Synchronous manifestation of colorectal cancer and intraductal papillary mucinous neoplasms

High rates of extrapancreatic malignancies,in particular colorectal cancer(CRC),have been detected in patients with intraductal papillary mucinous neoplasm(IPMN).So far,there is no distinct explanation in the literature for the development of secondary or synchronous malignancies in patients with IPMN.In the past few years,some data related to common genetic alterations in IPMN and other affiliated cancers have been published.This review elucidated the association between IPMN and CRC,shedding light on the most relevant genetic alterations that may explain the possible relationship between these entities.In keeping with our findings,we suggested that once the diagnosis of IPMN is made,special consideration of CRC should be undertaken.Presently,there are no specific guidelines regarding colorectal screening programs for patients with IPMN.We recommend that patients with IPMNs are at high-risk for CRC,and a more rigorous colorectal surveillance program should be implemented.

Molecular features of gastroenteropancreatic neuroendocrine carcinoma: A comparative analysis with lung neuroendocrine carcinoma and digestive adenocarcinomas

Objective: There is an ongoing debate about whether the management of gastroenteropancreatic(GEP)neuroendocrine carcinoma(NEC) should follow the guidelines of small-cell lung cancer(SCLC). We aim to identify the genetic differences of GEPNEC and its counterpart.Methods: We recruited GEPNEC patients as the main cohort, with lung NEC and digestive adenocarcinomas as comparative cohorts. All patients undergone next-generation sequencing(NGS). Different gene alterations were compared and analyzed between GEPNEC and lung NEC(LNEC), GEPNEC and adenocarcinoma to yield the remarkable genes.Results: We recruited 257 patients, including 99 GEPNEC, 57 LNEC, and 101 digestive adenocarcinomas.Among the mutations, KRAS, RB1, TERT, IL7R, and CTNNB1 were found to have different gene alterations between GEPNEC and LNEC samples. Specific genes for each site were revealed: gastric NEC(TERT amplification),colorectal NEC(KRAS mutation), and bile tract NEC(ARID1A mutation). The gene disparities between small-cell NEC(SCNEC) and large-cell NEC(LCNEC) were KEAP1 and CDH1. Digestive adenocarcinoma was also compared with GEPNEC and suggested RB1, APC, and KRAS as significant genes. The TP53/RB1 mutation pattern was associated with first-line effectiveness. Putative targetable genes and biomarkers in GEPNEC were identified in22.2% of the patients, and they had longer progression-free survival(PFS) upon targetable treatment [12.5 months vs. 3.0 months, HR=0.40(0.21-0.75), P=0.006].Conclusions: This work demonstrated striking gene distinctions in GEPNEC compared with LNEC and adenocarcinoma and their clinical utility.

The Clinical Usefulness of ^(99m)Tc-Tetrofosmin Scintigraphy in the Diagnosis of Lung Neoplasmas and Mediastinal Lymphoid Node Involvement

In order to investigate the clinical significance of 99mTc-Tetrofosmin （TF） scintigraphy in the evaluation of lung cancer and mediastinal lymphoid node involvement, 33 patients with pulmo- nary neoplasmas were subjected to both 99mTc-TF scintigraphies and CT scans in one week before their operations or puncturations. All the images were judged visually and the emission images were analyzed with semi-quantitative methods in addition. The results of each group were compared. There was marked difference in target/non-target （T/N） ratio between the lung cancer group and the benign lesion group （P〈0.001）. Moreover, in the lung cancer group, T/N ratio in tomographies was signifi- cantly higher than that in planar images （P〈0.01）. The sensitivity and accuracy of semi-quantitative analysis in 99mTc-TF SPECT were significantly higher than those of CT in the diagnosis of pulmonary neoplasmas （P〈0.05 and P〈0.01 respectively）, so was the sensitivity of 99mTc-TF SPECT vs CT in the diagnosis of mediastinal lymphoid node metastasis （P〈0.05）. It was also found that epidermoid squamous cell carcinomas and adenocarcinomas had a higher T/N ratio than in small cell carcinomas （P〈0.05）, and 2 h washout rate （WR） of adenocarcinomas was higher than that of epidermoid squamous cell carcinomas （P〈0.05）. In conclusion, 99mTc-TF scintigraphy showed a favorable diag- nostic accuracy in appraising lung cancers and mediastinal lymph node metastases. Furthermore semi-quantitative technology can improve the accuracy, and is potential to offer some information about histological type of the cancer tissue. Therefore, 99mTc-TF scintigraphy will be a useful tool in the diagnosis and staging of lung cancer.

