Surgery versus radiotherapy in octogenarians with stage Ia non­small cell lung cancer: propensity score matching analysis of the SEER database.

OBJECTIVES: To compare overall survival (OS) and cancer-specific survival (CSS) outcomes of surgery with radiotherapy in octogenarians with stage Ia non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Patients aged ≥ 80 years with clinical stage Ia (T1N0M0) NSCLC between 2012 and 2017 were identified from the population-based Surveillance, Epidemiology, and End Results (SEER) database. Patients were assigned into surgery and radiotherapy groups. Multivariate Cox regression analysis was used to identify survival-associated factors. Treatment groups were adjusted by propensity score matching (PSM) analysis while OS and CSS outcomes were compared among groups by Kaplan-Meier analysis. RESULTS: A total of 1641 patients were identified, with 46.0% in the surgical group and 54.0% in the radiotherapy group. Compared to surgery, radiotherapy-treated patients were older, later diagnosed, had more often unmarried, more squamous cell carcinoma, more unknown grade and increased tumor sizes. Radiotherapy was associated with a significantly worse OS, compared to surgery (hazard ratio 2.426; 95% CI 2.003-2.939; P < .001). After PSM, OS (P < 0.001) and CSS (P < 0.001) were higher in the surgery group. The 1-, 3-, and 5-year OS rates of surgical and radiotherapy group were 90.0%, 76.9%, 59.9%, and 86.0%, 54.3%, 28.0%, respectively. The 1-, 3-, and 5-year CSS rates of surgical and radiotherapy group were 94.5%, 86.1%, 78.0% and 90.7%, 74.5%, 61.0%, respectively. There were no survival differences between the matched surgery without lymph node examination (LNE) and radiotherapy group, as well as between the matched surgery and radiotherapy who were recommended but refused surgery group. CONCLUSIONS: In octogenarians with stage Ia NSCLC, surgery with lymph node dissection offers better OS and CSS outcomes than radiotherapy.

Analysis of pulmonary nodules detected by annual low-dose computed tomography in the elderly during a 10-year follow-up.

AIM: To describe pulmonary nodules detected by annual low-dose computed tomography (LDCT) in the elderly during a 10-year follow-up, and to provide a basis for clinical decision-making in the elderly. METHODS: In this retrospective study, patients who completed at least a 3-year follow-up visit with annual LDCT imaging data were eligible for inclusion. The evolution of pulmonary nodules was evaluated, including malignant, suspicious malignant, benign and undetermined nodules. Additionally, the nature and outcome of new nodules during the follow-up were analyzed. RESULTS: For the 365 subjects included, 899 positive pulmonary nodules were detected in 286 patients. Among these there were 788 solid nodules, 20 part-solid nodules and 91 nonsolid nodules. The detection rate of positive nodules and of lung cancer was 78.4% and 5.5%, respectively. 99.7% (786/788) of solid nodules were benign, and 75% (15/20) of part-solid nodules and 28.6% (26/91) of nonsolid nodules were malignant or suspected malignant. 124 new positive nodules appeared during the annual follow-up, but 58.9% of them subsequently disappeared. Significant higher detection rates of 10-20-mm nodules (P = 0.0485) and suspicious malignant nodules (P = 0.017) were observed in subjects over 75 years old as compared with those under 75 years old. CONCLUSIONS: Solid nodules accounted for the highest proportion of lung nodules screened at baseline, and most of them were benign. The malignant probability of part-solid nodules was the highest. Most newly appeared nodules disappeared during subsequent follow-up. The proportions of suspicious malignant nodules and 10-20-mm nodules in subjects over 75 years old were higher than in those under 75 years old. Geriatr Gerontol Int 2022; 22: 865-869.

Age-specific markers of adiposity in patients with obstructive sleep apnea.

