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Ma S, Wang R, Peng Q, Liu Y, Qian J, Li M, Li K, Huang Z, Wu L, Xie D. Is there a prognostic difference among stage I lung adenocarcinoma patients with different BRAF-mutation status? Thorac Cancer 2024; 15:715-721. [PMID: 38362771 PMCID: PMC10961218 DOI: 10.1111/1759-7714.15248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND The data of the prognostic role of V-Raf murine sarcoma viral oncogene homolog B1 (BRAF) mutations in early-stage lung adenocarcinoma (LUAD) patients is scarce. This study aimed to investigate the proportion, clinicopathological features, and prognostic significance of patients with stage I LUAD carrying BRAF mutations. METHODS We collected 431 patients with pathological stage I LUAD from cBioPortal for Cancer Genomics and 1604 LUAD patients tested for BRAF V600E and epidermal growth factor receptor (EGFR) mutations from Shanghai Pulmonary Hospital. Survival curves were drawn by the Kaplan-Meier method and compared by log-rank test. Cox proportional hazard models, propensity-score matching (PSM), and overlap weighting (OW) were performed in this study. The primary endpoint was recurrence-free survival (RFS). RESULTS The proportion of BRAF mutations was estimated at 5.6% in a Caucasian cohort. BRAF V600E mutations were detected in six (1.4%) patients in Caucasian populations and 16 (1.0%) patients in Chinese populations. Two BRAF V600E-mutant patients were detected to have concurrent EGFR mutations, one for 19-del and one for L858R. For pathological stage I LUAD patients, BRAF mutations were not significantly associated with worse RFS than wild-type BRAF patients (HR = 1.111; p = 0.885). After PSM and OW, similar results were presented (HR = 1.352; p = 0.742 and HR = 1.246; p = 0.764, respectively). BRAF V600E mutation status also lacked predictive significance for RFS (HR, 1.844; p = 0.226; HR = 1.144; p = 0.831 and HR = 1.466; p = 0.450, respectively). CONCLUSIONS In this study, we demonstrated that BRAF status may not be capable of predicting prognosis in stage I LUAD patients. There is a need for more data to validate our findings.
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Affiliation(s)
- Shang‐Shang Ma
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiP. R. China
| | - Rang‐Rang Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiP. R. China
| | - Qiao Peng
- School of MedicineTongji UniversityShanghaiP. R. China
| | - Yu'e Liu
- School of MedicineTongji UniversityShanghaiP. R. China
| | - Jia‐Yi Qian
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiP. R. China
| | - Ming‐Jun Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiP. R. China
| | - Kun Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiP. R. China
| | - Zhi‐Ye Huang
- School of MedicineTongji UniversityShanghaiP. R. China
| | - Lei‐Lei Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiP. R. China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiP. R. China
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Wu LL, Lin WK, Qian JY, Ma SS, Li MJ, Li K, Li ZX, Lan G, Xie D. Prognostic assessment of lung adenocarcinoma patients with early-staging diseases: a nomogram based on coagulation-related factors. Eur J Cardiothorac Surg 2023; 64:ezad313. [PMID: 37699000 DOI: 10.1093/ejcts/ezad313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/24/2023] [Accepted: 09/11/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVES Early-stage lung adenocarcinoma (ADC) has a great heterogeneity in prognosis that is difficult to evaluate effectively. Thus, we developed and validated an effective nomogram prognostic model based on the clinical and laboratory characteristics of stage I-IIA ADC. METHODS We included 1585 patients with pathologically diagnosed stage I-IIA ADC who underwent surgery at Shanghai Pulmonary Hospital. The nomogram was constructed based on the peripheral blood test and coagulation test indicators and evaluated using Calibration plots, concordance index, decision curve analysis and the X-tile software. Recurrence-free survival (RFS) and overall survival (OS) were estimated by the Kaplan-Meier method and the Cox proportional hazard regression model. The primary end point of this study was RFS. RESULTS Thrombin time and 4 clinical indicators for RFS were integrated into nomograms. A favourable agreement between the nomogram prediction and validation was observed in the calibration curves for RFS probabilities. The concordance index of the nomogram to predict RFS was 0.736 (95% confidence interval, 0.717-0.755). Moreover, significant differences were shown between the high-risk and low-risk groups in RFS and OS (P < 0.001) after effective cut-off values of risk points were found based on the nomogram. CONCLUSIONS We established and validated a prognostic nomogram including thrombin time to predict RFS and OS of stage I-IIA ADC patients. This nomogram provided an effective prediction ability for the prognosis of stage I-IIA ADC patients.
