrasonography revealed a solid cystic mass in the pelvic cavity.An emergency laparotomy was performed,and a huge hematoma was found in the deep layer of the rectus abdominis muscle.We used anticoagulants with caution based on the patient’s condition.CONCLUSION Optimal management of patients with RSH s depends on timely diagnosis and when to reintroduce anticoagulants.

Multiorgan dysfunction syndrome due to high-dose cantharidin poisoning:A case report

BACKGROUND This report delves into the diagnostic and therapeutic journey undertaken by a patient with high-dose cantharidin poisoning and multiorgan dysfunction syndrome(MODS).Particular emphasis is placed on the comprehensive elucidation of the clinical manifestations of high-dose cantharidin poisoning,the intricate path to diagnosis,and the exploration of potential underlying mechanisms.CASE SUMMARY A patient taking 10 g of cantharidin powder orally subsequently developed MODS.The patient was treated with supportive care,fluid hydration and antibiotics,and hemoperfusion and hemofiltration therapy for 24 h and successfully recovered 8 d after hospital admission.Cantharidin poisoning can cause lifethreatening MODS and is rare clinically.This case underscores the challenge in diagnosis and highlights the need for early clinical differentiation to facilitate accurate assessment and prompt intervention.CONCLUSION This article has reported and analyzed the clinical data,diagnosis,treatment,and prognosis of a case of high-dose cantharidin poisoning resulting in MODS and reviewed the relevant literature to improve the clinical understanding of this rare condition.

Mycobacterium gordoniasis of the cervical lymph nodes:A case report

BACKGROUND Owing to the advancement in bacterial identification techniques,the detection rate of non-tuberculous mycobacterium(NTM)has been on the rise.Different from Mycobacterium tuberculosis,the clinical symptoms of NTM are not easily detected,and the clinical efficacy and prognosis are somewhat heterogeneous.To report a case of Mycobacterium gordoniasis of cervical lymph node diagnosed in Anhui Chest Hospital in July 2022.CASE SUMMARY Upon examination,the patient who weighed 67.5 kg,was human immunodeficiency virus negative,healthy,without hypertension,diabetes,heart disease and other basic diseases microscopic analysis revealed granulomatous inflammation with coagulation necrosis in the lymphocyte,and tuberculosis was not ruled out.Plain computed tomography scans of the neck and chest indicated the presence of a single grayish-yellow and grayish-brown tissue,the dimensions of which was top of form 10.5 cm×3.0 cm×1.5 cm.After pathological consultation in our hospital,the diagnosis was confirmed as NTM infection.CONCLUSION This case report and the clinical epidemiological research on improving NTM have important guiding significance for improving decision-making in clinical treatments.

High rate of clinically relevant improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis

BACKGROUND The minimal clinically important difference(MCID)is defined as the smallest meaningful change in a health domain that a patient would identify as important.Thus,an improvement that exceeds the MCID can be used to define a successful treatment for the individual patient.AIM To quantify the rate of clinical improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis.METHODS Patients were treated with the Global Unite total shoulder platform arthroplasty between March 2017 and February 2019 at Herlev and Gentofte Hospital,Denmark.The patients were evaluated preoperatively and 3 months,6 months,12 months,and 24 months postoperatively using the Western Ontario Osteoarthritis of the Shoulder index(WOOS),Oxford Shoulder Score(OSS)and Constant-Murley Score(CMS).The rate of clinically relevant improvement was defined as the proportion of patients who had an improvement 24 months postoperatively that exceeded the MCID.Based on previous literature,MCID for WOOS,OSS,and CMS were defined as 12.3,4.3,and 12.8 respectively.RESULTS Forty-nine patients with a Global Unite total shoulder platform arthroplasty were included for the final analysis.Mean age at the time of surgery was 66 years(range 49.0-79.0,SD:8.3)and 65%were women.One patient was revised within the two years follow-up.The mean improvement from the preoperative assessment to the two-year follow-up was 46.1 points[95%confidence interval(95%CI):39.7-53.3,P<0.005]for WOOS,18.2 points(95%CI:15.5-21.0,P<0.005)for OSS and 37.8 points(95%CI:31.5-44.0,P<0.005)for CMS.Two years postoperatively,41 patients(87%)had an improvement in WOOS that exceeded the MCID,45 patients(94%)had an improvement in OSS that exceeded the MCID,and 42 patients(88%)had an improvement in CMS that exceeded the MCID.CONCLUSION Based on three shoulder-specific outcome measures we find that approximately 90%of patients has a clinically relevant improvement.This is a clear message when informing patients about their prognosis.

