Association of PD-1, PD-L1, and CTLA-4 Gene Expression and Clinicopathologic Characteristics in Patients With Non-Small-Cell Lung Cancer.

INTRODUCTION: Recent studies show a potential benefit of therapies that target programmed death receptor 1 (PD-1)/programmed death-ligand 1 (PD-L1) and cytotoxic T-lymphocyte antigen 4 (CTLA-4) inhibitory checkpoints in a subgroup of patients with non-small-cell lung cancer (NSCLC), without the clinicopathologic characteristics related to positive responses to these treatments being well determined. The aim of this study was to determine PD-1, PD-L1, and CTLA-4 gene expression at the mRNA level in tumoral tissue from patients with NSCLC and analyze their possible relationship with the clinicopathological characteristics and their potential prognostic role. PATIENTS AND METHODS: PD-1, PD-L1, and CTLA-4 expression levels were analyzed using real-time quantitative reverse transcriptase polymerase chain reaction in fresh-frozen tumor and normal adjacent lung tissue samples from 78 patients with NSCLC. Later, a significant association between mRNA levels, clinicopathologic characteristics, and patient's survival was assessed. RESULTS: No significant correlation between gene expression levels and sex, age, histological type, smoking status, pathologic stage, or tumor differentiation was found. However, higher levels of PD-1 were significantly associated with worse prognosis in patients with NSCLC, and PD-L1 overexpression was associated with a worse prognosis in stage I patients and in Grade 1 to 2 tumors. CONCLUSION: Alterations in PD-1/PD-L1 and CTLA-4 expression in lung tumoral tissue seem not to be related to age, sex, smoking status, histological type, pathological stage, or tumor differentiation degree. However, PD-1 and PD-L1 overexpression might predict worse survival in patients with stage I NSCLC and in well differentiated tumors.

Biopsia pulmonar por videotoracoscopia en el diagnóstico de la enfermedad pulmonar intersticial. Estudio prospectivo y multicéntrico en 224 pacientes / Video-Assisted Thoracoscopic Lung Biopsy in the Diagnosis of Interstitial Lung Disease: A Prospective, Multi-Center Study in 224 Patients

Introducción: Analizar si la localización y el número de biopsias pulmonares obtenidas por videotoracoscopia (BP-VTC) influyen en el diagnóstico de las enfermedades pulmonares intersticiales difusas (EPID) y evaluar la aplicabilidad de un programa de cirugía ambulatoria (CA). Pacientes y método: Estudio prospectivo y multicéntrico de BP-VTC practicadas en pacientes con sospecha de EPID desde enero de 2007 a diciembre de 2009, incluyendo 224 pacientes de 13 centros españoles. Los datos fueron recogidos de manera prospectiva en cada centro y enviados al centro coordinador para su análisis. Resultados: Las zonas más afectadas en la TACAR torácica fueron los lóbulos inferiores (55%). Se llevó a cabo broncoscopia en el 84%, y biopsia transbronquial en el 49,1%. En 179 casos (79,9%) se realizó más de una biopsia (concordancia diagnóstica: 97,2%). Se obtuvo un diagnóstico histopatológico definitivo en 195 pacientes (87%). No se hallaron factores estadísticamente significativos que pudieran predecir un mayor rendimiento diagnóstico (ni la localización anatómica de la biopsia ni el número de ellas). Setenta pacientes (31,3%) fueron incluidos en un programa de CA. Los índices de morbilidad tras el alta fueron comparables entre ingresados (9/154: 5.8%) y ambulatorios (3/70: 4.3%). Conclusiones: La localización anatómica y el número de BP no parecen influir en el diagnóstico de EPID. Los pacientes ambulatorios tuvieron un índice de complicaciones comparable a los casos que ingresaron, por lo cual este procedimiento podría ser incluido en un programa de CA. La BP-CVT es una herramienta fiable y segura para el diagnóstico de los pacientes con sospecha de EPID(AU)

Objectives: To evaluate whether the location and number of lung biopsies obtained by video-assisted thoracoscopy (VAT) influence the diagnosis of diffuse interstitial lung disease (ILD). To assess the applicability of an Ambulatory Surgery Program (ASP). Methods: Prospective, multicenter study of VAT lung biopsies due to suspected ILD from January 2007 to December 2009, including 224 patients from 13 Spanish centers (mean age 57.1 years; 52.6% females). Data were prospectively collected in every institution and sent to the coordination center for analysis. Results: The most affected areas in high resolution chest CT were the lower lobes (55%). Bronchoscopy was performed in 84% and transbronchial biopsy in 49.1%. In 179 cases (79.9%), more than one biopsy was performed, with a diagnostic agreement of 97.2%. A definitive histopathologic diagnosis was obtained in 195 patients (87%). Idiopathic pulmonary fibrosis was the most frequent diagnosis (26%). There were no statistically significant factors that could predict a greater diagnostic yield (neither anatomical location nor number of biopsies). Seventy patients (31.3%) were included in an ASP. After discharge, there were complications in 12 patients (5.4%), similar between patients admitted postoperatively (9/154: 5.8%) and those included in an ASP (3/70: 4.3%). Conclusions: Anatomical location and number of lung biopsy specimens did not seem to influence the diagnosis. The patients included in an ASP had a complication rate comparable to that of the hospitalized, so this procedure can be included in a surgical outpatient program. Lung biopsy obtained by VAT is a powerful and safe tool for diagnosis of suspected ILD, resulting in a definitive diagnosis for the majority of patients with a low morbidity rate(AU)