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Affiliation(s)
- Lei-Lei Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei-Kang Lin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jia-Yi Qian
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shang-Shang Ma
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ming-Jun Li
- Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Jiaxing, China
| | - Kun Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhi-Xin Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Gang Lan
- Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Jiaxing, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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Ping C, Liang J, Liu ZY, He J, Zhou JY, Cheng H, Yuan GD. The impact of surgery and age on mortality with primary trachea malignant tumors: a retrospective study based on propensity-score matching analysis. J Cardiothorac Surg 2023; 18:224. [PMID: 37430368 DOI: 10.1186/s13019-023-02340-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 07/03/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE This study aimed to explore the survival significance of surgery and age on the prognosis of patients with primary trachea malignancies. METHODS The entire cohort of 637 patients with primary malignant trachea tumors was used to perform the main analyses. The data of those patients were from a public database. Overall survival (OS) curves were drawn by the Kaplan-Meier method and compared by the Log-rank test. The univariable and multivariable Cox regression analyses calculated the hazard ratio (HR) and 95% confidence interval (CI) for overall mortality. The propensity-score matching analysis was used to reduce the selection bias. RESULTS Age, surgery, histological type, N classification, M classification, marital status, and tumor grading were identified as independent prognostic factors after eliminating confounding factors. The results of the Kaplan-Meier method revealed that patients with age < 65 had a survival advantage over those with age ≥ 65 (HR = 1.908, 95% CI 1.549-2.348, P < 0.001). The 5-year OS rates were 28% and 8% in the group with age < 65 and age ≥ 65, respectively (P < 0.001). Cases with surgery had better survival over patients without surgery (HR = 0.372, 95% CI 0.265-0.522, P < 0.001). Compared with patients who did not undergo operations, patients with surgery had a higher median survival time (20 vs. 174 months). For patients with surgery, young age was considered a survival-promoting factor (HR 2.484; 95% CI 1.238-4.983, P = 0.010). CONCLUSION We suggested that age and surgery were the independent prognostic factors in patients with primary malignant trachea tumors. Besides, age serves as an essential indicator for evaluating the prognosis of postoperative patients.
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Affiliation(s)
- Chen Ping
- Department of Thoracic Surgery, Suzhou Wuzhong People's Hospital, Suzhou, Jiangsu Province, 215128, P. R. China
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, P. R. China
| | - Jia Liang
- Department of Internal Medicine, Zhabei central hospital, Shanghai, 200070, P. R. China
| | - Zhi-Yuan Liu
- School of Medicine, School of Life Science and Technology, Shanghai Tenth People's Hospital of Tongji University, Tongji University, Shanghai, 200072, P. R. China
| | - Jiang He
- Department of Thoracic Surgery, Suzhou Wuzhong People's Hospital, Suzhou, Jiangsu Province, 215128, P. R. China
| | - Ji-Yao Zhou
- Department of Thoracic Surgery, Suzhou Wuzhong People's Hospital, Suzhou, Jiangsu Province, 215128, P. R. China
| | - Hao Cheng
- School of Medicine, School of Life Science and Technology, Shanghai Tenth People's Hospital of Tongji University, Tongji University, Shanghai, 200072, P. R. China.
| | - Guang-Da Yuan
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, P. R. China.
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Jiang H, Xie W, Li X, Wang H, Yu WJ, Chen X. The survival benefit from surgery on patients with large-cell neuroendocrine carcinoma in the lung: a propensity-score matching study. J Cardiothorac Surg 2023; 18:216. [PMID: 37408065 DOI: 10.1186/s13019-023-02314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/28/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE This study aimed to investigate the prognostic significance of surgery in large-cell neuroendocrine carcinoma (LCNC) patients. METHODS A total of 453 patients from the Surveillance, Epidemiology, and End Results database diagnosed with stage T1-4N0-2M0 LCNC from 2010 to 2015 were analyzed. The propensity-score matching analysis with a ratio of 1:1 was used to minimize the bias effect of other clinical characteristics, and 77 pairs of patients' data were performed for subsequent statistical analysis. The Cox proportional hazards model, Kaplan-Meier analysis, and Log-rank test were used in the present study. The primary observational endpoint was cancer-specific survival (CSS). RESULTS The 1-year, 3-year, and 5-year CSS rates were 60.0%, 45.0%, and 42.0% in those 453 LCNC patients. Compared with patients who underwent surgical resection, patients without surgery had a lower 5-year CSS rate (18.0% vs. 52.0%, P < 0.001). After analyses of multivariable Cox regression, chemotherapy, T stage, N stage, and surgery were identified as independent prognostic indicators (all P < 0.05). In the cohort of old patients, the median survival time was longer in cases after surgery than those without surgery (13.0 months vs. NA, P < 0.001). Besides, in patients with different clinical characteristics, the receiving surgery was a protective prognostic factor (all hazard ratio < 1, all P < 0.05). In addition, for the cohort with stage T1-2N0-2M0, patients after the operation had more improved outcomes than patients without surgery (P < 0.001). CONCLUSIONS We proposed that the surgery could improve the survival outcomes of LCNC patients with stage T1-4N0-2M0. Moreover, old patients could benefit from surgery.
