Current Status of Lung Cancer and Surgery Based on Studies Using a Nationwide Database

Exploring the impact of surgical treatment for lung cancer in patients with Airway Obstruction from a Lung Cancer Screening Program

INTRODUCTION

Little information is available on the surgical treatment options for patients with Airway Obstruction (AO) and early-stage non-small cell lung cancer (NSCLC) followed in lung cancer screening programs (LCS). This study aims to compare the potential impact of anatomical sub lobar resections vs. lobectomies in these patients.

METHODS

This is a retrospective analysis of participants who underwent surgical resections within a Lung Cancer Screening Program, including those with AO (post bronchodilator FEV1/FVC < 0.70). The short-term survival, locoregional recurrence, perioperative complications, and difference between pre and postoperative pulmonary function tests were compared between the surgical groups in those with AO.

RESULTS

Anatomical sub lobar resections or lobectomies for Stages IA and IB NSCLC were performed in 133 patients. Out of these, 57 had AO. Anatomical sub lobar resections were non-inferior to lobectomies for short-term survival in patients with AO (3-year survival rate: 95.8% vs. 97%, p = 0.83). In these patients, sub lobar resections had a higher recurrence rate (12.5% vs 0%, p < 0.01). No significant differences were found in postoperative complications between surgical techniques (sub lobar 33% vs lobectomy 24%, p = 0.44). Lastly, no significant difference was found on the change between pre and postoperative FEV1 and DLCO (p = 0.96 and 0.79 for FEV1 and DLCO, respectively).

CONCLUSIONS

The present retrospective analysis suggests that sub lobar resection might be the best surgical option for treating early-stage NSCLC in patients with AO, where lung function preservation techniques are desired, but requires closer follow up to detect recurrence. Further studies in larger samples should confirm our findings.

Financial burden of complications in lung resection surgery: scoping review

BACKGROUND

Lung resection surgery is a common procedure in the treatment of lung cancer. It has been associated with a high cost burden, with complications considered a substantial contributor to associated expenses. This review sought to understand and describe the financial burden associated with complications of lung resection surgery.

METHODS

Key databases (Ovid MEDLINE and Embase, Cochrane CENTRAL) were searched up to 14 October 2024. Studies reporting on costs of at least one complication of lung resection surgery, including lobectomy, wedge resection, segmentectomy, sleeve resection, pneumonectomy, or a combination of these, were included. Following identification of eligible articles, all relevant data were extracted. Quality assessment tools, including the Scottish Intercollegiate Guidelines Network Checklists for Economic Evaluations and Cohort Studies and the Risk Of Bias In Non-randomized Studies-of Interventions tool, were used to confirm articles for inclusion.

RESULTS

In all, 31 articles were identified for inclusion: 2 prospective and 29 retrospective studies. All lung-specific complications and all but one non-pulmonary complication were associated with increased hospitalization costs. Hospital expenses also increased with increasing numbers and grades of complications.

CONCLUSION

Substantial variation in the definitions of costs and complications across studies has rendered a comparison of findings between studies challenging. Greater uniformity in definitions and classifications of costs and complications in future studies will facilitate further characterization of the cost burden of specific complications.

The Impact of Nutritional Support on Outcomes of Lung Cancer Surgery-Narrative Review

Background: Malnutrition is a prevalent yet often overlooked issue in lung cancer patients, significantly affecting surgical outcomes. This review examines the impact of nutritional status on lung cancer surgery and explores the role of nutritional assessment and intervention strategies. Methods: A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Web of Science. Key studies on nutritional status assessment, preoperative nutritional support, and their impact on surgical outcomes were analyzed. Results: Malnutrition in lung cancer patients is associated with increased postoperative complications, prolonged hospital stays, and reduced survival rates. Various assessment tools, including dietary interviews, physical examinations, laboratory tests, and body composition analyses, can help identify malnourished patients. Nutritional support strategies such as high-protein diets, oral supplements, enteral and parenteral nutrition, and perioperative immunomodulation improve clinical outcomes. Conclusions: Implementing standardized nutritional assessment and support protocols is crucial for optimizing surgical outcomes in lung cancer patients. Integrating these strategies into the Enhanced Recovery After Surgery (ERAS) protocol may further enhance recovery and long-term prognosis.

