Multidetector CT angiography with volumetric three-dimentional rendering to evaluate bronchial arteries in primary lung cancer

Objective：To evaluate the imageologic characteristics of the bronchial arteries （BAs） in primary lung cancer （PLC）with multidetector CT （MDCT）angiography. Methods： Thin-section enhanced CT scanning （with an Toshiba Aquilion 16 scanner） was performed in 164 PLC patients, of whom 123 were confirmed by pathology and the remaining 41 were confirmed by typical radiological and clinical findings. Another 46 patients with normal thoracic CT presentations were served as control. Three-dimensional （3D） images of the BAs were processed at workstation （Vitrea 2, Vital Corp, USA）. Spatial anatomical characters of the BAs were observed using volume rendering （VR） and multiplanar reconstruction （MPR） or maximum intensity projection （MIP）. Results： At least one bronchial artery was displayed clearly on VR in 152 （92.7%） of the 164 PLC patients and 32 （69.6%） of the 46 controls. There were 48. 92% of the right BAs originating from the descending aorta and 46. 24% from the right intercostal artery. 97.53% of the left BAs originated from the descending aorta, and 94.87% of the common trunk from the descending aorta. There were 10 distribution patterns of the BAs, with one on the right and one on the left predominating （48. 68%）. More BA branches were found to reach far from the segmental bronchi or enter into the lesions in the PLC group than those in the control group （25.8% vs 1.7% ）, and also the ipsilateral side of the PLC than the contralateral side （40% vs 8. 8%）. The diameter and the total transaxial areas of the BAs on the ipsilateral side of the PLC lesions were significantly larger than those on the contralateral side or those of the control group （P〈0. 05）. Conclusion：The anatomic characters and pathologic changes can be depicted in vivo stereographically and clearly by CTA with volumetric 3D rendering. Dilation of the BAs and increase of total blood flow in patients with PLC can be evaluated quantitatively, which may be useful in the diagnosis and assessment of PLC, and have the potential to increase the safety and effect of interventional therapy.

Surgical Treatment and Prognosis of Synchronous Double Primary Lung Cancer： a Report of 31 Cases

OBJECTIVE The concept of double primary lung cancer （DPLC） has been generally accepted. Recently, an increasing incidence of synchronous DPLC has been reported, while the diagnostic standard and treatment strategies remain to be improved. This study was conducted to investigate effective surgical treatment and prognosis of synchronous DPLC. METHODS From January 1983 to April 2004, 31 patients with synchronous DPLC were operated in our department. Clinical data, such as surgical pattern, postoperative complications, and survival status, of all these patients were reviewed retrospectively. RESULTS The 31 patients with synchronous DPLC accounted for 0.67% of all the 4,649 patients operated for primary lung cancer in our department during the same period. Both tumors of the synchronous DPLC were resected with Iobectomy or pneumonectomy in 12 patients, while among the other 19 patients at least 1 tumor was treated with partial pulmonary resection. The postoperative morbidity was 29%（9/31）, including 1 case of respiratory insufficiency, 3 cases of atelectasis, 2 cases of atrial fibrillation, 1 case of haemoptysis, 1 case of pleural effusion, and 1 case of wound fat necrosis. No deaths occurred during the operations or within 30 days postoperatively. The postoperative 1 -, 3-, and 5-year survival rates were 52%, 29%, and 20%, respectively. CONCLUSION The incidence of synchronous DPLC is low. An aggressive and reasonable surgical approach can achieve a satisfactory outcome in patients with synchronous DPLC. The postoperative morbidity is low. Some patients might achieve long-term survival.

Simultaneous Bilateral Thoracoscopic Pneumonectomy for Early Multiple Primary Lung Cancer Feasibility Analysis

Objective:To analyze the feasibility of simultaneous bilateral thoracoscopic lung resection in the treatment of multiple primary lung cancers in the early stage.Methods:The study time range is between March 2019 and March 2021.A sample of 30 patients with early multiple primary lung cancer admitted to this hospital were included,and they were divided into a study group,a control group,and samples within the group using a random number table scheme n=15,patients in the control group underwent staged bilateral thoracoscopic pneumonectomy,and patients in the study group underwent bilateral thoracoscopic pneumonectomy at the same time.The indicators of the two groups were compared and analyzed.Results:There was no significant difference in the operation time and intraoperative blood loss between the two groups(P>0.05).There were significant differences in the VAS score,total length of hospital stay,and total surgical costs on the first day after surgery(P<0.05);there was no significant difference in the two groups'postoperative recovery indicators and the incidence of complications(P>0.05).Conclusion:It is safe and feasible to treat patients with multiple primary lung cancer in both lungs at the same time with simultaneous bilateral thoracoscopic surgery,and is suitable for promotion.

