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PloS One 2024Lung cancer is the primary cause of cancer-related deaths worldwide, with high rates of morbidity and mortality. The most effective treatment for early stage (I-II)...
Comparison of postoperative complications in mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: Protocol for a systematic review and meta-analysis.
INTRODUCTION
Lung cancer is the primary cause of cancer-related deaths worldwide, with high rates of morbidity and mortality. The most effective treatment for early stage (I-II) non-small cell lung cancer (NSCLC) is surgical resection. However, the extent of mediastinal lymph nodes removal required and the impact of their removal remains controversial. This systematic review and meta-analysis aimed to evaluate the postoperative complications in patients with stage I-II NSCLC who received mediastinal lymph node dissection (MLND) or mediastinal lymph node sampling (MLNS).
METHODS AND ANALYSIS
According to the predefined inclusion criteria, we will conduct a comprehensive search for randomized controlled trials (RCTs) and observational studies examining the postoperative complications of MLND compared to MLNS in patients with stage I-II NSCLC. The search will be performed across multiple databases including PubMed, Embase, the Cochrane Library, CNKI, WanFang, Sinomed, VIP, Duxiu, and Web of Science from inception to February 2024. Additionally, relevant literature references will be retrieved and hand searching of pertinent journals will be conducted. Screening, data extraction, and quality assessment will be performed by two independent reviewers. Review Manager 5.4 will be applied in analyzing and synthesizing. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used to assess the quality of evidence for the whole RCTs and used Newcastle-Ottawa scale to assess the methodologic quality of observational studies.
ETHICS AND DISSEMINATION
This study did not include personal information. Ethical approval was not required for this study. This study is based on a secondary analysis of the literature, so ethical review approval is not required. The final report will be published in a peer-reviewed journal.
CONCLUSION
This systematic review will contribute to compare the safety and survival benefits of these two surgical techniques for the treatment of early stage NSCLC, to further guide the selection of surgical approaches.
TRIAL REGISTRATION
The protocol of the systematic review has been registered on Open Science Framework, with a registration number of DOI https://doi.org/10.17605/OSF.IO/N2Y5D.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Neoplasm Staging; Systematic Reviews as Topic; Meta-Analysis as Topic; Lung Neoplasms; Lymph Node Excision; Small Cell Lung Carcinoma; Lymph Nodes; Postoperative Complications
PubMed: 38377060
DOI: 10.1371/journal.pone.0298368 -
Clinical Case Reports Feb 2024Thymolipoma is a rare benign thymic lesion that can manifest as a sizable anterior mediastinal mass. Considering their rarity and challenging preoperative diagnosis, it...
Thymolipoma is a rare benign thymic lesion that can manifest as a sizable anterior mediastinal mass. Considering their rarity and challenging preoperative diagnosis, it is crucial to consider these tumors when dealing with anterior mediastinal masses.
PubMed: 38374882
DOI: 10.1002/ccr3.8530 -
Prolonged survival after thoracic metastasectomy in patients with nonseminomatous testicular cancer.Clinics (Sao Paulo, Brazil) 2024Almost 20 % of patients with Non-Seminomatous Germinative Cell Tumors (NSGCT) will require intrathoracic metastasectomy after chemotherapy. The authors aim to determine...
INTRODUCTION
Almost 20 % of patients with Non-Seminomatous Germinative Cell Tumors (NSGCT) will require intrathoracic metastasectomy after chemotherapy. The authors aim to determine their long-term survival rates.
METHODS
Retrospective study including patients with NSGCT and intrathoracic metastasis after systemic therapy from January 2011 to June 2022. Treatment outcomes and overall survival were analyzed with the Kaplan-Meier method.
RESULTS
Thirty-seven male patients were included with a median age of 31.8 years. Six presented with synchronous mediastinum and lung metastasis, nine had only lung, and 22 had mediastinal metastasis. Over half had retroperitoneal lymph node metastasis. Twenty-two had dissimilar pathologies, with a discordance rate of 62 %. Teratoma and embryonal carcinoma were the prevalent primary tumor types, 40.5 % each, while teratoma was predominant (70.3 %) in the metastasis group. Thoracotomy was the main surgical approach (39.2 %) followed by VATS (37.2 %), cervico-sternotomy (9.8 %), sternotomy (5.8 %), and clamshell (3.9 %). Lung resection was performed in 40.5 % of cases. Overall, 10-year survival rates were 94.3 % with no surgical-related mortality.
CONCLUSION
Multimodality treatment with systemic therapy followed by radical surgery offers a high cure rate to patients with intrathoracic metastatic testicular germ cell tumors.
