Radiomics nomogram for prediction disease-free survival and adjuvant chemotherapy benefits in patients with resected stage I lung adenocarcinoma.

BACKGROUND: Robust imaging biomarkers are needed for risk stratification in stage I lung adenocarcinoma patients in order to select optimal treatment regimen. We aimed to construct and validate a radiomics nomogram for predicting the disease-free survival (DFS) of patients with resected stage I lung adenocarcinoma, and further identifying candidates benefit from adjuvant chemotherapy (ACT). METHODS: Using radiomics approach, we analyzed 554 patients' computed tomography (CT) images from three multicenter cohorts. Prognostic radiomics features were extracted from computed tomography (CT) images and selected using least absolute shrinkage and selection operator (LASSO) Cox regression model to build a radiomics signature for DFS stratification. The biological basis of radiomics was explored in the Radiogenomics dataset (n=79) by gene set enrichment analysis (GSEA). Then a nomogram that integrated the signature with these significant clinicopathologic factors in the multivariate analysis were constructed in the training cohort (n=238), and its prognostic accuracy was evaluated in the validation cohort (n=237). Finally, the predictive value of nomogram for ACT benefits was assessed. RESULTS: The radiomics signature with higher score was significantly associated with worse DFS in both the training and validation cohorts (P<0.001). The GSEA presented that the signature was highly correlated to characteristic metabolic process and immune system during cancer progression. Multivariable analysis revealed that age (P=0.031), pathologic TNM stage (P=0.043), histologic subtype (P=0.010) and the signature (P<0.001) were independently associated with patients' DFS. The integrated radiomics nomogram showed good discrimination performance, as well as good calibration and clinical utility, for DFS prediction in the validation cohort. We further found that the patients with high points (point ≥8.788) defined by the radiomics nomogram obtained a significant favorable response to ACT (P=0.04) while patients with low points (point <8.788) showed no survival difference (P=0.7). CONCLUSIONS: The radiomics nomogram could be used for prognostic prediction and ACT benefits identification for patient with resected stage I lung adenocarcinoma.

Primary tumour resection showed survival benefits for non-small-cell lung cancers with unexpected malignant pleural dissemination.

OBJECTIVES: Although non-small-cell lung cancer (NSCLC) with malignant pleural nodules is generally contraindicated for surgery, there is no consensus concerning on-site operative decisions for unexpected, intraoperatively encountered malignant pleural disseminations. The rationale underlying the primary tumour removal and other aggressive interventions remains controversial. METHODS: All surgical NSCLC cases (9576) of Shanghai Pulmonary Hospital between January 2005 and December 2013 were reviewed. Among them, 83 cases (0.9%) met the definition of 'unexpected' macroscopic malignant pleural nodules, despite routine preoperative evaluations for tumour metastasis. No pleural effusion was visualized in 52 cases during operations, and 31 had pleural effusion in minimal volume (<300 ml). Survivals were calculated with the Kaplan-Meier method and risk factors were evaluated by the log-rank test. RESULTS: The overall 3- and 5-year survival rates were 36.1 and 16.8%, respectively. The median survival time (MST) after surgery was significantly longer in the group without pleural effusion (37 months) compared with the group with pleural effusion (22 months, P = 0.005). Twenty-one cases had only biopsy, whereas 62 cases had primary tumour resection. Primary tumour resection had significantly better outcome compared with biopsy (MST: respectively, 35 vs 17 months, 3-year survival rate 45.8 vs 11.8%, P = 0.001). No baseline differences emerged in characteristics between biopsy and primary tumour resection groups including targeted therapy. Multivariate analysis showed that primary tumour resection (HR: 3.678, P = 0.014), no pleural effusion (HR: 3.409, P = 0.001) and adenocarcinoma (HR: 5.481, P = 0.002) were favourable prognostic factors in patients with malignant pleural nodules. CONCLUSIONS: Patients with malignant pleural nodules but without pleural effusion had better survival compared with those with effusions. Primary tumour resection had survival benefits for patients with unexpected intraoperatively proven malignant pleural nodules.

A Novel Technique of Long-Segment Tracheal Repair With Extended Bronchial Flap of Right Upper and Main Bronchus Plus Tracheoplasty.