Association of genetic polymorphisms of GSTM1 and smoking status with lung cancer risk

Objective Long-term cigarette smoke exposure damages the airway epithelium.However,the correlation among GSTM1 gene polymorphism,smoking status,and lung cancer susceptibility remains unclear.This study aimed to identify the genetic polymorphism of GSTM1 and examine the association of GSTM1 polymorphism and smoking history with lung cancer susceptibility.Methods The genetic polymorphism of GSTM1 was genotyped by polymerase chain reaction(PCR) in 217 lung cancer patients and 198 controls.The demographic data and smoking history of the patients were collected.The age,sex,and residence of the two groups were also obtained.Results Significant differences in GSTM1 polymorphism were observed between the case and control groups(P=0.024).Smoking time and smoking index were significantly different between the case and control groups.With the increase in smoking time and smoking index,the differences became more obvious.There was a synergistic effect between GSTM1 and smoking(S=3.35).The risk of developing lung cancer increased 4.82 fold in smokers carrying deficient-type GSTM1.Compared with patients carrying wild-type GSTM1,the risk of developing lung cancer was higher in those carrying deficient-type GSTM1 with the increase in smoking time and smoking index.In different pathological types,no significant differences were observed in GSTM1 polymorphism.In different pathological types,the proportions of patients increased with the increase in smoking time and smoking index,especially the proportion of patients with squamous cell carcinoma.Compared with wild-type GSTM1,the proportion of patients with deficient-type GSTM1 increased with the increase in smoking time and smoking index(P=0.003 and 0.017).This trend was mainly observed in those with squamous cell carcinoma.Conclusion GSTM1 mutation is associated with lung cancer susceptibility.Smokers carrying deficienttype GSTM1 are more likely to develop lung cancer.Compared with patients carrying wild-type GSTM1,smokers with deficient-type GSTM1 are more likely develop lung cancer when smoking time is more than 30 years and smoking index is more than 400.In patients carrying deficient-type GSTM1,the risk of developing squamous cell carcinoma increases with an increase in smoking time and smoking dose.

GLTSCR1, ATM, PPPIR13L and CD3EAP Genetic Variants and Lung Cancer Risk in a Chinese Population

Genetic variants in glioma tumor suppressor candidate region gene 1 （GLTSCR1） and ATM serine/threonine kinase （ATM） have been associated with various cancer risks. Epidemiological studies also revealed the association of variants of GLTSCR1 and ATM genes with different brain tumors. However, little is known about the relationship between both gene polymorphisms and lung cancer risk. We conducted a Chinese hospital-based casecontrol study involving 384 lung cancer cases and 387 cancer-free controls. No significant differences in the single polymorphism （GLTSCR1 rs1035938 and ATM rs11212592） association were found in five genetic models （co-dominant, dominant, recessive, overdominant and log-additive models） （adjusted by smoking duration）. Join effect of three SNPs （PPPIR13L rs1970764, CD3EAP rs967591, GLTSCR1 rs1035938） on chromosome 19q 13.3 showed that the designated haplotype2 （rs 1970764 G-rs967591 A-rs 1035938 C） [OR （95% CI）=1.60 （1.11-2.32）, P=0.012] and haplotype8 （rs 1970764 G-rs967591 G-rs 1035938 T） [OR （95% CI）=2.45 （1.17-5.12）, P=0.018] were associated with increased risk of lung cancer （adjusted by smoking duration）. The analysis ofmultifactor dimensionality reduction revealed that two 3-way models were the best fit models in analyses of 2 loci （P〈0.001） or 4 loci （P=0.015-0.016）. The entropy-based analysis indicated the strongest synergistic effect between PPPIR13L rs1970764 and ATM rs11212592 in analysis of four genes. In conclusion, our study suggests that haplotypes consisting of PPPIR13L rs1970764- CD3EAP rs967591-GLTSCR1 rs1035938 on Chr19q13.3, interaction of smoking and GLTSCR1 rs1035938-ATM rs11212592, and synergistic action of PPPIR13L rs1970764 and ATM rs 11212592 may associate with lung cancer risk in the Chinese population.

