Lung cancer

CD44 and αV-integrins dual-targeting bimetallic nanozymes for lung adenocarcinoma therapy via NIR-enhanced ferroptosis/apoptosis

Combination therapy is a promising strategy for lung adenocarcinoma (LUAD), due to the advantages of overcoming drug resistance, side effects, and tumor heterogeneity. Herein, we report a novel dual-targeting bimetallic nanozyme (MH-iRGD) consisting of nanosized manganese ferrite (MF) after encapsulating with dopamine and methacrylic anhydride to modify hyaluronic acid, followed by integrin receptor targeting peptide (HS-PEG3400-iRGD) modification for LUAD targeted therapy. Our study confirmed that MH-iRGD combined with near-infrared irradiation (NIR) possessed dramatic photothermal effects and reactive oxygen species (ROS) production and GSH depletion abilities. Importantly, MH-iRGD possessed dual-targeting capacities for LUAD cells overexpressed CD44 and αV-integrin receptors owing to hyaluronic acid coating and iRGD modification. Inhibitors of CD44 and integrins could impair the uptake of MH-iRGD in LUAD cells. Moreover, MH-iRGD + NIR displayed excellent anti-LUAD effects as a result of the production of intracellular ROS, consumption of glutathione (GSH) and mitochondrial dysfunction. Mechanistically, NIR robustly strengthened MH-iRGD-induced ferroptosis and apoptosis by down-regulating SLC7A11, GPX4, Bcl-2 levels while up-regulating Bax level. Specifically, ferroptosis and apoptosis were increased while the LUAD progression was inhibited after intravenous injection of MH-iRGD + NIR in xenograft mouse models. Taken together, our results indicate that MH-iRGD + NIR serves as a promising targeted therapy for LUAD, which broadens the applications of highly active dual-targeting bimetallic nanozymes.

Effect of extracellular vesicle ZNF280B derived from lung cancer stem cells on lung cancer progression

OBJECTIVE

The purpose of this research was to investigate the role of extracellular vesicles derived from lung cancer stem cells (lung CSCs-EVs) in lung cancer and to explore their potential mechanisms.

METHODS

Lung CSCs were first isolated and verified using flow cytometry and RT-qPCR assays. Lung CSCs-EVs were extracted through ultracentrifugation and further characterized using transmission electron microscopy and Western blotting. The interaction between lung CSCs-EVs and lung cancer cells was observed through PKH67 staining. Subsequently, we analyzed the differentially expressed genes in lung CSCs using bioinformatics data analysis and evaluated the prognostic value of ZNF280B in lung cancer with the Kaplan-Meier Plotter. RT-qPCR was utilized to assess the mRNA expression levels of these genes, while Western blotting was used to evaluate the protein expression levels of ZNF280B and P53. Next, CCK-8 and colony formation assays were conducted to assess the effects of lung CSCs-EVs and ZNF280B on cancer cell proliferation, migration (via wound healing assay), and invasion (using transwell assay). Additionally, subcutaneous tumor-bearing experiments in nude mice were performed to evaluate the roles of lung CSCs-EVs in lung cancer progression in vivo.

RESULTS

The results indicated that lung CSCs-EVs accelerated the progression of lung cancer. Mechanistically, these lung CSCs-EVs transferred ZNF280B into cancer cells, leading to the inhibition of P53 expression.

CONCLUSIONS

In summary, the manuscript first describes the molecular mechanism by which lung CSCs-EVs promote pro-cancer functions in lung cancer through the ZNF280B/P53 axis.

Deciphering the molecular fingerprint of haemoglobin in lung cancer: A new strategy for early diagnosis using two-trace two-dimensional correlation near infrared spectroscopy (2T2D-NIRS) and machine learning techniques

Lung cancer remains one of the deadliest malignancies worldwide, highlighting the need for highly sensitive and minimally invasive early diagnostic methods. Near-infrared spectroscopy (NIRS) offers unique advantages in probing molecular vibrational information from blood, effectively capturing potential structural changes in haemoglobin (Hb) in lung cancer patients. In this study, we address the challenge of detecting subtle Hb features within the broader blood matrix and introduce an innovative two-stage spectral analysis framework. First, continuous wavelet transform (CWT) is employed to enhance spectral resolution and reinforce the key absorption bands of Hb. Subsequently, two-trace two-dimensional correlation spectroscopy (2T2D-COS) is applied to examine the fine vibrational differences-in both synchronous and asynchronous spectra-between lung cancer patients and healthy controls, revealing alterations in Hb secondary structures (e.g., α-helices and β-sheets). Results show that critical Hb-related peaks at 4862 cm-1, 4615 cm-1, and 4432 cm-1 undergo significant changes in lung cancer samples. Furthermore, combining these refined spectral features with machine learning classifiers (e.g., support vector machines) achieves an overall accuracy of 97.50 % and a sensitivity of 100.00 %. This work not only confirms the value of NIRS in detecting protein-level molecular information in blood but also presents a promising, efficient spectroscopic strategy for early lung cancer diagnosis, offering broad biomedical applicability.

Novel erbium complex with anticancer activity against radiation resistant lung adenocarcinoma cells

In this work, novel erbium complex with anticancer activity against radiation resistant lung adenocarcinoma cells was obtained and demonstrated. Firstly, stronger inhibitory effect of Er3+ on non-small cell lung cancer (NSCLC) cells and NSCLC- radiation resistant (RR) cells was experimentally confirmed. Then, by selecting highly biocompatible porphyrins as ligands, a novel erbium complex tetraphenylporphyrin erbium acetylacetonate (Er(acac)TPP) was synthesized and purified. Compared with Cisplatin, notably, Er(acac)TPP exhibits relatively higher inhibitory efficiency on NSCLC-RR cells. Moreover, the toxicities of Er(acac)TPP to normal cells are much lower than that of cancer cells. Subsequently, cell expansion, increased apoptosis, a decline in mitochondrial membrane potential (MMP), an accumulation of intracellular reactive oxygen species (ROS), increased Caspase-9 protein level and G2/M arrest were seen. These data all pointed to Er(acac)TPP as a possible candidate for more research and development as a chemotherapeutic drug.

Prognostic and clinicopathological significance of the new grading system for invasive pulmonary adenocarcinoma: A systematic review and meta-analysis

In 2020, the International Association for the Study of Lung Cancer (IASLC) introduced a new grading system for invasive pulmonary adenocarcinoma (IPA). This meta-analysis aimed to validate the prognostic utility of this grading system and identify relevant clinicopathological features. The PubMed, Embase, Web of Science, and Cochrane Library databases were searched for relevant studies published between January 1, 2020 and March 5, 2024. Hazard ratios (HRs) with corresponding 95 % confidence intervals (CIs) were pooled to evaluate the effect of IASLC grading on prognosis. Odds ratios with corresponding 95 % CIs were pooled to assess relevant clinicopathological features. Twenty-two studies comprising 12,515 patients with IPA were included. Regarding overall survival, grade 3 adenocarcinomas had a worse prognosis compared with grades 1-2 (HR: 2.26, 95 % CI: 1.79-2.85, P<0.001), grade 1 (HR: 4.75, 95 % CI: 2.61-8.66, P<0.001), or grade 2 (HR: 1.71, 95 % CI: 1.28-2.29, P<0.001). Considering recurrence-free survival, grade 3 tumors had a higher recurrence risk than grades 1-2 (HR: 1.92, 95 % CI: 1.53-2.41, P<0.001), grade 1 (HR: 4.43, 95 % CI: 2.91-6.73, P<0.001), or grade 2 (HR: 1.67, 95 % CI: 1.33-2.10, P<0.001). In the subgroup analysis of stage I patients, grade 3 tumors exhibited a similarly poor prognosis. In addition, grade 3 adenocarcinomas were associated with aggressive clinicopathological features. This study demonstrated that the IASLC grading system is a robust predictor of prognostic stratification in patients with IPA, and warrants further promotion and worldwide implementation.

HnRNPR promotes non-small cell lung cancer progression by protecting XB130 mRNA from XRN1- and DIS3L2-mediated degradation

The adaptor protein XB130 is critically implicated in tumorigenesis. However, the mechanisms regulating its expression in tumors are not well understood. Our previous studies have identified hnRNPR as a potential binding protein of XB130 3'UTR in non-small cell lung cancer (NSCLC). This study aimed to clarify hnRNPR's role in NSCLC progression and its specific mechanisms regulating XB130 expression. The expression of hnRNPR in NSCLC and normal tissues was assessed using NSCLC tissue microarray and the TCGA database. Subsequently, in vitro and in vivo experiments were conducted to investigate the impact of hnRNPR on NSCLC cell proliferation and epithelial-mesenchymal transition (EMT) by modulating XB130 expression. The underlying molecular mechanisms of hnRNPR regulating XB130 expression were explored utilizing a range of molecular biology techniques including Western blotting, Real-time quantitative PCR, Immunohistochemistry, Dual-luciferase reporter assay, RNA pull-down assay, and RNA immunoprecipitation. We identified the overexpression of hnRNPR in NSCLC, with heightened hnRNPR levels significantly associated with poor prognosis in patients with lung adenocarcinoma. Functionally, hnRNPR overexpression promoted NSCLC cell proliferation and EMT and activated the Akt signaling pathway. Mechanistically, hnRNPR protected XB130 mRNA from XRN1- and DIS3L2-mediated degradation by binding to specific regions within XB130 3'UTR, consequently elevating XB130 expression. Lastly, XB130 overexpression counteracted the effects of hnRNPR silencing on NSCLC cells. Overall, our study unveils the potential of targeting the hnRNPR/XB130 axis as a promising therapeutic strategy for NSCLC.

Intersection between lung cancer and neuroscience: Opportunities and challenges

Lung cancer, which has the highest morbidity and mortality rates worldwide, involves intricate interactions with the nervous system. Research indicates that the nervous system not only plays a role in the origin of lung cancer, but also engages in complex interactions with cancer cells through neurons, neurotransmitters, and various neuroactive molecules during tumor proliferation, invasion, and metastasis, especially in brain metastases. Cancer and its therapies can remodel the nervous system. Despite advancements in immunotherapy and targeted therapies in recent years, drug resistance of lung cancer cells after treatment limits improvements in patient survival and prognosis. The emergence of neuroscience has created new opportunities for the treatment of lung cancer. However, it also presents challenges. This review emphasizes that a deeper understanding of the interactions between the nervous system and lung cancer, along with the identification of new therapeutic targets, may lead to significant advancements or even a revolution in treatment strategies for patients with lung cancer.