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Affiliation(s)
- Hao Jiang
- Infectious Department, The Affiliated People's Hospital of Ningbo University, Yinzhou People's Hospital, Ningbo, 315040, P. R. China.
| | - Weixia Xie
- Hematological Department, The Affiliated People's Hospital of Ningbo University, Yinzhou People's Hospital, Ningbo, 315040, P. R. China
| | - Xianpeng Li
- Infectious Department, The Affiliated People's Hospital of Ningbo University, Yinzhou People's Hospital, Ningbo, 315040, P. R. China
| | - Huaying Wang
- Department of Respiratory and Critical Care, Yinzhou People's Hospital, The Affiliated People's Hospital of Ningbo University, Ningbo, 315040, P. R. China
| | - Wan-Jun Yu
- Department of Respiratory and Critical Care, Yinzhou People's Hospital, The Affiliated People's Hospital of Ningbo University, Ningbo, 315040, P. R. China
| | - Xiaolu Chen
- Department of Respiratory and Critical Care, Yinzhou People's Hospital, The Affiliated People's Hospital of Ningbo University, Ningbo, 315040, P. R. China
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Wu LL, Jiang WM, Liu ZY, Zhang YY, Qian JY, Liu Y, Huang YY, Li K, Li ZX, Ma GW, Xie D. AMG-510 and cisplatin combination increases antitumor effect in lung adenocarcinoma with mutation of KRAS G12C: a preclinical and translational research. Discov Oncol 2023; 14:91. [PMID: 37284902 PMCID: PMC10247598 DOI: 10.1007/s12672-023-00698-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The efficacy of monotherapy of AMG-510 is limited. This study explored whether the AMG-510 and cisplatin combination increases the anti-tumor effect in lung adenocarcinoma with the mutation of Kirsten rat sarcoma viral oncogene (KRAS) G12C. METHODS Patients' data were used to analyze the proportion of KRAS G12C mutation. Besides, the next-generation sequencing data was used to uncover information about co-mutations. The cell viability assay, the concentration inhibiting 50% of cell viability (IC50) determination, colony formation, and cell-derived xenografts were conducted to explore the anti-tumor effect of AMG-510, Cisplatin, and their combination in vivo. The bioinformatic analysis was conducted to reveal the potential mechanism of drug combination with improved anticancer effect. RESULTS The proportion of KRAS mutation was 2.2% (11/495). In this cohort with KRAS mutation, the proportion of G12D was higher than others. Besides, KRAS G12A mutated tumors had the likelihood of concurrent serine/threonine kinase 11 (STK11) and kelch-like ECH-associated protein 1 (KEAP1) mutations. KRAS G12C and tumor protein p53 (TP53) mutations could appear at the same time. In addition, KRAS G12D mutations and C-Ros oncogene 1 (ROS1) rearrangement were likely to be present in one tumor simultaneously. When the two drugs were combined, the respective IC50 values were lower than when used alone. In addition, there was a minimum number of clones among all wells in the drug combination. In in vivo experiments, the tumor size reduction in the drug combination group was more than twice that of the single drug group (p < 0.05). The differential expression genes were enriched in the pathways of phosphatidylinositol 3 kinase-protein kinase B (PI3K-Akt) signaling and extracellular matrix (ECM) proteoglycans compared the combination group to the control group. CONCLUSIONS The anticancer effect of the drug combination was confirmed to be better than monotherapy in vitro and in vivo. The results of this study may provide some information for the plan of neoadjuvant therapy and the design of clinical trials for lung adenocarcinoma patients with KRAS G12C mutation.
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Affiliation(s)
- Lei-Lei Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, People's Republic of China
| | - Wen-Mei Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510030, People's Republic of China
| | - Zhi-Yuan Liu
- School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
| | - Yi-Yi Zhang
- School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
| | - Jia-Yi Qian
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, People's Republic of China
| | - Yu'e Liu
- School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
| | - Yang-Yu Huang
- Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Kun Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, People's Republic of China
| | - Zhi-Xin Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, People's Republic of China
| | - Guo-Wei Ma
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510030, People's Republic of China.
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, People's Republic of China.
