Outcomes of lobectomy on pulmonary function for early stage non-small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD)

SPECT/CT Accurately Predicts Postoperative Lung Function in Patients with Limited Pulmonary Reserve Undergoing Resection for Lung Cancer

Background: Preoperative prediction of postoperative pulmonary function after anatomical resection for lung cancer is essential to prevent long-term morbidity and mortality. Here, we compared the accuracy of hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) with traditional anatomical and planar scintigraphy approaches in predicting postoperative pulmonary function in patients with impaired lung function. Methods: We analyzed the predicted postoperative pulmonary function in patients undergoing major anatomical lung resection, applying a segment counting approach, planar perfusion scintigraphy (PPS), and SPECT/CT-based lung function quantification. Results: In total, 120 patients were evaluated, of whom 82 were included in the study. Postoperative lung function tests were obtained in 21 of 82 patients. The preoperative SPECT/CT-based quantification yielded very accurate results compared to the actual postoperative FEV1 and DLCO values. The linear regression analysis showed that the SPECT/CT-based analysis predicted postoperative FEV1 (%) and DLCO values more accurately than the segment counting approach or PPS. Accordingly, 58/82 patients would qualify for anatomical lung resection according to the SPECT-based quantification, 56/82 qualified according to the PPS (Mende), and only 47/82 qualified according to the segment counting method. Moreover, we noted that the SPECT-predicted FEV1 values were very close to the actual postoperative values in emphysema patients, and selected patients even showed improved lung function after surgery. Conclusions: Anatomically driven methods such as SPECT/CT yielded a very accurate prediction of the postoperative pulmonary function. Accordingly, applying SPECT/CT revealed more patients who would formally qualify for lung resection. We suggest SPECT/CT as the preferred method to evaluate eligibility for lung surgery in selected patients with impaired pulmonary reserve.

A non-enhanced CT-based deep learning diagnostic system for COVID-19 infection at high risk among lung cancer patients

Background

Pneumonia and lung cancer have a mutually reinforcing relationship. Lung cancer patients are prone to contracting COVID-19, with poorer prognoses. Additionally, COVID-19 infection can impact anticancer treatments for lung cancer patients. Developing an early diagnostic system for COVID-19 pneumonia can help improve the prognosis of lung cancer patients with COVID-19 infection.

Method

This study proposes a neural network for COVID-19 diagnosis based on non-enhanced CT scans, consisting of two 3D convolutional neural networks (CNN) connected in series to form two diagnostic modules. The first diagnostic module classifies COVID-19 pneumonia patients from other pneumonia patients, while the second diagnostic module distinguishes severe COVID-19 patients from ordinary COVID-19 patients. We also analyzed the correlation between the deep learning features of the two diagnostic modules and various laboratory parameters, including KL-6.

Result

The first diagnostic module achieved an accuracy of 0.9669 on the training set and 0.8884 on the test set, while the second diagnostic module achieved an accuracy of 0.9722 on the training set and 0.9184 on the test set. Strong correlation was observed between the deep learning parameters of the second diagnostic module and KL-6.

Conclusion

Our neural network can differentiate between COVID-19 pneumonia and other pneumonias on CT images, while also distinguishing between ordinary COVID-19 patients and those with white lung. Patients with white lung in COVID-19 have greater alveolar damage compared to ordinary COVID-19 patients, and our deep learning features can serve as an imaging biomarker.