Long-segment tracheal resection and repair pose a great challenge. We present a successful case of long-segment tracheal defect repair with extended bronchial flap of the right upper and main bronchus, together with a tracheoplastic method. This is a novel technique for repairing a large tracheal defect with an extended pedicled bronchial flap in specific situations.

Prognostic analysis of the bronchoplastic and broncho-arterioplastic lobectomy of non-small cell lung cancers-10-year experiences of 161 patients.

BACKGROUND: Bronchoplastic and broncho-arterioplastic lobectomy is technically demanding. Present study performed a prognostic analysis of lobectomy patient based on 10-year data in a high-volume center. METHODS: Overall, 161 non-small cell lung cancer (NSCLC) cases underwent bronchoplastic and broncho-arterioplastic lobectomy between January 2004 and November 2013. Follow-up information was obtained for 88.8% patients. Prognostic analysis was performed with the Cox proportional hazards model. RESULTS: There were 133 bronchoplastic and 28 broncho-arterioplastic procedures. In detail, 97 sleeve and 64 wedge broncho-resection and reconstructions were conducted; pulmonary artery sleeve reconstructions were performed in 26 cases and tangential resection in 135 cases. 90-day post-operative mortality was 3.1% (5/161), and 24.8% (40/161) patients had post-operative complications. 5-year overall survival was 53.4% and 5-year disease-free survival (DFS) was 48.2% for the entire case series; these survival rates were 67.7% and 55.7% for stage I (n=31), 64.4% and 58.9% for stage II (n=62), and 36.9% and 31.9% for stage III disease, respectively. Univariate analysis revealed that age >65 and higher grade of pN were associated with worse overall survival while right side tumor, non-squamous histology type, and higher grade of pT and pN were associated with worse DFS. Multivariate analysis revealed that pN is the only independent factor of worse outcome. CONCLUSIONS: Bronchoplastic and broncho-arterioplastic lobectomy are safe procedures for indicated NSCLC patients associated with a low rate of post-operative complications but favorable long-term survival. Recognition of prognostic factors helps improve outcomes for these patients.

Transcriptome profilings of female Schistosoma japonicum reveal significant differential expression of genes after pairing.

Pairing of Schistosoma japonicum initiates female development, leads to female sexual maturation, and maintains this mature state. To understand the mechanism involved in these processes, we studied parasites isolated from single- and double-sex cercariae-infected mice using deep-sequencing analysis, Solexa, to uncover pair-regulated transcriptional profiles. In this study, we report the results of high-throughput tag-sequencing (Tag-seq) analysis of the transcriptome of female worms 18 and 23 days postsingle- and double-sex infections. We sequenced over 3 million tags, obtained a total of 14,034, 27,251, 22,755, and 22,555 distinct tags corresponding to 5,773, 9,794, 8,885, and 8,870 tag-mapped genes for 23-day-old female schistosomula from double-sex infections (23DSI), 23-day-old female schistosomula from single-sex infections (23SSI), 18-day-old female schistosomula from double-sex infections (18DSI), and 18-day-old female schistosomula from single-sex infections (18SSI), respectively. Analyses of differentially expressed genes revealed similarities in the gene expression profiles between 18SSI and 18DSI as well as rational differential gene expression between 18SSI and 23SSI. However, fewer upregulated genes were found in 23DSI compared with 18DSI. Of the 3,446 differentially expressed genes between 23DSI and 23SSI, 2,913 genes were upregulated in 23SSI, whereas only 533 genes were upregulated in 23DSI. In these upregulated genes in 23DSI, phosphoglycerate mutase, superoxide dismutase, egg antigen, ribosomal proteins, ferritin-1 heavy chain, and eukaryotic translation initiation factor 2 were detected. Detection of these genes suggests that gene expression in 23DSI is specialized for functions such as promotion and maintenance of female sexual maturation and egg production. Quantitative real-time (RT)-PCR analysis confirmed the Solexa results, thereby supporting the reliability of the system. Our results offer new insights into the biological significance of pairing, which directs the expression of genes specific for sexual maturation and egg production.