Design and Synthesis of New pyrazole Hybrids Linked to Oxime and Nitrate Moieties as COX-2, EGFRL858R/T790M Inhibitors and Nitric Oxide Donors with dual Anti-inflammatory/Anti-proliferative Activities

Two new series of pyrazole derivatives 14a-l and 17a-c with oxime/nitrate moieties as EGFRWT, mutant (EGFRL858R/T790M) and COX-2 inhibitors were synthesized and evaluated for anti-proliferative and anti-inflammatory activities. Compounds 14c, 14e, 14 g, 14i-l, 17b and 17c exhibited COX-2 selectivity in the range of (S.I. = 17-42) when compared to celecoxib (S.I. = 20.43). Concerning anti-neoplastic activity, screening was carried out against 60 human cancer cell lines by (NCI); Nine compounds (14c, 14e, 14 g, 14i-l, 17b and 17c) showed excellent inhibitory activity against all cancer cell lines especially non-small cell lung cancer (NSCLC). Further cytotoxicity testing of compounds 14c, 14e, 14 g, 14i-l, 17b and 17c was conducted on established EGFRT790M/L858R-resistant NSCLC (H1975), all tested compounds except 14 l exhibited potent activity (IC50 = 3.02-27.32 μM) which is higher than that of osimertinib (IC50 = 37.29 μM). It was noted that compound 17c, showed cell cycle arrest at G0/G1 phase of NSCLC (H1975) cells. In addition, compounds 14c, 14e, 14 g, 14i-l, 17b and 17c induced improved selective inhibitory activity against double mutant EGFRL858R/T790M tyrosine kinases with IC50 in the range of (0.031-0.076 μM, with selectivity index range S.I. of 2.5-14.58) which was comparable to that of osimertinib (IC50 = 0.037 μM, with S.I. of 1.89). The most potent anti-cancer compounds 14c, 14e, 14 g, 14i-l, 17b and 17c released NO in a slow rate of (1.45-3.37 %). Finally, applying covalent docking, we identified the covalent binding of 14 g, 14 k, and 17c with Cys797, providing insights into their potential as irreversible inhibitors targeting EGFRL858R/T790M protein.

Impact of Spread Through Air Spaces (STAS) on Recurrence and Surgical Trends in Stage I Non-Small Cell Lung Cancer: A Real-World Cohort Study

Non-small cell lung cancer (NSCLC) is the most common form of lung cancer, which remains a leading cause of cancer mortality worldwide. Early detection, particularly at Stage I, is critical for improving survival outcomes. Low-dose computed tomography (LDCT) has increased the detection of small asymptomatic tumors, resulting in an earlier diagnosis and facilitating less invasive surgical approaches such as segmentectomy and wedge resection, which preserve lung function while offering survival outcomes comparable to lobectomy. However, the risk factors for recurrence in Stage I NSCLC remain poorly understood. This retrospective study analyzed 1077 Stage I NSCLC patients treated at Kaohsiung Medical University Hospital from 2010 to 2022. Data including AJCC 7th and 8th editions staging, surgical interventions, and pathological features were analyzed. The proportion of Stage I cases increased significantly from 9.3% in 2010 to 33.8% in 2017, with Stage IA cases increasing from 12.1% in 2018 to 38.2% in 2022. Concurrently, the lobectomy rate decreased from 75% in 2010 to 43.6% in 2022, with more sublobar resections performed. Kaplan-Meier analysis found no significant differences in recurrence-free survival between lobectomy and sublobar resection with regional lymph node dissection. Cox regression identified spread through air spaces (STAS) as an independent risk factor for recurrence (hazard ratio 2.87, p = 0.006), along with male sex, larger tumor size, and visceral pleural invasion. These findings highlight the role of LDCT in early detection and the importance of tailored treatment strategies, particularly addressing STAS, to optimize recurrence-free survival and improve outcomes of patients with Stage I NSCLC.

Prognostic value of LncRNA SH3BP5-AS1 in non-small cell lung cancer and its regulatory effect on tumor progression

OBJECTIVE

This study aimed to investigate the prognostic significance of SH3BP5-AS1 in non-small cell lung cancer (NSCLC) patients, and also to uncover its function in the progression of NSCLC.

METHODS

100 NSCLC patients were recruited in this study. SH3BP5-AS1 was measured by RT-qPCR. The prognostic significance of SH3BP5-AS1 in NSCLC progression was appraised utilizing the Kaplan-Meier and Cox regression test. CCK-8 was used to detect the proliferative viability of NSCLC cells. The migratory and invasive capabilities of NSCLC cells were evaluated by Transwell assay. The interplay between SH3BP5-AS1 and miR-424-5p was verified by luciferase reporter assay and ENCORI database. The potential target genes of miR-424-5p were inspected by means of bioinformatics analysis.

RESULTS

A reduced SH3BP5-AS1 was manifested in tissues of NSCLC patients and tumor cells. Compared with patients showing SH3BP5-AS1 low-expression, those with SH3BP5-AS1 high-expression possessed a more favorable progression-free survival time. SH3BP5-AS1 might function as an autonomous prognostic biomarker for NSCLC. Upregulation of SH3BP5-AS1 suppressed the proliferation, migration and invasion of NSCLC cells. MiR-424-5p was a downstream target miRNA of SH3BP5-AS1, and luciferase reporter assays verified that SH3BP5-AS1 and miR-424-5p interact. In NSCLC patient tissues, miR-424-5p was upregulated and it exhibited an inverse correlation with SH3BP5-AS1. Elevation of miR-424-5p neutralized the inhibitory effect of SH3BP5-AS1 overexpression on the proliferation, migration, and invasion abilities of NSCLC cells.

CONCLUSION

SH3BP5-AS1 is involved in NSCLC development by targeting its downstream target miRNA miR-424-5p, and it is a latent prognostic indicator for NSCLC.

miRNA-548d-3p represses non-small cell lung cancer growth by perturbing DDX5-mediated pyroptosis through JAK2/STAT3 signaling

BACKGROUND

The function of microRNAs (miRNAs) in tumor development has been extensively characterized. Pyroptosis is a kind of programmed death, which can effectively hinder cancer development. However, there is still a large gap in the function of miRNAs in NSCLC pyroptosis.

METHODS

The pyroptosis-related differentially expressed miRNAs and their promising targets in NSCLC were analyzed using bioinformatic analyses. The effects of miR-548d-3p on cell proliferation, pyroptosis and tumor growth were verified in vivo and in vitro. The expression of pyroptosis-related factors was examined in cells and xenografted tumors. Additionally, the molecular interaction was assessed by using Co-IP and dual-luciferase reporter gene assays.

RESULTS

We found that miR-548d-3p was poorly expressed in NSCLC in public datasets and an independent cohort of 48 NSCLC patients. Low miR-548d-3p expression was positively associated with pathologic T stage and poor prognosis of NSCLC patients. Transfection of miR-548d-3p mimics significantly decreased the cell viability of NSCLC cells, partly attributing to the increase in the proportion of pyroptotic cells. These changes were accompanied by a rise in the protein abundance of NLRP3, ASC, cleaved Caspase-1 and GSDMD-N and release of IL-1β and IL-18. Integrating bioinformatic, expressional and experimental analyses, we predicted and validated DDX5 as the direct target of miR-548d-3p. Furthermore, we demonstrated that miR-548d-3p/DDX5 axis regulated pyroptosis via the Phosphorylated JAK2/STAT3-mediated NLRP3/Caspase-1/GSDMD pathway in vitro and in vivo.

CONCLUSION

Our study revealed that miR-548d-3p/DDX5 promoted pyroptosis in NSCLC by promoting the JAK2/STAT3/NLRP3/Caspase-1/GSDMD pathway, indicating the promising effect of miR-548d-3p in NSCLC treatment.

Amplified TPM1 suppresses non-small cell lung cancer cells proliferation and metastasis

BACKGROUND

TPM1 a member of TPM family and acts as a crucial role in a variety of tumors progression. However, the effect and mechanism of TPM1 on NSCLC need to be further explored. Here, effect and mechanism of TPM1 on NSCLC were revealed to provide new target for clinical therapy.

METHODS

TPM1 expression in NSCLC tissues and normal tissues was analyzed using GEPIA online database. NSCLC cells were transfected with TPM1 overexpression plasmid. TPM1 mRNA expression of NSCLC cells was assessed by RT-qPCR. NSCLC cells proliferation and apoptosis were detected by CCK-8 and flow cytometry. Scratch healing and Transwell experiments were introduced to measure NSCLC cells migration and invasion. The effects of TPM1 overexpression on TPM1, YAP1 and EMT related proteins expression in NSCLC cells were detected by Western blot experiments. The interaction between TPM1 and YAP1 was analyzed by the HitPredict database and Co-IP assay.

RESULTS

TPM1 expression in NSCLC was decreased. High expression of TPM1 could inhibit NSCLC cells proliferation, migration and invasion and promote apoptosis. EMT marker E-Cadherin increased in TPM1 overexpression group, while Vimentin and N-Cadherin decreased. EMT process was inhibited by TPM1 overexpression. There is a mutual binding between TPM1 and YAP1, and TPM1 could down-regulate YAP1 expression. Overexpressed YAP1 could partly counteract the inhibition of NSCLC cells proliferation and metastasis induced by TPM1 overexpression.

CONCLUSION

TPM1 was down-regulated in NSCLC, and its overexpression inhibited NSCLC cells proliferation and metastasis, and this was achieved by regulating YAP1. TPM1 may become a new therapeutic target for NSCLC.

Rechallenge with immune-checkpoint inhibitors in patients with advanced-stage lung cancer

Lung cancer remains the leading cause of cancer-related mortality globally, with many patients diagnosed with advanced-stage disease. Treatment in this setting relies on systemic therapies, including chemotherapy, targeted therapy and immunotherapy. Immune-checkpoint inhibitors (ICIs), which promote or restore antitumour immunity by inhibiting immunosuppressive signalling pathways, are currently the most widely used immunotherapies in these patients. However, immune-related adverse events (irAEs) or disease progression often necessitate discontinuation of these agents, leaving many patients with limited subsequent treatment options. In this scenario, ICI rechallenge has emerged as a potential strategy. Despite this potential, evidence for ICI rechallenge after either disease progression or irAEs in patients with non-small-cell lung cancer is limited and evidence for those with small cell lung cancer seems to be non-existent. In this Review, we provide a comprehensive overview of the available data on ICI rechallenge in the context of both disease progression and irAEs, including a summary of current guidance on clinical management and detailed discussions of safety and efficacy. We also highlight important unanswered questions in an attempt to guide future research in this area.

Early radiotherapy improved survival of patients with extensive-stage small cell lung cancer treated with first-line chemo-immunotherapy

BACKGROUND AND PURPOSE

This real-world study aimed to investigate the efficacy of early radiotherapy (RT) in ES-SCLC patients treated with first-line chemo-immunotherapy.

MATERIALS AND METHODS

ES-SCLC patients were enrolled from August 2018 to October 2023. Patients who received early radiotherapy before disease progression were defined as Early RT group, while the others, named Salvage and Non-RT (S&N RT) group. Propensity score matching (PSM) with a 1:1 ratio was performed to balance the baseline characteristics.