Blastic plasmacytoid dendritic cell neoplasm in Jinhua,China:Two case reports

BACKGROUND Blastic plasmacytoid dendritic cell neoplasm(BPDCN)is a rare and clinically aggressive hematologic malignancy originating from the precursors of plasmacytoid dendritic cells.BPDCN often involves the skin,lymph nodes,and bone marrow,with rapid clinical progression and a poor prognosis.The BPDCN diagnosis is mainly based on the immunophenotype.CASE SUMMARY In this paper,we retrospectively analyzed 2 cases of BPDCN.Both patients were elderly males.The lesions manifested as skin masses.Morphological manifestations included diffuse and dense tumor cell infiltration of the dermis and subcutaneous tissues.Immunohistochemistry staining showed that cluster of differentiation CD4,CD56,CD43,and CD123 were positive.CONCLUSION In this paper,we retrospectively analyzed 2 cases of BPDCN.Both patients were elderly males.The lesions manifested as skin masses.Morphological manifestations included diffuse and dense tumor cell infiltration of the dermis and subcutaneous tissues.Immunohistochemistry staining showed that cluster of differentiation CD4,CD56,CD43,and CD123 were positive.

Magnetic compression anastomosis to restore biliary tract continuity after obstruction following major abdominal trauma:A case report

BACKGROUND The combination of magnetic compression anastomosis(MCA)and endoscopy has been used to treat biliary stricture after liver transplantation.However,its use for the treatment of complex biliary obstruction after major abdominal trauma has not been reported.This case report describes the successful use of MCA for the treatment of biliary obstruction resulting from major abdominal trauma.A 23-year-old man underwent major abdominal surgery(repair of liver rupture,right half colon resection,and ileostomy)following a car accident one year ago.The abdominal drainage tube,positioned at the Winslow foramen,was draining approximately 600-800 mL of bile per day.During the two endoscopic retrograde cholangiopancreatography procedures,the guide wire was unable to enter the common bile duct,which prevented placement of a biliary stent.MCA combined with endoscopy was used to successfully achieve magnetic anastomosis of the peritoneal sinus tract and duodenum,and then a choledochoduodenal stent was placed.Finally,the external biliary drainage tube was removed.The patient achieved internal biliary drainage leading to the removal of the external biliary drainage tube,which improved the quality of life.CONCLUSION Magnetic compression technique can be used for the treatment of complex biliary obstruction with minimal operative trauma.

Patient-centric periodontal research:A pioneering application of patient-reported outcome measures

Conventional dentistry or periodontal research often ignores the human component in favor of clinical outcomes and biological causes.Clinical research is driven by the statistical significance of outcome parameters rather than the satisfaction level of the patient.In this context,patient-centric periodontal research(PCPR)is an approach that considers the patient´s feedback concerning their functional status,experience,clinical outcomes,and accessibility to their treatments.It is argued that data self-reported by the patient might have low reliability owing to the confounding effect of their personal belief,cultural background,and social and economic factors.However,literature has shown that the incorporation of“patient-centric outcome”components considerably enhances the validity and applicability of research findings.Variations in the results of different studies might be due to the use of different and non-standardized assessment tools.To overcome this problem,this editorial enlists various reliable tools available in the literature.In conclusion,we advocate that the focus of researchers should shift from mere periodontal research to PCPR so that the results can be effectively applied in clinical settings and the therapeutic strategy can also change from mere periodontal therapy to patient-centric periodontal therapy.