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Zhou H, Gao P, Liu F, Shi L, Sun L, Zhang W, Xu X, Liu X. Development and validation of a novel nomogram to predict the overall survival of patients with large cell lung cancer: A surveillance, epidemiology, and end results population-based study. Heliyon 2023; 9:e15924. [PMID: 37223713 PMCID: PMC10200837 DOI: 10.1016/j.heliyon.2023.e15924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
Background Large cell lung cancer (LCLC) is a rare subtype of non-small cell lung carcinoma (NSCLC), and little is known about its clinical and biological characteristics. Methods LCLC patient data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. All patients were randomly divided into a training group and a validation group at a ratio of 7:3. The independent prognostic factors that were identified (P < 0.01) by stepwise multivariate Cox analysis were incorporated into an overall survival (OS) prediction nomogram, and risk-stratification systems, C-index, time-ROC, calibration curve, and decision curve analysis (DCA) were applied to evaluate the quality of the model. Results Nine factors were incorporated into the nomogram: age, sex, race, marital status, 6th AJCC stage, chemotherapy, radiation, surgery and tumor size. The C-index of the predicting OS model in the training dataset and in the test dataset was 0.757 ± 0.006 and 0.764 ± 0.009, respectively. The time-AUCs exceeded 0.8. The DCA curve showed that the nomogram has better clinical value than the TNM staging system. Conclusions Our study summarized the clinical characteristics and survival probability of LCLC patients, and a visual nomogram was developed to predict the 1-year, 3-year and 5-year OS of LCLC patients. This provides more accurate OS assessments for LCLC patients and helps clinicians make personal management decisions.
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Affiliation(s)
- Hongxia Zhou
- Department of Nephrology, The 908th Hospital of the People's Liberation Army Joint Logistics Support Force, The Great Wall Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi 330006, China
| | - Pengxiang Gao
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
| | - Fangpeng Liu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
| | - Liangliang Shi
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
| | - Longhua Sun
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
| | - Wei Zhang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
- Jiangxi Institute of Respiratory Diseases, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
- Jiangxi Clinical Research Center for Respiratory Diseases, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
| | - Xinping Xu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
- Jiangxi Institute of Respiratory Diseases, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
- Jiangxi Clinical Research Center for Respiratory Diseases, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
| | - Xiujuan Liu
- Department of Nephrology, The 908th Hospital of the People's Liberation Army Joint Logistics Support Force, The Great Wall Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi 330006, China
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A Nomogram Based on Atelectasis/Obstructive Pneumonitis Could Predict the Metastasis of Lymph Nodes and Postoperative Survival of Pathological N0 Classification in Non-small Cell Lung Cancer Patients. Biomedicines 2023; 11:biomedicines11020333. [PMID: 36830869 PMCID: PMC9953094 DOI: 10.3390/biomedicines11020333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
The eighth TNM staging system proposal classifies lung cancer with partial or complete atelectasis/obstructive pneumonia into the T2 category. We aimed to develop nomograms to predict the possibility of lymph node metastasis (LNM) and the prognosis for NSCLC based on atelectasis and obstructive pneumonitis. METHODS NSCLC patients over 20 years old diagnosed between 2004 and 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. The nomograms were based on risk factors that were identified by Logistic regression. The area under the receiver operating characteristic (ROC) curve (AUC) was performed to confirm the predictive values of our nomograms. Cox proportional hazards analysis and Kaplan-Meier survival analysis were also used in this study. RESULTS A total of 470,283 patients were enrolled. Atelectasis/obstructive pneumonitis, age, gender, race, histologic types, grade, and tumor size were defined as independent predictive factors; then, these seven factors were integrated to establish nomograms of LNM. The AUC is 0.70 (95% CI: 0.694-0.704). Moreover, the Cox proportional hazards analysis and Kaplan-Meier survival analysis showed that the scores derived from the nomograms were significantly correlated with the survival of pathological N0 classification. CONCLUSION Nomograms based on atelectasis/obstructive pneumonitis were developed and validated to predict LNM and the postoperative prognosis of NSCLC.
