Development of a predictive model to predict postoperative bone metastasis in pathological I-II non-small cell lung cancer.

Background: Bone is a common metastatic site in postoperative metastasis, but related risk factors for early-stage non-small cell lung cancer (NSCLC) remain insufficiently investigated. Thus, the study aimed to identify risk factors for postoperative bone metastasis in early-stage NSCLC and construct a nomogram to identify high-risk individuals. Methods: Between January 2015 and January 2021, we included patients with resected stage I-II NSCLC at the Department of Thoracic Surgery, West China Hospital. Univariable and multivariable Cox regression analyses were used to identify related risk factors. Additionally, we developed a visual nomogram to forecast the likelihood of bone metastasis. Evaluation of the model involved metrics such as the area under the curve (AUC), C-index, and calibration curves. To ensure reliability, internal validation was performed through bootstrap resampling. Results: Our analyses included 2,106 eligible patients, with 54 (2.56%) developing bone metastasis. Multivariable Cox analyses showed that tumor nodules with solid component, higher pT stage, higher pN stage, and histologic subtypes especially solid/micropapillary predominant types were considered as independent risk factors of bone metastasis. In the training set, the developed model demonstrated AUCs of 0.807, 0.769, and 0.761 for 1-, 3-, and 5-year follow-ups, respectively. The C-index, derived from 1,000 bootstrap resampling, showed values of 0.820, 0.793, and 0.777 for 1-, 3-, and 5-year follow-ups. The calibration curve showed that the model was well calibrated. Conclusions: The predictive model is proven to be valuable in estimating the probability of bone metastasis in early-stage NSCLC following surgery. Leveraging four easy-to-acquire clinical parameters, this model effectively identifies high-risk patients and enables individualized surveillance strategies for better patient care.

Effect of histological subtype on the efficacy of perioperative chemotherapy in pulmonary sarcomatoid carcinoma: a retrospective study based on SEER population.

Background: The efficacy of perioperative chemotherapy (PC) in pulmonary sarcomatoid carcinoma (PSC) is controversial. We conducted this study to investigate the effect of different histological subtypes on the efficacy of PC in PSC patients. Methods: Clinicopathological data of 811 PSC patients of different histological subtypes were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier method and log-rank test were used to evaluate the effects of PC on the overall survival (OS) and cancer-specific survival (CSS) in different subtypes of PSC patients. Propensity score matching (PSM) was used to reduce potential confounding effects. Subgroup analyses were conducted to further investigate the efficacy of PC in patients with different characteristics. Results: A total of 210 (25.89%) enrolled PSC patients received PC. PC was not associated with OS or CSS benefit in pleomorphic carcinoma, giant cell carcinoma, or spindle cell carcinoma patients, neither before nor after matching. But survival benefit of PC was observed in carcinosarcoma patients both before (5-year OS: 48.79% vs. 38.75%, P=0.01) and after (5-year OS: 51.29% vs. 17.54%, P=0.003) matching. Subgroup analyses showed that in patients whose tumor larger than 4 cm, PC was still associated with improved survival in carcinosarcoma, but not in the other histological subtypes of PSC. Conclusions: The efficacy of PC varies between different subtypes of PSC. Survival benefit of PC was only observed in carcinosarcoma patients, but not in pleomorphic carcinoma, giant cell carcinoma, or spindle cell carcinoma patients. Histological subtype should be considered when treating PSC patients with PC.

Suction versus non-suction drainage strategy after uniportal thoracoscopic lung surgery: a prospective cohort study.

Background: The postoperative outcomes of suction drainage versus non-suction drainage after uniportal video-assisted thoracoscopic surgery (UniVATS) come with little consensus. This study aimed to prospectively compare the postoperative outcomes of suction drainage versus non-suction drainage in patients who underwent UniVATS. Methods: Between October 2022 and January 2023, patients undergoing UniVATS were prospectively enrolled. The choice of drainage strategy (suction or non-suction) was at the surgeon's discretion. The primary outcome was chest tube duration, with secondary outcomes including postoperative drainage volume, pain scores, postoperative complications, length of hospital stay, and hospitalization cost. Baseline characteristics and postoperative outcomes were compared. Univariable and multivariable analyses were used to identify risk factors for postoperative outcomes. Results: A total of 206 patients were enrolled in this study, with 103 patients in each group. Baseline characteristics were well-balanced. The chest tube duration did not significantly differ between the two groups. However, suction drainage exhibited a significantly lower total drainage volume compared to non-suction drainage (280.00 vs. 400.00 mL, P=0.03). Suction drainage was associated with a significantly shorter postoperative hospital stay (3.00 vs. 4.00 days, P<0.001) and lower pain score on the second postoperative day (POD). Multivariable analyses also confirmed that suction drainage was significantly correlated with a lower total drainage volume and a shorter postoperative hospital stay. Conclusions: These findings suggested that the suction drainage was superior to non-suction drainage in terms of postoperative drainage volume and length of hospital stay in patients undergoing UniVATS.

