¹⁸FDG-PET/CT Is a Useful Tool in Staging Procedure before Chemo-Radiotherapy in Patients with Limited Disease Small-Cell Lung Cancer. Pattern of Failure and Survival Is Analyzed

Background: The purpose of this study was to evaluate the use of 18FDG-PET/CT in staging procedure, the pattern of failure and survival in patients with small-cell lung cancer limited disease (LD-SCLC) undergoing chemo-radiotherapy. Methods: A total of 79 LD-SCLC patients were treated with a combination of chemotherapy and chest radiotherapy. Radiotherapy of the tumour and the pathological lymph nodes was performed either as 45 Gy twice-daily or 46 - 50 Gy once-daily. 18Fluro-2-deoxy-D-glucose (18FDG)-PET/CT was performed in 35 patients as part of the staging procedure. Results: With a median follow-up time of 17 months 6% developed isolated loco-regional failures while 57% developed distant metastases. No isolated regional failures were seen. Median overall survival was 22 months. Patients staged with a 18FDG-PET/CT had a significantly lower incidence of distant failures and a significantly improved overall survival compared with patients only staged with a CT scan (p = 0.03) (median overall survival of 34 versus 17 months, respectively). Conclusion: The pattern of failure showed a high risk of distant metastases but a low incidence of isolated loco-regional failures. Patients staged with an 18FDG-PET/CT had a significantly lower incidence of distant failures and better overall survival, indicating that 18FDG-PET could be beneficial in patients with LD-SCLC before deciding on treatment regimen.

An Enhanced Lung Cancer Detection Approach Using Dual-Model Deep Learning Technique

Lung cancer continues to be a leading cause of cancer-related deaths worldwide,emphasizing the critical need for improved diagnostic techniques.Early detection of lung tumors significantly increases the chances of successful treatment and survival.However,current diagnostic methods often fail to detect tumors at an early stage or to accurately pinpoint their location within the lung tissue.Single-model deep learning technologies for lung cancer detection,while beneficial,cannot capture the full range of features present in medical imaging data,leading to incomplete or inaccurate detection.Furthermore,it may not be robust enough to handle the wide variability in medical images due to different imaging conditions,patient anatomy,and tumor characteristics.To overcome these disadvantages,dual-model or multi-model approaches can be employed.This research focuses on enhancing the detection of lung cancer by utilizing a combination of two learning models:a Convolutional Neural Network(CNN)for categorization and the You Only Look Once(YOLOv8)architecture for real-time identification and pinpointing of tumors.CNNs automatically learn to extract hierarchical features from raw image data,capturing patterns such as edges,textures,and complex structures that are crucial for identifying lung cancer.YOLOv8 incorporates multiscale feature extraction,enabling the detection of tumors of varying sizes and scales within a single image.This is particularly beneficial for identifying small or irregularly shaped tumors that may be challenging to detect.Furthermore,through the utilization of cutting-edge data augmentation methods,such as Deep Convolutional Generative Adversarial Networks(DCGAN),the suggested approach can handle the issue of limited data and boost the models’ability to learn from diverse and comprehensive datasets.The combined method not only improved accuracy and localization but also ensured efficient real-time processing,which is crucial for practical clinical applications.The CNN achieved an accuracy of 97.67%in classifying lung tissues into healthy and cancerous categories.The YOLOv8 model achieved an Intersection over Union(IoU)score of 0.85 for tumor localization,reflecting high precision in detecting and marking tumor boundaries within the images.Finally,the incorporation of synthetic images generated by DCGAN led to a 10%improvement in both the CNN classification accuracy and YOLOv8 detection performance.

Diagnosis and treatment of lung cancer:A molecular perspective

This editorial comments on the review by Da Silva et al,published in the World Journal of Clinical Oncology which focuses on the molecular perspectives of lung cancer.With the rapid development of molecular technology,new diagnostic methods are constantly emerging,including liquid biopsy,the identification of gene mutations,and the monitoring biomarkers,thus providing precise in-formation with which to identify the occurrence and development of lung cancer.Biomarkers,such as circulating tumor cells,circulating tumor DNA,and cir-culating RNA can provide helpful information for clinical application.Common types of genetic mutations and immune checkpoints include epidermal growth factor receptor,anaplastic lymphoma kinase,c-ROS proto-oncogene 1,progra-mmed death-1 and cytotoxic T-lymphocyte-associated protein.According to specific biomarkers,targeted therapy and immunotherapy can improve survival outcomes based on the types of gene mutation and immune checkpoints.The application of molecular approaches can facilitate our ability to control the progression of disease and select appropriate therapeutic strategies for patients with lung cancer.

