Risk factors of chest wall invasion in non-small cell lung cancer

Diagnostic utility of chest wall vessel involvement sign on ultra-high-resolution CT for primary lung cancer infiltrating the chest wall

OBJECTIVES

Chest wall infiltration in primary lung cancer affects the surgical and therapeutic strategies. This study evaluates the efficacy of the chest wall vessel involvement in subpleural lung cancer (CWVI)　on ultra-high-resolution CT (UHR-CT) for detecting chest wall invasion.

MATERIALS AND METHODS

A retrospective analysis of lung cancer cases with confirmed pleural and chest wall invasion was conducted from November 2019 to April 2022. Seventy-seven patients (mean ± standard deviation age 70 ± 8 years, 64 males) who underwent preoperative contrast-enhanced UHR-CT were included. They were grouped into 51 non-chest wall infiltration (pl1 and pl2) and 26 chest wall infiltration (pl3). Clinical, histopathological, and UHR-CT findings were reviewed.

RESULTS

Upper lobe tumors exhibited a higher chest wall invasion rate (p < 0.001). Rib destruction was evident in five patients with chest wall invasion but none with pleural invasion (p < 0.001). CWVI was present in 19 of 26 patients with chest wall invasion and 2 of 51 patients with pleural invasion (p < 0.001). The maximum tumor diameter (Dmax), arch distance which means the interface length between the primary tumor and the chest wall (Adist), and the ratio of Dmax to Adist were higher in chest wall invasion cases (all p < 0.001). After excluding patients with rib destruction, in multivariate logistic regression analysis, only CWVI was a significant predictor for chest wall invasion (odds ratio 29.22 (95% confidence interval 9.13-262.90), p < 0.001).

CONCLUSION

CWVI on UHR-CT can help diagnose lung cancer infiltrating the chest wall, offering a potential tool for clinical decision-making.

KEY POINTS

Question Chest wall infiltration in primary lung cancer has implications for the treatment plan, but diagnosis is often difficult with conventional CT. Findings Chest wall vessel involvement in subpleural lung cancer on ultra-high-resolution CT is a valuable predictor for diagnosing chest wall infiltration. Clinical relevance The delineation of chest wall vessels with contrast-enhanced ultra-high-resolution CT may improve the diagnosis of chest wall infiltration and allow accurate staging and optimal treatment options for subpleural primary lung cancer.

Chest wall resections for non-small cell lung cancer: a literature review

Background and Objective

The development of early screening for lung cancer has led to improved overall survival in patients with non-small cell lung cancer (NSCLC). However, the management of NSCLC patients with resectable and potentially resectable chest wall invasion (CWI) requires attention. The purpose of this review is to summarize the role of surgery (chest wall resections) in NSCLC patients with CWI.

Methods

A literature search and review from three databases (PubMed, Embase, and ScienceDirect) comprised the last 39 years. This review was focused on the treatment of NSCLC patients with CWI, mainly including the preoperative evaluation, principles of treatment and strategic decision-making, surgical complications, and prognostic factors.

Key Content and Findings

Through the collection of relevant literature on NSCLC that invades the chest wall, this narrative review describes the actual role in clinical practice and future developments of chest wall resections. Preoperative treatment requires the multidisciplinary team (MDT) team to conduct accurate clinical staging of the patient and pay attention to the patient's lymph node status and rib invasion status. The successful implementation of chest wall resection and possible chest wall reconstruction requires refined individualized treatment based on the patient's clinical characteristics, supplemented by possible postoperative systemic treatment.

Conclusions

Surgery plays an important role in treating NSCLC patients with CWI, and a collaborative, experienced MDT is an essential component of the successful treatment of CWI with lung cancer. In the future, more high-quality clinical research is needed to focus on CWI patients so that patients can receive more effective treatment options and better clinical prognosis.

IRE1α-XBP1 regulates PDK1-dependent induction of epithelial-mesenchymal transition in non-small cell lung cancer cells

Mounting evidence indicates that activation of unfolded protein response (UPR) and metabolic reprogramming contribute to cancer cell migration and invasion, but the molecular mechanism of pro-EMT program through a coordinated action of UPR with metabolism has not been defined. In this study, we utilized ER stress-inducing reagent, thapsigargin (TG), to induced pharmacologic ER stress in lung cancer cells. Here. We report that the branch of UPR, IRE1α-XBP1 pathway plays a pivotal role in reprogramming lung cancer cell metabolism. At the molecular level, the expression of pyruvate dehydrogenase kinase-1 (PDK-1) is directly induced by XBP1 as a consequence of UPR activation, thus facilitating aerobic glycolysis and lactate production. We also demonstrated that PDK1 serves as a downstream element of UPR activation in induction of Snail and EMT program. In addition, PDK1-induced Snail was dependent on the lactate production derived from metabolic reprogramming. Our findings reveal a critical role of lactate in pro-invasion events and establishes a direct connection between ER-stress and metabolic reprogramming in facilitating cancer cell progression.

Potential therapeutics using tumor-secreted lactate in nonsmall cell lung cancer

Targeted-therapy failure in treating nonsmall cell lung cancer (NSCLC) frequently occurs because of the emergence of drug resistance and genetic mutations. The same mutations also result in aerobic glycolysis, which further antagonizes outcomes by localized increases in lactate, an immune suppressor. Recent evidence indicates that enzymatic lowering of lactate can promote an oncolytic immune microenvironment within the tumour. Here, we review factors relating to lactate expression in NSCLC and the utility of lactate oxidase (LOX) for governing therapeutic delivery, its role in lactate oxidation and turnover, and relationships between lactate depletion and immune cell populations. The lactate-rich characteristic of NSCLC provides an exploitable property to potentially improve NSCLC outcomes and design new therapeutic strategies to integrate with conventional therapies.