Effect of lung rehabilitation training combined with nutritional intervention on patients after thoracoscopic resection of lung cancer

Thoracoscopic lobectomy is the main type of surgical treatment for lung cancer. Postoperative patients have complications and decreased pulmonary function, which affects their discharge time and quality of life. Lung ventilator training has been shown to promote the postoperative recovery of patients; however, no specific treatment plan has been approved to enhance lung rehabilitation. Therefore, it is necessary to explore methods to promote the postoperative rehabilitation of patients with lung cancer. The patients with lung cancer who were admitted to Banan Hospital Affiliated to Chongqing Medical University (Chongqing, China) between January 2022 and January 2023, and who planned to undergo a thoracoscopic lobectomy, were randomly categorized into two groups. The experimental group began lung rehabilitation training 2 weeks before the operation and received individualized nutrition programs. The control group did not receive lung rehabilitation training and nutrition programs. The quality of life, lung function, 6-min walking distance (6MWD), nutritional status, postoperative complications, hospital expenses and hospital stay between the two groups were compared. Finally, 86 and 83 patients were included in the test and control groups, respectively. Regarding the postoperative indicators, the patients in the test group scored higher in all areas of quality of life, exhibited higher lung function and 6MWD, and had significantly higher serum total protein, albumin and hemoglobin levels, and body mass index, compared with the control group. Furthermore, the incidence of postoperative pulmonary complications, the duration of hospitalization and the hospitalization costs were lower in the experimental group. In conclusion, lung rehabilitation training combined with nutritional intervention can promote the postoperative rehabilitation of patients with lung cancer. The research has been duly registered in the Chinese Clinical Trial Register platform (registration no. ChiCTR2300078681; registered Dec 15, 2023).

Prediction of the benign and malignant nature of masses in COPD background based on Habitat-based enhanced CT radiomics modeling: A preliminary study

BACKGROUND

It is difficult to differentiate between chronic obstructive pulmonary disease (COPD)-peripheral bronchogenic carcinoma (COPD-PBC) and inflammatory masses.

OBJECTIVE

This study aims to predict COPD-PBC based on clinical data and preoperative Habitat-based enhanced CT radiomics (HECT radiomics) modeling.

METHODS

A retrospective analysis was conducted on clinical imaging data of 232 cases of postoperative pathological confirmed PBC or inflammatory masses. The PBC group consisted of 82 cases, while the non-PBC group consisted of 150 cases. A training set and a testing set were established using a 7:3 ratio and a time cutoff point. In the training set, multiple models were established using clinical data and radiomics texture changes within different enhanced areas of the CT mass (HECT radiomics). The AUC values of each model were compared using Delong's test, and the clinical net benefit of the models was tested using decision curve analysis (DCA). The models were then externally validated in the testing set, and a nomogram of predicting COPD-PBC was created.

RESULTS

Univariate analysis confirmed that female gender, tumor morphology, CEA, Cyfra21-1, CT enhancement pattern, and Habitat-Radscore B/C were predictive factors for COPD-PBC (P< 0.05). The combination model based on these factors had significantly higher predictive performance [AUC: 0.894, 95% CI (0.836-0.936)] than the clinical data model [AUC: 0.758, 95% CI (0.685-0.822)] and radiomics model [AUC: 0.828, 95% CI (0.761-0.882)]. DCA also confirmed the higher clinical net benefit of the combination model, which was validated in the testing set. The nomogram developed based on the combination model helped predict COPD-PBC.

CONCLUSION

The combination model based on clinical data and Habitat-based enhanced CT radiomics can help differentiate COPD-PBC, providing a new non-invasive and efficient method for its diagnosis, treatment, and clinical decision-making.

Spectrum of Imaging Patterns of Lung Cancer following Radiation Therapy

Radiation therapy using conventional or newer high-precision dose techniques, including three-dimensional conformal radiotherapy, intensity-modulated radiation therapy, stereotactic body radiation therapy, four-dimensional conformational radiotherapy, and proton therapy, is an important component of treating patients with lung cancer. Knowledge of the radiation technique used and the expected temporal evolution of radiation-induced lung injury, as well as patient-specific parameters such as previous radiotherapy, concurrent chemoradiotherapy, or immunotherapy, is important in image interpretation. This review discusses factors that affect the development and severity of radiation-induced lung injury and its radiological manifestations, as well as the differences between conventional and high-precision dose radiotherapy techniques.