Therapeutic insights into epidermal growth factor receptor/reactive oxygen species proto-oncogene 1-receptor co-mutated non-small cell lung cancer:Crizotinib as a promising option

This letter provides a review of the report by Peng et al on a unique case of non-small cell lung cancer(NSCLC),specifically lung adenocarcinoma,featuring reactive oxygen species proto-oncogene 1-receptor(ROS1)co-mutation.The case involves a 64-year-old patient who exhibited both epidermal growth factor receptor(EGFR)L858R mutation and ROS1 rearrangement,achieving significant disease stabilization following treatment with crizotinib.This rare EGFR/ROS1 co-mutation poses distinct challenges for clinical management and highlights the necessity of personalized treatment strategies.While third-generation EGFR tyrosine kinase inhibitors(TKIs),such as osimertinib,are commonly regarded as first-line therapies,recent studies indicate that crizotinib may offer superior disease control in certain EGFR-mutant patients,particularly those who exhibit poor responses to EGFR TKIs.The case also examines the influence of tumor cell genetic heterogeneity on treatment response,underscoring the importance of evaluating tumor characteristics.In patients with EGFR/ROS1 co-mutation,gefitinib is generally effective as a first-line treatment;however,its efficacy can be limited,whereas crizotinib has demonstrated improved disease control.Future research should focus on identifying optimal treatment strategies for patients with EGFR/ROS1 co-mutation to enhance patient outcomes.In conclusion,this case report not only illustrates the effectiveness of crizotinib in managing patients with EGFR/ROS1 co-mutation but also underscores the importance of personalized treatment approaches,offering valuable insights for improving clinical outcomes in NSCLC patients with complex genetic profiles.TO THE EDITOR I read with great interest the case report by Peng et al[1],titled“Concomitant Epidermal Growth Factor Receptor Mutation/C-ROS Oncogene 1 Rearrangement in Non-Small Cell Lung Cancer”,published in the World Journal of Clinical Oncology[1].This report presents a compelling case of the exceedingly rare epidermal growth factor receptor(EGFR)/reactive oxygen species proto-oncogene 1-receptor(ROS1)co-mutation in non-small cell lung cancer(NSCLC),specifically in a patient with lung adenocarcinoma.The authors describe a 64-year-old woman with an EGFR L858R mutation and ROS1 rearrangement,who achieved notable disease stability with prolonged crizotinib treatment.This case,with its distinct clinical features and challenges inherent to EGFR/ROS1 co-mutations,provides valuable insights for the oncology community and underscores the potential efficacy of ROS1-targeted therapies in treating co-mutated NSCLC.

Vitiligo-like rash in a patient with lung cancer caused by sintilimab: A case report

BACKGROUND This article discusses a case involving a 63-year-old man with non-small cell lung cancer,who was treated with a combination of chemotherapy and immunothe-rapy.The patient was treated with five cycles of chemotherapy(pemetrexed and carboplatin)combined with sintilimab,a programmed death 1 inhibitor.CASE SUMMARY After the fifth cycle of treatment,the patient developed skin itching and a vitiligo-like rash,which are known side effects of immunotherapy.Despite dermatologi-cal consultation and treatment with topical corticosteroids,the rash worsened while the itching subsided.The patient continued with the treatment,and after 15 cycles,the tumor showed a response with a reduction in size.The vitiligo-like rash increased,but the antitumor treatment remained effective.CONCLUSION The case highlights the use of immunotherapy in patients with non-small cell lung cancer and the potential side effect of vitiligo-like rash.The patient’s tumor res-ponded well to the treatment,and despite the skin reaction,the treatment was not discontinued due to its effectiveness.The article suggests that further studies are needed to understand the mechanism behind vitiligo in patients with lung cancer receiving immune checkpoint inhibitors and whether the development of vitiligo-like rash after immune checkpoint inhibitor therapy is associated with improved prognosis.The case also underscores the importance of managing immune-related adverse events in the context of effective antitumor treatment.

Tankyrase 2 as a therapeutic target in non-small cell lung cancer: Implications for apoptosis and migration

This letter addresses Wang and Zhang's investigation into the role of tankyrase 2(TNKS2)as a pivotal driver of malignancy in non-small cell lung cancer(NSCLC)through mechanisms including apoptosis inhibition,enhanced cellular migration,andβ-catenin pathway activation.Their study in NSCLC cell lines demonstrates that TNKS2 overexpression stabilizesβ-catenin,subsequently triggering onco-genic gene expression and facilitating cellular migration-key attributes of meta-static potential.These insights position TNKS2 as a compelling target for therapy and a potential prognostic marker in NSCLC.Nevertheless,translating these in vitro findings to clinical practice requires validation in in vivo models.Addi-tionally,further research should investigate TNKS2 expression in patient samples and assess its implications in therapy resistance and combination treatment strategies.