Topics: Humans; Male; Adult; Testicular Neoplasms; Retrospective Studies; Metastasectomy; Neoplasms, Germ Cell and Embryonal; Teratoma; Lymph Node Excision
PubMed: 38359698
DOI: 10.1016/j.clinsp.2024.100338 -
Indian Journal of Pathology &... 2024Distinguishing T-lymphoblastic leukemia/lymphoma (T-ALL/T-LBL) from thymomas (especially B1 or B2 type) can be challenging particularly in limited trucut biopsy material... (Observational Study)
Observational Study
Distinguishing T-lymphoblastic leukemia/lymphoma (T-ALL/T-LBL) from thymomas (especially B1 or B2 type) can be challenging particularly in limited trucut biopsy material where appreciating architecture is difficult or the background epithelial component does not provide tangible evidence for definite diagnosis. As a pathologist, it is important to accurately diagnose these neoplasms because they have entirely distinct management protocols. Recent studies have reported that LIM Domain Only 2 (LMO2) is expressed in neoplastic lymphoblasts of T-ALL/T-LBL and is absent in thymocytes of normal thymuses or thymomas. An observational study was done to test the sensitivity and specificity of LMO2 in differentiating neoplastic lymphoblasts from thymocytes of thymomas/normal thymuses. Our study showed that LMO2 had sensitivity of 70% and specificity of 100% in diagnosing LBL. None of the thymomas (B1 or B2 type) showed expression of LMO2 in the neoplastic cells. LMO2 is a reliable marker of transformed T-cell precursors and should be routinely included in immunohistochemical panel when evaluating thymic/mediastinal neoplasms.
Topics: Humans; Thymoma; Immunohistochemistry; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma; Thymus Neoplasms; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Lymphoma, T-Cell; Proto-Oncogene Proteins; Adaptor Proteins, Signal Transducing; LIM Domain Proteins
PubMed: 38358204
DOI: 10.4103/ijpm.ijpm_111_23 -
Therapeutic Advances in Respiratory... 2024Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established minimally invasive method for the diagnosis of benign and malignant...
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established minimally invasive method for the diagnosis of benign and malignant conditions. Continuous efforts are underway to improve the material adequacy of EBUS-TBNA, including the introduction of a new technique called EBUS-guided transbronchial nodal cryobiopsy (EBUS-TBNC). This method allows for the retrieval of larger and well-preserved histologic samples from the mediastinum. We present a case series of four patients who underwent combined EBUS-TBNA and EBUS-TBNC procedures in our centre. All procedures were performed under general anaesthesia using a convex probe EBUS scope (Pentax EB-1970UK). Two patients were diagnosed with malignancy and two with benign disorders (silicosis and tuberculosis). In the malignant cases, both EBUS-TBNA/cell block and cryobiopsy provided a diagnosis but cryobiopsy yielded more material for ancillary tests in one patient. However, in the benign cases, there was discordance between EBUS-TBNA/cell block and cryobiopsy. Only cryobiopsy detected granuloma in the patient with TB (tuberculosis), and in the patient with silicosis, TBNC provided a better overall histological evaluation, leading to a definitive diagnosis. No complications were observed. This case series supports the potential diagnostic value of combining EBUS-TBNA and EBUS-TBNC, particularly in benign mediastinal lesions (granulomatous diseases), and in cases requiring additional molecular tests in cancer diagnosis.
Topics: Humans; Malaysia; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Mediastinum; Tuberculosis; Silicosis; Bronchoscopy; Lung Neoplasms; Retrospective Studies
PubMed: 38357899
DOI: 10.1177/17534666241231122 -
Frontiers in Endocrinology 2024Treating advanced thyroid cancer presents challenges due to its resistance to various treatment modalities, thereby limiting therapeutic options. To our knowledge, this... (Review)
Review
Deep response to a combination of mTOR inhibitor temsirolimus and dual immunotherapy of nivolumab/ipilimumab in poorly differentiated thyroid carcinoma with mutation: a case report and literature review.
