Ken Suzawa

Locally advanced non-small cell lung cancer (LA-NSCLC) is a heterogeneous disease that requires tailored treatment strategies. This study investigates the correlation between T and N factors and postoperative recurrence patterns to refine therapeutic approaches. The subjects of this retrospective cohort study were 193 patients with LA-NSCLC, who underwent trimodality therapy between 1999 and 2021. Tumors were categorized as Nodal-Dominant (ND) LA-NSCLC (T1-2 with advanced nodal involvement) or Tumor-Dominant (TD) LA-NSCLC (T3-4 with limited nodal involvement). We compared recurrence patterns and survival outcomes between the two groups. The 193 patients comprised 83 with ND-LA-NSCLC and 110 with TD-LA-NSCLC. The patients with ND-LA-NSCLC had a significantly higher rate of distant metastasis than those with TD-LA-NSCLC (50.6% vs. 26.4%, P = 0.001). The patients with TD-LA-NSCLC had significantly better 5-year disease-free survival (DFS) than those with ND-LA-NSCLC (62.4% vs. 37.2%, P < 0.001). ND-LA-NSCLC is associated with a higher risk of distant metastatic recurrence, underscoring the need for more effective systemic therapies before surgery. Conversely, TD-LA-NSCLC exhibits superior local disease control, reinforcing the role of intensive local therapies. These findings emphasize the importance of tumor classification based on T and N factors for optimizing perioperative treatment strategies for LA-NSCLC.

BackgroundVisceral pleural invasion (VPI) remains a critical factor influencing surgical decision-making in non-small cell lung cancer (NSCLC). However, accurately predicting VPI on radiological images remains challenging in lung cancers.Materials and MethodsThis retrospective study analyzed 299 cases of NSCLC with pleural contact and ground-glass opacity (GGO) components on thin-section CT, all of which were surgically treated between 2012 and 2019. Clinical and radiological features were evaluated for their predictive value in detecting VPI.ResultsVPI was confirmed in 14 cases (4.7%). Univariate analysis revealed significant associations between VPI and part-solid tumors (p = 0.025), larger tumor diameter (p = 0.006), greater solid component size (p < 0.001), higher consolidation-to-tumor ratio (CTR) (p = 0.001), increased pleural contact length (p < 0.001), elevated CT attenuation values (p < 0.001), and SUVmax on FDG-PET (p < 0.001). No cases of pathological VPI were observed in lesions where only the GGO component was in contact with the pleura.ConclusionSpecific radiological features can serve as reliable predictors of non-VPI in ground-glass nodules with pleural contact. Notably, VPI was absent in tumors where only the GGO component contacted the pleura. These findings underscore the importance of careful preoperative evaluation for non-VPI, incorporating additional imaging parameters to enhance risk stratification and surgical decision-making.

Background: The physiological relevance of postoperative perfusion distribution after single lung transplantation (SLT) remains poorly defined, as asymmetric blood flow toward the graft is often regarded as an inherent consequence of the remaining native lung. This study aimed to determine whether the graft‐directed perfusion ratio assessed by quantitative lung perfusion scintigraphy (QLPS) in the early postoperative period serves as an early physiological marker after SLT. Methods: We retrospectively analyzed SLT recipients who underwent surgery at Okayama University Hospital between 1998 and 2021 and completed QLPS approximately 3 months posttransplant. The graft perfusion ratio (graft flow/total pulmonary flow × 100%) was quantified, and recipients were classified into high (≥ 80%) and low (< 80%) perfusion groups. CLAD‐free survival, overall survival, and longitudinal perfusion changes were compared using Kaplan–Meier analysis and repeated‐measures ANOVA. Results: Recipients with higher graft perfusion demonstrated significantly better CLAD‐free survival ( p = 0.027). Overall survival was higher in the high‐perfusion group, although the difference did not reach statistical significance ( p = 0.075). Repeated‐measures ANOVA revealed a significant group‐by‐time interaction ( p = 0.019): recipients who developed CLAD had lower graft perfusion as early as 3 months after transplantation, followed by a progressive decline, whereas those who did not develop CLAD maintained stable perfusion. In the multivariable Cox analysis, higher graft perfusion was associated with a lower hazard of reaching the composite CLAD‐free survival endpoint. Conclusions: Early postoperative graft perfusion assessed by QLPS may serve as a noninvasive physiological marker after SLT. Higher graft‐directed perfusion was associated with a lower hazard of reaching the composite CLAD‐free survival endpoint and may aid early risk stratification and posttransplant surveillance.

INTRODUCTION: Parenchyma-preserving strategies for anomalous systemic arterial supply to the basal segment of the lung have gained increasing attention. However, pulmonary infarction of the preserved lung has been reported, and clear criteria for selecting the optimal treatment have yet to be established. We report 2 cases in which detailed preoperative imaging informed tailored management—right posterior basal segmentectomy in 1 patient and endovascular embolization of the aberrant artery in the other—both without postoperative complications. A review of the relevant literature is also provided, with an emphasis on potential selection criteria.CASE PRESENTATION: Case 1: A 20-year-old asymptomatic woman was referred after an abnormal screening chest radiograph. CT demonstrated an aberrant artery arising from the abdominal aorta supplying the right posterior basal segment (S10) with a large intravascular thrombus. The pulmonary artery showed hypoplasia limited to A10, while the other branches were normal, and no parenchymal congestion was identified. Following resection of the aberrant artery, robot-assisted right S10 segmentectomy was performed. The postoperative course was uneventful, and the patient was discharged on POD 6. Case 2: A 27-year-old woman was incidentally diagnosed on CT for an unrelated indication. An aberrant artery arising from the descending thoracic aorta supplied the left basal segment. Pulmonary arterial branches were preserved, with only minimal congestion in S9-10. Angiography revealed no evidence of an arteriovenous fistula. As surgical lung resection was considered unnecessary, coil embolization of the aberrant artery was performed. No complications occurred, and the patient was discharged on day 3 after the procedure.CONCLUSIONS: In patients with anomalous systemic arterial supply to the basal segment of the lung, when pulmonary arterial branches are preserved and background parenchymal congestion is minimal, parenchyma-sparing approaches should be considered.

Pulmonary pleomorphic carcinoma (PPC) is a rare subtype of lung cancer that comprises both epithelial and sarcomatoid components. The molecular basis of PPC, including the cellular dynamics of its components, remains largely unknown. To elucidate potential therapeutic targets for PPC, we perform a multi-omics analysis incorporating digital spatial profiling and single-cell RNA sequencing (scRNA-seq). PPC exhibits diverse driver gene alterations, including MET exon 14 skipping mutation (METex14) and ALK fusion. In spatial transcriptomics, MET gene and protein are overexpressed exclusively within the epithelial component and not in the sarcomatoid component, even in patients harboring METex14. Epithelial-mesenchymal transition (EMT)-related transcriptional changes, along with extracellular matrix (ECM) remodeling between the epithelial and sarcomatoid components, are observed. scRNA-seq identifies cell populations within the epithelial component that contribute to the malignant transformation and differentiation of the sarcomatoid component. They are characterized by an intermediate EMT state with ECM remodeling signature, suggesting their potential as novel therapeutic targets for PPC.