Neoadjuvant therapy bridging percutaneous coronary intervention (PCI) and video-assisted thoracoscopic (VATS) lobectomy: a retrospective study.

Background: Currently, there is no unified standard for the treatment of coronary artery disease (CAD) in non-small cell lung cancer (NSCLC), and the treatments have their own advantages and disadvantages. Thus, this study aimed to analyze the safety and feasibility of neoadjuvant therapy during the dual antiplatelet therapy (DAPT) period before surgery in patients with NSCLC coexisting with CAD after percutaneous coronary intervention (PCI) treatment. Methods: We retrospectively included 13 patients with T2aN0M0 (stage IB) NSCLC who also had concomitant CAD. After PCI treatment, neoadjuvant targeted or immunotherapy was administered based on the type of lung cancer, and the effects on treatment and impact on surgery were observed. Results: The objective response rate (ORR) after neoadjuvant treatment in 13 patients was 53.8% [95% confidence interval (CI): 25.1-80.8%], and the disease control rate (DCR) reached 100%. Ten patients (76.9%) experienced adverse events (AEs) ≤ grade 2. All patients underwent standard VATS lobectomy with lymph node dissection. One case (7.7%) required conversion to open thoracotomy, and all cases achieved R0 resection. The median operative time was 150 [interquartile range (IQR) 125-250] minutes, median intraoperative blood loss was 180 (IQR 150-235) mL, median postoperative drainage tube placement time was 4 (IQR 3-5) days, median total drainage volume was 1,310 (IQR 780-1,705) mL, and the median postoperative hospitalization was 7 (IQR 7-8) days. One patient (7.7%) experienced rapid atrial fibrillation. No deaths occurred. Postoperative pathological evaluation in three cases achieved major pathological response (MPR) (23.1%, 95% CI: 5-53.8%), with two cases achieving pathological complete response (pCR) (15.4%, 95% CI: 1.9-45.4%). Conclusions: The study presents initial evidence suggesting for the safety and feasibility of performing PCI treatment followed by neoadjuvant therapy during the DAPT period for patients with T2aN0M0 (IB) stage NSCLC coexisting with CAD. This approach presents a potential treatment option to control the disease while eliminating concerns about tumor progression and metastasis.

Molecular subtyping for lung adenocarcinoma and a novel prognostic model based on ligand-receptor pairs.

PURPOSE: Lung adenocarcinoma (LUAD) is a leading cause of cancer death worldwide. Ligands and receptors play important roles in cell communication. This study aimed to demonstrate the importance of ligand-receptor (LR) pairs in LUAD development through constructing molecular subtypes and a prognostic model based on LR pairs. MATERIALS AND METHODS: A total of 1110 LUAD samples with clinical and expression data were obtained from public databases. Unsupervised consensus clustering was applied to construct molecular subtypes based on LR pairs. Least absolute shrinkage and selection operator (LASSO) Cox regression and stepwise Akaike information criterion (stepAIC) were conducted to build a prognostic model. RESULTS: Three molecular subtypes (C1, C2 and C3) were constructed based on 17 prognosis-related LR pairs. C1 subtype had the worst prognosis, while C3 subtype had the optimal prognosis. Oncogenic pathways such as epithelial-mesenchymal transition (EMT) were activated in C1 subtype. A prognostic model was built based on 8 LR pairs, and could classify samples into high- and low-LR score groups. Two groups had distinct overall survival and tumor microenvironment (TME). High-LR score group was more sensitive to chemotherapeutic drugs, while low-LR score group could benefit much from anti-PD-1/PD-L1 therapy. CONCLUSIONS: The study showed that LR pairs played critical roles in LUAD development. The prognostic model could predict prognosis and guide personalized therapy for LUAD patients.

Microarray profile of circular RNAs identifies hsa_circ_0014130 as a new circular RNA biomarker in non-small cell lung cancer.

Accumulating evidence has revealed that aberrant Circular RNAs (circRNAs) expression plays important roles in carcinogenesis and tumor progression. However, their role in non-small cell lung cancer (NSCLC) remains unclear. In this study, we first used circRNA microarrays to screen for tumour-specific circRNA candidates in between NSCLC (n = 3) and adjacent lung (n = 3) tissue. Among the circRNA expression profile, two circRNAs (hsa_circ_0014130 and hsa_circ_0016760) were selected for validation in ten pairs of NSCLC and adjacent non-cancerous tissues by real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Only hsa_circ_0014130 exhibited significantly overexpressed in NSCLC tissues (P < 0.001), which were further confirmed in another 36 matched tissue samples using qRT-PCR. Hsa_circ_0014130 expression significantly correlated with TNM stage (P = 0.001) and lymphatic metastasis (P = 0.004). The area under the receiver operating characteristic curve was 0.878 (95% confidence interval = 0.804-0.951; P < 0.001), which showed good diagnostic potential. Bioinformatics platforms predicted that hsa_circ_0014130 might interact with five miRNAs and their corresponding mRNAs. Gene oncology analysis and pathway analysis revealed that hsa_circ_0014130 could participate in NSCLC development. In summary, our findings indicated that hsa_circ_0014130 could be used as a potential NSCLC biomarker and might be closely related to the carcinogenesis of NSCLC.

Lung cancer resection with concurrent off-pump coronary artery bypasses: safety and efficiency.