OBJECTIVES: Adiposity can have varying effects on the individual depending upon its distribution pattern. We assessed age-related distribution of adipose tissue by anthropometric measures and bioelectrical impedance analysis, as well as their association with obstructive sleep apnea (OSA) severity. METHODS: Participants were 169 elderly (aged ≥ 65 years) and 142 non-elderly (aged < 65 years) referred for overnight polysomnography. The associations between obesity parameters and apnea-hypopnea index (AHI) were determine by univariate and multivariate linear regression analyses. Area under receiver operating characteristic curve (AUC) was used to access the predicting performance of some parameters. RESULTS: Compared with non-elderly, elderly showed higher conicity index and visceral adiposity (VA)/subcutaneous adiposity (SA), lower body mass index (BMI), neck circumference, waist circumference, hip circumference and SA. Multiple regression analyses revealed that VA and VA/SA were independently associated with AHI in elderly (explained 17.2% of the AHI 0.5 variability), while BMI and VA/SA were independently associated with AHI in non-elderly (explained 25.9% of the AHI 0.5 variability), after adjusting for age, sex, cigarette smoking, alcohol drinking and main comorbidities. In elderly, VA over 128 cm2 and VA/SA less than 0.41 resulted in sensitivity, specificity and AUC of 0.382, 0.790, 0.580 and 0.176, 0.947, 0.553 in predicting moderate-to-severe OSA, respectively. In non-elderly, BMI over 24.7 kg/m2 and VA/SA over 0.54 resulted in sensitivity, specificity and AUC of 0.883, 0.484, 0.704 and 0.550, 0.710, 0.667 in predicting moderate-to-severe OSA, respectively. CONCLUSIONS: VA is strongly associated with OSA severity in elderly, independently of general obesity as per BMI standards, while general adiposity appears to be more strongly associated with OSA severity in non-elderly. Our study supports age-specific approaches should be developed with respect to prediction and treatment of OSA.

Evaluation of Extended-Interval Dabigatran Dosing in Older Patients With Non-Valvular Atrial Fibrillation.

OBJECTIVE: To evaluate the safety and efficacy of extended-interval dabigatran dosing in older Chinese patients with non-valvular atrial fibrillation. METHODS: We conducted an observational study on non-valvular atrial fibrillation patients administered dabigatran at different dosing intervals at the Department of Geriatrics, Peking University First Hospital, China. We enrolled 121 consecutive non-valvular atrial fibrillation patients aged ≥60 years on dabigatran therapy (mean age, 79.6 ± 7.4 years); they were administered conventional low-dose dabigatran (110 mg twice daily) or extended-interval dosing with dabigatran (110 mg every 16 h or every 24 h). All patients received follow-up care, and we evaluated the presence of bleeding and thromboembolic events. RESULTS: All patients exhibited creatinine clearance greater than 30 mL/min with an average of 56.6 ± 17.3 mL/min. Sixty-two patients received extended-interval dosing with dabigatran at a mean dose of 117.1 ± 18.6 mg daily. Patients on extended-interval dosing were older; they exhibited lower creatinine clearance and bodyweight and higher CHA2DS2-VASc and HAS-BLED scores. The mean follow-up time was 25.8 ± 15.6 months. No significant differences were observed in the trough and peak values of the activated partial thromboplastin time and in thromboembolic or bleeding events between the 2 groups. CONCLUSION: Extended-interval dabigatran dosing in older patients with non-valvular atrial fibrillation and lower creatinine clearance can maintain activated partial thromboplastin time trough and peak values comparable to the conventional low dose. Physician-prescribed practices regarding dabigatran dosing intervals do not lead to worse outcomes in the above-mentioned population.

[Mechanisms of Resistance to the Third-generation Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors in Non-small Cell Lung Cancer].

Targeted therapy of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs) has been the standard modality as first-line treatment of advanced EGFR-mutated non-small cell lung cancer (NSCLC). The third-generation EGFR-TKIs has been approved to overcome the EGFR T790M mutation in patients resistant to the first-or second-generation TKIs, which brings more survival benefits for patients with advanced NSCLC. Unfortunately, acquired resistance inevitably develops after application of approximately 10 months. Heterogeneities of the tumor determines the diversity of resistance. Mechanisms of resistance to the third-generation TKIs includs EGFR-dependent pathway (such as new EGFR mutations, T790M reduction/disappearance and EGFR amplification, etc.) and EGFR-independent pathway (such as bypass pathway activation and histological transformation, etc.). In this paper, we reviewed principle mechanisms of acquired resistance to third-generation EGFR-TKIs.

[Clinical analysis of histiocytic necrotizing lymphadenitis in 68 cases].