RESULTS

In this study, 375 patients with ES-SCLC treated with first-line chemo-immunotherapy were enrolled. The median PFS was 11.4 months of the Early RT group compared to 6.1 months of the S&N RT group (HR = 0.59, 95%CI 0.45-0.77; p < 0.001). The median OS was 23.8 months of the Early RT group versus 18.0 months of the S&N RT group (HR = 0.50, 95%CI 0.34-0.73; p = 0.004). The survival benefit persisted in the PSM cohort. Furthermore, survival was significantly improved in Early RT group compared to Salvage RT group (p = 0.028), while Salvage RT group had a similar survival with Non-RT group (p = 0.868). The risk of adverse events was tolerable. The multivariate analysis also demonstrated that early radiotherapy was an independently positive predictor for PFS and OS.

CONCLUSIONS

Administering early radiotherapy significantly improved both PFS and OS in patients with ES-SCLC treated with first-line chemo-immunotherapy with tolerable adverse events, while salvage radiotherapy did not improve survival. This finding warrants further validation through prospective randomized studies.

PI3K/mTOR Inhibitor VS-5584 Alters Expression of WNT Signaling Genes and Induces Apoptosis in Lung Adenocarcinoma Cells: In Vitro and In Silico Insight

Lung cancer (LC) accounts for approximately 25% of all cancer cases, with 80-85% of these being non-small cell lung cancer (NSCLC). VS-5584 is a novel anti-cancer agent that specifically inhibits mTORC1/2 and class I PI3K isoforms. There is cross-talk between the PI3K-Akt-mTOR and WNT signaling pathways that are abnormally activated in NSCLC. In this study, we aimed to evaluate the anti-cancer effects of VS-5584 on A549 lung adenocarcinoma cells and changes in WNT signaling gene expression in vitro, while also correlating differentially expressed genes in silico. The effect of VS-5584 on A549 cell viability was assessed by the MTT assay. Apoptosis and cell cycle profiles were analyzed by flow cytometry, while WNT signaling gene expression was measured by quantitative RT-PCR. Differentially expressed genes (DEGs) in the TCGA LUAD and LUSC datasets were identified using the GEPIA2 platform. VS-5584 treatment induced apoptosis and caused cell cycle arrest at the G0/G1 phase in A549 cells. The mRNA expression levels of WNT signaling genes significantly decreased in treated cells. The expression of some upregulated DEGs in the datasets decreased in A549 cells treated with VS-5584. VS-5584 shows promise as an anti-cancer agent in the treatment of NSCLC by downregulating the expression of WNT signaling genes.

Explainable PET-based intratumoral and peritumoral machine learning model for predicting visceral pleural invasion in clinical-stage IA non-small cell lung cancer: A two-center study

AIM

The aim of this study was to develop a PET-based machine learning model for predicting visceral pleural invasion (VPI) in patients with clinical stage IA non-small cell lung cancer.

MATERIALS AND METHODS

A total of 294 patients and 69 patients from two institutions who underwent the 18F-FDG-PET scan were retrospectively analyzed. We extracted PET-based radiomics features from the gross tumor volume (GTV) and gross tumor volume incorporating peritumoral 4, 8 and 12 mm regions (GPTV4, GPTV8, GPTV12), respectively. Then four models were respectively established by using machine learning algorithms. The performance of the models was assessed by the receiver operating characteristic (ROC) curve and decision curve analyses (DCA). Shapley additive explanation (SHAP) was employed to explain the machine learning (ML) models and visualize variable predictions.

RESULTS

Compared with GTV, GPTV4, and GPTV12 radiomics models, the radiomics model based on GPTV8 using random forest (RF) among the 10 features demonstrated better prediction performance, with the AUC of 0.879, 0.846, and 0.745 in the training, internal validation, and external validation sets, respectively. The results of the SHAP method showed that the GLRLM_ShortRunLowGreyLevel Emphasis features were the most important factors in VPI. At the patient level, SHAP force plots provided a deep understanding for predicting VPI.

CONCLUSION

The PET-based intratumoral and peritumoral model based on machine learning offers an innovative tool for preoperative prediction of VPI in patients with lung adenocarcinoma. By employing the SHAP method, clinicians may gain a clearer insight into the factors contributing to VPI, which could enhance clinical decision-making of prognosis assessment.

Role of stem cells in ageing and age-related diseases

Stem cell functions and ageing are deeply interconnected, continually influencing each other in multiple ways. Stem cells play a vital role in organ maintenance, regeneration, and homeostasis, all of which decline over time due to gradual reduction in their self-renewal, differentiation, and growth factor secretion potential. The functional decline is attributed to damaging extrinsic environmental factors and progressively worsening intrinsic genetic and biochemical processes. These ageing-associated deteriorative changes have been extensively documented, paving the way for the discovery of novel biomarkers of ageing for detection, diagnosis, and treatment of age-related diseases. Age-dependent changes in adult stem cells include numerical decline, loss of heterogeneity, and reduced self-renewal and differentiation, leading to a drastic reduction in regenerative potential and thereby driving the ageing process. Conversely, ageing also adversely alters the stem cell niche, disrupting the molecular pathways underlying stem cell homing, self-renewal, differentiation, and growth factor secretion, all of which are critical for tissue repair and regeneration. A holistic understanding of these molecular mechanisms, through empirical research and clinical trials, is essential for designing targeted therapies to modulate ageing and improve health parameters in older individuals.

Evaluating the efficacy of 8Spheres microsphere embolization combined with iodine‑125 seed implantation in advanced refractory lung cancer: A retrospective study

Patients with advanced non-small cell lung cancer (NSCLC) have seen improvements in care; however, outcomes remain poor for certain individuals despite treatment with radiation, chemotherapy, targeted therapies and immunotherapy. The present study aimed to assess the safety and efficacy of combining 8Spheres microsphere embolization with iodine-125 seed implantation for treating advanced refractory NSCLC. The retrospective analysis included 45 patients with advanced refractory NSCLC. Using the surv_cutpoint function in R, the optimal maximum tumor diameter threshold was determined as 53 mm, dividing patients into two groups: ≤53 mm and >53 mm. The study evaluated the association between treatment regimen, tumor diameter, and progression-free survival (PFS) and overall survival (OS). The findings demonstrated that the experimental group achieved a significantly longer median PFS (12 vs. 10 months; P=0.006) and OS (19 vs. 12 months; P=0.032) compared with the control group. Both the treatment approach and tumor size were identified as independent factors influencing survival. The risk of death was 2.291-fold higher for patients on the control regimen than for those in the experimental group. Similarly, patients with a tumor diameter of >53 mm had a 2.723-fold higher risk of death than those with a tumor diameter of ≤53 mm. Adverse events were mild and resolved in both groups. In summary, the combination of 8Spheres microsphere embolization and iodine-125 seed implantation demonstrate promising clinical outcomes and it may be a viable treatment for advanced refractory NSCLC. Additionally, maximum tumor diameter was strongly associated with patient survival and therefore it may serve as a valuable prognostic indicator to guide treatment decisions.

Effective neoadjuvant aumolertinib therapy facilitates transformation of unresectable to resectable advanced non‑small cell lung: A case report

The majority of stage III non-small cell lung cancer (NSCLC) is unresectable. However, effective treatment may enable patients to transition to resectable NSCLC, thereby extending the progression-free survival time. The current study presents the case of a female patient with stage IIIC unresectable lung cancer. The patient received icotinib followed by neoadjuvant aumolertinib, resulting in significant tumor shrinkage and downstaging to meet resectability criteria. Despite ~16 months of targeted therapy, including resistance to both first- and third-generation epidermal growth factor receptor-tyrosine kinase inhibitors, the patient achieved partial remission (PR) and became a candidate for surgical intervention. The patient was successfully transitioned from inoperable stage IIIC cancer to surgically resectable stage IB (ypT2N0M0). Postoperatively, the patient received aumerotinib as adjuvant therapy and is currently undergoing follow-up visits without evidence of recurrence or metastasis. The present findings provide novel insights into potential treatment choices for patients with inoperable stage IIIC NSCLC, emphasizing the possibility of achieving PR and undergoing surgery despite drug resistance. However, individual variations in such cases necessitate further research and validation before this approach can be widely implemented.

Predicting the spread through air spaces in lung adenocarcinoma from preoperative 18 F-FDG PET/CT radiomics

OBJECTIVE

This study aimed to develop an effective radiomics-clinical model to preoperatively discriminate the spread through air spaces (STAS) in lung adenocarcinoma (ADC).

METHODS

Data from 192 ADC patients were enrolled, with 2/3 ( n  = 128) allocated as the training cohort and the remaining 1/3 ( n  = 64) designated as the validation cohort. A total of 2212 radiomics features were extracted from PET/computed tomography (PET/CT) images. The least absolute shrinkage and selection operator regression method was applied to select features. Logistic regression was used to construct radiomics and clinical models. Finally, a radiomics-clinical model that combined clinical with radiomics features was developed. The models were evaluated by receiver operating characteristic (ROC) curve and decision curve analysis.

RESULTS

The area under the ROC curve (AUC) of the radiomics-clinical model was 0.924 (95% confidence interval, 0.878-0.969) in the training cohort and 0.919 (0.833-1.000) in the validation cohort. The AUC of the radiomics model was 0.885 (0.825-0.945) in the training cohort and 0.877 (0.766-0.988) in the validation cohort. The AUC of the clinical model was 0.883 (0.814-0.951) in the training cohort and 0.896 (0.7706-1.000) in the validation cohort. The decision curve analysis indicated its clinical usefulness.

CONCLUSION

The PET/CT-based radiomics-clinical model achieved satisfactory performance in discriminating the STAS in ADC preoperatively.

Single-Cell Sequencing-Guided Annotation of Rare Tumor Cells for Deep Learning-Based Cytopathologic Diagnosis of Early Lung Cancer

Deep learning (DL) models for medical image analysis are majorly bottlenecked by the lack of well-annotated datasets. Bronchoalveolar lavage (BAL) is a minimally invasive procedure to diagnose lung cancer, but BAL cytology suffers from low sensitivity. The success of DL in BAL cytology is rare due to the rarity of exfoliated tumor cells (ETCs) and their subtle morphological differences from normal cells. Single-cell DNA sequencing (scDNA-Seq) is utilized as an objective ground truth of ETC annotation for generating an unbiased, accurately annotated dataset comprising 580 ETCs and 1106 benign cells from BAL cytology slides. A DL model is developed, to distinguish ETC from benign cells in BAL fluid, achieving an Area Under the Curve of 0.997 and 0.956 for detecting large- and small-sized ETCs, respectively. The model is applied in a discovery cohort (n = 156) to establish BAL-based cytopathologic diagnostic model for lung cancer. The model is evaluated in a validation cohort (n = 158), and yielded 47.6% sensitivity and 97.7% specificity in lung cancer diagnosis, outperforming cytology with improved sensitivity (47.6% vs 19.0%). In an external validation cohort (n = 141), the model achieved 60.0% sensitivity and 92.5% specificity in lung cancer diagnosis.