Lung cancer risk in never-smokers:An overview of environmental and genetic factors

Lung cancer is the leading cause of cancer-related mortality globally,accounting for 1.8 million deaths in 2020.While the vast majority are caused by tobacco smoking,15%-25%of all lung cancer cases occur in lifelong neversmokers.The International Agency for Research on Cancer(IARC)has classified multiple agents with sufficient evidence for lung carcinogenesis in humans,which include tobacco smoking,as well as several environmental exposures such as radon,second-hand tobacco smoke,outdoor air pollution,household combustion of coal and several occupational hazards.However,the IARC evaluation had not been stratified based on smoking status,and notably lung cancer in never-smokers(LCINS)has different epidemiological,clinicopathologic and molecular characteristics from lung cancer in ever-smokers.Among several risk factors proposed for the development of LCINS,environmental factors have the most available evidence for their association with LCINS and their roles cannot be overemphasized.Additionally,while initial genetic studies largely focused on lung cancer as a whole,recent studies have also identified genetic risk factors for LCINS.This article presents an overview of several environmental factors associated with LCINS,and some of the emerging evidence for genetic factors associated with LCINS.An increased understanding of the risk factors associated with LCINS not only helps to evaluate a never-smoker’s personal risk for lung cancer,but also has important public health implications for the prevention and early detection of the disease.Conclusive evidence on causal associations could inform longer-term policy reform in a range of areas including occupational health and safety,urban design,energy use and particle emissions,and the importance of considering the impacts of second-hand smoke in tobacco control policy.

Establishment and application of a multiplex genetic mutation-detection method of lung cancer based on MassARRAY platform

Objective: This study aims to establish a method for highly parallel multiplexed detection of genetic mutations in Chinese lung cancer samples through Agena i PLEX chemistry and matrix-assisted laser desorption ionization time-of-flight analysis on Mass ARRAY mass spectrometry platform.Methods: We reviewed the related literature and data on lung cancer treatments. We also identified 99 mutation hot spots in 13 target genes closely related to the pathogenesis, drug resistance, and metastasis of lung cancer. A total of 297 primers, composed of99 paired forward and reverse amplification primers and 99 matched extension primers, were designed using Assay Design software. The detection method was established by analyzing eight cell lines and six lung cancer specimens. The proposed method was then validated through comparisons by using a Lung Carta^(TM) kit. The sensitivity and specificity of the proposed method were evaluated by directly sequencing EGFR and KRAS genes in 100 lung cancer cases.Results: The proposed method was able to detect multiplex genetic mutations in lung cancer cell lines. This finding was consistent with the observations on previously reported mutations. The proposed method can also detect such mutations in clinical lung cancer specimens. This result was consistent with the observations with Lung Carta^(TM) kit. However, an FGFR2 mutation was detected only through the proposed method. The measured sensitivity and specificity were 100% and 96.3%, respectively.Conclusions: The proposed Mass ARRAY technology-based multiplex method can detect genetic mutations in Chinese lung cancer patients. Therefore, the proposed method can be applied to detect mutations in other cancer tissues.

Genetic Fingerprint Concerned with Lymphatic Metastasis of Human Lung Squamous Cancer

背景与目的筛选肺鳞癌患者淋巴转移差异表达基因群。方法原发癌组织及区域淋巴结取自10例接受完全性肺癌切除手术的肺鳞癌患者。根据组织来源将标本分为三组:不伴淋巴转移的肺鳞癌组织(TxN-,n=5)、伴有淋巴转移的肺鳞癌组织(TxN+,n=5)及相应转移淋巴结中的肺鳞癌细胞(N+,n=5)。对各组进行激光显微切割以获得纯净癌细胞,T7RNA线性扩增获取足够量的RNA,实验通道和参照通道分别标记以后与含6000个已知人类基因或表达序列标签的cDNA基因芯片杂交,扫描荧光信号以后进行数据分析。结果共有37个基因可将TxN+组与TxN-组区分开,其中在TxN+组高表达的基因有8个,主要涉及蛋白合成、信号传导、伴侣蛋白和酶等。有29个基因在TxN-组高表达,这些基因主要编码细胞周期调节子、转导子、信号传导蛋白以及细胞凋亡调节蛋白。比较N+组与TxN+组却没有发现具有显著性的差异表达基因。结论肺鳞癌的淋巴转移表型的获得可能是早期事件。这些差异基因的发现有助于阐明肺鳞癌淋巴转移的分子机制和寻找新的治疗靶点。