Exercise rehabilitation on patients with non-small cell lung cancer: A meta-analysis of randomized controlled trials

BACKGROUND Lung cancer is one of the most common and deadly cancers worldwide.As the disease progresses and due to the side effects of treatment,patients’physical activity significantly decreases.AIM To systematically review and conduct a meta-analysis on the effects of exercise rehabilitation on the physical activity of lung cancer patients and determine the best implementation methods to provide clinical guidance.METHODS Literature was searched through multiple electronic databases.A random effects model was used to combine effect sizes through standardized mean difference(SMD).The Cochrane risk of bias tool was used to assess the quality of the lite-rature,sensitivity analysis was used to ensure the robustness of the results,and Egger’s test was used to detect publication bias and asymmetry.RESULTS A total of 11 studies involving 541 patients were included in this study.The phy-sical endurance,muscle function and cardiopulmonary function of non-small cell lung cancer(NSCLC)patients were evaluated.The overall effect size of the six-minute walk test(6MWT)was not statistically significant.However,subgroup analysis found that endurance significantly improved when exercise duration exceeded 0.5 hours(P≤0.05).In terms of muscle function,the overall effect size was SMD=0.619.Subgroup analysis showed that strength training,respiratory training,and cross-training(XT)significantly improved muscle function.Exercise rehabilitation significantly enhanced cardiopulmonary endurance(SMD=0.856,P=0.002),and the effect was better when the single exercise duration was more than 1 hour,age was over 65 years,and the intervention period was more than 3 months.CONCLUSION Exercise rehabilitation effectively improved muscle function in NSCLC patients,especially strength training,respiratory training,and cross-training.Cardiopulmonary function also showed improvement,particularly when exercise duration exceeded 1 hour,age was≥65 years,and the intervention period was more than 3 months.A single exercise duration of more than 0.5 hours can enhance patients’physical endurance.Appropriately increasing exercise duration and selecting suitable exercise forms can effectively improve the physical activity of NSCLC patients.

Research Progress of PTCH1 Gene in Lung cancer

Background:The PTCH1 gene,also known as Patched 1,is located on the long arm of human chromosome 9(9q22.3).It encodes the PTCH1 protein,which is a critical transmembrane receptor within the Hedgehog signaling pathway(Hh),playing a pivotal role in cellular communication and developmental processes.Recent studies have highlighted the significance of mutations in PTCH1 in the pathogenesis of lung cancer,positioning it as a crucial molecule for investigation in oncology.Purpose:This review aims to elucidate the role of the PTCH1 and the Hedgehog pathway in the initiation,progression,and potential treatment of lung cancer,thereby providing a theoretical foundation for personalized and precise therapeutic strategies.Method:To ensure a comprehensive review,this study systematically searched for literature related to the PTCH1,lung cancer,and the Hedgehog pathway across multiple databases including PubMed,Web of Science,and CNKI(China National Knowledge Infrastructure).The search strategy involved using specific keywords and advanced filtering options to include the most relevant and recent studies.Initial screening excluded irrelevant articles,followed by a detailed evaluation of the selected studies based on their scientific quality and relevance.Results:This review indicated that specific mutations in the PTCH1 gene are closely associated with the onset and progression of lung cancer.These mutations impede normal Hedgehog signaling,leading to unregulated cell proliferation and tumor growth.Targeting PTCH1,including vismodegib,have shown efficacy in clinical cases,particularly in SCCL with specific PTCH1 mutations,leading to complete remissions.Furthermore,the interaction between PTCH1 and microRNA-212 suggests potential therapeutic approaches by targeting miRNA to regulate PTCH1 expression.In addition,the investigation of traditional Chinese medicines such as Ginsenosides and Cordyceps sinensis extracts has shown their potential to modulate the Hedgehog pathway and reverse drug resistance.Conclusions:An in-depth understanding of the precise mechanisms by which PTCH1 mutations promote lung cancer could facilitate the development of targeted therapies.This study highlights the potential of PTCH1 as a biomarker for diagnosis and a target for precision medicine in lung cancer treatment,advocating for further research into its molecular pathways and therapeutic applications.

