Jianfei Shen

Objectives: The goal of this study was to compare early recurrence patterns and survival outcomes between neoadjuvant chemoimmunotherapy (NCIT) and neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced oesophageal squamous cell carcinoma. Methods: This retrospective cohort study included 1428 patients with stage IIB-IVA esophageal squamous cell carcinoma who underwent NCIT or NCRT followed by a radical surgical procedure. Outcomes included overall survival (OS), recurrence-free survival, loco-regional recurrence, distant metastasis, and post-recurrence survival. Propensity score matching (1:1 ratio, 0.1 caliper; balance threshold: standardized mean difference <0.10) and multivariable Cox regression were utilized. Results: After propensity score matching (532 patients per group), the NCIT group exhibited better 3-year OS (72.2% vs 60.9%; hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.56-0.85; P < .001) and recurrence-free survival (67.8% vs 59.3%; HR, 0.70; 95% CI, 0.57-0.86; P < .001) than the NCRT group. The NCIT group also had lower rates of early overall recurrence (131 [24.6%] vs 196 [36.8%]; P < .001) and early distant metastasis (73 [13.7%] vs 125 [23.5%]; P < .001) than the NCRT group. Multivariable regression analysis identified NCRT (vs NCIT), higher ypN stage, and not achieving a major pathological response as independent risk factors for both early overall recurrence and early distant metastasis. Among patients who experienced early recurrence, post-recurrence survival did not differ between the 2 modalities (HR, 0.81; 95% CI, 0.63-1.04; P = .086). Although the NCRT group had a higher major pathological response rate, NCIT was associated with better early recurrence control even among patients achieving a major pathological response (HR, 0.61; 95% CI, 0.47-0.84; P < .001). Conclusions: Compared with NCRT, NCIT is associated with a lower incidence of early recurrence, particularly distant metastasis, which may contribute to the observed OS advantage. The poor prognosis after early recurrence highlights the need for intensified post-operative surveillance in high-risk patients.

Across two independent clinical cohorts, a distinct progressive growth pattern associated with family history of lung cancer was identified in patients with incidental pure ground-glass nodules detected at low-dose chest CT.

1. Lung cancer remains the leading cause of cancer-associated mortality worldwide, with lung adenocarcinoma (LUAD) accounting for over half of all diagnosed cases [1]. Current standard regimens, in...

Background: A significant number of patients are unable to undergo surgery due to poor pulmonary function. In order to verify that this group of patients can be operated safely after a cardiopulmonary exercise test (CPET) and thus increase the number of operated patients, we conducted this trial. Methods: This was a retrospective study. From 2022 to 2024, we conducted preoperative evaluations on a cohort of hospitalized patients. These patients initially underwent a pulmonary function test (PFT) to assess surgical risk. Those with suboptimal PFT results underwent further CPET. Ultimately, 130 patients proceeded to surgical treatment. The primary outcome focused on the incidence of postoperative complications. Secondary endpoints included operative duration, intraoperative bleeding, postoperative hospital stay, etc. Results: This study included a total of 130 older patients, with 71 patients in the PFT group and 59 in the CPET group. Regarding postoperative complications, there was no statistically significant difference between the PFT group (n=17, 23.94%) and the CPET group (n=15, 25.42%) (P=0.76). Length of hospitalization (P=0.04) and chest tube duration (P=0.045) showed significant differences. No significant differences were observed in other perioperative outcomes either. Conclusions: For patients with suboptimal PFT results, further CPET is recommended. Compared to patients who underwent PFT alone, no significant differences were observed in postoperative complications. This suggests that CPET serves as a feasible supplementary tool that does not result in a statistically significant increase in postoperative complications in selected patients who proceed to surgery.

Lung cancer represents one of the most prevalent malignant tumors and the leading cause of mortality from neoplastic diseases worldwide. Despite significant advancements of lung cancer treatment in recent years, thanks to advancements in technologies such as chemotherapy, targeted therapy, immunotherapy, and so on, the development of drug resistance in lung cancer remains a major challenge. Ferroptosis, dependent on iron and accompanied by lipid peroxidation, is a unique form of cell death. Strategies targeting ferroptosis, either by blocking antioxidant defense pathways or activating oxidative pathways, are usually aimed at killing cancer cells or boosting cancer therapy effectiveness. The regulation of ferroptosis entails synergistic interactions among multiple pathways. Core pathways, including the glutathione peroxidase 4 (GPX4)-glutathione (GSH) axis, iron metabolism pathway, lipid metabolism pathway, and non-coding RNAs, are all involved in modulating ferroptosis sensitivity. Here, we describe in detail the mechanisms of ferroptosis and elucidate its promising therapeutic role of modulating ferroptosis in countering lung cancer resistance to conventional therapies, such as chemotherapy, targeted therapy, immunotherapy, and photodynamic therapy. At the same time, we emphasize the challenges and prospect of translating these findings on the use of strategies aimed at reversing lung cancer resistance, and expect that our review will serve as a valuable reference for further research.