Efficacy Differences of First-line EGFR-TKIs Alone vs in Combination with Chemotherapy in Advanced Lung Adenocarcinoma Patients with Sensitive EGFR Mutation and Concomitant Non-EGFR Genetic Alterations

Background and objective:Epidermal growth factor receptor(EGFR)mutations are often associated with non-EGFR genetic alterations,which maybe a reason for the poor efficacy of EGFR tyrosine kinase inhibitors(TKIs).Here we conducted this study to explore whether EGFR-TKIs combined with chemotherapy would benefit advanced lung adenocarcinoma patients with both sensitive EGFR mutation and concomitant non-EGFR genetic alterations.Materials and methods:Cases of advanced lung adenocarcinoma with EGFR mutation combined with concomitant nonEGFR genetic alterations were retrospectively collected.And the patients were required to receive first-line EGFR-TKIs and chemotherapy combination or EGFR-TKIs monotherapy.Demographic,clinical and pathological data were collected,and the electronic imaging data were retrieved to evaluate the efficacy and time of disease progression.Survival data were obtained through face-to-face or telephone follow-up.The differences between the two groups in objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS)and overall survival(OS)were investigated.Results:107 patients were included,including 63 cases in the combination group and 44 cases in the monotherapy group.The ORR were 78%and 50%(P=0.003),and DCR were 97%and 77%(P=0.002),respectively.At a median follow-up of 13.7 mon,a PFS event occurred in 38.1%and 81.8%of patients in the two groups,with median PFS of18.8 mon and 5.3 mon,respectively(P<0.000,1).Median OS was unreached in the combination group,and 27.8 mon in the monotherapy group(P=0.31).According to the Cox multivariate regression analysis,combination therapy was an independent prognostic factor of PFS.Conclusion:In patients with EGFR-mutant advanced lung adenocarcinoma with concomitant non-EGFR genetic alterations,combination of TKIs and chemotherapy was significantly superior to EGFR-TKIs monotherapy,which should be the preferred treatment option.

SIGNIFICANCE OF ELECTRON MICROSCOPIC EXAMINATION IN THE DIAGNOSIS OF PULMONARY NEOPLASMS

The significance of electronic microscopc examination(EM) in the diagnosis of pulmonary neoplasms was evaIuated in 40 cases of Patients with different kinds of Pulmonary neoplasms.In 27 of the 40 cases,final diagnoses were made by light microscope(LM) examination,while in the remaining 13 cases,LM faded to reach definite diagnoses which were established with the help of EM.By analyzing our data,we conclude that in the following situations,EM helps meet in the diagnosis of pulmonary neoplasm:1.diagnosis of neuroendocrinal carcinomas of the lung;2.diagnosis of some rare pulmonary neoplasm;3.documentation of the histologic origins of the matastatic pulmonary neoplasms and 4.differentiation of malignant mesothelioma with pleural metastasis of Pulmonary adenocarcinoma.

A Genetic Susceptibility Study of Lung Cancer Risk Potentially Associated with Polycyclic Aromatic Hydrocarbon Inhalation Exposure

For lifetime non-smokers, lung cancer risk is mainly associated with inhalation exposure to air pollution. For the Chinese population, indoor air pollution due to solid fuel combustion has been the primary source of inhalation exposure for decades. Polycyclic aromatic hydrocarbons （PAHs） are the by-products of incomplete combustion.

The Genetic Epidemiology of Lung Cancer-What have we learned?

With the completion of the Human Genome Project new opportunities have been arisen to more fully characterize the genomic factor contributing to human susceptibility to chemical and pharmacological toxicity. Over 6 million single nucleotide polymorphisms（SNPs） have been identified and cataloged in public databases. Research efforts are now underway to identify which SNPs are associated with variation in disease risk, chemical sensitivity, drug toxicity, as well as drug responsiveness.