Increased risk of subsequent primary lung cancer among female hormone-related cancer patients:A meta-analysis based on over four million cases

Background:The incidence rate of lung cancer in women has significantly increased over the past decade,and previous evidence has indicated a significant relationship between the elevated levels of sex hormones and the risk of lung cancer.Therefore,we hypothesized that female hormone-related cancer(FHRC)patients,including breast,endometrial,cervical,and ovarian cancer patients,may experience a higher risk of developing subsequent lung cancer.This meta-analysis aimed to identify the risk of lung cancer among FHRC patients compared to the general population.Methods:The PubMed,Web of Science,EMBASE,Cochrane Library,and CNKI databases were searched up to May 11,2022.Standardized incidence ratios(SIRs)with 95%confidence intervals(CIs)were used to identify the risk of subsequent lung cancer after FHRC.Subgroup analyses based on the follow-up time and tumor type were also conducted.Results:A total of 58 retrospective cohort studies involving 4,360,723 FHRC participants were included.The pooled results demonstrated that FHRC patients had a significantly increased risk of developing subsequent primary lung cancer(SIR=1.61,95%CI:1.48-1.76,P<0.001).Subgroup analysis revealed an obvious trend of increasing lung cancer risk over time(SIRs for<5 years,≥5 years,≥10 years,≥20 years,and≥30 years after FHRC:1.32,1.59,1.57,1.68,and 1.95,respectively).In addition,subgroup analysis stratified by tumor type indicated an increased risk of developing subsequent lung cancer after breast(SIR=1.25,P<0.001),endometrial(SIR=1.40,P=0.019),cervical(SIR=2.56,P<0.001),and ovarian cancer(SIR=1.50,P=0.010).Conclusion:FHRC patients are more likely to develop lung cancer than the general population.Furthermore,the increased risk of subsequent primary lung cancer is more obvious with a longer survival time and is observed in all types of hormone-related cancer.Registration:International Platform of Registered Systematic Review and Meta-analysis Protocols:No.INPLASY202270044;https://inplasy.com/.

Inhalation treatment of primary lung cancer using liposomal curcumin dry powder inhalers

Lung cancer is the leading cause of cancer-related deaths. Traditional chemotherapy causes serious toxicity due to the wide bodily distribution of these drugs. Curcumin is a potential anticancer agent but its low water solubility, poor bioavailability and rapid metabolism significantly limits clinical applications. Here we developed a liposomal curcumin dry powder inhaler(LCD) for inhalation treatment of primary lung cancer. LCDs were obtained from curcumin liposomes after freeze-drying. The LCDs had a mass mean aerodynamic diameter of 5.81 μm and a fine particle fraction of 46.71%, suitable for pulmonary delivery. The uptake of curcumin liposomes by human lung cancer A549 cells was markedly greater and faster than that of free curcumin. The high cytotoxicity on A549 cells and the low cytotoxicity of curcumin liposomes on normal human bronchial BEAS-2B epithelial cells yielded a high selection index partly due to increased cell apoptosis. Curcumin powders, LCDs and gemcitabine were directly sprayed into the lungs of rats with lung cancer through the trachea. LCDs showed higher anticancer effects than the other two medications with regard to pathology and the expression of many cancer-related markers including VEGF, malondialdehyde, TNF-α, caspase-3 and BCL-2. LCDs are a promising medication for inhalation treatment of lung cancer with high therapeutic efficiency.

Endobronchial Metastases after Radical Resection of a Primary Lung Cancer

Endotracheal/endobronchial metastasis （EEM） generally originates from nonpulmonary malignancies such as cancers of the breast, colon, and kidney. Although the incidence of EEM has been reported to be between 2.0% and 50.0%, cases diagnosed after radical resection of primary lung cancer are extremely rare. We hereby presented a patient of squamous cell lung carcinoma who was confirmed to have EEM 3 years alter his radical resection of primary tumor.

Lack of evolutionary convergence in multiple primary lung cancer suggests insufficient specificity of personalized therapy

Multiple primary lung cancer(MPLC)is an increasingly prevalent subtype of lung cancer.According to recent genomic studies,the different lesions of a single MPLC patient exhibit functional similarities that may reflect evolutionary convergence.We perform whole-exome sequencing for a unique cohort of MPLC patients with multiple samples from each lesion found.Using our own and other relevant public data,evolutionary tree reconstruction reveals that cancer driver gene mutations occurred at the early trunk,indicating evolutionary contingency rather than adaptive convergence.Additionally,tumors from the same MPLC patient are as genetically diverse as those from different patients,while within-tumor genetic heterogeneity is significantly lower.Furthermore,the aberrant molecular functions enriched in mutated genes for a sample show a strong overlap with other samples from the same tumor,but not with samples from other tumors or other patients.Overall,there is no evidence of adaptive convergence during the evolution of MPLC.Most importantly,the similar between-tumor diversity and between-patient diversity suggest that personalized therapies may not adequately account for the genetic diversity among different tumors in an MPLC patient.To fully exploit the strategic value of precision medicine,targeted therapies should be designed and delivered on a per-lesion basis.