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Wu LL, Liang SH, Jiang F, Qiu LH, Chen X, Yu WJ, Li CW, Qian JY, Huang YY, Lin P, Long H, Li ZX, Li K, Ma GW, Xie D. The postoperative prognosis of skip-N2 metastasis is favorable in small-cell lung carcinoma patients with pathological N2 classification: a propensity-score-adjusted retrospective multicenter study. Ther Adv Med Oncol 2023; 15:17588359221146134. [PMID: 36643656 PMCID: PMC9837280 DOI: 10.1177/17588359221146134] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/01/2022] [Indexed: 01/13/2023] Open
Abstract
Background The study on skip-N2 metastasis in small-cell lung cancer (SCLC) is lacking. Therefore, this study aimed to explore the prognostic significance of skip-N2 metastasis based on a multicenter cohort. Methods We collected 176 SCLC patients with pathological categories T1-4N1-2M0 from four hospitals in China. Survival curves were drawn through the Kaplan-Meier method and compared by the log-rank test. The Cox regression method was used to calculate the hazard ratio (HR) and 95% confidence interval of the characteristics for cancer-specific survival (CSS). Two propensity-score methods were used to reduce the bias, including the inverse probability of treatment weighting (IPTW) and propensity-score matching (PSM). Results This multicenter database included 64 pN1 patients, 63 non-skip-N2 cases, and 49 skip-N2 cases. Skip-N2 and the non-skip-N2 patients had gap CSS rates (skip-N2 no versus yes: 41.0% versus 62.0% for 1-year CSS, 32.0% versus 46.0% for 2-year CSS, and 20.0% versus 32.0% for 3-year CSS). After PSM, there were 32 pairs of patients to compare survival differences between N2 and skip-N2 diseases, and 34 pairs of patients to compare prognostic gaps between N1 and skip-N2 diseases, respectively. The results of IPTW and PSM both suggested that skip-N2 cases had better survival outcomes than the non-skip-N2 cases (IPTW-adjusted HR = 0.578; PSM-adjusted HR = 0.510; all log-rank p < 0.05). Besides, the above two analytic methods showed no difference in prognoses between pN1 and skip-N2 diseases (all log-rank p > 0.05). Conclusions Skip-N2 patients were confirmed to have a better prognosis than non-skip-N2 patients. Besides, there was no survival difference between pN1 and skip-N2 cases. Therefore, we propose that the next tumor-node-metastasis staging system needs to consider the situation of skip metastasis with lymph nodes in SCLC.
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Affiliation(s)
| | | | | | - Li-Hong Qiu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Xiaolu Chen
- Department of Respiratory and Critical Care, The Affiliated People’s Hospital of Ningbo University, Ningbo, P. R. China
| | - Wan-Jun Yu
- Department of Respiratory and Critical Care, The Affiliated People’s Hospital of Ningbo University, Ningbo, P. R. China
| | - Chong-Wu Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | - Jia-Yi Qian
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | - Yang-Yu Huang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Peng Lin
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Hao Long
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Zhi-Xin Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | - Kun Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | - Guo-Wei Ma
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Dongfengdong road, No. 651, Guangzhou 510000, P. R. China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Zhengmin road, No.507, Shanghai 200433, P. R. China
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Li K, Wu LL, Wang H, Cheng H, Zhuo HM, Hao Y, Liu ZY, Li CW, Qian JY, Li ZX, Xie D, Chen C. The characterization of tumor microenvironment infiltration and the construction of predictive index based on cuproptosis-related gene in primary lung adenocarcinoma. Front Oncol 2022; 12:1011568. [PMID: 36505852 PMCID: PMC9733577 DOI: 10.3389/fonc.2022.1011568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022] Open
Abstract
Objective We aimed to use the cancer genome atlas and gene expression omnibus databases to explore the characterization of tumor microenvironment (TME) infiltration and construct a predictive index of prognosis and treatment effect based on cuproptosis-related genes (CRGs) in primary lung adenocarcinoma (LUAD). Methods We described the alterations of CRGs in 954 LUAD samples from genetic and transcriptional fields and evaluated their expression patterns from three independent datasets. We identified two distinct molecular subtypes and found that multi-layer CRG alterations were correlated with patient clinicopathological features, prognosis, and TME cell infiltrating characteristics. Then, a cuproptosis scoring system (CSS) for predicting the prognosis was constructed, and its predictive capability in LUAD patients was validated. Results Two molecular subtypes of cuproptosis (Copper Genes cluster A and cluster B) in LUAD were identified. Copper Genes cluster B had better survival than those with Copper Genes cluster A (p <0.01). Besides, we found that the infiltration of activated CD4+ T cells, natural killer T cells, and neutrophils was stronger in cluster A than in cluster B. Then, we constructed a highly accurate CSS to predict the prognosis, targeted therapy effect, and immune response. Compared with the low-CSS subgroup, the mutations of the TP53, MUC16, and TTN genes were more common in the high-CSS subgroup, while the mutation of TP53, TTN, and CSMD3 genes were more common in the low-CSS subgroup than in high-CSS subgroup. The low-score CSS group had an inferior survival than high-score CSS group (p <0.01). In addition, CSS presented good ability to predict the immune response (area under curve [AUC], 0.726). Moreover, AZD5363 and AZD8186 were the inhibitors of AKT and PI3K, respectively, and had lower IC50 and AUC in the low-score CSS group than it in the high-score CSS group. Conclusions CRGs are associated with the development, TME, and prognosis of LUAD. Besides, a scoring system based on CRGs can predict the efficacy of targeted drugs and immune response. These findings may improve our understanding of CRGs in LUAD and pave a new path for the assessment of prognosis and the development of more effective targeted therapy and immunotherapy strategies.