Early Routine Lung Cancer Screening Leads to Improved Treatment Options and Survival

BackgroundLung cancer is the second-most common cancer and leading cause of cancer-related deaths. American adults aged 55 to 80 years are at heightened risk for lung cancer; only 4.5% underwent screening history by computed tomography. The hypothesis is that lung cancers diagnosed on screening were an earlier stage which broadens treatment options and improves survival.MethodsThe electronic health record (EHR) was retrospectively queried to identify patients with lung cancer from 2017 to 2020. Kaplan-Maier curves were used to compare survival based on screening history.Results764 patients with lung cancer were included. 14.7% (112/764) had a history of lung cancer screening. Patients with a history of screening were significantly more likely to be diagnosed at early stages (66/112, 59% vs 215/652, 33%; P < .0001). They were significantly more likely to have surgery (46/112, 41% vs 97/652, 15%, respectively; P < 0.0001). Patients diagnosed in late stages were significantly more likely than those diagnosed at early stages to receive chemotherapy (318/483, 66% vs 76/281, 27%, respectively; P < .0001). Three-year survival was higher with screening (P < .0001). Survival rates at 3 years after initial diagnosis with screening history is 47.4% (95% CI, 34.8-59.0) while the rate without screening is 25.2% (95% CI, 21.2-29.4).DiscussionLung cancer diagnosed via screening was more likely to be earlier stages. Patients diagnosed at early stages were more likely to undergo surgery. Those diagnosed via screening had a higher 3-year survival. These findings indicate that early routine screening leads to improved treatment options and survival.

Pathologic upstaging and survival outcomes for patients undergoing segmentectomy versus lobectomy in clinical stage T1cN0M0 non-small cell lung cancer

Objectives

To assess the impact of the extent of surgical resection on overall survival in patients with clinical T1cN0M0 (cT1cN0M0) non-small cell lung cancer (NSCLC), with and without pathologic nodal upstaging (pN1+).

Methods

The National Cancer Database (NCDB) was queried to identify patients with cT1cN0M0 NSCLC who underwent lobectomy or segmentectomy without receiving neoadjuvant therapy between 2010 and 2021. Bivariate analyses were performed to compare demographic and clinical characteristics across surgical groups. Propensity score matching was used to compare outcomes of segmentectomy versus lobectomy. Cox proportional hazard models and Kaplan-Meier survival estimates were used to assess the association of overall survival on the interaction between extent of resection and pathologic nodal upstaging.

Results

A total of 22,945 patients were analyzed, including 21,875 (95.3%) who underwent lobectomy and 1070 (4.7%) who underwent segmentectomy. Pathologic nodal upstaging to pN1+ occurred in 14.5% of lobectomy cases and in 6.6% of segmentectomy cases. Propensity score-matched analysis revealed that patients undergoing segmentectomy had comparable overall survival to those undergoing lobectomy (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.86-1.16), and those undergoing segmentectomy with pN1+ had comparable overall survival to those undergoing lobectomy with pN1+ (HR, 1.04; 95% CI, 0.65-1.66).

Conclusions

In patients with cT1cN0M0 NSCLC, overall survival outcomes are similar between segmentectomy recipients and lobectomy recipients, including those incidentally found to have pN1+, suggesting a potential role of lobe-preserving approaches. Additionally, completion lobectomy may not offer a survival benefit in cT1cN0M0 patients incidentally discovered to have pathologic N1 nodes.

Exploring the key pathogenic mechanisms and potential intervention targets for Sophorae Flavescentis radix in managing bone metastasis of lung cancer based on network pharmacology and molecular docking techniques

Background

Lung cancer often metastasizes to the bone, which significantly complicates treatment and worsens patient prognosis. Thus, new therapeutic strategies need to be established. Using network pharmacology and bioinformatics analysis, this study sought to determine the molecular targets and associated mechanisms of the traditional Chinese medicine (TCM) Sophorae Flavescentis radix in the treatment of lung cancer bone metastasis.