Prevalence, diagnosis, and treatment of chronic obstructive pulmonary disease in a hospitalized lung cancer population: a single center study

Background

Chronic obstructive pulmonary disease (COPD) often coexists with lung cancer (LC) and has a detrimental effect on the prognosis of LC patients. Presently, there is a lack of adequate assessment regarding the management of COPD in LC patients. This study assessed the screening, prevalence, diagnosis and treatment of COPD in hospitalized LC patients and compared the management practices between two departments at our hospital.

Methods

We retrospectively assessed the data of 3,578 patients diagnosed with primary LC in the Department of Respiratory and Critical Care Medicine and the Department of Thoracic Surgery from January 2019 to December 2020. We also compared the rate of spirometry, COPD diagnosis and COPD inhalation treatment between the LC patients from both departments, the proportion of patients aware of their COPD diagnosis and adhered to inhaled therapy, and analyzed factors influencing COPD diagnosis and inhalation treatment.

Results

A total of 2,762 (77.2%) LC patients underwent spirometry, and the observed spirometry-defined COPD prevalence was 25.0% (690/2,762). The proportion of spirometry performed in the Department of Thoracic Surgery was significantly higher than in the Department of Respiratory and Critical Care Medicine (90.5% vs. 62.9%; P<0.001). The overall COPD diagnosis rate recorded in the discharge diagnosis in the 690 spirometry-defined COPD patients was 46.5% (321/690), and the COPD treatment rate during hospitalization was 45.2% (312/690). In addition, physicians from the Department of Respiratory and Critical Care Medicine had a higher diagnostic rate than surgeons from the Department of Thoracic Surgery (69.1% vs. 7.5%; P<0.001), as well as a better-standardized COPD treatment rate (60.6% vs. 18.6%; P<0.001). Further, the proportion of COPD inhalation treatment was higher among LC patients with COPD recorded in discharge diagnosis (74.8% vs. 19.5%; P<0.001), and multivariate logistic regression analysis showed that COPD recorded in discharge diagnosis significantly increased the proportion of COPD awareness post-hospitalization (P<0.001).

Conclusions

This study showed that COPD could be a frequently undiagnosed and undertreated condition among LC patients, especially those hospitalized in a surgical ward. Additionally, a discharge diagnosis of COPD may increase the rate of inhalation treatment and awareness of the condition in LC patients.

Effects of preoperative pulmonary function on perioperative outcomes after robotic-assisted pulmonary lobectomy

INTRODUCTION

Effects of pulmonary function test (PFT) results on perioperative outcomes were investigated after robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy.

METHODS

We retrospectively analyzed 706 consecutive patients who underwent RAVT lobectomy by one surgeon over 10.8 years. Preoperative (preop) forced expiratory volume in 1 s as a percent of predicted (FEV1%) was used to group patients as having normal FEV1% (≥80%) versus reduced FEV1% (<80%). Demographics, preop comorbidities, intraoperative (intraop) and postoperative (postop) complications, perioperative outcomes, and median survival time (MST) were compared across patients with normal vs. reduced FEV1% using Chi-Square (X2), Fisher's Exact test, Student's t-test, Kruskal-Wallis test, or Kaplan-Meier analysis respectively, with significance at p ≤ 0.05. Multivariable analysis was performed for perioperative outcomes to investigate the differences across patients in the FEV1% groups.

RESULTS

There were 470 patients with normal FEV1% and 236 patients with reduced FEV1%. The two FEV1% groups did not differ in intraop or postop complication rates, except for higher postop other arrhythmia requiring intervention (p = 0.004), prolonged air leak >5 days (p = 0.002), mucous plug formation (p = 0.009), hypoxia (p < 0.001), and pneumonia (p = 0.002), and total postop complications (p < 0.001) in reduced-FEV1% patients. Reduced FEV1% correlated with increased intraop estimated blood loss (p < 0.0001) and skin-to-skin operative time (p < 0.0001). Median overall survival in patients with normal FEV1% was 93.20 months (95% CI: 76.5-126.0) versus 58.9 months (95% CI: 50.4-68.4) in patients with reduced FEV1% (p = 0.0004).