Effect of a prior thyroid cancer on the survival of lung cancer patients: a retrospective study based on SEER database.

PURPOSE: The effect of a history of thyroid cancer on the prognosis of lung cancer patients has not been fully investigated. Therefore, we aimed to evaluate this effect based on a large cohort. METHODS: Data of 154844 lung cancer patients, of whom 406 had prior thyroid cancer, were collected from SEER database. Primary survival analysis was conducted between patients with and without prior thyroid cancer using Kaplan-Meier method. Secondary survival analysis was conducted to investigate the effects of the stage and histological subtype of the prior thyroid cancer on the survival of lung cancer patients. Propensity adjustment was used to reduce confounding effect. RESULTS: Compared to patients without prior malignancy, patients with prior thyroid cancer were predominantly female (72.4% vs. 48.7%, p < 0.001), had lower stage (proportion of localized tumor: 40.4% vs. 25.6%, p < 0.001), and larger proportion of surgery (52.2% vs. 29.4%, p < 0.001), and had better survival (5-year survival rate: 55.53% vs. 33.16%, p < 0.001). After propensity adjustment, the survival was similar between the groups (5-year survival rate: 55.53% vs. 51.78%, p = 0.24). The survival of patients with different stages (localized tumor vs. regional tumor: p = 0.88) or different histological subtypes (p = 0.46) of prior thyroid cancer were comparable. CONCLUSION: Survival of lung cancer patients with or without prior thyroid cancer was similar after propensity adjustment, and the stage or histological subtype of the prior thyroid cancer had no significant effect on the survival of lung cancer patients.

Genetically predicted childhood body mass index and lung cancer susceptibility: A two-sample Mendelian randomization study.

BACKGROUND: The association between adult body mass index (BMI) and lung cancer (LC) susceptibility have been reported, but the causal relationship with childhood BMI remains largely unclear. To evaluate the causal effect of childhood BMI on LC susceptibility, a two-sample Mendelian randomization (MR) study was performed. METHODS: The two-sample MR analysis utilized 25 single nucleotide polymorphisms (SNPs) as instrumental variables for childhood BMI. Genetic summary data from the International Lung Cancer Consortium and FinnGen databases were analyzed to estimate the causal effect of these SNPs on LC susceptibility. The IVW method was employed as the primary analysis, supplemented by the Weighted Median, MR-Egger, and MR pleiotropy residual sum and outlier test. RESULTS: Our findings indicated that there was no causal association between childhood BMI and the susceptibility of LC (odds ratio [OR]: 1.03, 95% confidence interval [CI]: 0.90-1.17, p = 0.705), lung adenocarcinoma (OR: 0.99, 95% CI: 0.86-1.13, p = 0.832), lung squamous cell carcinoma (OR: 0.97, 95% CI: 0.84-1.13, p = 0.726), and small cell LC (OR: 1.09, 95% CI: 0.82-1.45, p = 0.554) based on the IVW as well as other methods employed. Furthermore, these findings indicated no causal effect of childhood BMI on the LC susceptibility in both ever smokers and never smokers. CONCLUSION: This study did not conclude a causal effect between childhood BMI and LC susceptibility. However, given the complex nature of cancer development, further studies are needed to verify these findings.

Risk-based screening for second primary extrapulmonary malignancies in stage I lung cancer patients: A study based on SEER database.

