Outcomes after Contralateral Anatomic Surgical Resection in Multiple Lung Cancer

Diagnosis and management of multiple primary lung cancer

Multiple primary lung cancer (MPLC), can be categorized as synchronous multiple primary lung cancer (sMPLC) and metachronous multiple primary lung cancer (mMPLC), which are becoming increasingly common in clinical practice. A precise differential diagnosis between MPLC and intrapulmonary metastases (IPM) is essential for determining the appropriate management strategy. MPLC is primarily diagnosed through histology, imaging, and molecular methods. Imaging serves as an essential foundation for preoperative diagnosis, while histology is a critical tool for establishing a definitive diagnosis. As molecular biology advances, the diagnosis of MPLC has stepped into the era of molecular precision. Surgery is the preferred treatment approach, with stereotactic radiotherapy and ablation being viable options for unresectable lesions. Targeted therapy and immunotherapy can be considered for specific patients. A multidisciplinary team approach to evaluation and the application of combination therapy can benefit more patients. Looking ahead, the development of more authoritative guidelines will be instrumental in streamlining the diagnosis and management of MPLC.

Outcomes of Surgery for Metachronous Second Primary Non-small Cell Lung Cancer

OBJECTIVE

The optimal surgical approach for second primary metachronous lung cancer (MPLC) remains unclear. Our aim is to evaluate the morbidity and prognostic value based on the extent of surgical resection in MPLC.

METHODS

Retrospective study of 84 patients with a history of anatomical resection for lung cancer and MPLC surgically treated between January 2010 and December 2020.

RESULTS

The interval between the initial primary tumor and the second was 50.38±32.89 months. The second resection was contralateral in 43 patients (51.2%) and ipsilateral in 41 (48.8%). Thirty-six patients (42.9%) underwent a second anatomical resection, and in 48 patients (57.1%), it was non-anatomical. Postoperative complications were observed in 29 patients (34.5%) after the second lung resection. According to the Clavien-Dindo classification, 95.2% were mild (Clavien-Dindo I-II), and a single patient died (1.2%) in the postoperative period (Grade V). Prolonged air leak (p=0.037), postoperative arrhythmias (p=0.019) and hospital stay showed significant differences depending on the extent of surgery in ipsilateral resections. The main histological type was adenocarcinoma (47.6%) and the median tumor size was 17.74±11.74mm. The overall survival was 58.07 months (95% CI 49.29-66.85) for patients undergoing anatomical resection and 50.97 months (95% CI 43.31-58.63) for non-anatomical without significant differences (p=0.144). The disease-free survival after the second surgery was 53.75 months (95% CI 45.28-62.23) for anatomical resection and 41.34 months (95% CI 33.04-49.65) for non-anatomical group.

CONCLUSION

Second anatomical resections provide good long-term outcomes and have been shown to provide better disease-free survival compared to non-anatomical resections in properly selected patients.

Design, synthesis and biological evaluation of nitric oxide-releasing 5-cyano-6-phenyl-2, 4-disubstituted pyrimidine derivatives

In this study, a series of nitric oxide (NO) -releasing 5-cyano-6-phenyl-2, 4-disubstituted pyrimidine derivatives were designed and synthesized. In the in vitro biological evaluation, compound 24l exhibited optimal antiproliferative activity against MGC-803 cells with the IC₅₀ value of 0.95 µM, significantly better than that of the positive control 5-FU. In addition, preliminary mechanistic studies indicated that 24l inhibited colony formation and blocked MGC-803 cells in the G0/G1 phase. DAPI staining, reactive oxygen species and apoptosis assays demonstrated that 24l induced apoptosis of MGC-803 cells. Particularly, the most potent compound 24l produced the highest level of NO, and the antiproliferative activity was significantly reduced after preincubation with NO scavengers. In conclusion, compound 24l may be considered as a potential candidate antitumor agent.

One-stage VATS surgery for synchronous bilateral lung lesion: a safe and feasible procedure

BACKGROUND

Synchronous bilateral lung lesions are emerging as a common but tricky disease for surgical management. Whether one or two-stage surgery should be taken remains in debate. We retrospectively analysed 151 patients who underwent one and two-stage Video Assisted Thoracic Surgery (VATS) to investigate the safety and feasibility of the two surgical approaches.

METHODS

A total of 151 patients were included in the study. Propensity score matching was performed to minimize the baseline characteristics difference between one and two-stage groups. Clinical factors including in-hospital days after surgery, chest tube drainage days, types and severity of post-operative complications were compared between the two groups. Logistic univariate and multivariate analyses were used to find the risk factors for post-operative complications. Nomogram was built to select the low risk candidates for the one-stage VATS.

RESULTS

After propensity score matching, 36 one-stage and 23 two-stage patients were enrolled. The age (p = 0.669), gender (p = 0.3655), smoking status (p = 0.5555), pre-operative comorbidity (p = 0.8162), surgical resection (p = 0.798) and lymph node dissection (p = 9036) were balanced between the two groups. There was no difference in post-surgery hospital days (8.67 ± 2.68 versus 8.46 ± 2.92, p = 0.7711) and chest tube retaining days (5.47 ± 2.20 versus 5.46 ± 1.95, p = 0.9772). Moreover, post-operative complications also showed no difference between one-stage and two-stage groups (p = 0.3627). Univariate and multivariate analysis revealed that advanced age (p = 0.0495), pre-surgical low haemoglobin (p = 0.045) and blood loss (p = 0.002) were risk factors for post-operative complications. Nomogram built with the three risk factors showed reasonable predictive value.

CONCLUSIONS

One-stage VATS for synchronous bilateral lung lesion patients was proved to be a safety procedure. Advanced age, pre-surgical low haemoglobin and blood loss may predict complications after surgery.

Multiple Primary Lung Cancers: A New Challenge in the Era of Precision Medicine

With the widespread implementation of lung cancer screening, more and more patients are being diagnosed with multiple primary lung cancers (MPLCs). In the era of precision medicine, many controversies remain in differentiating MPLCs from intrapulmonary metastasis and the optimum treatment choice, especially in patients exhibiting similar histology. In this review, we summarize common diagnostic criteria and novel discrimination methods with a special emphasis on the emerging value of broad panel next-generation sequencing (NGS) for the diagnosis of MPLCs. We then discuss current advances regarding therapeutic approaches for MPLCs. Radical surgery is the main treatment modality, while stereotactic body radiotherapy (SBRT) is safe and feasible for early-stage MPLC patients with inoperable tumors. In addition, immunotherapy and targeted therapy, particularly epidermal growth factor receptor-tyrosine kinase inhibitors, are emerging therapeutic strategies that are still in their infancy. Characteristics of both genomic profiles and tumor microenvironment are currently being evaluated but warrant further exploration to facilitate the application of targeted systematic therapies in MPLC patients.