Abordajes anteriores mini-open en el raquis toracolumbar / Mini-open approaches in anterior lumbar spine surgery

Introducción El abordaje anterior vertebral conocido como mini-open fue introducido hace unos años para el tratamiento quirúrgico de la patología del raquis. Dicho abordaje permite la exposición directa de las estructuras anteriores, cuerpo y disco intervertebral, la descompresión anterior del saco dural y la reconstrucción y/o estabilización de los niveles de interés con un sistema adecuado. En el presente trabajo presentamos nuestra experiencia en mini-open anterior spine surgery (MOASS) en el abordaje anterior del raquis para tratamiento de patología del raquis toracolumbar. Material y métodos En el periodo entre enero de 2004 y julio de 2011 hemos realizado 74 abordajes anteriores de columna mediante cirugía abierta. En 38 casos utilizamos la técnica MOASS a distintos niveles: torácico, lumbar e infraumbilical extraperitoneal. Resultados No tuvimos mortalidad quirúrgica ni postoperatoria, ni déficits neurológicos añadidos derivados del acto quirúrgico, en ninguna de las técnicas (clásica versus MOASS). Las complicaciones fueron escasas y corregidas con el adecuado tratamiento. Conclusiones Mediante la técnica MOASS hemos realizado la corrección quirúrgica de lesiones vertebrales que pueden afectar al raquis toracolumbar, con resultados similares a los obtenidos mediante el abordaje clásico y ventajas reseñables (AU)

Introduction The anterior spine approach known as «mini-open» was introduced a few years ago for the surgical treatment of spine diseases. This approach allows the anterior, body and intervertebral disc structures to be exposed, as well as the anterior compression of the dural sac and the reconstruction and/or stabilisation of the levels of interest with an appropriate system. In the present article we present our experience in mini-open anterior spine surgery (MOASS) approach in the treatment of lumbar spine diseases. Material and methods We performed 74 anterior spine approaches using open surgery between the period January 2004 and July 2011. In 38 cases we used the MOASS technique at different levels: thoracic, lumbar, and infraumbilical extraperitoneal. Results There were no surgical or post-operative deaths, or further neurological deficits arising from the surgical procedure in any of the techniques (classic versus MOASS). The few complications were corrected with the appropriate treatment. Conclusions Using the MOASS technique we have performed corrective surgery on spine injuries that could affect the thoracic spinal column, with similar results to those obtained using the classic approach and with obvious advantages (AU)

[Mini-open approaches in anterior lumbar spine surgery]. / Abordajes anteriores mini-open en el raquis toracolumbar.

INTRODUCTION: The anterior spine approach known as «mini-open¼ was introduced a few years ago for the surgical treatment of spine diseases. This approach allows the anterior, body and intervertebral disc structures to be exposed, as well as the anterior compression of the dural sac and the reconstruction and/or stabilisation of the levels of interest with an appropriate system. In the present article we present our experience in mini-open anterior spine surgery (MOASS) approach in the treatment of lumbar spine diseases. MATERIAL AND METHODS: We performed 74 anterior spine approaches using open surgery between the period January 2004 and July 2011. In 38 cases we used the MOASS technique at different levels: thoracic, lumbar, and infraumbilical extraperitoneal. RESULTS: There were no surgical or post-operative deaths, or further neurological deficits arising from the surgical procedure in any of the techniques (classic versus MOASS). The few complications were corrected with the appropriate treatment. CONCLUSIONS: Using the MOASS technique we have performed corrective surgery on spine injuries that could affect the thoracic spinal column, with similar results to those obtained using the classic approach and with obvious advantages.

Video-assisted thoracoscopic lung biopsy in the diagnosis of interstitial lung disease: a prospective, multi-center study in 224 patients.

OBJECTIVES: To evaluate whether the location and number of lung biopsies obtained by video-assisted thoracoscopy (VAT) influence the diagnosis of diffuse interstitial lung disease (ILD). To assess the applicability of an Ambulatory Surgery Program (ASP). METHODS: Prospective, multicenter study of VAT lung biopsies due to suspected ILD from January 2007 to December 2009, including 224 patients from 13 Spanish centers (mean age 57.1 years; 52.6% females). Data were prospectively collected in every institution and sent to the coordination center for analysis. RESULTS: The most affected areas in high resolution chest CT were the lower lobes (55%). Bronchoscopy was performed in 84% and transbronchial biopsy in 49.1%. In 179 cases (79.9%), more than one biopsy was performed, with a diagnostic agreement of 97.2%. A definitive histopathologic diagnosis was obtained in 195 patients (87%). Idiopathic pulmonary fibrosis was the most frequent diagnosis (26%). There were no statistically significant factors that could predict a greater diagnostic yield (neither anatomical location nor number of biopsies). Seventy patients (31.3%) were included in an ASP. After discharge, there were complications in 12 patients (5.4%), similar between patients admitted postoperatively (9/154: 5.8%) and those included in an ASP (3/70: 4.3%). CONCLUSIONS: Anatomical location and number of lung biopsy specimens did not seem to influence the diagnosis. The patients included in an ASP had a complication rate comparable to that of the hospitalized, so this procedure can be included in a surgical outpatient program. Lung biopsy obtained by VAT is a powerful and safe tool for diagnosis of suspected ILD, resulting in a definitive diagnosis for the majority of patients with a low morbidity rate.