OBJECTIVES: We conducted this study to identify the risk for second primary malignancy (SPM), especially for second primary extrapulmonary malignancy (SPEM), in resected stage I lung cancer patients. MATERIALS AND METHODS: Resected stage I lung cancer patients were retrospectively enrolled from the SEER database (2008-2017). Standardized incidence ratio (SIR) was used to evaluate the relative risk of SPM of patients as compared to general population. Competing risk model was utilized to identify the risk factors for SPEM of increased risk (rSPEM). A simplified nomogram based on the factors was developed to stratify patients at different risks of rSPEM. RESULTS: A total of 14,495 patients were enrolled, and 1779 (12.27%) patients developed SPM during follow-up, of which 896 (50.37%) were SPEM. Enrolled patients had higher risk of SPM than general population (SIR: 1.92, 95% CI: 1.83 - 2.01). The yearly morbidity of SPM was about 3% - 4% over time. The three most frequent SPEM were prostate cancer, breast cancer, and urinary bladder cancer. The competing-risk multivariable analysis showed that increasing age, male, and white race were independent risk factors for rSPEM. The simplified nomogram showed favorable performance in stratifying patients at different risks of rSPEM (P < 0.001). CONCLUSION: The risk of SPM in stage I lung cancer patients was high. Risk factors for rSPEM were identified and the corresponding simplified nomogram based on the risk factors could discriminate patients at different risks well. The nomogram might help physicians to make more appropriate screening strategy for the SPEM.

A Competing Risk Model Nomogram to Predict the Long-Term Prognosis of Lung Carcinoid.

BACKGROUND: The prediction of long-term, cancer-specific survival of lung carcinoid remains controversial. We aimed to build a prognostic model by using competing-risk analysis to predict the long-term, cancer-specific survival of lung carcinoid patients. METHODS: Patients were retrospectively enrolled from the SEER database, and clinicopathological data were collected. Univariable and multivariable competing-risk analyses were conducted to identify prognostic factors. A competing-risk model and a nomogram were developed by using independent prognostic factors. The model was assessed by using concordance index and calibration curves. RESULTS: A total of 2496 patients were enrolled, of which 267 (10.7%) died of diagnosed carcinoma; 316 (12.7%) died because of other reasons. The 5-year, 10-year, and 15-year cancer-specific survival of carcinoid patients were 91.35%, 86.60%, and 84.39%, respectively. Multivariable analysis demonstrated that increasing age, male, larger tumor size, higher N stage, M1, atypical carcinoid, and undergoing no surgery were independent risk factors. A competing-risk model based on the risk factors and a corresponding nomogram were developed. Concordance index of the developed model for 5-year, 10-year, and 15-year were 0.891, 0.856, 0.836 respectively in the training cohort and 0.876, 0.841, 0.819 respectively in the validation cohort after bootstrap adjustment. The calibration curves of 5-year, 10-year, and 15-year showed good agreement. CONCLUSIONS: Increasing age, male, larger tumor size, higher N stage, M1, atypical carcinoid, and undergoing no surgery were independent risk factors. A competing risk model of excellent performance in predicting long-term survival was developed, and a nomogram was established.

A Clinical Prediction Model for Postoperative Pneumonia After Lung Cancer Surgery.

INTRODUCTION: Postoperative pneumonia (POP) is a common complication following lung cancer surgery and is associated with increased hospitalization costs and mortalities. We aimed to identify risk factors associated with POP and to develop a reliable predictive model. METHODS: Patients who underwent lung cancer surgery between January 2015 and December 2021 in our hospital were enrolled. Least absolute shrinkage and selection operator regression analysis was used to select predictors of POP. Multivariable logistic regression was performed to construct the nomogram. Bootstrap resampling was conducted for internal validation. The performance of the model was evaluated by discrimination and calibration. RESULTS: A total of 5269 consecutive patients were enrolled. POP occurred in 1.7% of patients (92/5269). Five independent predictors were identified: age, predicted forced expiratory volume in 1 s, predicted diffusing capacity of the lungs for carbon monoxide, tuberculosis history, and surgery duration. The multivariable regression model showed good discrimination (C-index: 0.821, 95% confidence interval, 0.783-0.859), which was well validated by internal validation. The calibration curve illustrated good agreement between the predicted probability and observed probability of POP. CONCLUSIONS: Based on the easily available risk factors, our nomogram could predict the risk of POP with good discrimination and calibration. The model has good clinical practicability, enabling precise and targeted interventions to reduce the incidence of POP in high-risk patients.

Clinicopathological characteristics and prognosis of resectable lung adenosquamous carcinoma: a population-based study of the SEER database.