Treatment of anastomotic stricture after rectal cancer operation by magnetic compression technique:A case report

BACKGROUNDThe treatment of postoperative anastomotic stenosis(AS)after resection of colorectalcancer is challenging.Endoscopic balloon dilation is used to treat stenosisin such cases,but some patients do not show improvement even after multipleballoon dilations.Magnetic compression technique(MCT)has been used for gastrointestinalanastomosis,but its use for the treatment of postoperative AS aftercolorectal cancer surgery has rarely been reported.CASE SUMMARYWe report a 72-year-old man who underwent radical resection of colorectal cancerand ileostomy one year ago.An ileostomy closure was prepared six months ago,but colonoscopy revealed a narrowing of the rectal anastomosis.Endoscopic balloondilation was performed three times,but colonoscopy showed no significantimprovement in stenosis.The AS was successfully treated using MCT.CONCLUSIONMCT is a minimally invasive method that can be used for the treatment of postoperativeAS after colorectal cancer surgery.

Novel magnetic compression technique for the treatment of postoperative anastomotic stenosis in rectal cancer:A case report

BACKGROUND The treatment of postoperative anastomotic stenosis after excision of rectal cancer is challenging.Endoscopic balloon dilation and radial incision are not effective in all patients.We present a new endoscopy-assisted magnetic compression technique(MCT)for the treatment of rectal anastomotic stenosis.We successfully applied this MCT to a patient who developed an anastomotic stricture after radical resection of rectal cancer.A 50-year-old man had undergone laparoscopic radical rectal cancer surgery at a local hospital 5 months ago.A colonoscopy performed 2 months ago indicated that the rectal anastomosis was narrow due to which ileostomy closure could not be performed.The patient came to the Magnetic Surgery Clinic of the First Affiliated Hospital of Xi'an Jiaotong University after learning that we had successfully treated patients with colorectal stenosis using MCT.We performed endoscopy-assisted magnetic compression surgery for rectal stenosis.The magnets were removed 16 d later.A follow-up colonoscopy performed after 4 months showed good anastomotic patency,following which,ileostomy closure surgery was performed.CONCLUSION MCT is a simple,non-invasive technique for the treatment of anastomotic stricture after radical resection of rectal cancer.The technique can be widely used in clinical settings.

Rare primary squamous cell carcinoma of the intrahepatic bile duct: A case report and review of literature

BACKGROUND Cholangiocarcinoma is the most common malignancy of the biliary tree and has a poor prognosis.Adenocarcinoma is the most common pathological type of cho-langiocarcinomas,but rare squamous,adenosquamous,and mucinous variants have been reported without adequate clinical data.CASE SUMMARY This report describes a rare case of primary squamous cell carcinoma(SCC)of the intrahepatic bile duct.The patient was admitted with a tumor in the hepatic caudate lobe with no obvious clinical symptoms.Examination revealed hepatitis B surface antigen positivity,a slight increase in alfa-fetoprotein to 16.34 ng/mL,and an irregular slightly heterogeneous enhancing lesion in the hepatic caudate lobe,which was initially thought to be hepatocellular carcinoma.Laparoscopic re-section was performed,and the final pathology suggested a rare primary SCC of the intrahepatic bile duct.Immunohistochemistry indicated positivity for villin,partial positivity for p63,and negativity for hepatocyte,CK7,CK8,CK19,and CK20.The Ki-67 index was approximately 60%.The patient received six cycles of Tegio chemotherapy.A new lesion was detected in the liver after 15 months.The surgery was performed,and the patient was followed-up at a local hospital.To date,no new lesions have been observed.CONCLUSION Surgery is the first choice for resectable lesions,and combined chemotherapy based on pathology is essential for increasing overall survival.

Clinical cure and liver fibrosis reversal after postoperative antiviral combination therapy in hepatitis B-associated non-cirrhotic hepatocellular carcinoma: A case report