Enhanced recovery after surgery in elderly patients with non-small cell lung cancer who underwent video-assisted thoracic surgery

BACKGROUND This study was designed to investigate the clinical outcomes of enhanced recovery after surgery(ERAS)in the perioperative period in elderly patients with nonsmall cell lung cancer(NSCLC).AIM To investigate the potential enhancement of video-assisted thoracic surgery(VATS)in postoperative recovery in elderly patients with NSCLC.METHODS We retrospectively analysed the clinical data of 85 elderly NSCLC patients who underwent ERAS(the ERAS group)and 327 elderly NSCLC patients who received routine care(the control group)after VATS at the Department of Thoracic Surgery of Peking University Shenzhen Hospital between May 2015 and April 2017.After propensity score matching of baseline data,we analysed the postoperative stay,total hospital expenses,postoperative 48-h pain score,and postoperative complication rate for the 2 groups of patients who underwent lobectomy or sublobar resection.RESULTS After propensity score matching,ERAS significantly reduced the postoperative hospital stay(6.96±4.16 vs 8.48±4.18 d,P=0.001)and total hospital expenses(48875.27±18437.5 vs 55497.64±21168.63 CNY,P=0.014)and improved the satisfaction score(79.8±7.55 vs 77.35±7.72,P=0.029)relative to those for routine care.No significant between-group difference was observed in postoperative 48-h pain score(4.68±1.69 vs 5.28±2.1,P=0.090)or postoperative complication rate(21.2%vs 27.1%,P=0.371).Subgroup analysis showed that ERAS significantly reduced the postoperative hospital stay and total hospital expenses and increased the satisfaction score of patients who underwent lobectomy but not of patients who underwent sublobar resection.CONCLUSION ERAS effectively reduced the postoperative hospital stay and total hospital expenses and improved the satisfaction score in the perioperative period for elderly NSCLC patients who underwent lobectomy but not for patients who underwent sublobar resection.

Secondary metabolites of mulberry leaves exert anti-lung cancer activity through regulating the PD-L1/PD-1 signaling pathway

Lung cancer ranks the top of malignancies that cause cancer-related deaths worldwide.The leaves of Morus alba L are traditional Chinese medicine widely applied in respiratory diseases.Our previous work has demonstrated the anti-lung cancer effect of secondary metabolites of mulberry leaf,but their mechanism of action has still not fully elucidated.We synthesized Moracin N(MAN)-Probe conjugated with alkyne to label lung cancer cells and identified protein targets by chemical proteomic analysis.MAN and its probe exerted similar growth-inhibitory effect on human lung cancer cells.Chemical proteomic results showed that MAN targeted the programmed death ligand 1(PD-L1)checkpoint pathway and T cell receptor(TCR)signaling pathway,indicating its immune-regulatory function.Cell-free surface plasmon resonance(SPR)results showed the direct interaction of MAN with PD-L1 protein.Molecular docking analysis demonstrated that MAN bound to E158 residue of PD-L1 protein.MAN downregulated the expression levels of PD-L1 in a time-and dose-dependent manner and disrupted the PD-L1/programmed death 1(PD-1)binding,including other secondary metabolites of mulberry leaves Guangsangon E(GSE)and Chalcomoracin(CMR).Human peripheral blood mononuclear cells(PBMCs)co-cultured with MAN-treated A549 cells,resulting in the increase of CD8^(+)GZMB^(+)T cells and the decrease of CD8^(+)PD-1^(+)T cells.It suggested that MAN exerts anti-cancer effect through blocking the PD-L1/PD-1 signaling.In vivo,MAN combined with anti-PD-1 antibody significantly inhibited lung cancer development and metastasis,indicating their synergistic effect.Taken together,secondary metabolites of mulberry leaves target the PD-L1/PD-1 signaling,enhance T cell-mediated immunity and inhibit the tumorigenesis of lung cancer.Their modulatory effect on tumor microenvironment makes them able to enhance the therapeutic efficacy of immune checkpoint inhibitors in lung cancer.