OBJECTIVE: Adenosquamous carcinoma is a rare subtype of non-small cell lung cancer characterized by aggressive behavior, with combination of adenocarcinoma and squamous cell carcinoma components. The clinicopathological characteristics and prognosis of resectable adenosquamous carcinoma are incompletely understood and this study aimed to depict those in a large population. METHODS: A total of 805 adenosquamous carcinoma, 7875 squamous cell carcinoma and 23 957 adenocarcinoma patients who underwent lobectomy or sublobectomy were queried from the Surveillance, Epidemiology, and End Results database (2010-17). Clinicopathological characteristics of adenosquamous carcinoma patients were compared with those of squamous cell carcinoma and adenocarcinoma patients. Prognostic factors were identified by univariable and multivariable Cox regression analyses. Propensity score matching was applied to reduce confounding effects. RESULTS: Adenosquamous carcinoma was associated with higher pleural invasion incidence and poorer differentiation compared with squamous cell carcinoma or adenocarcinoma (P values < 0.001). The independent risk factors of cancer-specific survival of adenosquamous carcinoma patients were increasing age, male sex, invading through visceral pleura, poor differentiation and higher stage. Stage IB adenosquamous carcinoma patients whose tumor invaded through visceral pleura had significantly worse survival than those not (P = 0.003). Adenosquamous carcinoma patients had worse survival compared with squamous cell carcinoma (5-year-survival: 64.55 vs. 69.09%, P = 0.003) and adenocarcinoma (5-year-survival: 64.55 vs. 76.79%, P < 0.001) patients before match. And this difference persisted after match. CONCLUSIONS: Resectable adenosquamous carcinoma patients had higher pleural invasion incidence, poorer differentiation and worse survival compared with squamous cell carcinoma and adenocarcinoma patients. Visceral pleural invasion status and differentiation grade were vital prognostic factors of adenosquamous carcinoma patients on the basis of stage.

Pulmonary sclerosing pneumocytoma: clinical features and prognosis.

BACKGROUND: Pulmonary sclerosing pneumocytoma is a kind of rare benign pulmonary tumor with potential malignancy. The clinical features, risk factors for prognosis, and optimal treatment have not been identified yet. This study aimed to investigate the clinical features and prognosis of pulmonary sclerosing pneumocytoma. METHODS: We retrospectively performed a review of pulmonary sclerosing pneumocytoma patients in West China Hospital from 2009 to 2019. The basic characteristics, treatment regimens, operation detail, postoperative variables, and follow-up time were recorded for each case. Differences in features between patients undergoing lobectomy and segmentectomy were compared. We also performed a case review and summarized reported clinical features in former studies. RESULTS: Altogether 61 pulmonary sclerosing pneumocytoma patients were retrospectively reviewed. Fifty-six patients were female and 5 were male. The patients' median age was 51 (23-73). Seven (11.48%) patients had smoking history. Twenty tumors were located in the right lung [upper lobe (n = 7), middle (n = 2), and lower (n = 11)] and 41 in the left [upper (n = 12) and lower (n = 29)]. The median tumor size was 2 (0.9-7) cm. Thirty-six (59.02%) patients underwent sublobectomy (segmentectomy or wedge resection) whereas 25 (40.98%) underwent lobectomy. All patients recovered uneventfully, and no perioperative mortality was identified. Sublobectomy showed a trend towards reduced chest tube duration and shorter postoperative hospital stays compared with lobectomy. CONCLUSIONS: The findings showed good prognosis of pulmonary sclerosing pneumocytoma and proved its benign characteristics. Sublobectomy showed advanced efficacy regarding chest tube duration and postoperative hospital stay compared with lobectomy.

Free of choice on anterior and posterior chest tube position after lung cancer resection.

