The Diagnostic and Prognostic Value of EBUS-TBNA for Intrathoracic Metastasis in Previously Treated Patients With Head and Neck Cancer.

OBJECTIVE: The present study assessed the diagnostic and prognostic significance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for suspected intrathoracic metastasis after HNC treatment. METHODS: A retrospective analysis was conducted on 75 patients with a prior history of head and neck cancer treatment who underwent EBUS-TBNA for suspected intrathoracic metastases between March 2012 and December 2021. RESULTS: A total of 126 targeted lesions, including 107 mediastinal/hilar lymph nodes and 19 intrapulmonary/mediastinal masses, were sampled. The metastatic head and neck cancer (HNC) cases detected by EBUS-TBNA consisted of nasopharyngeal carcinoma (n = 24), oropharyngeal carcinoma (n = 3), hypopharynx carcinoma (n = 6), laryngeal carcinoma (n = 6), and oral cavity carcinoma (n = 6). Cases with negative EBUS-TBNA results consisted of tuberculosis (n = 9), sarcoidosis (n = 3), anthracosis (n = 9), and reactive lymphadenitis (n = 9). Six false-negative cases were found among the 75 patients with suspected intrathoracic metastases. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the EBUS-TBNA procedure for metastatic HNC were 88.2, 100.0, 100.0, 80, and 92.0%, respectively. The diagnosis of HNC intrathoracic metastasis by EBUS-TBNA correlated with an adverse prognosis in terms of overall survival (OS) (P = .008). The log-rank univariate analysis and Cox regression multivariate analysis results indicated that the detection of metastatic HNC through EBUS-TBNA was a significant independent prognostic factor for patients with HNC who had received prior treatment. CONCLUSIONS: Endobronchial ultrasound-guided transbronchial needle aspiration is a safe, effective, and minimally invasive procedure for assessing suspected intrathoracic metastasis in HNC patients after treatment. The intrathoracic metastasis detected by EBUS-TBNA has crucial prognostic significance in previously treated HNC patients.

Alleviation of neoadjuvant immunochemotherapy for esophageal squamous cell carcinoma and its relationship with expression and changes of PD-L1.

The alleviation of neoadjuvant immunochemotherapy (NICT) and neoadjuvant chemoradiotherapy (NCRT) was compared for esophageal squamous cell carcinoma (ESCC), and the correlation between the expression and changes of PD-L1 and the efficacy of NICT was evaluated in this study. Fourteen patients with ESCC who received preoperative NICT were included in group A, and fourteen patients with ESCC who received preoperative NCRT were included in group B. Next, group A was divided into CR (complete response), PR (partial response), and NR (no response) according to the degree of pathological response. Also, the expression and changes of PD-L1 (CPS, TPS, IPS) before and after treatment were compared between the groups. We observed that after the treatment, the expression of PD-L1 in both groups was higher than before treatment. In group B, the expression of PD-L1 was elevated in 92.8% of patients, which was higher than that in group A, which had significantly increased IPS (p<0.05). In group A, 9 (64.2%) patients with CPS <10 achieved partial or complete response. There was no significant difference in pathological response and reduction of tumor thickness between the two groups or significant differences in CPS and TPS among CR, PR, and NR groups before treatment. The IPS was the highest in the CR group; however, the difference was not statistically significant. The differences in IPS change were significant among the three groups (p<0.05). In conclusion, NICT and NCRT could upregulate the expression of PD-L1. NCRT more significantly upregulated the expression of PD-L1, mainly of PD-L1 in immune cells in the tumor microenvironment. NICT was not less effective than NCRT in pathological response and tumor thickness changes. The preoperative CPS and TPS scores of PD-L1 did not effectively predict the degree of pathological response, but the high IPS and high IPS downregulation could be related to the degree of pathological response. Some patients with low preoperative expression of PD-L1 could still achieve a good response by NICT. As NCRT can upregulate the expression of PD-L1, the low preoperative expression of PD-L1 is no contraindication for immunotherapy, which provides a new basis and prognostic indexes for chemoradiotherapy combined with immunotherapy.