CONCLUSION

Patients should have PFTs conducted before surgery to determine at-risk patients. However, RAVT pulmonary lobectomy is feasible and safe even in patients with reduced FEV1%.

Rapid Recovery of Postoperative Pulmonary Function in Patients With Lung Cancer and Influencing Factors

Among malignant tumors, lung cancer has the highest morbidity and mortality worldwide. Surgery is the first-line treatment for early-stage lung cancers, and has gradually advanced from conventional open-chest surgery to video-assisted thoracic surgery (VATS). Additionally, increasingly smaller surgical incisions and less surgical trauma have resulted in reduced pulmonary function damage. Previous studies have found that the level of pulmonary function loss and recovery is significantly correlated with postoperative complications and the quality of life. Thus, an accurate assessment of the preoperative pulmonary function and effective rehabilitation of postoperative pulmonary function are highly important for patients undergoing lung surgery. In addition, pulmonary function assessment after pulmonary rehabilitation serves as an objective indicator of the postoperative pulmonary rehabilitation status and is crucial to facilitating pulmonary function recovery. Furthermore, a complete preoperative assessment and effective rehabilitation are especially critical in elderly patients with pulmonary tumors, poor basic physiological functions, comorbid lung diseases, and other underlying diseases. In this review, we summarize the clinical significance of pulmonary function assessment in patients undergoing lung cancer surgery, postoperative changes in pulmonary function, effective pulmonary function rehabilitation, and the influencing factors of pulmonary function rehabilitation.

Preoperative electromagnetic navigation bronchoscopy-guided one-stage multiple-dye localization for resection of subsolid nodules: A single-center pilot study

Background

Electromagnetic navigation bronchoscopy (ENB)‐guided transbronchial dye marking and video‐assisted thoracoscopic surgery (VATS) is an emerging technique that enables successful resection of multiple small subsolid pulmonary nodules. The aim of this study was to evaluate the accuracy and safety of preoperative ENB‐guided transbronchial multiple dye localization for VATS resection of subsolid pulmonary nodules.

Methods

As a single‐center pilot study, we recruited patients with at least two small or subsolid pulmonary nodules. Multiple‐dye localization was performed by intraoperative ENB‐guided transbronchial injection of an indigo carmine dye. The patients underwent VATS for sublobar resection immediately after localization. The accuracy of ENB‐guided dye marking was checked.

Results

ENB‐guided one‐stage multiple dye localization was conducted for 18 pulmonary nodules in seven patients between September 2018 and December 2019. The mean diameter of the pulmonary nodules was 9.3 mm (range, 4–18) and the mean distance from the pleura to pulmonary nodule was 6 mm (range, 1–17 mm). ENB‐guided transbronchial multiple dye localization was successfully performed in 94.4% (17/18), and the accuracy of ENB‐guided dye marking was 88.2% (15/17). When two nodules were not seen in intraoperative fields, anatomical sublobar resection was performed. There was no conversion to thoracotomy and operative mortalities. Among the seven patients, only one patient showed mild intrabronchial bleeding but stopped spontaneously. The changes in lung function after multiple wedge resections (−1.6% to 24.8%) were tolerable level.

Conclusions

ENB‐guided one‐stage transbronchial dye localization showed accurate and safe intraoperative identification of multiple subsolid pulmonary nodules. A large scale prospective clinical study is warranted.

Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document

OBJECTIVE

Lobectomy is a standard treatment for stage I non-small cell lung cancer, but a significant proportion of patients are considered at high risk for complications, including mortality, after lobectomy and might not be candidates. Identifying who is at risk is important and in evolution. The objective of The American Association for Thoracic Surgery Clinical Practice Standards Committee expert panel was to review important considerations and factors in assessing who is at high risk among patients considered for lobectomy.