The Era of Precision Medicine: Advancing Treatment Paradigms for Small Cell Lung Cancer

Small cell lung cancer (SCLC) remains a challenge prognostically. A clinically silent early stage and predilection for early metastasis leads to over half of patients presenting with metastatic disease at the time of diagnosis. Akin to many other cancers, once SCLC metastasizes, current therapies begin to lose their effectiveness. The future of SCLC rests in innovative treatments aimed at improving patient outcomes. Chemotherapy and radiation remain the backbone treatment for SCLC. Most patients diagnosed with SCLC begin treatment with combination chemotherapy consisting of a platinum analog and topoisomerase inhibitor with or without concurrent radiation. Disease progression or recurrence warrants new treatment approaches. New chemotherapy combinations and advances in radiation precision offer patients novel approaches using the same backbone of treatment used in many other cancers. The introduction of newer therapeutic approaches, such as immune checkpoint inhibitors, small molecule targeted therapies, bispecific antibodies, and antibody-drug conjugates offer a bright future for patients with SCLC who fail first-line therapy. This review will focus on advancing treatment paradigms for SCLC in the era of precision medicine. Such a study might be helpful for pulmonologists and oncologists to manage precisely patients with SCLC.

Targeting BATF2-RGS2 axis reduces T-cell exhaustion and restores anti-tumor immunity

OBJECTIVE

This study aims to investigate the role of RGS2 in immune regulation in lung cancer (LC) and explore the regulatory relationship between RGS2 and BATF2 in modulating T cell exhaustion and tumor immune evasion.

METHODS

Single-cell transcriptome-based analysis was performed to identify CD8+ T-cell profiles and regulatory factors in six LC patients receiving neoadjuvant PD-1 blockade therapy. Mouse 3LL cells or murine tumor organoid models were transplanted into wild-type, RGS2 knock-out (RGS2-/-), or BATF2 knock-out (BATF2-/-) mice to analyze the effects of RGS2 and BATF2 on tumor growth, metastasis, and immune cell infiltration. CD8+ from these mice were isolated and co-cultured with cancer cells to analyze T cell cytotoxicity in vitro. The transcriptional regulation of RGS2 by BATF2 was analyzed using luciferase reporter assays.

RESULTS

RGS2 was highly expressed in CD8+ T-exhausted (Tex) cells and was associated with pro-inflammatory pathways. High RGS2 expression predicted poor clinical outcomes and limited response to PD-1/PD-L1 blockade therapy. In RGS2-/- mice, tumor metastasis and angiogenesis were suppressed, CD8+ effector T cells were enhanced, and T cell exhaustion markers were reduced. BATF2 was identified as a key transcriptional regulator of RGS2, promoting T cell exhaustion through inhibition of CXCL13 secretion. Knockdown of BATF2 or RGS2 impaired lung cancer cell proliferation and enhanced sensitivity to NK cell-mediated cytotoxicity in vitro. In BATF2-/- mice, the populations of immune active CD8+ T cells were increased, while exhausted T cells were reduced, leading to improved anti-tumor immune responses.

CONCLUSIONS

RGS2, regulated by BATF2, plays a critical role in driving T cell exhaustion and tumor immune evasion in LC. Targeting the BATF2-RGS2 axis may enhance the effectiveness of immunotherapy by reversing T cell exhaustion and improving anti-tumor immunity.

The Presence of Emphysema in Patients with Idiopathic Pulmonary Fibrosis and Lung Cancer: Impact on Tumor Features, Acute Exacerbation, and Survival

Background: Idiopathic pulmonary fibrosis (IPF) and emphysema often coexist in patients with lung cancer (LC), forming a syndrome with combined pulmonary fibrosis and emphysema (CPFE). The three share the pathogenic mechanisms of smoking, chronic inflammation, and oxidative stress. The clinical management of CPFE patients is challenging, but its impact on tumor characteristics, acute exacerbation (AE), and prognosis is still controversial. The purpose of this study was to clarify the effect of CPFE on tumor biological behavior, AE risk, and survival outcome in patients with IPF-LC so as to optimize individualized treatment strategies. Methods: This was a retrospective and single-center study. Newly diagnosed LC patients with IPF, COPD, and normal lungs were recruited in the west China hospital. Patients with IPF were further categorized into CPFE-LC and isolated IPF-LC groups based on the presence of emphysema. Clinical and tumor features, lung function parameters, and prognosis were obtained and compared. Results: Patients with IPF and LC were more common in older men and heavy smokers. IPF-associated tumors had a higher proportion of carrying EGFR wild-type, occurring in the lower lobe of the lung and developing adenocarcinoma and squamous cell carcinoma. Among IPF-LC patients, 68.2% (103/151) met CPFE criteria. Pulmonary function tests demonstrated preserved VC% but significantly reduced FEV1/FVC in CPFE versus non-emphysema IPF (76.3% vs. 80.7%, p = 0.004), alongside elevated CPI and impaired DLCO. CPI ≥ 40 (HR = 2.087, 95%CI: 1.715-6.089, p = 0.012), combined with COPD (HR = 2.281, 95%CI: 1.139-4.569, p = 0.040), isolated IPF (HR = 5.703, 95%CI: 2.516-12.925, p < 0.001), and CPFE (HR = 6.275, 95%CI: 3.379-11.652, p < 0.001), were independent prognostic risk factors in LC patients. The incidence of treatment-induced AEs (49.5% vs. 29.2%, p = 0.038) and AE-related mortality (28.0% vs. 11.8%, p = 0.045) were significantly higher in the CPFE group than in the isolated IPF group. Logistic regression analysis showed that CPFE (OR: 3.494, 95%CI: 2.014-6.063, p = 0.001) was independently associated with the risk of AE-related mortality in patients with LC and IPF. Conclusions: Compared to LC patients with solely IPF, the presence of emphysema had no significant impact on overall survival, but CPFE increased the risk of treatment-triggered AE and was associated with AE-related mortality. In patients with LC, CPFE with AEs had a worse prognosis than IPF with AEs.

Proteomic insights into the molecular mechanism of anlotinib inhibition in TP53-mutated non-small cell lung cancer

OBJECTIVE

Tumor protein 53 (TP53) is the commonly mutated gene in non-small cell lung cancer (NSCLC) that is associated with poor prognosis, and anlotinib exerts inhibitory effects on TP53-mutated NSCLC. The aim of this study was to investigate the inhibitory effect of anlotinib on TP53-mutated NSCLC and its possible mechanism.

METHODS

The growth ability of TP53-mutated NSCLC cells were tested by Cell counting kit-8 assay. Proteins in TP53-mutated NSCLC cells treated with anlotinib were analyzed using label-free liquid chromatography-mass spectrometry. Differentially represented proteins were analyzed by KEGG, GO, and PPIs. TP53 pathway related proteins were verified using western blotting.

RESULTS

The cell viability was significantly reduced in TP53-mutated NSCLC cell as opposed to TP53 wild cell by anlotinib treatment. 126 differentially represented proteins (37 upregulated and 89 downregulated) were found between the anlotinib and control groups in TP53-mutated NSCLC cell. Bioinformatics analyses revealed that the differentially represented proteins were primarily involved in catalytic activity, cellular processes, and metabolite interconversion. PANTHER Classification System found that anlotinib mainly impacted the p53 signaling pathway, De novo purine biosynthesis and Integrin signaling. KEGG enrichment and PPI networks of the differentially represented proteins revealed cyclin-dependent kinase 1 (CDK1) and mitogen-activated protein kinase kinase 3 (MAP2K3) as the core protein, which are related to the p53 signaling pathway. Western blotting also revealed that anlotinib significantly suppressed the expression of CDK1 and MAP2K3 in TP53-mutated NSCLC cells, that indicated the possible mechanism may involve the MAP2K3/p53/CDK1 pathway.

CONCLUSIONS

Our findings showed that anlotinib selectively inhibited the growth of TP53-mutated NSCLC cells and downregulated the expression levels of CDK1 and MAP2K3. The MAP2K3/p53/CDK1 pathway may be the molecular mechanism underlying anlotinib's efficacy in TP53-mutated NSCLC.

STATEMENT OF SIGNIFICANCE

Tumor protein 53 (TP53) is the commonly mutated gene in non-small cell lung cancer (NSCLC) that is associated with poor prognosis, and anlotinib exerts inhibitory effects on TP53-mutated NSCLC. However, the action mechanism of anlotinib in the treatment of TP53-mutated NSCLC remains unclear. In this study, we used label-free quantitative proteomics to reveal the molecular mechanism of anlotinib inhibition in TP53-mutated NSCLC. We found that anlotinib significantly inhibited the growth of TP53-mutated NSCLC cells and downregulated the expression levels of CDK1 and MAP2K3. The MAP2K3/p53/CDK1 pathway may be the molecular mechanism underlying anlotinib's efficacy in TP53-mutated NSCLC. Our study promotes the use of anti-angiogenic drugs in TP53-mutated NSCLC. It provides new ideas for the treatment of TP53-mutated NSCLC.

A study on the prediction of targeted therapy efficacy in advanced lung adenocarcinoma patients with EGFR mutations using CT-based delta-radiomics model

Objective

This study aimed to evaluate the predictive performance of integrated clinical and CT-based radiomic models for assessing targeted therapy efficacy in advanced lung adenocarcinoma patients with EGFR (epidermal growth factor receptor) mutations.

Materials and methods

This retrospective study included 106 EGFR-mutated advanced lung adenocarcinoma patients treated with targeted therapies at the Second Hospital of Jilin University (2020-2023). Patients were classified as responders (PR) or non-responders (SD/PD) based on RECIST (Response Evaluation Criteria in Solid Tumors) 1.1 criteria, then randomly divided into training (n = 74) and validation (n = 32) cohorts at a 7:3 ratio. We segmented tumor regions on pre-and post-treatment CT scans using ITK-SNAP, then extracted radiomic features and applied mRMR-LASSO (Minimum Redundancy Maximum Relevance-Least Absolute Shrinkage and Selection Operator). A delta-radiomics model was developed by quantifying feature changes between treatment phases. Significant clinical predictors identified by logistic regression were integrated with radiomic features to build a combined model. Performance was assessed via AUC, sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), DeLong's test, calibration curves, and decision curve analysis.