Bronchoalveolar lavage fluid assessment facilitates precision medicine for lung cancer

Lung cancer is the most common and fatal malignant disease worldwide and has the highest mortality rate among tumor-related causes of death.Early diagnosis and precision medicine can significantly improve the survival rate and prognosis of lung cancer patients.At present,the clinical diagnosis of lung cancer is challenging due to a lack of effective non-invasive detection methods and biomarkers,and treatment is primarily hindered by drug resistance and high tumor heterogeneity.Liquid biopsy is a method for detecting circulating biomarkers in the blood and other body fluids containing genetic information from primary tumor tissues.Bronchoalveolar lavage fluid(BALF)is a potential liquid biopsy medium that is rich in a variety of bioactive substances and cell components.BALF contains information on the key characteristics of tumors,including the tumor subtype,gene mutation type,and tumor environment,thus BALF may be used as a diagnostic supplement to lung biopsy.In this review,the current research on BALF in the diagnosis,treatment,and prognosis of lung cancer is summarized.The advantages and disadvantages of different components of BALF,including cells,cell-free DNA,extracellular vesicles,and micro RNA are introduced.In particular,the great potential of extracellular vesicles in precision diagnosis and detection of drug-resistant for lung cancer is highlighted.In addition,the performance of liquid biopsies with different body fluid sources in lung cancer detection are compared to facilitate more selective studies involving BALF,thereby promoting the application of BALF for precision medicine in lung cancer patients in the future.

Influence of initial check, information exchange, final accuracy check, reaction information nursing on the psychology of elderly with lung cancer

BACKGROUND As one of the fatal diseases with high incidence,lung cancer has seriously endangered public health and safety.Elderly patients usually have poor self-care and are more likely to show a series of psychological problems.AIM To investigate the effectiveness of the initial check,information exchange,final accuracy check,reaction(IIFAR)information care model on the mental health status of elderly patients with lung cancer.METHODS This study is a single-centre study.We randomly recruited 60 elderly patients with lung cancer who attended our hospital from January 2021 to January 2022.These elderly patients with lung cancer were randomly divided into two groups,with the control group taking the conventional propaganda and education and the observation group taking the IIFAR information care model based on the conventional care protocol.The differences in psychological distress,anxiety and depression,life quality,fatigue,and the locus of control in psychology were compared between these two groups,and the causes of psychological distress were analyzed.RESULTS After the intervention,Distress Thermometer,Hospital Anxiety and Depression Scale(HADS)for anxiety and the HADS for depression,Revised Piper’s Fatigue Scale,and Chance Health Locus of Control scores were lower in the observation group compared to the pre-intervention period in the same group and were significantly lower in the observation group compared to those of the control group(P<0.05).After the intervention,Quality of Life Questionnaire Core 30(QLQ-C30),Internal Health Locus of Control,and Powerful Others Health Locus of Control scores were significantly higher in the observation and the control groups compared to the pre-intervention period in their same group,and QLQ-C30 scores were significantly higher in the observation group compared to those of the control group(P<0.05).CONCLUSION The IIFAR information care model can help elderly patients with lung cancer by reducing their anxiety and depression,psychological distress,and fatigue,improving their tendencies on the locus of control in psychology,and enhancing their life qualities.

Efficacy and safety of dacomitinib as first-line treatment for advanced non-small cell lung cancer patients with epidermal growth factor receptor 21L858R mutation:A multicenter,case-series study in China

Objective:To provide real-world evidence for the application of first-line dacomitinib treatment for epidermal growth factor receptor(EGFR)21L858R mutant non-small cell lung cancer(NSCLC)patients in China and to explore the factors influencing the efficacy and safety.Methods:A longitudinal,consecutive case-series,multicenter study with mixed prospective and retrospective data was conducted.The primary endpoint was progression-free survival(PFS),and the secondary endpoints included duration of treatment(DOT),overall survival(OS),objective response rate(ORR),disease control rate(DCR)and safety.Results:A total of 155 EGFR 21L858R mutant patients treated with first-line dacomitinib were included.The median follow-up time for these patients was 20.4 months.Among 134 patients with evaluable lesions,the ORR was 70.9%and the DCR was 96.3%.The median PFS was 16.3[95%confidence interval(95%CI),13.7−18.9]months.Multivariate Cox regression analysis suggested that the baseline brain metastasis(BM)status[with vs.without BM:hazard ratio(HR),1.331;95%CI,0.720−2.458;P=0.361]and initial doses(45 mg vs.30 mg:HR,0.837;95%CI,0.427−1.641;P=0.604)did not significantly affect the median PFS.The median DOT was 21.0(95%CI,17.5−24.6)months and the median OS was not reached.Genetic tests were performed in 64 patients after progression,among whom 29(45.3%)patients developed the EGFR 20T790M mutation.In addition,among the 46 patients who discontinued dacomitinib treatment after progression,31(67.4%)patients received subsequent third-generation EGFR-tyrosine kinase inhibitors.The most common grade 3−4 adverse events were rash(10.4%),diarrhea(9.1%),stomatitis(7.1%)and paronychia(4.5%).The incidence of grade 3−4 rash was significantly higher in the 45 mg group than that in the 30 mg group(21.9%vs.7.5%,P=0.042).Conclusions:First-line dacomitinib treatment demonstrated promising efficacy and tolerable adverse events among EGFR 21L858R mutant NSCLC patients in China.