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Affiliation(s)
- Kun Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei-Lei Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hui Wang
- School of Pharmacy, Naval Medical University, Shanghai, China
| | - Hao Cheng
- School of Medicine and School of Life Science and Technology, Shanghai Tenth People’s Hospital of Tongji University, Tongji University, Shanghai, China
| | - Hui-Min Zhuo
- School of Medicine and School of Life Science and Technology, Shanghai Tenth People’s Hospital of Tongji University, Tongji University, Shanghai, China
| | - Yun Hao
- School of Medicine and School of Life Science and Technology, Shanghai Tenth People’s Hospital of Tongji University, Tongji University, Shanghai, China
| | - Zhi-Yuan Liu
- School of Medicine and School of Life Science and Technology, Shanghai Tenth People’s Hospital of Tongji University, Tongji University, Shanghai, China
| | - Chong-Wu Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jia-Yi Qian
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhi-Xin Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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10
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Wu LL, Qian JY, Li CW, Zhang Y, Lin WK, Li K, Li ZX, Xie D. The Clinical and Prognostic Characteristics of Primary Salivary Gland-Type Carcinoma in the Lung: A Population-Based Study. Cancers (Basel) 2022; 14:4668. [PMID: 36230589 PMCID: PMC9564309 DOI: 10.3390/cancers14194668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to explore the clinical and prognostic characteristics of primary salivary gland-type carcinoma (SGC). The entire cohort from the Surveillance, Epidemiology, and End Results database was used to calculate the SGC proportion. In total, 253,096 eligible patients, including 165,715 adenocarcinomas (ADCs), 87,062 squamous cell carcinomas (SCCs), and 319 SGCs, were selected to perform survival analyses. The data of 42 SGC patients from our hospital showed postoperative survival. Overall survival (OS) curves for different histological and surgical types were presented. The proportion of primary SGCs was 0.8 per 1000 patients. Patients with age ≤ 64 years old had a much higher proportion of SGC than those patients with age >64 years old. After adjusting for other confounders, among ADCs, SCCs, and SGC, SGCs had the best prognosis (HR 0.361, p < 0.001). Moreover, the 5-year OS rates of SGC patients were 55% and 7% in the group with surgery or without surgery, respectively (p < 0.001). The data of 42 patients from our hospital also showed a good survival of SGCs. Lobectomy improved the survival of SGCs significantly (adjusted HR 0.439, p = 0.016). In conclusion, pulmonary SGCs had the best prognosis among ADCs, SCCs, and SGCs. In addition, lobectomy could further improve the prognostic outcomes of SGCs.
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Affiliation(s)
- Lei-Lei Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Jia-Yi Qian
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Chong-Wu Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Yu Zhang
- School of Medicine, Tongji University, Shanghai 200092, China
| | - Wei-Kang Lin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Kun Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Zhi-Xin Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
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11
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Wu LL, Chen WT, Li CW, Song SH, Xu SQ, Wan SP, Liu ZY, Lin WK, Li K, Li ZX, Xie D. The Construction and Validation of Nomogram to Predict the Prognosis with Small-Cell Lung Cancer Followed Surgery. Cancers (Basel) 2022; 14:3723. [PMID: 35954386 PMCID: PMC9367260 DOI: 10.3390/cancers14153723] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/01/2023] Open
Abstract
This study constructed and validated a prognostic model to evaluate the survival of small-cell lung cancer (SCLC) patients following surgery, and shed light on the strategy of postoperative radiotherapy. A total of 882 patients from Shanghai Pulmonary Hospital and the Surveillance, Epidemiology and End Results database after lung resection were selected. Multivariable Cox analysis was used to identify the indicators affecting long-term survival in patients. A nomogram was constructed to predict the prognosis of eligible patients. Indices of concordance (C-index) was used to access the predictive ability of cancer-specific survival (CSS) for the prognostic model. CSS discrimination in the prognostic model was comparable in the training and validation cohorts (C-index = 0.637[NORAD-T], 0.660[NORAD-V], 0.656[RAD] and 0.627[our hospital], respectively. Stratification based on the cutoff value of the nomogram yielded low- and high-risk subgroups in four cohorts. For patients in the high-risk group, postoperative radiotherapy was considered a survival-promoting strategy (unadjusted HR 0.641, 95% CI 0.469-0.876, p = 0.0046). In the low-risk group, however, the implementation of radiotherapy barely had an influence on CSS. In conclusion, the nomogram we constructed and validated could predict the prognosis of SCLC patients followed surgery and identify high-risk patients who were likely to benefit from postoperative radiotherapy.