OBJECTIVE: To investigate and analyze the clinical features in patients with histiocytic necrotizing lymphadenitis (HNL). METHODS: A total of 68 HNL patients at our hospital between the years of 1999 to 2009 were enrolled. The clinical data were collected from the hospital records and the relevant literature was reviewed. RESULTS: HNL mainly affected young people with an average age of (19 ± 13) years old and a female-to-male ratio of 1:1. All patients had lymphadenectasis. And 95.6% patients (65 cases) were feverish and 36.8% patients (25 cases) had mild hepatosplenomegaly; 25.0% (17 cases) upper respiratory symptoms such as sore throat and cough; 14.7% (10 cases) skin rash in their history; 51.5% (35 cases) leucopenia; 25.0% (17 cases)hepatic dysfunctions; 72.1% (44/61) elevated erythrocyte sedimentation rate (ESR); 11.1% (6/54) positive antinuclear antibody (ANA). The final diagnosis of HNL was confirmed by pathological examination and immunohistochemical staining of biopsy specimens. And 34 (50.0%) patients received glucocorticoid for 2 weeks to 3 months. Seven (10.3%) patients relapsed in which glucocorticoid was effective. Of 6 patients with positive ANA, one case was complicated with systemic lupus erythematosus (SLE) and another case diagnosed with SLE at 2 years after HNL. CONCLUSIONS: The clinical manifestations of HNL lack specificity so that it can be easily misdiagnosed. While the etiology of HNL remains elusive, the histopathological examination of affected lymph nodes has contributed greatly to the final diagnoses of HNL. Glucocorticoid therapy is recommended for treatment. Generally, HNL has an excellent prognosis but it often relapses. It should be noted that HNL may coexist with SLE or evolve ultimately into SLE.

[Expression of major histocompatibility complex class II antigens on lungs in rat with bleomycin-induced pulmonary fibrosis].

OBJECTIVE: To explore the expression levels of MHC II molecules and its regulator genes CIITA on bleomycin-induced pulmonary fibrosis in rats, and to investigate the underlying immunologic mechanisms of pulmonary fibrosis. METHODS: The rats were treated with either a single intratracheal bleomycin injection (fibrosis group) or a normal saline injection (control group). The pathologic changes of lung tissues stained with HE and Masson were observed, and the contents of hydroxyproline were detected on the 7th and 28th day respectively after bleomycin administration. The expression of MHC II molecules in the lung tissues was evaluated with immunohistochemistry techniques, and the percentage of MHC II+ cells was measured. The amounts of total CIITA and type I, III and IV CIITA mRNA of lung tissues were measured by real-time PCR using Taqman probe. RESULTS: (1)The percentage of MHC II+ cells in lung tissues increased significantly in fibrosis group compared with that of control group on the 7th day and the 28th day [(0.10 +/-0.03) vs (0.06+/-0.02), P < 0.05; (0.15+/-0.03) vs (0.06+/-0.01),P < 0.01, respectively]; In fibrosis group, the percentage on the 28th day was higher than that on the 7th day [(0.15+/-0.03) vs (0.10+/-0.03), P < 0.05]; (2) Compared with control group on the 7th day, total CIIA mRNA increased 170.4% [(2.89+/-1.07) vs (1.07+/-0.46), P < 0.05], type I CIIA increased 258.8% [(0.77+/-0.38) vs (0.21+/-0.09), P < 0.05], while type IV CIITA decreased 87.2% [(0.39+/-0.15) vs (3.01+/-0.79), P < 0.01]; On the 28th day, total CIITA mRNA increased 98.6% [(4.14+/-1.15) vs (2.08+/-0.76), P < 0.05], type I CIIA increased 137.1% [(0.79+/-0.34) vs (0.33+/-0.23), P < 0.05], type IV CIITA mRNA still decreased, but there was no significant difference [(2.98 +/-0.92) vs (3.95+/-0.93), P > 0.05]; In fibrosis group, type IV CIIA mRNA was 667.3% [(2.98+/-0.92) vs (0.39+/-0.15), P < 0.01] higher on the 28th day than that on the 7th day; Type III CIIA mRNA levels of both groups had no significant difference. CONCLUSION: MHC II/CIITA system of lung tissues was probably involved in the development of rat pulmonary fibrosis.

[Expression of human leukocyte antigen-DR in idiopathic pulmonary fibrosis].

OBJECTIVE: To study the expression of human leukocyte antigen (HLA)-DR in the lungs of the patients with idiopathic pulmonary fibrosis (IPF), and to explore the possible autoimmunity mechanisms of lung fibrosis. METHODS: Methods Immunohistochemistry (SP method) was used to detect the expression of HLA-DR in the lung specimens from 10 IPF patients and in 5 specimens of normal lung tissue immediately adjacent to lung carcinomas as controls. RESULTS: HLA-DR antigens were expressed in the hyperplastic bronchi-alveolar epithelial cells in IPF, but not in the epithelial cells of the normal control lung tissues. The accumulated positive scores of HLA-DR of the IPF group was 27, significantly higher than that of the control group (2, Z = - 3.002, P = 0.001). CONCLUSIONS: Inappropriate HLA-DR expression is present in the bronchi -alveolar epithelium in IPF. Immune dysfunction may play an important role in the development of IPF.