Genetic polymorphisms of GSTM1,GSTP1 and GSTT1 genes and lung cancer susceptibility in the Bangladeshi population

Objective:To verify possible associations between polymorphisms of glutathione S-transferase Mu(GSTM1),glutathione S-transferase θ(GSTT1) and glutathione S-transferase Pi(GSTP1)genes and susceptibility to lung cancer.Methods:A total of 106 lung cancer patients and 116 controls were enrolled in a case-control study.The GSTM1 and GSTT1 were analyzed using PCR while GSTP1 was analyzed using PCR-restriction fragment length polymorphism.Risk of lung cancer was estimated as odds ratio at 95%confidence interval using unconditional logistic regression models adjusting for age,sex,and tobacco use.Results:GSTM1 null and GSTT1 null genotypes did not show a significant risk for developing lung cancer.A significandy elevated lung cancer risk was associated with GSTP1 heterozygous,mutant and combined heterozygous+mutant variants of rs1695.When classified by tobacco consumption status,no association with risk of lung cancer was found in case of tobacco smokers and nonsmokers carrying null and present genotypes of GSTM1 and GSTTL There is a three-fold(approximately) increase in the risk of lung cancer in case of both heterozygous(AG) and heterozygous+mutant homozygous(AG+GG) genotypes whereas there is an eightfold increase in risk of lung cancer in cases of GG with respect to AA genotype in smokers.Conclusions:Carrying the GSTM1 and GSTT1 null genotype is not a risk factor for lung cancer and GSTP1Ile105 Val is associated with elevated risk of lung cancer.

Role of Genetic Ancestry in Oropharyngeal Squamous-Cell Carcinoma: A Cross-Sectional Study in Brazil

Background: HPV infection represents an important etiologic factor for Oropharyngeal Squamous Cell Carcinoma (OPSCC). The different ethnic backgrounds could be related to different susceptibility to Human Papillomavirus (HPV). The aim of our study was to assess the whole of genetic ancestry in HPV status in OPSCC patients. Methods: We conducted a cross-sectional study on patients with OPSCC admitted to the Barretos Cancer Hospital, Brazil from 2014 to 2019. Of these, DNA extraction was performed on 40 patients and genetic ancestry was assessed using a specific panel of 46 informative ancestry markers. Results: We observed a predominance of European ancestry (63%), followed by African (18%), Amerindian (9%) and Asian (8%) both in the OPSCC HPV-positive and HPV-negative group. We did not find any statistically significant differences between the HPV-positive and HPV-negative OPSCC groups in relation to European (p = 0.499), African (p = 0.448), Asian (p = 0.275) or Amerindian (p = 0.836) ancestry. Conclusions: We found a predominance of European ancestry, both in the HPV-positive and HPV-negative groups. In our study, we did not find statistically significant differences between HPV-positive or HPV-negative groups in relation to ancestry.

Bioinformatics Identification of ZNFs/LINC00520/miR-181d/BCL2 Axis as a Novel Network in Cisplatin-Resistant Lung Adenocarcinoma Cells

Background: Resistance to cisplatin (DDP) leads to poor prognosis in patients with Lung Adenocarcinoma (LUAD) and limits its clinical application. It has been confirmed that autophagy promotes chemoresistance and, therefore, novel strategies to reverse chemoresistance by regulating autophagy are desperately needed. Methods: The differentially expressed lncRNAs (DElncRNAs), miRNAs (DEmiRNAs), and mRNAs (DEmRNAs) between A549 and A549/DDP cell lines were identified using the limma package in R, after gene expression profiles were obtained from Gene Expression Omnibus (GEO) database. By combining Autophagy-Related Genes (ARGs) from Human Autophagy Database (HADb), the interactions lncRNA-miRNAs and the interactions miRNAs-mRNAs respectively predicted by miRcode and miRDB/Targetscan database, the autophagy-related ceRNA network was constructed. Then, extraction of ceRNA subnetwork and Cox regression analyses were performed. A prognosis-related ceRNA subnetwork was constructed, and the upstream Transcription Factors (TFs) regulating lncRNAs were predicted by the JASPAR database. Finally, the expression patterns of candidate genes were further verified by quantitative real-time polymerase chain reaction (qRT-PCR) experiments. Results: A total of 3179 DEmRNAs, 180 DEmiRNAs, and 160 DElncRNAs were identified, and 35 DEmRNAs were contained in the HADb. Based on the ceRNA hypothesis, we established a ceRNA network, including 10 autophagy-related DEmRNAs, 9 DEmiRNAs, and 14 DElncRNAs. Then, LINC00520, miR-181d, and BCL2 were identified to construct a risk score model, which was confirmed to be a well-predicting prognostic factor. Furthermore, 5 TF ZNF family members were predicted to regulate LINC00520, whereas the RT-PCR results showed that the 5 ZNFs were consistent with the bioinformatics analysis. Finally, a ZNF regulatory LINC00520/miR-181d/BCL2 ceRNA subnetwork was constructed. Conclusions: An ZNFs/LINC00520/miR-181d/BCL2 axis as a novel network in DDP-resistant LUAD has been constructed successfully, which may provide potential therapeutic targets for LUAD.