Results

In the pre-treatment radiomics model, the AUC, accuracy, sensitivity, specificity, PPV, and NPV of the training cohorts were 0.751, 0.690, 0.737, 0.639, 0.683, and 0.697; in validation cohorts, these values were 0.726, 0.656, 0.778, 0.500, 0.667, and 0.636. In the delta-radiomics model, the AUC, accuracy, sensitivity, specificity, PPV, and NPV of the training cohorts were 0.906, 0.865, 0.868, 0.861, 0.868, and 0.861, vs. 0.825, 0.719, 0.722, 0.714, 0.765, and 0.667 in validation. For the clinical model, the AUC, accuracy, sensitivity, specificity, PPV, and NPV of the training cohorts were 0.828, 0.729, 0.737, 0.722, 0.737, and 0.722, compared to 0.766, 0.750, 0.722, 0.786, 0.812, and 0.688 in validation. In the combined model, the AUC, accuracy, sensitivity, specificity, PPV, and NPV of the training cohorts were 0.977, 0.946, 0.947, 0.944, 0.947, and 0.944, while in the validation cohorts, these values were 0.913, 0.781, 0.778, 0.786, 0.824, and 0.733.

Conclusion

The combined model integrating delta-radiomics with clinical predictors demonstrates superior predictive performance for evaluating targeted therapy efficacy in EGFR-mutated advanced lung adenocarcinoma, significantly outperforming conventional radiomics models relying exclusively on pre-treatment imaging data.

Association between modified weight loss grading system and overall survival in adults with lung cancer: A retrospective cohort study

This multicenter retrospective cohort study evaluated the prognostic value of the modified weight loss grading system (mWLGS) in patients with lung cancer by analyzing data from 3601 individuals. The investigation demonstrated that mWLGS effectively stratified patient outcomes, with median overall survival progressively declining from 35.5 months for grade 0 to 26.0 months for grade 4. Multivariate Cox regression showed grades 1, 2, 3, and 4 were independently associated with reduced survival, showing incrementally worsening hazard ratios (HR) (HR 1.56, 95% CI: 1.03-2.37, P = 0.037; HR 1.87, 95% CI: 1.24-2.84, P = 0.003; HR 1.94, 95% CI: 1.27-2.96, P = 0.003; HR: 1.95, 95% CI: 1.27-3.00, P = 0.002, respectively). Sensitivity analyses, in which we excluded patients who died within 30 days, showed that mWLGS remained an independent prognostic indicator. The system significantly enhanced prognostic discrimination when combined with TNM staging, as evidenced by improved C-statistics, continuous net reclassification improvement (NRI), and integrated discriminant improvement (IDI). These findings establish that the mWLGS can better stratification the prognosis of patients with lung cancer and is an effective indicator to predict the survival time and quality of life of lung cancer patients.

Gut and Intratumoral microbiota: Key to lung Cancer development and immunotherapy

Lung cancer is a common malignant tumor worldwide with high incidence and mortality rates. Previous studies have claimed that the microbial community plays an integral role in the development and progression of lung cancer. Emerging evidence reveals that gut flora plays a key role in cancer formation and evolution by participating in mechanisms such as metabolism, regulation of inflammation and immune response. Not only the gut flora, but also the presence of intratumoral microbiota may influence lung cancer progression through multiple mechanisms. These research advances suggest that intestinal flora and intratumoral microbiota may not only serve as potential biomarkers for lung cancer, but may also be targets for therapy. However, current studies on both in lung cancer are still limited. Given this, this study aimed to systematically review the latest findings on the major bacterial species of the intestinal flora and their possible protective or harmful roles in the formation, progression, and metastasis of lung cancer. In addition, we analyzed the potential mechanisms by which the intratumoral microbiota affected lung cancer and elaborated on the potential roles of the gut flora and its metabolites, as well as the intratumoral microbiota, in modulating the efficacy of immunotherapy in lung cancer.

The effect and toxicity profile of consolidative or salvage thoracic radiotherapy following chemoimmunotherapy in patients with extensive stage small cell lung cancer

This study evaluated the efficacy and safety of thoracic radiotherapy (TRT) after first-line chemotherapy or chemoimmunotherapy in patients with extensive-stage small cell lung cancer (ES-SCLC), focusing on the impact of different TRT timing strategies (consolidative vs. salvage) on survival. A total of 54 ES-SCLC patients treated between January 2019 and July 2022 were retrospectively analyzed. Patients receiving consolidative TRT (cTRT) within 3 months after first-line treatment completion were compared to those receiving salvage TRT (sTRT) following disease progression. Primary endpoints included overall survival (OS), progression-free survival (PFS), locoregional-free survival (LRFS), and distant metastasis-free survival (DMFS); safety was a secondary endpoint. The cTRT group (n=41) showed significantly longer median OS (26.6 vs. 14.8 months, P=0.048), PFS (12.9 vs. 3.5 months, P< 0.0001), and DMFS (10.7 vs. 3.4 months, P= 0.0044) than the sTRT group (n=13). Multivariate analysis identified cTRT as an independent favorable prognostic factor. No significant differences in OS or LRFS were found between high-dose (≥50 Gy) and low-dose (<50 Gy) TRT. Hematologic and respiratory toxicities were the most common adverse events, with acceptable tolerability. In conclusion, consolidative TRT after chemoimmunotherapy significantly improves survival outcomes in ES-SCLC patients, and low-dose TRT may be a suitable option.

Clinical, immune cell, and genetic features predicting survival and long-term response to first-line chemo-immunotherapy treatment for non-small cell lung cancer

INTRODUCTION

Chemo-immunotherapy has become a standard of care for the first-line treatment of non-small cell lung cancer (NSCLC), but currently still lacks reliable markers to predict therapeutic efficacy and long-term response (LTR).

METHODS

In this study, we retrospectively summarized the survival outcome of 319 patients with locally advanced or metastatic NSCLC who received anti-programmed cell death protein-1 (PD-1)/programmed cell death-ligand 1 (PD-L1) based therapy from January 1st, 2018 to February 28th, 2022 at the Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College. Then a comprehensive analysis of the association of LTR or survival outcomes with various characteristics including clinical parameters, peripheral blood lymphocyte subsets and common gene mutations in 167 NSCLC patients who received first-line anti-PD-1 plus chemotherapy treatment was conducted. LTR was defined as progression-free survival (PFS) exceeding 24 months, while non-responders had a PFS of less than 6 months.

RESULTS

With a median follow-up time of 32.1 months (95% confidence interval [CI] 29.2-38.0), the median overall survival (OS) was 29.9 months (95% CI 23.6-37.5) in locally advanced or metastatic NSCLC receiving anti-PD-1/PD-L1 based treatment. Among 167 patients who received the first-line chemo-immunotherapy, 25.1% (n = 42) achieved LTR. Independent baseline predictors of LTR included age < 65 years (odds ratio [OR] = 3.22, p = 0.024), overweight or obesity (body mass index [BMI] ≥ 24 kg/m2, OR = 3.26, p = 0.020), and a C-reactive protein/albumin ratio (CAR) score < 0.07 (OR = 9.94, p = 0.039). In multivariate cox analysis, both patients with higher CAR scores of ≥ 0.07 (hazard ratio [HR] = 2.83, p = 0.016) and those who were underweight (BMI < 18.5 kg/m2) (HR = 4.52, p = 0.005) were observed with significantly shorter OS. A peripheral B cell percentage ≥ 14.5% was more prevalent among LTR patients (OR = 9.23, p = 0.045) after adjusting for age, BMI and TNM stage. Additionally, the presence of TP53 mutation (16/66) was associated with non-response to first-line chemo-immunotherapy (p = 0.048) and shorter PFS (p = 0.028) and OS (p = 0.023) outcomes in univariate analysis.

CONCLUSIONS

This study provides some new insights into the features and predictors significantly associated with LTR and survival in NSCLC patient receiving first-line treatment of anti-PD-1 plus chemotherapy. Those whose age < 65 years, overweight or obesity, or has a baseline CAR score < 0.07 are more likely to achieve optimal benefit from the first-line treatment of chemo-immunotherapy.

RacGAP1 Plays an Oncogenic Role in Lung Adenocarcinoma by Regulating the Wnt/β-Catenin Pathway

Lung cancer is the most diagnosed cancer and the primary cause of cancer-related mortality worldwide, with lung adenocarcinoma (LUAD) becoming the prevalent histological subtype. Rac GTPase activating protein 1 (RacGAP1) has been found to be upregulated in several cancers, where it acts as an oncogene; nevertheless, its role in lung adenocarcinoma is largely unknown. The present study investigated the clinical relevance, the oncogenic function and the underlying molecular mechanisms of RacGAP1 in LUAD. Analyses of five patient cohorts' datasets revealed that RacGAP1 was upregulated in adenocarcinoma tissues compared to normal lung tissues, and its overexpression was associated with unfavorable prognostic factors and poor survival; intriguingly, RacGAP1 expression was related to tobacco smoke, a well-known risk factor for LUAD. Then, experimental analyses demonstrated that RacGAP1 knockdown inhibited cell proliferation, migration and invasion, thus highlighting its role in promoting LUAD. Finally, the finding of significant correlations between RacGAP1 and Wnt-altered status or β-catenin in patients led to experiments demonstrating that silencing of RacGAP1 reduced β-catenin transcriptional activity, thereby downregulating the expression of Wnt-related genes, i.e., LGR5, Wnt2B and Wnt5A. Overall, our findings indicate that RacGAP1 plays an oncogenic role in adenocarcinoma, contributing to the abnormal activation of the Wnt/β-catenin signaling pathway. These findings may pave the way for innovative therapeutic strategies and the development of advanced diagnostic panels.

Causal validation of the relationship between air pollution and lung cancer: A bidirectional Mendelian randomization study and meta-analysis

Recent studies suggest a link between air pollution and lung cancer, but causality remains uncertain due to confounding and reverse causation. Mendelian randomization (MR) reduces such bias and offers a new way to explore this relationship. MR is a method that uses genetic variants as instrumental variables to assess the causal relationship between an exposure and an outcome, effectively controlling for confounding and reverse causation. The inverse-variance weighted method is a commonly used approach in MR analysis, which estimates the overall causal effect by weighting the effect ratios of multiple single nucleotide polymorphisms, assuming all instruments are valid. Based on 2-sample MR, this study incorporated 5 air pollution indices and conducted MR analyses with lung cancer outcome data from 2 different sources. Subsequently, a meta-analysis was performed on the primary inverse-variance weighted results, followed by multiple corrections of the thresholds after the meta-analysis to ensure accuracy. Finally, reverse causality was tested through MR analysis for air pollution indices significantly associated with lung cancer. And the selection criteria for instrumental variables were: P < 5 × 10⁻⁶, F > 10, minor allele frequency > 0.01, clump_kb = 10,000, and clump_r2 = 0.001. Five air pollution indices were analyzed using MR analysis and meta-analysis with lung cancer data from the FinnGen R12 and OpenGWAS databases. Multiple corrections were applied to the significance threshold results after the meta-analysis. The final results showed that only nitrogen dioxide (NO₂) exhibited a significant association, with an OR of 3.426 (95% CI: 1.897-6.186, P = 2.21 × 10⁻⁴). Additionally, the positive air pollution index NO₂ showed no evidence of reverse causality with lung cancer from either data source. This study demonstrates a significant causal association between NO₂ and lung cancer, indicating that NO₂ may be a potential risk factor for lung cancer.