Multilevel Attention Unet Segmentation Algorithmfor Lung Cancer Based on CT Images

Lung cancer is a malady of the lungs that gravely jeopardizes human health.Therefore,early detection and treatment are paramount for the preservation of human life.Lung computed tomography(CT)image sequences can explicitly delineate the pathological condition of the lungs.To meet the imperative for accurate diagnosis by physicians,expeditious segmentation of the region harboring lung cancer is of utmost significance.We utilize computer-aided methods to emulate the diagnostic process in which physicians concentrate on lung cancer in a sequential manner,erect an interpretable model,and attain segmentation of lung cancer.The specific advancements can be encapsulated as follows:1)Concentration on the lung parenchyma region:Based on 16-bit CT image capturing and the luminance characteristics of lung cancer,we proffer an intercept histogram algorithm.2)Focus on the specific locus of lung malignancy:Utilizing the spatial interrelation of lung cancer,we propose a memory-based Unet architecture and incorporate skip connections.3)Data Imbalance:In accordance with the prevalent situation of an overabundance of negative samples and a paucity of positive samples,we scrutinize the existing loss function and suggest a mixed loss function.Experimental results with pre-existing publicly available datasets and assembled datasets demonstrate that the segmentation efficacy,measured as Area Overlap Measure(AOM)is superior to 0.81,which markedly ameliorates in comparison with conventional algorithms,thereby facilitating physicians in diagnosis.

Imbalance of Circulating Follicular Regulatory and Follicular Helper T Cell Subpopulations Is Associated with Disease Progression and Serum CYFRA 21-1 Levels in Patients with Non-small Cell Lung Cancer

Objective This study aimed to investigate the changes of follicular helper T(TFH)and follicular regulatory T(TFR)cell subpopulations in patients with non-small cell lung cancer(NSCLC)and their significance.Methods Peripheral blood was collected from 58 NSCLC patients at different stages and 38 healthy controls.Flow cytometry was used to detect TFH cell subpopulation based on programmed death 1(PD-1)and inducible co-stimulator(ICOS),and TFR cell subpopulation based on cluster determinant 45RA(CD45RA)and forkhead box protein P3(FoxP3).The levels of interleukin-10(IL-10),interleukin-17a(IL-17a),interleukin-21(IL-21),and transforming growth factor-β(TGF-β)in the plasma were measured,and changes in circulating B cell subsets and plasma IgG levels were also analyzed.The correlation between serum cytokeratin fragment antigen 21-1(CYFRA 21-1)levels and TFH,TFR,or B cell subpopulations was further explored.Results The TFR/TFH ratio increased significantly in NSCLC patients.The CD45RA^(+)FoxP3^(int) TFR subsets were increased,with their proportions increasing in stages Ⅱ to Ⅲ and decreasing in stage IV.PD-1^(+)ICOS+TFH cells showed a downward trend with increasing stages.Plasma IL-21 and TGF-β concentrations were increased in NSCLC patients compared with healthy controls.Plasmablasts,plasma IgG levels,and CD45RA^(+)FoxP3^(int) TFR cells showed similar trends.TFH numbers and plasmablasts were positively correlated with CYFRA 21-1 in stages Ⅰ-Ⅲ and negatively correlated with CYFRA 21-1 in stage IV.Conclusion Circulating TFH and TFR cell subpopulations and plasmablasts dynamically change in different stages of NSCLC,which is associated with serum CYFRA 21-1 levels and reflects disease progression.

Nursing effect of narrative nursing intervention on postoperative patients with severe lung cancer

BACKGROUND Lung cancer is a common disease with high mortality,and psychological support is very important in the diagnosis and treatment of postoperative patients with cancer pain.AIM To explore the application effect of the narrative nursing method in postoperative lung cancer patients in the intensive care unit.METHODS A total of 120 patients diagnosed with lung cancer and experiencing cancer-related pain were randomly allocated into two groups:an observation group and a control group,each consisting of 60 cases.The control group was given routine analgesic and psychological care,while the research group applied the five-step narrative nursing method based on routine care,comparing the visual analogue scale scores,sleep status,anxiety and depression status,and quality of life of the two groups of patients before and after the intervention.RESULTS The pain scores,anxiety scores,and depression scores of the study group were lower than those of the control group after the intervention using the narrative nursing method,and the difference was statistically significant(P<0.05).CONCLUSION Using narrative nursing methods to intervene in patients with lung cancer combined with cancerous pain can help patients to correctly recognize their disease,adjust their mentality,establish confidence,alleviate patients'subjective pain feelings,and improve their adverse emotions.