Methods

The active components of Sophorae Flavescentis radix were screened using the TCM Systems Pharmacology (TCMSP) platform based on drug-likeness and oral bioavailability. The target genes of these active compounds were obtained from the DrugBank database. Differentially expressed genes (DEGs) between primary and bone metastatic lung cancer samples were screened in the GSE175601 dataset from the Gene Expression Omnibus (GEO) database using GEO2R. The intersecting DEGs from both groups were used to construct a Venn diagram to identify the candidate target genes. The expression and prognostic relevance of these genes were validated in The Cancer Genome Atlas (TCGA) database. The GeneMania and Search Tool for Recurring Instances of Neighbouring Genes (STRING) databases were used to generate the protein-protein interaction networks. Molecular docking was performed using the PubChem, Protein Data Bank (PDB), and CB-DOCK2 databases. A Gene Set Enrichment Analysis (GSEA) was conducted to explore the possible mechanisms of action.

Results

In the TCMSP database, 28 active compounds and 227 target genes of the Sophorae Flavescentis radix were identified. In total, 952 DEGs related to lung cancer bone metastasis were found in the GSE175601 dataset from the GEO database. Five common DEGs were identified via Venn diagram construction (i.e., F10, JUN, AKR1B1, MMP1, and CCND1). MMP1 was selected as the candidate gene. MMP1 was upregulated in lung cancer tissues, and patients with low MMP1 expression had better survival rates than those with high MMP1 expression (P<0.05). MMP1 has an affinity of -8.9 with luteolin. The GSEA results suggested that MMP1 might influence biological processes in lung cancer by participating in pathways such as chemokine signaling, apoptosis, Wingless/Integrated (Wnt) signaling, tumor protein p53-regulated cell cycle arrest, Hedgehog signaling, and mitogen-activated protein kinase signaling.

Conclusions

Patients with lower MMP1 levels had prolonged overall survival and may serve as a novel predictive biomarker for lung cancer. Sophorae Flavescentis radix appears to exert therapeutic effects on lung cancer bone metastasis by inhibiting MMP1 expression and modulating the abnormal activation of the Wnt pathway. Our findings further extend the understanding of the pathogenic mechanisms and potential therapeutic interventions of Sophorae Flavescentis radix in lung cancer bone metastasis, providing a theoretical basis for clinical diagnosis and treatment research.

Comparative Study of Indocyanine Green Intravenous Injection and the Inflation-Deflation Method for Assessing Resection Margins in Segmentectomy for Lung Cancer: A Single-Center Retrospective Study

Background

The inflation-deflation (ID) method has long been the standard for intraoperative margin assessment in segmentectomy. However, with advancements in vision technology, the use of near-infrared mapping with indocyanine green (ICG) has become increasingly common. This study was conducted to compare the perioperative outcomes and resection margins achieved using these methods.

Methods

This retrospective study included patients who underwent direct segmentectomy for clinical stage I lung cancer between January 2018 and September 2022. We compared perioperative factors, including bronchial and parenchymal resection margins, according to the margin assessment method and the type of segmentectomy performed. Since the ICG approach was adopted in April 2021, we also examined a recent subgroup of patients treated from then onward.

Results

A total of 319 segmentectomies were performed. ID and ICG were utilized for 261 (81.8%) and 58 (18.2%) patients, respectively. Following April 2021, 61 patients (51.3%) were treated with ID, while 58 (48.7%) received ICG. We observed no significant difference in resection margins between ID and ICG for bronchial (2.7 cm vs. 2.3 cm, p=0.07) or parenchymal (2.5 cm vs. 2.3 cm, p=0.46) margins. Additionally, the length of hospitalization and the complication rate were comparable between groups. Analysis of the recent subgroup confirmed these findings, showing no significant differences in resection margins (bronchial: 2.6 cm vs. 2.3 cm, p=0.25; parenchymal: 2.4 cm vs. 2.3 cm, p=0.75), length of hospitalization, or complication rate.

Conclusion

The perioperative outcomes and resection margins achieved using ID and ICG were comparable, suggesting that both methods can safely guide segmentectomy procedures.