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Affiliation(s)
- Lei-Lei Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China; (L.-L.W.); (C.-W.L.); (W.-K.L.); (K.L.)
| | - Wu-Tao Chen
- School of Medicine, Shanghai Jiao Tong University, No. 227 South Chongqing Road, Shanghai 200025, China;
| | - Chong-Wu Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China; (L.-L.W.); (C.-W.L.); (W.-K.L.); (K.L.)
| | - Si-Hui Song
- School of Medicine, Tongji University, Shanghai 200092, China; (S.-H.S.); (S.-Q.X.); (S.-P.W.); (Z.-Y.L.)
| | - Shu-Quan Xu
- School of Medicine, Tongji University, Shanghai 200092, China; (S.-H.S.); (S.-Q.X.); (S.-P.W.); (Z.-Y.L.)
| | - Sheng-Peng Wan
- School of Medicine, Tongji University, Shanghai 200092, China; (S.-H.S.); (S.-Q.X.); (S.-P.W.); (Z.-Y.L.)
| | - Zhi-Yuan Liu
- School of Medicine, Tongji University, Shanghai 200092, China; (S.-H.S.); (S.-Q.X.); (S.-P.W.); (Z.-Y.L.)
| | - Wei-Kang Lin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China; (L.-L.W.); (C.-W.L.); (W.-K.L.); (K.L.)
| | - Kun Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China; (L.-L.W.); (C.-W.L.); (W.-K.L.); (K.L.)
| | - Zhi-Xin Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China; (L.-L.W.); (C.-W.L.); (W.-K.L.); (K.L.)
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China; (L.-L.W.); (C.-W.L.); (W.-K.L.); (K.L.)
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12
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Feng S, Liu X, Huang B, Shi J, Zhang H. The Effect of Examined Lymph Nodes and Lymph Node Ratio on Pathological Nodal Classification in the Lung Adenosquamous Carcinoma After Lobectomy. Front Surg 2022; 9:909810. [PMID: 35756483 PMCID: PMC9218197 DOI: 10.3389/fsurg.2022.909810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The effects of examined lymph nodes (LNs) and lymph node ratio (LNR) on pN classification and the prognosis are unclear in lung adenosquamous carcinoma (ASC) patients. Thus, this study aimed to investigate the significance of LNs and LNR in the prognosis of ASC and the impact of the abovementioned factors on the pN classification. Methods Patients diagnosed with pathological stage T1-4N0-2M0 ASC from the Surveillance Epidemiology and End Results database were included in the study. The primary clinical endpoint was cancer-specific survival (CSS). The optimal cutoff values of the LNs and LNR were determined. An LN indicator, including pN0 #LNs ≤9, pN0 #LNs >9, pN+ #LNR ≤0.53, and pN+ #LNR > 0.53, was developed. Concordance index (C-index) was used to compare the prognostic predictive ability between N classification and LN indicator. The univariable and multivariable Cox regression analyses were used in this study. Results The cohort of 1,416 patients were included in the study. The level of LNs stratified the patients without metastasis of lymph nodes (pN0 #LNs ≤9 vs. pN0 #LNs >9, unadjusted hazard ratio [HR] = 1.255, P = 0.037). Two groups based on the cutoff value of LNR differentiated prognosis of patients with metastasis of lymph nodes (pN+ #LNR >0.53 vs. pN+ #LNR ≤0.53, unadjusted HR = 1.703, P = 0.001). The LN indicator had a much better predictive ability over N classification in this cohort (LN indicator: C-index = 0.615; N classification: C-index = 0.602, P = 0.001). Conclusions We explored clinicopathological factors affecting prognosis in resected lung ASC patients. Besides, the LN indicator was confirmed to be played an essential role in affecting the survival rate in ASC patients. The high-level LNs or low-level LNR might be corelated to improved survival outcomes.