BACKGROUND The incidence of hepatocellular carcinoma(HCC)is high in China,and approximately 15%-20%of HCC cases occur in the absence of cirrhosis.Compared with patients with cirrhotic HCC,those with non-cirrhotic HCC have longer postoperative tumor-free survival.However,the overall survival time is not significantly increased,and the risk of postoperative recurrence remains.Strategies to improve the postoperative survival rate in these patients are currently required.CASE SUMMARY A 47-year-old man with a family history of HCC was found to have hepatitis B virus(HBV)infection 25 years ago.In 2000,he was administered lamivudine for 2 years,and entecavir(ETV 0.5 mg)was administered in 2006.In October 2016,magnetic resonance imaging revealed a tumor in the liver(5.3 cm×5 cm×5 cm);no intraoperative hepatic and portal vein and bile duct tumor thrombi were found;and postoperative pathological examination confirmed a grade II HCC with no nodular cirrhosis(G1S3).ETV was continued,and no significant changes were observed on imaging.After receiving pegylated interferon alfa-2b(PEG IFNα-2b)(180μg)+ETV in February 2019,the HBsAg titer decreased significantly within 12 wk.After receiving hepatitis B vaccine(60μg)in 12 wk,HBsAg serological conversion was realized at 48 wk.During the treatment,no obvious adverse reactions were observed,except for early alanine aminotransferase flares.The reexamination results of liver pathology were G2S1,and reversal of liver fibrosis was achieved.CONCLUSION The therapeutic regimen of ETV+PEG IFNα-2b+hepatitis B vaccine for patients with HBV-associated non-cirrhotic HCC following hepatectomy can achieve an HBV clinical cure and prolong the recurrence-free survival.

Hypothyroidism with elevated pancreatic amylase and lipase without clinical symptoms: A case report

BACKGROUND Hypothyroidism is an endocrine disorder that has worldwide prevalence and can affect multiple organ systems.We report a case of hypothyroidism with elevated pancreatic amylase and trypsin without acute pancreatitis.No such case has been previously reported.CASE SUMMARY A 29-year-old woman did not pay much attention to a fever 4 d prior.During this time,she experienced anorexia and only drank a small amount of water every day.She did not present with abdominal distension,postprandial nausea,vomiting,cough or expectoration.After physical and laboratory examinations,the patient was diagnosed with hypothyroidism.During the course of the disease,hypothyroidism was generally accompanied by constantly increased pancreatic amylase and trypsin.After admission,the possible etiology of the patient was excluded and the concentrations of pancreatic lipase and amylase in serum were>2000U/L(reference range 23-300 U/L)and 410 U/L(reference range 30-110 U/L),respectively.So we highly suspected that it may be acute pancreatitis.Interestingly,she never developed any complications associated with acute pancreatitis despite high levels of serum pancreatic amylase and trypsin,and she reported no symptoms of abdominal pain.Serum amylase and lipase decreased gradually after active thyroxine supplementation,and the patient was discharged from the hospital after active treatment.CONCLUSION This case suggests that clinicians should pay attention to hypothyroidism with elevated pancreatic amylase and trypsin,even if no complications of acute pancreatitis are reported.

Clinical observation of pediatric-type follicular lymphomas in adult:Two case reports

BACKGROUND Pediatric-type follicular lymphoma(PTFL)is a unique pathological type in the 4th edition of hematopoiesis and lymphoid tissue tumor classification revised by World Health Organization.It is unique in clinical practice and seldom seen in adult.PTFL mainly occurs in the head and neck lymph nodes.Most of the cases are short of fever,night sweat,weight loss,and other B symptoms which substitute for lymphadenopathy as the main symptom.PTFL can be disposed of surgical resection and it can achieve long-term tumor-free survival,and it has an excellent outcome.CASE SUMMARY Two cases of PTFL were reported and their clinicopathological features,differential diagnosis,therapy and prognosis were discussed.PTFL showed graybrown tough texture in general performance.The histological manifestations of PTFL were similar to that of adult-follicular lymphoma(FL).Under low power microscope,the structure of lymph nodes was destroyed in different degree,the follicles were closely arranged,expanded and irregular,and the mantle zone became thin or disappeared.In addition,the“starry sky phenomenon”could be seen.At high magnification,the follicles were mainly composed of single medium-sized central cells,and some of them mainly consisted of centroblastic cells to characterize scattered chromatin and inconspicuous nucleoli.Immunohistochemical showed the tumor cells expressed CD20,PAX5,CD79a and CD10,BCL6,FOXP-1,which were limited in germinal center;Ki-67 was highly expressed in germinal center.CD21 and CD23 showed nodular and expanded follicular dendritic cells.Immunoglobulin gene rearrangement was positive for IGH and IGK.The two patients underwent surgical resection with no complications.After discharge,the two patients with a close review for 18 mo and 5 mo respectively and showed no evidence of recurrence.CONCLUSION PTFL in adult is generally supposed to be extremely rare.PTFL displayed characteristic morphological,immunophenotypic,and molecular biological changes which are a kind of neoplasm with satisfactory prognosis after surgical excision.