Bioinformatic analysis of differentially expressed genes in lung cancer bone metastasis and their implications for disease progression in lung cancer patients

Background

Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death worldwide. Moreover, it is highly susceptible to distant metastasis, which is the main cause of pain in advanced lung cancer, and frequently occurs in the bone. This study aimed to identify the differentially expressed genes (DEGs) related to metastatic bone disease in lung cancer using bioinformatics methods and to analyze the risk factors influencing the incidence of secondary bone metastasis in lung cancer.

Methods

Gene expression profiles from the GSE175601 and GSE10799 datasets in the Gene Expression Omnibus (GEO) database were analyzed to screen for the DEGs associated with lung cancer bone metastasis. The STRING database was used to construct a protein-protein interaction (PPI) network, and the MCODE plugin was used to identify the key genes. The expression of these important genes in lung tumor tissues and their correlation with prognosis were validated in The Cancer Genome Atlas (TCGA) database. An examination of clinical data from patients diagnosed with stage IV lung adenocarcinoma treated at the Anhui No. 2 Provincial People's Hospital was conducted. Immunohistochemistry was used to examine the expression of key genes in lung cancer tumor tissues. A binary logistic regression analysis was conducted to examine the interactions in the expression of critical genes associated with bone metastasis in lung carcinoma patients.

Results

In total, 59 DEGs were identified in the GSE175601 and GSE10799 datasets through Venn diagram construction. The PPI network analysis revealed two significant modules and eight candidate genes (LAPTM5, LCP2, CD53, ARHGAP25, C1QA, DES, MYH11, and VIM). According to TCGA database analysis, in carcinogenic tissues of the lung, the expression of these eight critical genes is downregulated. Further, only the lung cancer patients who had high expressions of ARHGAP25 had an improved progress-free interval (PFI) (P<0.05), disease-specific survival (DSS), and overall survival (OS). Of the 49 with stage IV lung adenocarcinoma patients included in the study, 27 (55.10%) developed bone metastasis. The immunohistochemical (IHC) results indicated that the expression score of ARHGAP25 was significantly lower in the group with bone metastasis (3.93±2.95) than the group without bone metastasis (6.64±3.62) (P=0.006). The proportion of patients with low ARHGAP25 expression was significantly higher in the group with bone metastasis (70.37%, 19/27) than the group without bone metastasis (31.82%, 7/22) (P=0.007). The binary logistic regression analysis identified serum alkaline phosphatase (ALP) and ARHGAP25 expression levels as independent risk factors for the occurrence of secondary bone metastatic disease in lung carcinoma patients.

Conclusions

The key gene ARHGAP25 identified through bioinformatics for lung cancer bone metastasis was significantly downregulated. Its low expression constitutes an independent risk factor for secondary bone metastatic disease in patients with lung carcinoma.

Safety and efficacy of percutaneous cryoablation for primary and metastatic pleural based tumors

PURPOSE

Assess safety and local tumor progression-free survival (LTPFS) of percutaneous cryoablation for pleural-based thoracic malignancies.

MATERIALS AND METHODS

Retrospective study of 46 patients (17 treated for palliation; 9 for oligoprogression; 20 for curative intent), with 62 pleural-based thoracic lesions, treated in 59 cryoablation sessions. Patients were treated from 9/2005-11/2021 with CryoCare CS (Varian, Irvine, CA) or IceFORCE (Boston Scientific, Marlborough, MA) systems. For tumors treated with curative intent and/or oligoprogression, LTPFS of the treated tumor(s) and overall survival (OS) were estimated using Kaplan-Meier method. Post-operative complications were reported for all sessions, including those with palliative intent; univariate analyses were used to calculate factors associated with increased complication risk.

RESULTS

Median number of tumors treated in a single treatment session was 1 (range 1-4). Largest dimension of the treated tumor was 2.1 cm [IQR:0.9-5 cm]. Of the 59 treatments, 98.3 % were technically successful. Median LTPFS was 14.4 (95 % CI: 9.4-25.6) months. Tumor size was a significant predictor of LTPFS (HR: 1.21, 95 % CI: 1.03-1.44, p = 0.023). Median OS was 52.4 (28.1-NR) months. Complications occurred in 28/59 sessions (47.5 %); 2/59 (3.4 %) were ≥ grade D by Society of Interventional Radiology adverse event criteria (death; hypoxia requiring supplemental oxygen upon discharge). Pain and pneumothorax were the most common complications. The length of lung parenchyma traversed was a significant predictor of pneumothorax: HR 0.48 (95 %CI: 0.14-0.83), p = 0.0024.