METHODS

The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an expert panel that developed an expert consensus document after systematic review of the literature. The expert panel generated a priori a list of important risk factors in the determination of high risk for lobectomy. A survey was administered, and the expert panel was asked to grade the relative importance of each risk factor. Recommendations were developed using discussion and a modified Delphi method.

RESULTS

The expert panel survey identified the most important factors in the determination of high risk, which included the need for supplemental oxygen because of severe underlying lung disease, low diffusion capacity, the presence of frailty, and the overall assessment of daily activity and functional status. The panel determined that factors, such as age (as a sole factor), were less important in risk assessment.

CONCLUSIONS

Defining who is at high risk for lobectomy for stage I non-small cell lung cancer is challenging, but remains critical. There was impressive strong consensus on identification of important factors and their hierarchical ranking of perceived risk. The panel identified several key factors that can be incorporated in risk assessment. The factors are evolving and as the population ages, factors such as neurocognitive function and frailty become more important. A minimally invasive approach becomes even more critical in this older population to mitigate risk. The determination of risk is a clinical decision and judgement, which should also take into consideration patient perspectives, values, preferences, and quality of life.

The Shared Genetic Architectures Between Lung Cancer and Multiple Polygenic Phenotypes in Genome-Wide Association Studies

BACKGROUND

Prior genome-wide association studies have identified numerous lung cancer risk loci and reveal substantial etiologic heterogeneity across histologic subtypes. Analyzing the shared genetic architecture underlying variation in complex traits can elucidate common genetic etiologies across phenotypes. Exploring pairwise genetic correlations between lung cancer and other polygenic traits can reveal the common genetic etiology of correlated phenotypes.

METHODS

Using cross-trait linkage disequilibrium score regression, we estimated the pairwise genetic correlation and heritability between lung cancer and multiple traits using publicly available summary statistics. Identified genetic relationships were also examined after excluding genomic regions known to be associated with smoking behaviors, a major risk factor for lung cancer.

RESULTS

We observed several traits showing moderate single nucleotide polymorphism-based heritability and significant genetic correlations with lung cancer. We observed highly significant correlations between the genetic architectures of lung cancer and emphysema/chronic bronchitis across all histologic subtypes, as well as among lung cancer occurring among smokers. Our analyses revealed highly significant positive correlations between lung cancer and paternal history of lung cancer. We also observed a strong negative correlation with parental longevity. We observed consistent directions in genetic patterns after excluding genomic regions associated with smoking behaviors.

CONCLUSIONS

This study identifies numerous phenotypic traits that share genomic architecture with lung carcinogenesis and are not fully accounted for by known smoking-associated genomic loci.

IMPACT

These findings provide new insights into the etiology of lung cancer by identifying traits that are genetically correlated with increased risk of lung cancer.

Quality of Life After Stereotactic Body Radiation therapy Versus Video-Assisted Thoracic Surgery in Early stage Non-small Cell Lung Cancer. Is there Enough Data to Make a Recommendation?

BACKGROUND AND AIM

Health reported quality of life test (HRQOLT) in oncologic patients has become a major concern. Early stage in non-small cell lung cancer has two options for treatment in fragile population: Stereotactic body radiation therapy (SBRT) and video-assisted thoracic surgery (VATS). Which option should be recommended in daily clinical practice remains a challenging question. The current review is addressing this concern. Among 1256 articles, 19 met the inclusion criteria and 2034 patients were analyzed treated either with VATS or SBRT. Eleven manuscripts in SBRT, five VATS studies, and three reviews were summarized in the present review. In fragile population, SBRT seems to be a valuable option of treatment with minor or no changes in HRQOLT. However, baseline quality of life status or geriatric assessment tools before treatment could be a good strategy to select appropriate population for undergoing SBRT or surgery.

RELEVANCE FOR PATIENTS

In this paper, we present a systematic review where we compare the current evidence of two options for treatment in fragile population: SBRT and VATS.