BACKGROUND: To assess the safety and efficacy of combined surgery for patients with concurrent lung cancer and severe coronary heart disease (CHD). METHODS: Between 2003 and 2014, 34 patients with stage I or II lung cancer and simultaneous severe CHD underwent combined off-pump coronary artery bypass (OPCAB) grafting and lung resection. Surgically, myocardial revascularization was performed first and followed by lobectomies through the same or a second incision. Video-assisted thoracoscopes were used in some cases. Five patients also received chemotherapy before or after combined surgery in an effort to improve the long-term survival. RESULTS: All patients survived the operation and no new myocardial infarctions (MIs) occurred in the perioperative period. The most frequent complications were cardiac arrhythmias (5 cases), atelectasis (4 cases), and pulmonary infections (2 cases). All patients were followed up for 5-60 months. Within this period, 6 patients (17.6%) died due to cancer recurrence. The 3- and 5-year survivals were 75% and 67% for these lung cancer patients, respectively. CONCLUSIONS: Combined OPCAB and pulmonary resection for early stage lung cancer patients with concurrent severe CHD is a relatively safe and effective treatment with satisfactory long-term survival rates, especially for those patients with three-vessel disease who are not usually candidates for percutaneous coronary intervention (PCI) before open surgery.

[Combined surgical intervention treatments for lung cancer and coronary heart disease patients].

BACKGROUND AND OBJECTIVE: The number of patients with both lung cancer and coronary heart disease has increased for the last ten years. The aim of this study is to analyze the outcome of the combined treatment of radical surgery and off-pump coronary artery bypass grafting (OPCABG) for patients with both lung cancer and coronary heart disease. METHODS: The clinical data of 18 patients (16 males and 2 females, mean age of 66.11 years) with both lung cancer and coronary heart disease who went through combined surgical interventions between 2003 and 2012 were summarized and analyzed. The lung cancer in these patients was predominantly at stages I and II (TNM). All patients' cardio-pulmonary function was favorable. RESULTS: All the patients survived the operation, without any recorded death and new myocardial infarction occurrence during the perioperative period. Squamous carcinoma and adenocarcinoma were found in 10 and 8 patients, respectively. Pathological lung cancer stage was Ia in 2 cases, Ib in 8 cases, IIa in 3 cases, II b in 3 cases, and IIIa in 2 cases. The most frequently observed complications were cardiac arrhythmias, atelectasis, and pulmonary infections. The mean values of operating room time, postoperative drainage, drainage tube time, and blood transfusion were significantly different between video-assisted thoracoscopic surgery (VATS) groups and thoractomy groups. No significant differences in survival rate were found (P=0.187). CONCLUSIONS: The combined method of OPCABG and pulmonary resection is a safe and effective treatment for patients with both lung cancer and coronary heart disease. VATS lobectomy is beneficial for lung cancer patients because it reduces lesions.

[Outcomes of combined pulmonary resection and off-pump coronary artery bypass grafting for patients with lung tumor and concurrent coronary heart disease].

OBJECTIVE: To analyze the outcomes of lung resection and off-pump coronary artery bypass grafting (OPCAB) synchronously for the patients with lung tumor and concurrent coronary heart disease. METHODS: Twenty-two patients with lung tumor and concurrent coronary heart disease underwent combined surgical interventions between January 2003 and December 2011. They included 20 males and 2 females with a mean age of (65 ± 4) years. The TNM stage of lung cancer was predominantly at stages I and II. A majority of them had two and three-vessel disease. The tests of cardiothoracic functions were normal. The biopsy of lung tumor was carried out initially through sternotomy approach. Then OPCAB was performed. Finally lung resection was carried out according to the pathological results of lung tumor. RESULTS: All patients survived. The average number of anastomosed coronary vessels was 2.3. After myocardial revascularization through a sternotomy approach, the procedures included lobectomy and partial lung resections through sternotomy only (n = 11), lobectomy through a lateral thoracotomy approach (n = 9) and lobectomy and bypass to left anterior descending (LAD) through left thoracotomy only (n = 2). Neither death nor new MI occurred during the perioperative period. The mean stay in-hospital was (17 ± 7) days and mean operative duration (233 ± 1) min. The diagnoses were non-small cell lung cancer (n = 18) and benign tumor (n = 4). The most frequent complications were cardiac arrhythmias, atelectasis and pulmonary infections. All of them were followed up for 10-60 months. Within this period, 4 patients died from cancer recurrence. CONCLUSION: The combined procedure of OPCABG grafting and pulmonary resection is a safe and effective treatment option for patients with lung cancer and concurrent coronary heart disease.

Fistulectomy as a surgical option for pulmonary arteriovenous malformation.

BACKGROUND: Surgical resection remains the treatment of choice for pulmonary arteriovenous malformation but removes some normal lung parenchyma. This study aimed to evaluate the effect and safety of the lung-saving procedure of fistulectomy as an alternative to lung resection. METHODS: From July 2003 to July 2008, 6 selected patients with pulmonary arteriovenous malformations underwent fistulectomies. Among them, 1 patient underwent emergency operation and 2 underwent bilateral operations. One patient received postoperative embolotherapy. RESULTS: No hospital deaths or postoperative morbidity occurred. PaO2 increased significantly after operation. All patients were free of symptoms and hypoxia during a follow-up for 9 months to 5 years. CONCLUSIONS: Fistulectomy is a safe and effective procedure for patients with pulmonary arteriovenous malformation and may be an alternative to lung resection.

[Experience in lung resection synchronous with off-pump coronary artery bypass grafting in patients with lung tumor and coronary disease].

OBJECTIVE: To summarize the experience in lung resection synchronous with off-pump coronary artery bypass grafting (OPCABG) in patients with lung tumor and coronary disease. METHODS: The clinical data of ten patients with coronary artery disease and lung tumor, 8 with peripheral malignant tumors and 2 with central benign tumors, all males, aged 56.2 (41 - 782), who underwent lung resection and OPCABG synchronously, were analyzed. RESULTS: There was no hospital death in this series. All patients regained their ideal cardiorespiratory function postoperatively. CONCLUSION: With experienced management, it is feasible and safe to perform lung resection and OPCABG synchronously for strictly selected patients.