Possible effect of blonanserin on gambling disorder:A clinical study protocol and a case report

BACKGROUND Gambling disorder is characterized by excessive and recurrent gambling and can have serious negative social consequences.Although several psychotherapeutic and pharmacological approaches have been used to treat gambling disorder,new treatment strategies are needed.Growing evidence suggests that dopamine D3 receptor plays a specific role in the brain reward system.AIM To investigate if blonanserin,a dopamine D3 receptor antagonist,would be effective in reducing gambling impulses in patients with gambling disorder.METHODS We developed a study protocol to measure the efficacy and safety of blonanserin as a potential drug for gambling disorder,in which up to 12 mg/d of blonanserin was prescribed for 8 wk.RESULTS A 37-year-old female patient with gambling disorder,intellectual disability,and other physical diseases participated in the pilot study.The case showed improvement of gambling symptoms without any psychotherapy.However,blonanserin was discontinued owing to excessive saliva production.CONCLUSION This case suggests that blonanserin is potentially an effective treatment for patients with gambling disorder who resist standard therapies,but it also carries a risk of adverse effects. Further studies are needed to confirm the findings.

Clinical features and genetic variations of severe neonatal hyperbilirubinemia:Five case reports

BACKGROUND Neonatal hyperbilirubinemia is a common problem faced by pediatricians.The role of genetic factors in neonatal jaundice has been gradually recognized.This study aims to identify genetic variants that influence the bilirubin level in five patients using next-generation sequencing(NGS).CASE SUMMARY Five neonates with severe hyperbilirubinemia were retrospectively studied.They exhibited bilirubin encephalopathy,hypothyroidism,ABO blood type incompatibility hemolysis,glucose-6-phosphate dehydrogenase(G6PD)deficiency and premature birth,respectively.A customized 22-gene panel was designed,and NGS was carried out for these neonates.Eight variations(G6PD c.G1388A,HBA2 c.C369G,ABCC2 c.C3825G,UGT1A1 c.G211A,SPTB c.A1729G,EPB41 c.G520A,c.1213-4T>G and c.A1474G)were identified in these five neonates.Genetic mutations of these genes are associated with G6PD deficiency,thalassemia,Dubin-Johnson syndrome,Gilbert syndrome,hereditary spherocytosis,and hereditary elliptocytosis.One of the neonates was found to have compound variants of the EPB41 splice site c.1213-4T>G and c.G520A(p.E174K),but no elliptocyte was seen on his blood smear of 4 years old.CONCLUSION Pathological factors of severe neonatal hyperbilirubinemia are complicated.Genetic variants may play an important role in an increased risk of neonatal hyperbilirubinemia,and severe jaundice in neonates may be related to a cumulative effect of genetic variants.

Are the data on quality of life and patient reported outcomes from clinical trials of metastatic non-small-cell lung cancer important?

Majority of the patients with advanced non-small-cell lung cancer(NSCLC)experience two or more disease related symptoms,which may have a negative impact on their health-related quality of life(HR QOL).These patients prefer a therapy that would improve disease related symptoms,as opposed or treatment that slightly prolongs their survival without improving symptoms.The improvements of the symptoms augment the significance of improved response rates or progression free survivals.The choice of the questionnaires to evaluate patients-reported outcomes(PROs)and HRQOL benefits and methods of collecting the data and their interpretations are very important and are discussed in this manuscript.PROs and HR QOL outcomes are important in patients with advanced NSCLC only when the data are collected and analyzed correctly.Then they can be viewed as components of the total value of a treatment,providing a comprehensive picture of the benefits and risks of anticancer therapies.Enabling the patients to feel during the last months of their lives more comfortable and not be dependent on their loved ones is a very important task in the treatment of advanced NSCLC.