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Affiliation(s)
- Shoujie Feng
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Thoracic Surgery Laboratory, Xuzhou Medical University, 84 West Huaihai Road, Xuzhou, China
| | - Xiangming Liu
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Thoracic Surgery Laboratory, Xuzhou Medical University, 84 West Huaihai Road, Xuzhou, China
| | - Bing Huang
- Department of Thoracic Surgery, Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jing Shi
- Department of Radiology, Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, China
| | - Hao Zhang
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Thoracic Surgery Laboratory, Xuzhou Medical University, 84 West Huaihai Road, Xuzhou, China
- Correspondence: Hao Zhang
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13
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Tang Y, Chen H, Zhou Y, Tan ML, Xiong SL, Li Y, Ji XH, Li YS. Analgesic Effects of Repetitive Transcranial Magnetic Stimulation in Patients With Advanced Non-Small-Cell Lung Cancer: A Randomized, Sham-Controlled, Pilot Study. Front Oncol 2022; 12:840855. [PMID: 35372024 PMCID: PMC8969560 DOI: 10.3389/fonc.2022.840855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/25/2022] [Indexed: 12/30/2022] Open
Abstract
Objective Current pharmacological intervention for the cancer-related pain is still limited. The aim of this study was to explore whether repetitive transcranial magnetic stimulation (rTMS) could be an effective adjuvant therapy to reduce pain in patients with advanced non-small cell lung cancer (NSCLC). Methods This was a randomized, sham–controlled study. A total of 41 advanced NSCLC patients with uncontrolled pain (score≥4 on pain intensity assessed with an 11-point numeric rating scale) were randomized to receive active (10 Hz, 2000 stimuli) (n = 20) or sham rTMS (n = 20) for 3 weeks. Pain was the primary outcome and was assessed with the Numeric Rating Scale (NRS). Secondary outcomes were oral morphine equivalent (OME) daily dose, quality of life (WHO Quality of Life-BREF), and psychological distress (the Hospital Depression and Anxiety Scale). All outcomes were measured at baseline, 3 days, 1 week, 2 weeks, and 3 weeks. Results The pain intensity in both groups decreased gradually from day 3 and decreased to the lowest at the week 3, with a decrease rate of 41.09% in the rTMS group and 23.23% in the sham group. The NRS score of the rTMS group was significantly lower than that of the sham group on the week 2 (p < 0.001, Cohen’s d =1.135) and week 3 (p=0.017, Cohen’s d = -0.822). The OME daily dose, physiology and psychology domains of WHOQOL-BREF scores, as well as the HAM-A and HAM-D scores all were significantly improved at week 3 in rTMS group. Conclusion Advanced NSCL patients with cancer pain treated with rTMS showed better greater pain relief, lower dosage of opioid, and better mood states and quality of life. rTMS is expected to be a new effective adjuvant therapy for cancer pain in advanced NSCLC patients.
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Affiliation(s)
- Ying Tang
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Han Chen
- Department of Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yi Zhou
- Department of Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Ming-Liang Tan
- Department of Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Shuang-Long Xiong
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Yan Li
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiao-Hui Ji
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Yong-Sheng Li
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
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Cai J, Yang F, Wang X. Occult Non-Small Cell Lung Cancer: An Underappreciated Disease. J Clin Med 2022; 11:jcm11051399. [PMID: 35268490 PMCID: PMC8910858 DOI: 10.3390/jcm11051399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/17/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The number of researches on occult non-small cell lung cancer (NSCLC) is modest. Herein, we defined the clinicopathological features, prognosis and survival outcome of this underappreciated tumor, with purpose of obtaining a clearer picture on this disease. Methods: The entire cohort was categorized into two groups (occult NSCLC and other NSCLC) and further into five groups (occult, T1, T2, T3 and T4). A least absolute shrinkage and selection operator (LASSO) penalized Cox regression model was performed to identify the prognostic indicators. A nomogram and a risk-classifying system were formulated. Kaplan–Meier with Log-rank method was carried out to compare overall survival (OS) and cancer specific survival (CSS) differences between groups. Results: 59,046 eligible NSCLC cases (occult NSCLC: 1158 cases; other NSCLC: 57,888 cases) were included. Occult NSCLC accounted for 2.0% of the included cases. Multivariate analysis revealed that age, sex, tumor location, histology, grade and surgery were prognostic factors for OS. The corresponding prognostic nomogram classified occult NSCLC patients into low-risk and high-risk group, and its performance was acceptable. Survival curves demonstrated that occult NSCLC patients exhibited worse survivals than other NSCLC. In further analyses, the survival of low-risk occult NSCLC and stage T3 NSCLC were comparable, and the high-risk occult NSCLC patients still owned the worst survival rate. Conclusions: Occult NSCLC was an aggressive tumor with poor prognosis, and surgery was the preferred treatment. More attention should be paid to this overlooked disease due to no evidence of tumor imaging.
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Affiliation(s)
| | - Fan Yang
- Correspondence: (F.Y.); (X.W.); Tel.: +86-138-1162-5357 (X.W.); Fax: +86-010-88326652 (X.W.)
| | - Xun Wang
- Correspondence: (F.Y.); (X.W.); Tel.: +86-138-1162-5357 (X.W.); Fax: +86-010-88326652 (X.W.)
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