Study on psychological resilience and associated influencing factors in lung cancer patients with bone metastases

BACKGROUND Evaluating the psychological resilience of lung cancer(LC)patients helps understand their mental state and guides future treatment.However,there is limited research on the psychological resilience of LC patients with bone me-tastases.AIM To explore the psychological resilience of LC patients with bone metastases and identify factors that may influence psychological resilience.METHODS LC patients with bone metastases who met the inclusion criteria were screened from those admitted to the Third Affiliated Hospital of Wenzhou Medical University.The psychological scores of the enrolled patients were collected.They were then grouped based on the mean psychological score:Those with scores lower than the mean value were placed in the low-score group and those with scores equal to or greater than the mean value was placed in the high-score group.The baseline data(age,gender,education level,marital status,residence,monthly income,and religious beliefs),along with self-efficacy and medical coping mode scores,were compared.RESULTS This study included 142 LC patients with bone metastases admitted to our hospital from June 2022 to December 2023,with an average psychological resilience score of 63.24±9.96 points.After grouping,the low-score group consisted of 69 patients,including 42 males and 27 females,with an average age of 67.38±9.55 years.The high-score group consisted of 73 patients,including 49 males and 24 females,with a mean age of 61.97±5.00 years.χ2 analysis revealed significant differences between the two groups in education level(χ2=6.604,P=0.037),residence(χ2=12.950,P=0.002),monthly income(χ2=9.375,P=0.009),and medical coping modes(χ2=19.150,P=0.000).Independent sample t-test showed that the high-score group had significantly higher self-efficacy scores(t=3.383,P=0.001)and lower age than the low-score group(t=4.256,P<0.001).Furthermore,multivariate logistic regression hazard analysis confirmed that self-efficacy is an independent protective factor for psychological resilience[odds ratio(OR)=0.926,P=0.035,95%confidence interval(CI):0.862-0.995],while age(OR=1.099,P=0.003,95%CI:1.034-1.169)and medical coping modes(avoidance vs confrontation:OR=3.767,P=0.012,95%CI:1.342-10.570;resignation vs confrontation:OR=5.687,P=0.001,95%CI:1.974-16.385)were identified as independent risk factors.A predictive model based on self-efficacy,age,and medical coping modes was developed.The receiver operating characteristic analysis showed an area under the curve value of 0.778(95%CI:0.701-0.856,P<0.001),indicating that the model has good predictive performance.CONCLUSION LC patients with bone metastases are less psychologically resilient than the general population.Factors such as self-efficacy,age,and medical coping modes influence their psychological resilience.Patients with low self-efficacy,old age,and avoidance/resignation coping modes should be closely observed.

Cancer-educated neutrophils promote lung cancer progression via PARP-1-ALOX5-mediated MMP-9 expression

Objective:Neutrophils are one of the most predominant infiltrating leukocytes in lung cancer tissues and are associated with lung cancer progression.How neutrophils promote lung cancer progression,however,has not been established.Methods:Kaplan–Meier plotter online analysis and tissue immunohistochemistry were used to determine the relationship between neutrophils and overall survival in lung cancer patients.The effect of neutrophils on lung cancer was determined using the Transwell migration assay,a proliferation assay,and a murine tumor model.Gene knockdown was used to determine poly ADPribose polymerase(PARP)-1 function in lung cancer-educated neutrophils.Western blot analysis and gelatin zymography were used to demonstrate the correlation between PARP-1 and matrix metallopeptidase 9(MMP-9).Immunoprecipitation coupled to mass spectrometry(IP/MS)was used to identify the proteins interacting with PARP-1.Co-immunoprecipitation(Co-IP)was used to confirm that PARP-1 interacts with arachidonate 5-lipooxygenase(ALOX5).Neutrophil PARP-1 blockage by AG14361 rescued neutrophil-promoted lung cancer progression.Results:An increased number of infiltrating neutrophils was negatively associated with overall survival in lung cancer patients(P<0.001).Neutrophil activation promoted lung cancer cell invasion,migration,and proliferation in vitro,and murine lung cancer growth in vivo.Mechanistically,PARP-1 was shown to be involved in lung cancer cell-induced neutrophil activation to increase MMP-9 expression through interacting and stabilizing ALOX5 by post-translational protein modification(PARylation).Blocking PARP-1 by gene knockdown or AG14361 significantly decreased ALOX5 expression and MMP-9 production,and eliminated neutrophil-mediated lung cancer cell invasion and in vivo tumor growth.Conclusion:We identified a novel mechanism by which PARP-1 mediates lung cancer cell-induced neutrophil activation and PARylates ALOX5 to regulate MMP-9 expression,which exacerbates lung cancer progression.