Treating advanced thyroid cancer presents challenges due to its resistance to various treatment modalities, thereby limiting therapeutic options. To our knowledge, this study is the first to report the efficacy of temsirolimus in conjunction with dual immunotherapy of nivolumab/ipilimumab to treat heavily treated advanced PDTC. A 50-year-old female initially presented with a rapidly enlarging mass on her right neck. Subsequent diagnosis revealed poorly differentiated thyroid carcinoma, leading to a total thyroidectomy followed by post-operative radioablation therapy. After four years, an examination for persistent cough revealed a recurrence of the disease within multiple mediastinal nodes. Genetic analysis of blood samples uncovered somatic mutations in the tumor, specifically involving and . The disease progressed despite palliative radiation, lenvatinib, and nivolumab/ipilimumab therapy. Consequently, temsirolimus, functioning as an mTOR inhibitor, was introduced as an adjunct to the nivolumab/ipilimumab regimen. This combination approach yielded remarkable clinical improvement and disease control for a duration of approximately six months. Temsirolimus likely suppressed the aberrantly activated PI3K/AKT/mTOR signaling pathway, facilitated by the PTEN genetic alteration, thus engendering an effective treatment response. This synergy between targeted agents and immunotherapy presents a promising therapeutic strategy for advanced PDTC patients with limited treatment alternatives. In previous clinical trials, mTOR inhibitors have demonstrated the ability to maintain stable disease (SD) in 65% to 74% for advanced thyroid cancer patients, including those with PDTC. When combined with other targeted therapies, the observed SD or partial response rates range from 80% to 97%. Many of these trials primarily involved differentiated thyroid carcinoma, with diverse genetic mutations. Thyroid cancer patients with alterations in the PI3K/mTOR/Akt appeared to benefit most from mTOR inhibitors. However, no clear association between the efficacy of mTOR inhibitors and specific histologies or genetic mutations has been established. Future studies are warranted to elucidate these associations.
Topics: Humans; Female; Middle Aged; MTOR Inhibitors; Nivolumab; Ipilimumab; Proto-Oncogene Proteins c-akt; Phosphatidylinositol 3-Kinases; Thyroid Neoplasms; TOR Serine-Threonine Kinases; Adenocarcinoma; Immunotherapy; Mutation; PTEN Phosphohydrolase; Proline; Thiocarbamates; Sirolimus
PubMed: 38356955
DOI: 10.3389/fendo.2024.1304188 -
Neoplasia (New York, N.Y.) Apr 2024The inconformity (IC) between pathological and imaging remissions after neoadjuvant immunotherapy in patients with NSCLC can affect the evaluation of curative effect of...
Tumor microenvironment(TME) and single-source dual-energy CT(ssDECT) on assessment of inconformity between RECIST1.1 and pathological remission in neoadjuvant immunotherapy of NSCLC.
BACKGROUND
The inconformity (IC) between pathological and imaging remissions after neoadjuvant immunotherapy in patients with NSCLC can affect the evaluation of curative effect of neoadjuvant therapy and the decision regarding the chance of surgery.
MATERIALS AND METHODS
Patients who achieved disease control(CR/PR/SD) after neoadjuvant chemoimmunotherapy from a clinical trial (NCT04326153) and after neoadjuvant chemotherapy during the same period were enrolled in this study. All patients underwent radical resection and systematic mediastinal lymphadenectomy after neoadjuvant treatments. The pathological remission, immunohistochemistry (CD4, CD8, CD20, CD56, FoxP3, CD68, CD163, CD11b tumor-infiltrating lymphocytes, or macrophages), and single-source dual-energy computed tomography (ssDECT) scans were assessed. The IC between imaging remission by CT and pathological remission was investigated. The underlying cause of IC, the correlation between IC and DFS, and prognostic biomarkers were explored.
RESULTS
After neoadjuvant immunotherapy, enhanced immune killing and reduced immunosuppressive performance were observed. 70 % of neoadjuvant chemoimmunotherapy patients were in high/medium IC level. Massive necrosis and repair around and inside the cancer nest were the main pathological changes observed 30-45 days post-treatment with PD1/PD-L1 antibody and were the main causes of IC between the pathology and imaging responses after neoadjuvant immunotherapy. High IC and preoperative CD8 expression (H score ≥ 3) indicate a high pathological response rate and prolonged DFS. Iodine material density ssDECT images showed that the iodine content in the lesion causes hyperattenuation in post-neoadjuvant lesion in PCR patient.
CONCLUSIONS
Compared to chemotherapy and targeted therapy, the efficacy of neoadjuvant immunotherapy was underestimated based on the RECIST criteria due to the unique antitumor therapeutic mechanism. Preoperative CD8+ expression and ssDECT predict this IC and evaluate the residual tumor cells. This is of great significance for screening immune beneficiaries and making more accurate judgments about the timing of surgery.