Expert Consensus on Prevention and Treatment of COVID-19 Infection in Patients with Lung Cancer

Corona virus disease 2019(COVID-19)infection has become a major public health issue affecting human health.The main goal of epidemic prevention and control at the current stage in China is to“protect people’s health and prevent severe cases”.Patients with lung cancer who receive antitumor therapy have low immunity,and the risk of severe illness and death once infected is much higher than healthy people,so they are vulnerable to COVID-19 infection.At present,less attention has been paid to the prevention and treatment of COVID-19 infection in patients with lung cancer in domestic guidelines and consensus.Based on the published data in China and abroad,we proposed recommendations and formed expert consensus on the vaccination of COVID-19,the use of neutralizing antibodies and small molecule antiviral drugs for patients with lung cancer,for physician’s reference.

Genetic polymorphisms in genes regulating cell death and prognosis of patients with rectal cancer receiving postoperative chemoradiotherapy

Objective:The identification of biomarkers for predicting chemoradiotherapy efficacy is essential to optimize personalized treatment.This study determined the effects of genetic variations in genes involved in apoptosis,pyroptosis,and ferroptosis on the prognosis of patients with locally advanced rectal cancer receiving postoperative chemoradiotherapy(CRT).Methods:The Sequenom MassARRAY was used to detect 217 genetic variations in 40 genes from 300 patients with rectal cancer who received postoperative CRT.The associations between genetic variations and overall survival(OS)were evaluated using hazard ratios(HRs)and 95%confidence intervals(CIs)computed using a Cox proportional regression model.Functional experiments were performed to determine the functions of the arachidonate 5-lipoxygenase(ALOX5)gene and the ALOX5 rs702365 variant.Results:We detected 16 genetic polymorphisms in CASP3,CASP7,TRAILR2,GSDME,CASP4,HO-1,ALOX5,GPX4,and NRF2 that were significantly associated with OS in the additive model(P<0.05).There was a substantial cumulative effect of three genetic polymorphisms(CASP4 rs571407,ALOX5 rs2242332,and HO-1 rs17883419)on OS.Genetic variations in the CASP4 and ALOX5 gene haplotypes were associated with a higher OS.We demonstrated,for the first time,that rs702365[G]>[C]represses ALOX5 transcription and corollary experiments suggested that ALOX5 may promote colon cancer cell growth by mediating an inflammatory response.Conclusions:Polymorphisms in genes regulating cell death may play essential roles in the prognosis of patients with rectal cancer who are treated with postoperative CRT and may serve as potential genetic biomarkers for individualized treatment.

Intraoperative photodynamic therapy for tracheal mass in non-small cell lung cancer:A case report

BACKGROUND Tracheal neoplasms represent less than 0.1%of all malignancies and have no established treatment guidelines.Surgical resection with reconstruction is the primary treatment.This study demonstrates successful treatment of concurrent lung and tracheal tumors using surgical excision and intraoperative photodynamic therapy(PDT),highlighting the effectiveness and safety of this approach.CASE SUMMARY A 74-year-old male with a history of smoking and chronic obstructive pulmonary disease was diagnosed with tracheal squamous cell carcinoma and right lower lobe adenocarcinoma.A multidisciplinary team created a treatment plan involving tumor resection and PDT.The tracheal tumor was removed through a tracheal incision and this was followed by intraluminal PDT.The trachea was repaired and a right lower lobectomy was performed.The patient received a second PDT treatment postoperatively and was discharged 10 d after the tracheal surgery,without complications.He then underwent platinum-based chemotherapy for lymphovascular invasion of lung cancer.Three-month postoperative bronchoscopy revealed normal tracheal mucosa with a scar at the resection site and no evidence of tumor recurrence in the trachea or lung.CONCLUSION Our case of concurrent tracheal and lung cancers was successfully treated with surgical excision and intraoperative PDT which proved safe and effective in this patient.