CONCLUSION

Percutaneous cryoablation for pleural lesions is associated with a long duration of local control and most complications were minor and self-limited.

Significance of Spread Through Air Spaces and Vascular Invasion in Early-stage Adenocarcinoma Survival: A Comprehensive Clinicopathologic Study of 427 Patients for Precision Management

Spread through air spaces (STAS) is a novel invasive pattern of lung cancer associated with poor prognosis in non-small cell cancer (NSCLC). We aimed to investigate the incidence of STAS in a surgical series of adenocarcinomas (ADCs) resected in our thoracic surgery unit and to identify the association of STAS with other clinicopathological characteristics. We retrospectively enrolled patients with stage cT1a-cT2b who underwent resection between 2016 and 2022. For each case, a comprehensive pathologic report was accessible which included histotype, mitoses, pleural invasion, fibrosis, tumor infiltrating lymphocytes, necrosis, inflammation, vascular and perineural invasion, as well as STAS. PD-L1 expression was also investigated. A total of 427 patients with ADCs underwent surgery. Regarding overall survival (OS), no significant difference was observed between the STAS positive (STAS+) and STAS negative (STAS-) groups ( P =0.44). However, vascular invasion (VI) was associated with a poorer survival probability ( P =0.018). STAS+/VI+ patients had tendentially worse survival compared with STAS+/VI- ( P =0.089). ADCs with pathologic evidence of immune system (IS) activation (TILs>10% and PD-L1≥1) demonstrated significantly increased OS compared with ADCs with no IS and VI. In terms of recurrence rate, no statistical differences were found between the STAS+ and STAS- samples ( P =0.2). VI was also linked to a significantly elevated risk of recurrence ( P =0.0048). Our study suggests that in resected early-stage ADCs, STAS+ does not seem to influence recurrence or mortality. VI was instead an adverse pathologic prognostic factor for both survival and recurrence, whereas IS seemed to be protective.

Toward Continuum Robot Tentacles for Lung Interventions: Exploring Folding Support Disks

Toward the future goal of creating a lung surgery system featuring multiple tentacle-like robots, we present a new folding concept for continuum robots that enables them to squeeze through openings smaller than the robot's nominal diameter (e.g., the narrow space between adjacent ribs). This is facilitated by making the disks along the robot's backbone foldable. We also demonstrate that such a robot can feature not only straight, but also curved tendon routing paths, thereby achieving a diverse family of conformations. We find that the foldable robot performs comparably, from a kinematic perspective, to an identical non-folding continuum robot at varying deployment lengths. This work paves the way for future applications with a continuum robot that can fold and fit through smaller openings, with the potential to reduce invasiveness during surgical tasks.

Effects of psychological nursing care on anxiety and depression in perioperative patients with lung cancer: A systematic review and meta-analysis

BACKGROUND

This study aimed to investigate the effects of psychological nursing care (PNC) on anxiety relief in perioperative lung cancer (LC) patients.

METHODS

We searched the Cochrane Library, PubMed, Embase, CNKI, CBM, and Wangfang electronic databases from inception to May 1, 2022. Eligible randomized controlled trials (RCTs) investigating the effects and safety of PNC on anxiety relief in perioperative LC patients. Anxiety was the primary outcome measure. The secondary outcomes were depression, length of hospital stay, and the occurrence of adverse events.

RESULTS

Six eligible RCTs with 494 patients were included in this study. Compared with routine nursing care, PNC showed better outcomes in terms of anxiety relief (mean difference [MD] = -13.24; random 95% confidence interval (CI), -18.28 to -8.20; P<.001), depression decrease (MD = -11.84; random 95% CI, -18.67 to -5.01; P < .001), and length of hospital stay (MD = -2.6; fixed 95% CI, -3.13 to -2.07; P < .001). No data on adverse events were pooled because only 1 trial reported this outcome.

CONCLUSIONS

This study showed that PNC may benefit more than routine nursing care for patients with LC in anxiety, depression, and length of hospital stay. High-quality RCTs are needed to validate the current findings in the future.