Enhancing Early Detection of Lung Cancer through Advanced Image Processing Techniques and Deep Learning Architectures for CT Scans

Lung cancer remains a major concern in modern oncology due to its high mortality rates and multifaceted origins,including hereditary factors and various clinical changes.It stands as the deadliest type of cancer and a significant cause of cancer-related deaths globally.Early diagnosis enables healthcare providers to administer appropriate treatment measures promptly and accurately,leading to improved prognosis and higher survival rates.The significant increase in both the incidence and mortality rates of lung cancer,particularly its ranking as the second most prevalent cancer among women worldwide,underscores the need for comprehensive research into efficient screening methods.Advances in diagnostic techniques,particularly the use of computed tomography(CT)scans,have revolutionized the identification of lung cancer.CT scans are renowned for their ability to provide high-resolution images and are particularly effective in detecting small,calcified areas,crucial for identifying earlystage lung cancer.Consequently,there is growing interest in enhancing computer-aided detection(CAD)systems.These algorithms assist radiologists by reducing false-positive interpretations and improving the accuracy of early cancer diagnosis.This study aims to enhance the effectiveness of CAD systems through various methods.Initially,the Contrast Limited Adaptive Histogram Equalization(CLAHE)algorithm is employed to preprocess CT scan images,thereby improving their visual quality.Further refinement is achieved by integrating different optimization strategies with the CLAHE method.The CutMix data augmentation technique is applied to boost the performance of the proposed model.A comparative analysis is conducted using deep learning architectures such as InceptionV3,ResNet101,Xception,and EfficientNet.The study evaluates the performance of these architectures in image classification tasks,both with and without the implementation of the CLAHE algorithm.The empirical findings of the study demonstrate a significant reduction in the false positive rate(FPR)and an overall enhancement in diagnostic accuracy.This research not only contributes to the field of medical imaging but also holds significant implications for the early detection and treatment of lung cancer,ultimately aiming to reduce its mortality rates.

Clinical and molecular significance of homologous recombination deficiency positive non-small cell lung cancer in Chinese population:An integrated genomic and transcriptional analysis

Objective:The clinical significance of homologous recombination deficiency(HRD)in breast cancer,ovarian cancer,and prostate cancer has been established,but the value of HRD in non-small cell lung cancer(NSCLC)has not been fully investigated.This study aimed to systematically analyze the HRD status of untreated NSCLC and its relationship with patient prognosis to further guide clinical care.Methods:A total of 355 treatment-naïve NSCLC patients were retrospectively enrolled.HRD status was assessed using the AmoyDx Genomic Scar Score(GSS),with a score of≥50 considered HRD-positive.Genomic,transcriptomic,tumor microenvironmental characteristics and prognosis between HRD-positive and HRDnegative patients were analyzed.Results:Of the patients,25.1%(89/355)were HRD-positive.Compared to HRD-negative patients,HRDpositive patients had more somatic pathogenic homologous recombination repair(HRR)mutations,higher tumor mutation burden(TMB)(P<0.001),and fewer driver gene mutations(P<0.001).Furthermore,HRD-positive NSCLC had more amplifications in PI3K pathway and cell cycle genes,MET and MYC in epidermal growth factor receptor(EGFR)/anaplastic lymphoma kinase(ALK)mutant NSCLC,and more PIK3CA and AURKA in EGFR/ALK wild-type NSCLC.HRD-positive NSCLC displayed higher tumor proliferation and immunosuppression activity.HRD-negative NSCLC showed activated signatures of major histocompatibility complex(MHC)-II,interferon(IFN)-γand effector memory CD8+T cells.HRD-positive patients had a worse prognosis and shorter progressionfree survival(PFS)to targeted therapy(first-and third-generation EGFR-TKIs)(P=0.042).Additionally,HRDpositive,EGFR/ALK wild-type patients showed a numerically lower response to platinum-free immunotherapy regimens.Conclusions:Unique genomic and transcriptional characteristics were found in HRD-positive NSCLC.Poor prognosis and poor response to EGFR-TKIs and immunotherapy were observed in HRD-positive NSCLC.This study highlights potential actionable alterations in HRD-positive NSCLC,suggesting possible combinational therapeutic strategies for these patients.