Diagnostic Utility of Podoplanin Immunohistochemistry Combined with the NanoSuit-Correlative Light and Electron Microscopy Method for Thoracic Malignant Tumors

Background/Objectives: Differentiating thoracic malignant tumors, such as epithelioid malignant pleural mesothelioma (EMPM) and non-small-cell lung carcinoma (NSCLC), primarily comprising lung adenocarcinoma (LAC) and lung squamous cell carcinoma (LSCC), remains a challenge in routine pathological diagnosis. This study aimed to evaluate whether podoplanin (PDPN) immunohistochemistry combined with scanning electron microscopy (SEM) using the NanoSuit-correlative light and electron microscopy (CLEM) methods could serve as a reliable tool for distinguishing these thoracic malignancies. Methods/Results: Initially, PDPN expression was assessed by immunohistochemical analysis in 11 EMPM, 100 LAC, and 23 LSCC cases. PDPN positivity was predominantly observed in the cell membrane and was significantly more frequent in EMPM (100%) than in LAC (2%; p < 0.0001) or LSCC (43.5%; p = 0.0018). Subsequently, field emission-SEM (FE-SEM) observations of PDPN-positive sites on immunohistochemical slides, conducted using the NanoSuit-CLEM method, revealed distinctive ultrastructural features. EMPM exhibited densely packed, elongated microvilli, whereas such structures were absent in LAC and LSCC. Furthermore, analysis of thick-cut sections (20 μm) demonstrated extensive microvilli coverage characteristic of EMPM. Conclusions: These findings suggest that the combined approach of PDPN immunohistochemistry and FE-SEM observation of PDPN-positive sites, using the NanoSuit-CLEM method, constitutes an effective diagnostic strategy for enhancing the accuracy of distinguishing EMPM from NSCLCs.

Exploring the Role of Peritumoral Edema in Predicting Lung Cancer Subtypes Through T2-FLAIR Digital Subtraction Imaging of Metastatic Brain Tumors

Background/Objectives: This study aimed to investigate whether small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC) can be distinguished based on radiomics data derived from T2-FLAIR digital subtraction images of the peritumoral edema region in patients with brain metastases. Methods: A total of 136 patients who underwent surgery for brain tumors, including 100 patients in the Pretreat-Metstobrain-MASKS dataset and 36 patients from our institution, were included in our study. Radiomic features were extracted from digitally subtracted T2-FLAIR images in the peritumoral edema area. Patients were divided into NSCLC and SCLC groups. The maximum relevance-minimum redundancy (mRMR) method was then used for dimensionality reduction. The Naive Bayes algorithm was used for model development, and the interpretability of the model was explored using SHapley Additive exPlanations (SHAP). The performance metrics included the area under the curve (AUC), sensitivity (SENS), and specificity (SPEC). Results: The mean age of NSCLC patients was 64.6 ± 10.3 years, and that of SCLC patients was 63.4 ± 11.7 years. In the external validation cohort, the model achieved an AUC of 0.82 (0.68-0.97), a SENS of 0.87 (0.74-0.91), and a SPEC of 0.72 (0.72-0.89). In the train cohort, the model achieved an AUC of 1.000, a SENS of 1.000, and a SPEC of 1.000. The feature providing the best effect was wavelet-HHHglcmJointEnergy, with a SHAP value of approximately 2.5. Conclusions: An artificial intelligence model developed using radiomics data from T2-FLAIR digital subtraction images of the peritumoral edema area can identify the histologic type of lung cancer in patients with associated brain metastases.

Label-Free Imaging Immunosensor Based on Nickel-Manganese Double Hydroxide with Delayed Chemiluminescence Properties for Detection of CYFRA21-1

Flash-type chemiluminescence (CL) systems are hardly used for CL imaging analysis due to their uncontrollable emission onset time. It is highly desired to develop emission time-controllable nanomaterials as analytical interfaces for CL immunosensors with CL imaging detection. Herein, nickel-manganese double hydroxide (NiMn-DH) was chosen as a carrier to synthesize a CL-functional nanomaterial NiMn-DH/L012-Au (NMLA) by reducing chloroauric acid with 8-amino-5-chloro-2,3-dihydro-7-phenylpyrido-[3,4-d]-pyridazine-1,4-dione (L012). Using H2O2 and NaHCO3 as the coreactants, NMLA not only produced a strong CL emission, but also its CL emission onset time could be adjusted by free radical scavengers such as thiourea, gallic acid, ascorbic acid, and dopamine. This feature not only avoided solution fluctuations caused by the addition of coreactants but also effectively captured the maximum CL signal and shortened the exposure time. Based on this, a rapid, accurate, and highly sensitive label-free CL immunosensor integrated with smartphone imaging technology was constructed for detecting CYFRA21-1. This CL immunosensor exhibited a wide detection range of 1.0 × 10-14 g/mL - 1.0 × 10-9 g/mL and a low detection limit of 3.41 fg/mL. In addition, it could quantify CYFRA21-1 concentrations in serum samples. Finally, the CL immunosensor was able to differentiate not only between healthy individuals and non-small cell lung cancer but also between squamous cell carcinoma and lung adenocarcinoma.

Transcription factor ZNF266 suppresses cancer progression by modulating CA9-mediated intracellular pH alteration in lung adenocarcinoma

BACKGROUND

Lung cancer remains the leading cause of cancer-related mortality globally, with lung adenocarcinoma (LUAD) being the most prevalent subtype. Despite extensive research efforts, the role of transcription factors in LUAD progression remains largely uncharacterized. In this study, we focused on ZNF266, a transcription factor whose impacts on LUAD have not been investigated.

METHODS

Using high-throughput sequencing data, we observed a significant downregulation of ZNF266 expression in LUAD tissues. To validate this finding, we conducted a retrospective analysis of nearly three thousand LUAD patients' data from public databases and our institution. Functional studies were performed using cell lines, organoids, and xenograft models to assess the role of ZNF266 in LUAD progression. RNA sequencing, chromatin immunoprecipitation, DNA pull-down assays, and dual-luciferase reporter assays were employed to elucidate the underlying mechanism. Additionally, adeno-associated virus (AAV)-mediated overexpression of ZNF266 was used to evaluate its therapeutic potential.

RESULTS

Patients with low ZNF266 expression had poorer prognosis compared to those with high expression. ZNF266 inhibits the malignant phenotypes of LUAD, including proliferation, migration, and invasion. Mechanistically, ZNF266 binds to the promoter region of CA9, suppressing its transcription. This leads to a reduction in intracellular pH and subsequent inhibition of the mTOR signaling pathway, which is crucial for cancer cell growth and survival. Furthermore, AAV-mediated overexpression of ZNF266 significantly inhibited tumor growth in patient-derived xenograft models.

CONCLUSIONS

Our study demonstrated that ZNF266 inhibits LUAD progression in a pH-dependent manner via modulating CA9 expression, uncovering its therapeutic significance for LUAD treatment.

Visualized chemiluminescence immunoassay for simultaneous detection of multiple lung cancer markers based on spatially resolved microfluidic paper chip device

Lung cancer ranks as the most prevalent form of cancer. Early detection and diagnosis can lower death rates, and variations in tumor markers can help assess cancer risk. In this work, a glow-type chemiluminescent (CL) hydrogel SCG-Co2+-luminol was synthesized by a simple approach, and this hydrogel was integrated with a 3D microfluidic paper-based analytical device (3D μPAD) to develop a visual biosensor for identifying multiple lung cancer markers. The prepared SCG-Co2+-luminol can produce strong CL signal after reacting with H2O2, and the CL time can last more than 60 min because of its porous structure. The 3D μPAD is designed with six detection areas and can simultaneously identify two lung cancer markers, NSE and CEA, based on the concept of spatial resolution. Using the hydrogel as the sensing interface and the 3D μPAD as the detection platform, a blue CL signal was emitted upon H2O2 injection, and the luminescence image was captured by a smartphone. Image J software was used to process the gray values of the images, demonstrating a clear linear relationship between the concentrations of NSE and CEA concentrations and the CL intensity. The linear range of the immunoassay is 0.1-10000 pg/mL, with detection limits for NSE and CEA at 0.032 pg/mL and 0.036 pg/mL, respectively. Finally, the proposed visualized CL immunoassay was successfully employed to determine NSE and CEA in real samples. Overall, the fabricated method has the merits of rapid detection, high sensitivity, and portability, making it highly promising for multi-component detection and analysis in lung cancer.

Circ_0002638 drives squamous cell lung cancer (LUSC) progression and chemotherapy resistance by inhibiting ferroptosis via SENP1-mediated deSUMOylation of ACSL4

AIMS

Chemotherapy is the first-line treatment for LUSC, but chemotherapy resistance often leads to tumor recurrence, significantly affecting the prognosis of patients. We sought to investigate the potential involvement of circRNAs in chemotherapy-resistant LUSC.

MAIN METHODS

qRT-PCR and circRNA sequencing were employed to assess the level of circRNAs in LUSC patients treated with chemotherapy, and the role of circ_0002638 in LUSC was explored in vivo and in vitro. RNA pulldown, mass spectrometry, and co-IP assays were performed to evaluate the underlying mechanism by which circ_0002638 promotes the progression of LUSC.

KEY FINDINGS

The expression of circ_0002638 is significantly upregulated in LUSC patients with PD (progressive disease) compared to those with PR (partial remission) after chemotherapy. Furthermore, upregulation of circ_0002638 enhanced the tumor progression. Mechanistically, circ_0002638 acts as a scaffold promoting the binding of SENP1 to ACSL4 and facilitates the process of deSUMOylation of ACSL4 was shown to protect LUSC from ferroptosis. Importantly, a combination of SENP1-IN-1 with chemotherapy has a synergistic effect in inhibiting tumor growth.

SIGNIFICANCE

This study offers novel perspectives on the function of circ_0002638 in LUSC, and provided a therapeutic target to enhance the chemotherapy sensitivity of LUSC.

Efficacy and safety of distinct regimens for individuals with advanced EGFR-mutated non-small-cell lung cancer who progressed on EGFR tyrosine-kinase inhibitors: a systematic review and network meta-analysis

Background

Targeted therapy with EGFR tyrosine-kinase inhibitors (TKIs) is the preferred first-line treatment for EGFR-mutated advanced non-small-cell lung cancer (NSCLC), but acquired resistance inevitably occurs in almost all responding individuals.