Topics: Humans; Neoadjuvant Therapy; Tumor Microenvironment; Carcinoma, Non-Small-Cell Lung; Tomography, X-Ray Computed; Immunotherapy; Lung Neoplasms; Iodine
PubMed: 38354688
DOI: 10.1016/j.neo.2024.100977 -
Journal of Surgical Case Reports Feb 2024Syndrome of inappropriate anti-diuretic hormone (SIADH) can be presented as a paraneoplastic syndrome in primary malignancies involving the lung and brain. However, the...
Syndrome of inappropriate anti-diuretic hormone (SIADH) can be presented as a paraneoplastic syndrome in primary malignancies involving the lung and brain. However, the development of SIADH in primary thymic carcinoma is poorly documented. We report a case of an elderly, with an initial presentation of symptomatic persistent hyponatremia as a paraneoplastic syndrome of SIADH with an incidental finding of anterior mediastinal mass confirmed on imaging. Further investigations are consistent with the diagnosis of poorly differentiated locally advanced thymic carcinoma with lung infiltration (T3N1Mx). The patient underwent an En-bloc total thymectomy and subsequently completed adjuvant chemotherapy and further follow-up showed a complete resolution of hyponatraemic SIADH. In conclusion, SIADH may be presented as a paraneoplastic syndrome in primary thymic carcinoma and early detection of thymic malignancy is paramount to ensure early diagnosis and prognostication.
PubMed: 38344137
DOI: 10.1093/jscr/rjae025 -
BMC Surgery Feb 2024In this study, we investigated the effect of preservation of the pulmonary branches of the vagus nerve during systematic dissection of mediastinal lymph nodes, when...
BACKGROUND
In this study, we investigated the effect of preservation of the pulmonary branches of the vagus nerve during systematic dissection of mediastinal lymph nodes, when performing radical resection of lung cancer, on the postoperative complication rate.
METHODS
The clinical data for 80 patients who underwent three-dimensional thoracoscopic radical resection of lung cancer in the Department of Thoracic Surgery at Huizhou Municipal Central Hospital between 2020 and 2022 were analyzed. The patients were divided into two groups according to whether the pulmonary branches of the vagus nerve were retained during intraoperative carinal lymph node dissection. The operation time, time until first postoperative defecation, duration for which a chest tube was needed, total chest drainage volume, average pain intensity during the first 5 postoperative days, incidence of postoperative pneumonia, and postoperative length of stay were compared between the two groups.
RESULTS
There was no statistically significant difference in histological staging or in time until first postoperative defecation between the two groups (p > 0.05). However, there were significant differences in operation time, the duration for which a chest tube was needed, total chest drainage volume, average pain intensity during the first 5 postoperative days, white blood cell count and procalcitonin level on postoperative days 1 and 5, and postoperative length of stay between the two groups (p < 0.05).
CONCLUSION
Preserving the pulmonary branches of the vagus nerve during carinal lymph node dissection when performing three-dimensional thoracoscopic radical resection of lung cancer can reduce the risk of postoperative complications.
Topics: Humans; Lung Neoplasms; Retrospective Studies; Lymph Node Excision; Lung; Postoperative Complications; Vagus Nerve; Thoracic Surgery, Video-Assisted
PubMed: 38336679
DOI: 10.1186/s12893-024-02347-w -
BMC Nephrology Feb 2024Minimal change nephrotic syndrome (MCNS) can be complicated by thymoma; however, no standard therapy for thymoma-associated MCNS has yet been established. We herein...
BACKGROUND
Minimal change nephrotic syndrome (MCNS) can be complicated by thymoma; however, no standard therapy for thymoma-associated MCNS has yet been established. We herein describe a case of steroid-resistant MCNS associated with thymoma, treated effectively with rituximab.
CASE PRESENTATION
A 71-year-old Japanese man was referred to our department with severe proteinuria (20 g/gCr). Renal biopsy showed minimal change disease and computed tomography revealed an anterior mediastinal mass. Based on these findings, he was diagnosed with thymoma-associated MCNS. He was treated with oral prednisolone (50 mg/day) and cyclosporine, and underwent thymectomy and plasma exchange. However, no improvement in proteinuria was observed. He therefore received intravenous rituximab 500 mg, resulting in a marked decrease in proteinuria from 5328 to 336 mg/day after 1 week.
CONCLUSIONS
This case suggests that rituximab might be an effective therapy in patients with steroid-resistant MCNS associated with thymoma.
Topics: Male; Humans; Aged; Thymoma; Cyclosporine; Nephrosis, Lipoid; Rituximab; Thymectomy; Thymus Neoplasms; Nephrotic Syndrome; Prednisolone; Proteinuria
PubMed: 38336671
DOI: 10.1186/s12882-024-03485-2