Risk of second primary lung cancer in patients with thyroid cancer:a meta-analysis based on big population studies

Background:Previous studies have revealed that the number of cancer survivors developing a second primary malignancy is increasing,especially among thyroid cancer patients,and lung cancer is still the main cause of cancer death.Therefore,we aimed to investigate the risk of second primary lung cancer(SPLC)in patients with thyroid cancer.Methods:We searched the PubMed,Web of Science,Embase,and Scopus databases up to November 24,2021,for relevant research and merged the standardized incidence ratios(SIRs)and 95%confidence intervals(95%CIs)to evaluate the risk of developing SPLC in patients with thyroid cancer.Results:Fourteen studies involving 1,480,816 cases were included in our meta-analysis.The pooled result demonstrated that thyroid cancer patients may have a higher risk of SPLC than the general population(SIR=1.21,95%CI:1.07-1.36,P<0.01,I^(2)=81%,P<0.01).Subgroup analysis stratified by sex indicated that female patients may have a markedly higher risk of SPLC than male patients(SIR=1.65,95%CI:1.40-1.94,P<0.01,I^(2)=75%,P<0.01).Conclusions:Thyroid cancer patients are more likely to develop SPLC than the general population,especially women.However,other risk factors must be investigated,and more prospective studies are needed to confirm our results.Registration:International Prospective Register of Systematic Reviews:No.CRD42021285399.

A pairwise radiomics algorithm–lesion pair relation estimation model for distinguishing multiple primary lung cancer from intrapulmonary metastasis

Background:Distinguishing multiple primary lung cancer(MPLC)from intrapulmonary metastasis(IPM)is critical for their disparate treatment strategy and prognosis.This study aimed to establish a non-invasive model to make the differentiation pre-operatively.Methods:We retrospectively studied 168 patients with multiple lung cancers(307 pairs of lesions)including 118 cases for modeling and internal validation,and 50 cases for independent external validation.Radiomic features on computed tomography(CT)were extracted to calculate the absolute deviation of paired lesions.Features were then selected by correlation coefficients and random forest classifier 5-fold cross-validation,based on which the lesion pair relation estimation(PRE)model was developed.A major voting strategy was used to decide diagnosis for cases with multiple pairs of lesions.Cases from another institute were included as the external validation set for the PRE model to compete with two experienced clinicians.Results:Seven radiomic features were selected for the PRE model construction.With major voting strategy,the mean area under receiver operating characteristic curve(AUC),accuracy,sensitivity,and specificity of the training versus internal validation versus external validation cohort to distinguish MPLC were 0.983 versus 0.844 versus 0.793,0.942 versus 0.846 versus 0.760,0.905 versus 0.728 versus 0.727,and 0.962 versus 0.910 versus 0.769,respectively.AUCs of the two clinicians were 0.619 and 0.580.Conclusions:The CT radiomic feature-based lesion PRE model is potentially an accurate diagnostic tool for the differentiation of MPLC and IPM,which could help with clinical decision making.

The Immunohistochemical Study of P_(53) Protein in Primary Lung Cancer

The expression of tumor suppresser gene Pproducts Pprotein in patients with primary lung cancer has been studied by ABC immunohistochemical method using McAb 1801 as probe.

Combined gastroscopic and laparoscopic resection of gastric metastatic adenosquamous carcinoma from lung: A case report

BACKGROUND Primary lung cancer is the leading cause of cancer-related death worldwide.Common metastatic sites include the brain,liver,bones,and adrenal glands.However,gastric metastases from lung cancer are rare.This case may be the first report of a combined gastroscopic and laparoscopic resection for gastric metasta-tic adenosquamous carcinoma(ASC).CASE SUMMARY We report a case of gastric metastasis from lung cancer.The patient was a 61-year-old Han Chinese female who first attended our hospital complaining of a per-sistent cough,leading to the diagnosis of advanced-stage lung adenocarcinoma.After more than four years of chemotherapy,the patient began to experience epi-gastric pain.Endoscopy was performed,and pathological examination of biopsy specimens confirmed that the gastric lesion was a metastasis from lung cancer.The lesion was successfully resected by combined gastroscopy and laparoscopy.Histopathological examination of the resected gastric specimen revealed ASC.CONCLUSION Gastric metastases from lung cancer are rare.Endoscopy,histological and immunohistochemical staining are useful for diagnosing metastatic lesions.Surgical management may provide extended survival in appropriately selected patients.

Understanding gastric metastasis of small cell lung carcinoma:Insights from case reports and clinical implications

Small cell lung cancer(SCLC)is a common type of primary lung cancer that contributes to approximately 15%of cases.It is closely associated with tobacco risk factors.It is also known as a type of lung cancer that has a high mortality rate within a short time due to its rapid growth rate(with tumor doubling time of 30 days)and its tendency to metastasize early in the disease process.The primary sites of metastasis in SCLC are similar to those in other primary lung cancers and often include the brain,bones,adrenal glands,liver,and lymph nodes.However,there are a few clinical reports of uncommon metastases,such as gastric metastasis from SCLC.Although the incidence of this clinical presentation is very low,reported cases have generally resulted in early mortality due to inadequate treatment.The purpose of this letter is to discuss the knowledge related to gastric metastasis from SCLC and remind clinical doctors not to miss atypical symptoms,thereby providing the right attitude to improve the prognosis for these patients.