Objectives

We aimed to comprehensively review the literature to investigate the efficacy and safety of distinct regimens in the subsequent-line setting, thereby identifying the optimal regimen for these TKI-resistant NSCLC patients.

Design

A systematic review and network meta-analysis (NMA) using a Bayesian framework.

Data sources and methods

The PubMed, Embase, Cochrane Library databases, and abstracts of ASCO, ESMO, and WCLC were searched from database inception to November 3, 2024, to identify eligible randomized controlled trials (RCTs) that assessed distinct regimens for individuals with advanced EGFR-mutated NSCLC who progressed on TKIs. The outcomes of progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and grade 3 or higher adverse events (⩾3AEs) were compared and ranked in overall patients and various subgroups among eight regimens by NMA and the surface under the cumulative ranking curve, respectively. The protocol is registered with PROSPERO, CRD42024601619.

Results

In total, 14 RCTs, involving 3177 participants and 8 treatment regimens (chemotherapy plus ivonescimab (programmed cell death protein 1/vascular endothelial growth factor inhibitor; chemotherapy + ivonescimab (CT + IVO)); CT + amivantamab + lazertinib (CT + AMI + LAZ), CT + immunotherapy + bevacizumab (CT + IO + BEV), CT + AMI, CT + BEV, CT + IO, CT, and IO), were included. Overall, in patients, the most pronounced PFS benefit was observed with the "CT + IVO," followed by "CT + AMI + LAZ," "CT + IO + BEV," and "CT + AMI," ranked second, third, and fourth, respectively. In terms of OS, the regimen of "CT + AMI" ranked the best, followed by "CT + IVO." However, the comparisons of OS among different regimens did not reach statistical significance, possibly due to immature data. The results for ORR and DCR were similar to those for OS, with "CT + AMI" topping the rankings, followed by "CT + AMI + LAZ." In terms of safety, the incidence of ⩾3AEs was highest in "CT + AMI + LAZ," followed by "CT + AMI." In subgroup analysis, "CT + IVO" demonstrates stable PFS benefits across clinicopathological characteristics, ranking first in most subgroups. Due to the unavailability of OS subgroup data in most RCTs, many regimens were missing in the OS subgroup analysis.

Conclusion

Integrating the results of different clinical outcomes and subgroup analyses, we conclude that "CT + IVO" is the optimal treatment option with an acceptable safety profile for patients with advanced EGFR-mutated NSCLC who have progressed on TKIs. "CT + AMI + LAZ" and "CT + AMI" are alternative subsequent line options as well, with superior efficacy compared to immunotherapy-based or chemotherapy regimens, yet elevated toxicity profiles requiring vigilant management.

ZC3H12D gene expression exhibits dual effects on the development and progression of lung adenocarcinoma

While precision oncology requires robust biomarkers, current predictors for lung adenocarcinoma (LUAD) often show limited clinical utility. This study investigates the multifaceted roles of ZC3H12D, a novel immunomodulatory molecule, in LUAD progression and tumor microenvironment regulation. Multi-omics analyses integrated ZC3H12D transcriptomic (511 tumors vs 59 normals), proteomic (74 tumors vs 69 normals), and single-cell RNA-seq data (15 tumors vs 11 normals). Immunohistochemistry validated ZC3H12D expression in 51 matched pairs. Computational biology approaches assessed immune infiltration, genomic instability (TMB/MSI/HRD), and pathway enrichment. Functional validation employed ZC3H12D knockdown in PC9 cells with colony formation and transwell assays. Multi-omics verification confirmed ZC3H12D upregulation in LUAD at both mRNA and protein levels (p < 0.001), with single-cell resolution revealing predominant localization in tumor-infiltrating immune cells. Moreover, ZC3H12D expression positively correlated with immune regulatory genes while inversely associating with genes involved in cellular respiration. Its expression was also linked to clinical markers such as TMB, MSI, HRD, tumor purity, and ploidy. Notably, high ZC3H12D expression revealed Immune-infiltrated microenvironment and favorable prognosis, despite silencing ZC3H12D resulted in significant inhibition of tumor cell proliferation and invasion in vitro (p < 0.001). Our findings demonstrate that high ZC3H12D expression in immune cells appears to enhance antitumor immune activity, whereas lower expression in malignant cells contributes to reduced cellular proliferation and migration. This spatial duality challenges conventional biomarker paradigms and provides mechanistic insights for developing cell type-targeted therapies.

Longitudinal Trajectory of Patient-Reported Fatigue in Patients Undergoing Thoracoscopic Lung Cancer Surgery

BACKGROUND

Postoperative fatigue is widely recognized as one of the most prevalent adverse effects of surgery, representing a critical determinant of functional recovery and quality of life. However, fatigue is commonly measured at a single time point, failing to capture its dynamic nature. This study aimed to characterize the longitudinal trajectories of postoperative fatigue and identify the potential factors.

METHODS

This retrospective study included patients with lung cancer who underwent thoracoscopic surgery between March 2021 and October 2023. Patients completed the Perioperative Symptom Assessment for Lung Surgery Scale (PSA-Lung) daily for 7 days after surgery. Latent class mixed modeling was used to analyze the longitudinal patient-reported data and identify subgroups based on trajectory features.

RESULTS

A total of 1,096 patients were included. Three-cluster trajectory model provided the best fit, consisting of deterioration-fatigue group (17.7%), recovery-fatigue group (31.4%) and mild-fatigue group (50.9%). Compared with the mild-fatigue group, patients with comorbidities had a higher risk of being categorized into the recovery-fatigue group (odds ratio 1.44, 95% confidence interval 1.02-2.04; p = 0.040). The presence of recovery-fatigue was associated with lower preoperative hemoglobin level (p = 0.025). Moreover, lower preoperative body mass index and albumin level increased the likelihood of being classified as the deterioration-fatigue group (p = 0.022 and p = 0.026, respectively).

CONCLUSIONS

This study elucidated the heterogeneity of fatigue trajectories, with half of the patients experiencing either recovery-fatigue or deterioration-fatigue. The severity of postoperative fatigue was found to be worse in patients with comorbidities or poor nutritional status.

Breath Insights: Advancing Lung Cancer Early-Stage Detection Through AI Algorithms in Non-Invasive VOC Profiling Trials

Background: Lung cancer (LC) is the leading cause of cancer-related deaths worldwide. Effective screening strategies for early diagnosis that could improve disease prognosis are lacking. Non-invasive breath analysis of volatile organic compounds (VOC) is a potential method for earlier LC detection. This study explores the association of VOC profiles with artificial intelligence (AI) to achieve a sensitive, specific, and fast method for LC detection. Patients and methods: Exhaled breath air samples were collected from 123 healthy individuals and 73 LC patients at two clinical sites. The enrolled patients had LC diagnosed with different stages. Breath samples were collected before undergoing any treatment, including surgery, and analyzed using gas chromatography coupled to ion-mobility spectrometry (GC-IMS). AI methods classified the overall chromatographic profiles. Results: GC-IMS is highly sensitive, yielding detailed chromatographic profiles. AI methods ranked the sets of exhaled breath profiles across both groups through training and validation steps, while qualitative information was deliberately not taking part nor influencing the results. The K-nearest neighbor (KNN) algorithm classified the groups with an accuracy of 90% (sensitivity = 87%, specificity = 92%). Narrowing the LC group to those only in early-stage IA, the accuracy was 90% (sensitivity = 90%, specificity = 93%). Conclusions: Evaluation of the global exhaled breath profiles using AI algorithms enabled LC detection and demonstrated that qualitative information may not be required, thus easing the frustration that many studies have experienced so far. The results show that this approach coupled with screening protocols may improve earlier detection of LC and hence its prognosis.

The association of immune-inflammation indices at multiple time points with treatment response and survival in advanced non-small cell lung cancer patients receiving immune checkpoint inhibitors

BACKGROUND

Immune and inflammation participate in the progression of non-small cell lung cancer (NSCLC) and some immune-inflammation indexes may serve as prognostic biomarkers in NSCLC patients. This study aimed to investigate the association between immune-inflammation indices at multiple time points and prognosis in advanced NSCLC patients treated with immune checkpoint inhibitors (ICIs).

METHODS

This retrospective study included 102 advanced NSCLC patients treated with ICIs and collected their blood indices within 7 days before treatment (T1), before the 3rd treatment cycle (T2), and before the 5th treatment cycle (T3) to calculate neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), pan-immune-inflammatory value (PIV), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), and lung immune prognostic index (LIPI).

RESULTS

dNLR (P = 0.006), SII (P = 0.005), PIV (P = 0.010), and LIPI (P = 0.001) reduced, while PNI increased (P = 0.009) from T1 to T3; NLR was not different among T1, T2, and T3 (P = 0.282). A lower NLR (P = 0.011) and higher PNI (P = 0.026) at T3, and lower LIPI at T2 (P = 0.023) were related to better disease control rate, but these immune-inflammation indices were not linked with objective response rate at any timepoint. Multivariate Cox regression analysis showed that high NLR at T1 was independently related to worse PFS (hazard ratio: 4.187, P = 0.008), while high PNI at T3 was independently associated with better PFS (hazard ratio: 0.454, P = 0.021).

CONCLUSION

NLR before and after treatment, as well as PNI and LIPI after treatment may serve as potential biomarkers for treatment response or survival in advanced NSCLC patients receiving ICIs.

DNAJC5 facilitates the proliferation and migration of lung adenocarcinoma cells by augmenting EGFR trafficking

Lung adenocarcinoma (LUAD) is a highly prevalent and lethal malignant tumor, with the aberrantly activated EGFR signaling pathway playing a crucial role in its development. However, resistance to tyrosine-kinase inhibitors (TKIs) targeting EGFR significantly limits the efficacy of LUAD clinical therapy. Therefore, it is imperative to identify novel therapeutic targets and elucidate the regulatory mechanisms of EGFR for improving LUAD treatment outcomes. In this study, we discover that DNAJC5 functions as an oncogene in LUAD. We observe elevated protein levels of DNAJC5 in tissues from LUAD patients, which are strongly associated with poor prognosis among these individuals. Furthermore, overexpression of DNAJC5 promotes proliferation and migration of LUAD cells both in vitro and in vivo. Mechanistic investigations reveal that DNAJC5 interacts with the intracellular domain of EGFR and enhances its endocytosis and recycle, thereby augmenting EGFR activity and downstream signaling pathways. Additionally, we find that DNAJC5 binds to AP2A1 protein-a key player in EGFR endocytosis-and strengthens its interaction with EGFR. Knockdown experiments targeting AP2A1 attenuate the ability of DNAJC5 to promote proliferation and migration of LUAD cells. Collectively, our findings unveil a functional role for DNAJC5 in regulating EGFR trafficking and driving LUAD progression.