Background: The significance of postoperative chemotherapy (POCT) in patients with thymoma and thymic carcinoma remains uncertain. This meta-analysis aims to evaluate the role of POCT in improving overall survival (OS) or disease-free survival (DFS) in patients with thymoma and thymic carcinoma. Methods: A systematic review was conducted, including 11 articles published before October 2023, with a focus on thymoma (3 articles) and thymic carcinoma (8 articles). We performed bias assessment and meta-analysis effect size pooling using StateSe and Review Manager software. The random-effects model was employed to account for heterogeneity, and a significance level of P≤0.05 was considered statistically significant. Results: Compared with non-POCT for thymoma and thymic carcinoma, POCT did not improve OS or DFS [hazard ration (HR) =0.87, 95% confidence interval (CI): 0.68–1.10; P=0.23 and HR =0.92, 95% CI: 0.54–1.58; P=0.76, respectively]. Similarly, compared with non-POCT in patients with thymoma, POCT did not improve OS or DFS (HR =1.23, 95% CI: 0.63–2.40; P=0.55 and HR =0.50, 95% CI: 0.06–3.97; P=0.52, respectively). For patients with thymic carcinoma, POCT can improve the prognosis and the OS rate significantly (HR =0.67, 95% CI: 0.50–0.89; P=0.006), but not the DFS time (HR =1.03, 95% CI: 0.57–1.88; P=0.91). Conclusions: Notably, POCT did not have a significant impact on DFS in patients with thymoma or thymic carcinoma. These findings suggest that postoperative adjuvant chemotherapy may not be necessary for advanced thymoma patients but can be beneficial for those with thymic carcinoma.

Background: Surgical resection remains the cornerstone of early-stage treatment for non-small cell lung cancer (NSCLC). However, the survival benefits of different surgical methods in clinical stage IA patients remain controversial. This systematic review aims to compare the efficacy of surgical methods—lobectomy, segmentectomy, and wedge resection—on survival outcomes in clinical stage IA NSCLC patients. Methods: A systematic search was performed in PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases between January 2000 and November 30, 2024. Studies meeting the inclusion and exclusion criteria were identified, and hazard ratio (HR) for overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) were extracted from each study for pairwise and Bayesian network meta-analyses. This study protocol was registered on PROSPERO (CRD42024618659). Results: A total of 58 retrospective studies and 3 randomized controlled trials (RCTs) were included. For patients with overall stage IA, network meta-analyses showed that both lobectomy and segmentectomy had significant advantages in OS, DFS, and RFS compared to wedge resection {HR_OS 0.67 [95% confidence interval (CI): 0.59–0.75], 0.75 (95% CI: 0.65–0.84); HR_DFS 0.69 (95% CI: 0.54–0.89), 0.71 (95% CI: 0.55–0.92); HR_RFS 0.57 (95% CI: 0.42–0.78), 0.53 (95% CI: 0.39–0.72)}. No significant differences were observed between lobectomy and segmentectomy. Based on ranking probabilities, lobectomy ranked first. In subgroup analyses, results for overall T1a/b patients were consistent with those of stage IA. When 0.5< consolidation-to-tumor ratio (CTR) OS 0.57 (95% CI: 0.38–0.94), 0.52 (95% CI: 0.34–0.84); HR_RFS 0.53 (95% CI: 0.32–0.83), 0.51 (95% CI: 0.31–0.84)], while no significant differences were observed otherwise. Segmentectomy ranked first in this group. When CTR =1, no significant differences were found, with lobectomy ranking first. For overall T1c patients, lobectomy demonstrated significant advantages in OS compared to segmentectomy and wedge resection [HR 0.73 (95% CI: 0.60–0.91); HR 0.60 (95% CI: 0.44–0.77)], while no significant differences were observed otherwise. Lobectomy ranked first in this group. For patients with 0.5< CTR Conclusions: Lobectomy and segmentectomy provide better OS benefits compared to wedge resection in stage IA NSCLC patients, with no significant differences between lobectomy and segmentectomy. However, the optimal surgical approach should still be determined based on tumor size and CTR.