OBJECTIVES: The optimal location to insert a chest tube for postoperative drainage has not been identified. We performed a retrospective equivalence study to identify whether the efficiency is similar regarding anterior or posterior position of chest tube in thoracic cavity after video-assisted thoracoscopic surgery for non-small-cell lung cancer. METHODS: A retrospective review of 4263 patients undergoing non-small-cell lung cancer resection from October 2009 to August 2019 in the Western China Lung Cancer Database was conducted. Propensity score matching was performed to balance baseline characteristics between anterior and posterior groups. Chest tube duration, drainage volume, postoperative complications and hospitalization cost were compared. Equivalence margin was defined as (-1, 1) in 95% confidence interval of the mean difference of chest tube duration. RESULTS: After propensity score matching, we investigated 2912 patients with anterior or posterior (1456 vs 1456) chest tube location following lung cancer resection. The mean time to chest tube removal was 3.39 days in the anterior group and 3.38 days in the posterior group (P = 0.52), while the mean difference and 95% confidence interval were 0.02 (-0.17, 0.20). The mean postoperative hospital stays in 2 groups were 5.47 vs 5.24 days (anterior vs posterior, P = 0.02). No significant differences were identified regarding the drainage volume during the first 3 postoperative days, postoperative complications and hospitalization cost. CONCLUSIONS: The comparison of clinical outcomes between anterior and posterior location of chest tube met the criteria for equivalence. For lung cancer patients undergoing video-assisted thoracoscopic surgery resection, it was free choice on anterior or posterior single-tube insertion.

Risk factors for prolonged air leak after pulmonary surgery: A systematic review and meta-analysis.

This study aimed to comprehensively identify risk factors for the occurrence of prolonged air leak (PAL) in patients undergoing pulmonary surgery. Studies were retrieved from 3 databases, including PubMed, Web of Science, and EmBase up to 13 May 2020. We performed meta-analysis using Bayesian random effect models through divergence restricting conditional tessellation (DIRECT) algorithm. The effect size was expressed as odds ratio (OR) or mean difference (MD), each with 95% credible interval (CrI). The evidence quality was evaluated. Subgroup analyses and sensitivity analyses were conducted. Thirty-nine studies with 89006 patients were finally included. Pooled PAL incidence was 15%. Of 30 risk factors, 22 were significantly associated with increased PAL incidence. Five risk factors were ultimately selected with high evidence quality: smoking history (OR 1.84, 95%CrI 1.45 to 2.31, P<0.001), preoperative steroid use (OR 1.51, 95%CrI 0.87 to 2.65, P = 0.031), lower ratio of forced expiratory volume in 1 s and forced vital capacity (OR 1.99, 95%CrI 1.22 to 3.33, P = 0.005), non-fissureless technique (OR 2.14, 95%CrI 1.31 to 3.66, P = 0.003), and pathological TNM stage III/IV (OR 1.50, 95%CrI 1.07 to 2.12, P = 0.003). Regarding the negative impact of PAL on the personal cost and postoperative recovery, the verification of previous proposed factors and investigation of recently discovered ones both implied directions for risk stratification and the establishment of an applicable prediction model.

Identifying the hub genes in non-small cell lung cancer by integrated bioinformatics methods and analyzing the prognostic values.

BACKGROUND: Lung cancer, a malignant tumor, has the highest mortality and second most common morbidity worldwide. Non-small cell lung cancer (NSCLC) is the most common pathological subtype of lung cancer. This study aimed to identify the gene signature associated with the NSCLC prognosis using bioinformatics analysis. MATERIALS AND METHODS: The dataset GSE103512 was utilized to construct co-expression networks using weighted gene co-expression network analysis (WGCNA). Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed using Database for Annotation, Visualization, and Integrated Discovery. Gene set enrichment analysis was conducted to ascertain the function of the hub genes more accurately. The relationship between the hub genes and immune infiltration was investigated using a single sample gene set enrichment analysis. Hub genes were screened and validated by other datasets and online websites. RESULTS: The results of WGCNA demonstrated that the blue module was most significantly related to tumor progression in NSCLC. Functional enrichment analysis showed that the blue module was associated with DNA replication, cell division, mitotic nuclear division, and cell cycle. A total of five hub genes (RFC5, UBE2S, CHAF1A, FANCI, and TMEM194A) were chosen to be identified and validated at transcriptional and translational levels. Receiver operating characteristic curve verified that the mRNA levels of these five genes can excellently discriminate between normal and tumor tissues. Survival analysis was also performed. Additionally, the protein levels of these five genes were also significantly different between tumor and normal tissues. Immune infiltration analysis showed that the expression levels of the hub genes had a negative correlation with the infiltration levels of many cells related to innate immune response, antigen-presenting process, humoral immune response, or T cell-mediated immune responses. CONCLUSIONS: We identified five hub genes associated with the NSCLC tumorigenesis. NSCLC patients with higher expressions of each hub gene had a worse prognosis than those with lower expressions. Moreover, the hub genes might serve as biomarkers and therapeutic targets for precise diagnosis, target therapy, and immunotherapy of NSCLC in the future.