囊腔型肺腺癌临床多特征分析及浸润性风险预测模型的构建

背景与目的囊腔型肺癌作为一种特殊类型的肺癌逐步得到人们的关注,其最常见的病理类型为腺癌。囊腔型肺腺癌的浸润性对诊疗方案的选择和预后至关重要。本研究旨在分析囊腔型肺腺癌临床多特征,探讨其浸润性的独立危险因素并建立风险预测模型。方法回顾性分析2021年1月至2022年7月于南京医科大学第一附属医院胸外科行手术治疗的129例囊腔型肺腺癌患者,根据病理结果分成浸润前组:非典型腺瘤样增生(atypical adenomatous hyperplasia,AAH)、原位腺癌(adenocarcinoma in situ,AIS)、微浸润型腺癌(minimally invasive adenocarcinoma,MIA)与浸润组:浸润性腺癌(invasive adenocarcinoma,IAC)。其中浸润前组47例,男性19例,女性28例,平均年龄(51.23±14.96)岁;浸润组82例,男性60例,女性22例,平均年龄(61.27±11.74)岁。收集两组病例多组临床特征,采用单因素分析、LASSO回归、多因素Logistic回归分析得出囊腔型肺腺癌浸润性的独立危险因素,建立浸润性风险预测模型。结果单因素分析显示年龄、性别、吸烟史、肺气肿、神经元特异性烯醇化酶(neuron-specific enolase,NSE)、囊腔数、病灶直径、囊腔直径、结节直径、实性成分直径、囊壁结节、囊壁光滑程度、囊腔形状、分叶征、短毛刺征、胸膜牵拉、血管穿行与支气管穿行在囊腔型肺腺癌浸润前组与浸润组间存在统计学差异(P<0.05)。上述变量经LASSO回归降维处理,进一步筛选出的变量包括:年龄、性别、吸烟史、NSE、囊腔数、病灶直径、囊腔直径、囊壁结节、囊壁光滑程度与分叶征,并纳入多因素Logistic回归分析,发现囊壁结节(P=0.035)与分叶征(P=0.001)是囊腔型肺腺癌浸润性的独立危险因素(P<0.05)。建立预测模型如下:P=e^x/(1+e^x),x=-7.927+1.476*囊壁结节+2.407*分叶征,曲线下面积(area under the curve,AUC)为0.950。结论囊壁结节及分叶征为囊腔型肺腺癌浸润性的独立危险因素,对囊腔型肺腺癌的浸润性预测具有一定的指导意义。

初诊Ⅳ期肺癌患者中性粒细胞/淋巴细胞比值与营养不良风险的相关性分析

背景与目的 恶性肿瘤患者往往伴随营养不良,与预后密切相关。中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)作为体内炎症的指标,能够预测多种疾病的营养不良风险,然而其与肺癌患者营养不良的关系尚不明确。本研究旨在分析NLR与初诊Ⅳ期肺癌患者营养不良风险的关系,并进一步确定NLR的截断值以更好地预测患者营养不良的风险。方法 回顾性分析2019年5月至2021年2月天津医科大学总医院肿瘤内科收治的209例初诊Ⅳ期肺癌患者,应用营养风险筛查2002 (nutritional risk screening 2002,NRS 2002)量表对其营养状况进行评估,同时收录患者人口学信息、病理、卡氏体能状态(Karnofsky performance status,KPS)评分、体重指数、合并疾病及临床生化指标的资料。分析NLR与营养不良风险的关系,并采用受试者工作特征(receiver operating characteristic,ROC)曲线来确定预测营养不良风险的最佳NLR临界值。应用多因素Logistic回归进一步评估NLR与营养不良风险之间的关系。结果 初诊Ⅳ期肺癌患者存在营养不良风险的比率为36.36%(76/209)。对NLR与NRS 2002营养不良风险评分进行分析发现,NLR与营养不良风险评分呈正相关(r=0.765,P<0.001)。通过ROC曲线分析,确定初诊Ⅳ期肺癌患者营养不良风险的最佳截断值NLR为3.94 [曲线下面积(area under the curve,AUC)=0.747,95%CI:0.678-0.815,P<0.001],敏感性为55%,特异性为86%,阳性预测值为68%,阴性预测值为77%。相比于NLR≤3.94组的患者,NLR>3.94组的患者更容易发生营养不良(69.49%vs 23.33%,P<0.001),并且NLR为初诊Ⅳ期肺癌患者营养不良风险的独立危险因素。结论 NLR在初诊Ⅳ期肺癌患者中与营养不良风险有关,NLR可作为Ⅳ期肺癌患者营养风险筛查的指标之一。