Development and Validation of a Machine Learning-Based Predictive Model for Postoperative Frailty in Patients with Non-Small Cell Lung Cancer and Its Relation to Early Recovery

PURPOSE

This study was designed to evaluate the postoperative frailty status of patients with non-small cell lung cancer, identify influencing factors, establish a machine learning-based prediction model, and explore the correlation between frailty status at 3 months and early recovery at 1 month postoperatively.

METHODS

This retrospective analysis included patients with non-small cell lung cancer who underwent surgery at our hospital from 2021 to 2024. Clinical variables, including demographics, tumor characteristics, treatment, and laboratory tests, were analyzed. Feature selection and model construction were performed by using LASSO regression. Cross-validation assessed the accuracy of the models. Frailty at 3 months and quality of recovery at 1 month postoperatively were measured by using the Tilburg Frailty Index and Quality of Recovery (QoR-15) scales, respectively.

RESULTS

A total of 1,013 patients were included. The initial model achieved an AUC of 0.833, accuracy of 0.854, recall of 0.382, and F1 score of 0.502 in the training set, and an AUC of 0.786, accuracy of 0.857, recall of 0.242, and F1 score of 0.364 in the validation set. Of the patients, 190 (18.8%) developed frailty at 3 months postoperatively. After applying Synthetic Minority oversampling Technique to balance the data, the model's performance improved (area under the curve [AUC] 0.850, accuracy 0.791, recall 0.818, and F1 score 0.795 for the training set; AUC 0.819, accuracy 0.778, recall 0.762, and F1 score 0.781 for the test set). Additionally, we developed a nomogram to visually represent the predictive model, enabling clinicians to easily assess frailty risk in individuals based on key factors. Correlation analyses showed that frailty at 3 months was moderately negatively correlated with early recovery at 1 month (correlation coefficient = - 0.370).

CONCLUSIONS

This study developed a predictive model of postsurgical frailty in lung cancer, providing insights into personalized patient management and early recovery improvement. Further studies should explore the clinical application of the model.

Narciclasine enhances cisplatin-induced apoptotic cell death by inducing unfolded protein response-mediated regulation of NOXA and MCL1

BACKGROUND

Platinum-based chemotherapy is commonly used to treat non-small cell lung cancer (NSCLC); however, innate and acquired resistance is clinically seen in many patients. Hence, a combinatorial approach with novel therapeutic agents to overcome chemoresistance is a promising option for improving patient outcomes. We investigated the combinational anticancer efficacy of cisplatin and narciclasine in three-dimensional NSCLC tumor spheroids.

METHODS

To assess the efficacy of cisplatin and narciclasine, cell viability assays, live/dead cell staining, cell death enzyme-linked immunosorbent assay (ELISA), western blot analysis for proteins related to apoptosis, and in vivo xenograft experiments were performed. The synergistic effects of cisplatin and narciclasine were elucidated through transcriptomic analysis and subsequent validation of candidate molecules by regulating their expression. To clarify the underlying molecular mechanisms, the activation of unfolded protein responses and kinetics of a candidate protein were assessed.

RESULTS

Narciclasine inhibited viability of NSCLC tumor spheroids and augmented the sensitivity of cisplatin-resistant tumor spheroids to cisplatin by inducing apoptosis. After conducting bioinformatic analysis using RNA sequencing data and functional validation experiments, we identified NOXA as a key gene responsible for the enhanced apoptosis observed with the combination of cisplatin and narciclasine. This treatment dramatically increased NOXA while downregulating anti-apoptotic MCL1 levels. Silencing NOXA reversed the enhanced apoptosis and restored MCL1 levels, while MCL1 overexpression protected tumor spheroids from combination treatment-induced apoptosis. Interestingly, narciclasine alone and in combination with cisplatin induced unfolded protein response and inhibited general protein synthesis. Furthermore, the combination treatment increased NOXA expression through the IRE1α-JNK/p38 axis and the activation of p53. Cisplatin alone and in combination with narciclasine destabilized MCL1 via NOXA-mediated proteasomal degradation.

CONCLUSIONS

We identified a natural product, narciclasine, that synergizes with cisplatin. The combination of cisplatin and narciclasine induced NOXA expression, downregulated MCL1, and ultimately induced apoptosis in NSCLC tumor spheroids. Our findings suggest that narciclasine is a potential natural product for combination with cisplatin for treatment of NSCLC.

Differentiating Lung Adenocarcinoma from Tuberculous Nodules in HIV/AIDS Patients Using Preoperative CT-Based Intratumoral and Peritumoral Radiomics Combined with Clinical Features

Purpose

This study aimed to develop and validate a preoperative CT-based radiomics nomogram model incorporating intratumoral and peritumoral features to accurately differentiate lung adenocarcinoma (LUAD) from pulmonary tuberculosis (PTB) nodules in HIV/AIDS patients.

Patients and Methods

This retrospective study analyzed clinical and CT imaging data from 187 hIV/AIDS patients (84 with LUAD and 103 with PTB) treated at the Fourth People's Hospital of Nanning. Patients were randomly divided into training and validation cohorts in a 7:3 ratio. Radiomics features were extracted from both the intratumoral region and a 2 mm peritumoral region, then combined with clinical factors (eg, fever, C-reactive protein levels, and cardiac disease) to develop multiple predictive models, including clinical model, intra model, peri 2mm model, fusion model, and combined model (which integrates clinical and fusion models). Diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and other metrics.

Results

The combined model achieved the highest AUC in both the training (0.978) and validation cohorts (0.969) cohorts, significantly outperforming the other models while mitigating the overfitting observed in the clinical model. Hosmer-Lemeshow (HL) tests, Integrated Discrimination Improvement (IDI), Net Reclassification Index (NRI), and decision curve analysis (DCA) confirmed its superior performance.

Conclusion

The CT-based radiomics nomogram model, intratumoral and peritumoral radiomics features, enables accurate differentiation between LUAD and PTB in HIV/AIDS patients, providing a non-invasive tool for preoperative diagnosis.

Innovative Approaches in the Synthesis and Optimization of Copper Complexes for Antitumor Therapies: A Comprehensive Review

Cancer is the second leading cause of death worldwide. Late diagnosis, low drug selectivity, high toxicity, and treatment resistance are challenges associated with pharmacological interventions. The commonly used therapies include surgery, radiotherapy, hormonal therapy, immunotherapy, and chemotherapy. Recently, Cu complexes have been studied owing to their biological functions and effects on tumor angiogenesis. In this review, we examined 23 types of cancer and revealed the use of cell lines. The synthesis of Cu complexes with ligands such as phenanthroline and thiosemicarbazones has also been reported. Such co-ligation is promising because of its high cytotoxicity and selectivity. Compared with cisplatin, Cu complexes, especially mixed complexes, showed better interactions with DNA, generating reactive oxygen species and inducing apoptosis. Nanoformulations have also been adopted to improve the pharmacological activity of compounds. They enhance the efficacy of complexes by targeting them to the tumor tissue, thereby improving their safety. Studies have also explored Cu complexes with clinically relevant pharmacophores, suggesting a "hybrid chemotherapy" against resistant tumors. Overall, Cu complexes have demonstrated therapeutic versatility, antitumor efficacy, and reduced adverse effects, showing great potential as alternatives to conventional chemotherapy and justifying future clinical investigations to validate their use.

The profile and clinical predicting effect of non-rash dermatologic toxicity related to targeted therapy in stage-IV non-small cell lung cancer patients

Dermatologic toxicities associated with targeted therapies may impact drug intolerance and predict drug response, among which rash is most frequently reported and well delineated. However, the profile and effect of non-rash dermatologic toxicity are not fully understood. We identified stage-IV non-small cell lung cancer patients diagnosed at Mayo Clinic in 2006-2019 and systematically analyzed demographics, targeted agents, toxicity, response, and survival outcomes of patients who received targeted therapy. Five toxicity subgroups-none, only non-rash dermatologic, concurrent non-rash and rash (concurrent) dermatologic, only rash, and others-were compared; multivariable survival analyses employed Cox Proportional Hazard models. This study included 533 patients who had taken targeted therapies: 36 (6.8%) had no toxicity, 26 (4.9%) only non-rash dermatologic, 193 (36.2%) only rash, 134 (25.1%) concurrent dermatologic, 144 (27.0%) other toxicities. Non-rash dermatologic toxicities predominately included xerosis (12.8%), pruritus (8.5%), paronychia (7.0%). Rash was the most frequent (59.4%) and the earliest occurring (21 median onset days [MOD]) dermatologic toxicity; paronychia was the latest (69 MOD) occurring. In 329 epidermal growth factor receptor inhibitors-treated patients with dermatologic toxicity, mild toxicity occurred the most frequently in patients with only non-rash (81.8%), then those with only rash (64.8%), and the least in the concurrent (50.4%, P=0.013). Patients with concurrent dermatologic toxicities had a significantly higher response rate (67.9%) than those with only non-rash (53.8%) or only rash (41.1%, p < 0.001). Multivariable analysis demonstrated concurrent dermatologic toxicity independently predicted a lower risk of death (harzard ratio [HR] 0.48 [0.30-0.77], p < 0.001). Compared to rash, non-rash dermatologic toxicity might be a stronger predictor of better treatment response and longer survival in patients who received targeted therapy.

Tumor cell-intrinsic circular RNA circFNDC3B attenuates CD8+ T cells infiltration in non-small cell lung cancer

Tumor-infiltrating CD8+ T cells are critical for anti-tumor immunity and positively associated with patient survival. However, the mechanisms governing CD8+ T cell infiltration remain incompletely elucidated, particularly those involving circular RNAs (circRNAs). In this study, we characterized circRNA expression profiles in four paired normal and tumor tissues of non-small-cell lung cancer (NSCLC) and identified that circFNDC3B, a circular transcript derived from exons 2 and 3 of the fibronectin type III domain containing 3B (FNDC3B) gene, as significantly upregulated in NSCLC tissues. Mechanistic investigations revealed that circFNDC3B directly binds to transcription factor II-I (TFII-I), forming an RNA-protein complex that competitively disrupts the interaction between TFII-I and STAT1. This sequestration abrogates the transcriptional activation of CXCL10 and CXCL11, two critical chemokines governing CD8+ T cell chemoattraction. Consequently, reduced CXCL10/11 expression significantly impairs CD8+ T cell infiltration into the tumor microenvironment. Consistently, the murine ortholog circFndc3b expression exhibits an inverse correlation with CD8+ T cell infiltration in tumors. Our study uncovers a crucial circRNA-mediated regulatory axis wherein circFNDC3B impedes anti-tumor immunity by suppressing chemokine-dependent CD8+ T cell recruitment, positioning circFNDC3B as a potential therapeutic target to enhance CD8+ T cell-mediated anti-tumor responses in NSCLC.