It is very limited that the benefit of perioperative chemotherapy in early non-small cell lung cancer (NSCLC), and the 5-year survival rate is only 5% higher than surgery. Antibodies that block programmed cell death protein 1/programmed death receptor-ligand 1 significantly improve the survival of advanced NSCLC. The value of immunotherapy in early NSCLC is also being explored. This paper firstly summarized and analyzed the progress of immunotherapy in the perioperative period of NSCLC. Secondly, the safety and feasibility of surgical resection after neoadjuvant immunotherapy were discussed. Finally, the clinical value of different therapeutic efficacy prediction indicators was summarized, in order to clarify the current status of immunotherapy in the perioperative period, so as to improve the clinical benefits of early NSCLC patients.
The new effective systemic treatment strategy has "created" many long-term stage Ⅳ non-small cell lung cancer (NSCLC) survivors, and surgeons should pay attention to those individual ineffective lesions of long-term survivors. Besides, the new effective systemic treatment strategy may have changed the original concept and population of oligometasis. To intervene the oligo-progression lesions of long-term stage Ⅳ survivors, particularly after effective systemic treatment, at appropriate time with appropriate way might be the main task of surgery in the future.
Surgical resection is the only radical method for the treatment of early-stage non-small cell lung cancer. Intraoperative frozen section (FS) has the advantages of high accuracy, wide applicability, few complications and real-time diagnosis of pulmonary nodules. It is one of the main means to guide surgical strategies for pulmonary nodules. Therefore, we searched PubMed, Web of Science, CNKI, Wanfang and other databases for nearly 30 years of relevant literature and research data, held 3 conferences, and formulated this consensus by using the Delphi method. A total of 6 consensus contents were proposed: (1) Rapid intraoperative FS diagnosis of benign and malignant diseases; (2) Diagnosis of lung cancer types including adenocarcinoma, squamous cell carcinoma, others, etc; (3) Diagnosis of lung adenocarcinoma infiltration degree; (4) Histological subtype diagnosis of invasive adenocarcinoma; (5) The treatment strategy of lung adenocarcinoma with inconsistent diagnosis on degree of invasion between intraoperative FS and postoperative paraffin diagnosis; (6) Intraoperative FS diagnosis of tumor spread through air space, visceral pleural invasion and lymphovascular invasion. Finally, we gave 11 recommendations in the above 6 consensus contents to provide a reference for diagnosis of pulmonary nodules and guiding surgical decision-making for peripheral non-small cell lung cancer using FS, and to further improve the level of individualized and precise diagnosis and treatment of early-stage lung cancer.
ObjectiveTo analyze risk factors for chronic cough after minimally invasive resection of non-small cell lung cancer (NSCLC) and explore the possible prevention measures.MethodsA total of 128 NSCLC patients who received minimally invasive resection in 2018 in our hospital were enrolled, including 63 males and 65 females with an average age of 60.82±9.89 years. The patients were allocated into two groups: a robot-assisted thoracic surgery (RATS) group (56 patients) and a video-assisted thoracic surgery (VATS) group (72 patients). Chronic cough was assessed by visual analogue scale (VAS), meanwhile, other perioperative indicators were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative chronic cough and explore the prevention strategies.ResultsOverall, 61 (47.7%) patients were diagnosed with chronic cough after surgery, including 25 (44.6%) patients in the RATS group and 36 (50.0%) patients in the VATS group, and the difference was not statistically significant (P>0.05). Compared with the VATS group, the RATS group got shorter endotracheal intubation time (P=0.009) and less blood loss (P<0.001). The univariate analysis showed that age (P=0.014), range of surgery (P=0.021), number of dissected lymph nodes (P=0.015), preoperative cough (P=0.006), endotracheal intubation time (P=0.004) were the influencing factors for postoperative chronic cough. The multivariate analysis showed that age <57 years (OR=3.006, 95%CI 1.294-6.986, P=0.011), preoperative cough (OR=3.944, 95%CI 4.548-10.048, P=0.004), endotracheal intubation time ≥172 min (OR=2.316, 95%CI 1.027-5.219, P=0.043), lobectomy (OR=2.651, 95%CI 1.052-6.681, P=0.039) were the independent risk factors for chronic cough.ConclusionThere is no statistical difference in postoperative chronic cough between the RATS and VATS groups. The RATS group gets less blood loss and shorter endotracheal intubation time. Patients with younger age (<57 years), preoperative cough, lobectomy, and longer duration of endotracheal intubation (≥172 min) are more likely to have chronic cough after surgery.
ObjectiveTo study the effect of Tangeretin on non-small cell lung cancer (NSCLC) and the tumor stemness, and to find the molecular mechanism of its effect. MethodsWe used cell counting and cell cloning experiments to study the effect of Tangeretin on the proliferation of NSCLC cells in vitro. The effect of Tangeretin on the invasion of NSCLC cells was detected by transwell assay. We detected the effect of Tangeretin on the proliferation of NSCLC cells in vivo by nude mouse tumor-bearing experiment. The effect of Tangeretin on tumor stemness of NSCLC cells was detected by self-renew assay, and CD133 and Nanog protein expressions. The expressions of PI3K/AKT/mTOR signaling pathway-related proteins were detected by Western blotting (WB). ResultsTangeretin had a good inhibitory effect on the proliferation of NSCLC cells in vivo and in vitro. Cell counting experiment, clonal formation experiment and nude mouse tumor-bearing experiment showed that Tangeretin could inhibit the proliferation activity, clonal formation ability, and tumor size of NSCLC cells in vivo. Self-renew experiments showed that Tangeretin could inhibit the self-renew ability of NSCLC cells. WB experiments showed that Tangeretin inhibited the expressions of tumor stemness markers CD133 and Nanog in NSCLC cells. Tangeretin could inhibit the activation of PI3K/AKT/mTOR signaling pathway-related proteins in NSCLC cells, and the activation of PI3K/AKT/mTOR signaling pathway could partially remit the inhibitory effect of Tangeretin on tumor stemness of NSCLC cells. ConclusionTangeretin can inhibit the tumor stemness of NSCLC cells, which may be related to the regulation of PI3K/AKT/mTOR signaling pathway.
In recent years, the computer science represented by artificial intelligence and high-throughput sequencing technology represented by omics play a significant role in the medical field. This paper reviews the research progress of the application of artificial intelligence combined with omics data analysis in the diagnosis and treatment of non-small cell lung cancer (NSCLC), aiming to provide ideas for the development of a more effective artificial intelligence algorithm, and improve the diagnosis rate and prognosis of patients with early NSCLC through a non-invasive way.
ObjectiveTo explore the potential role of tumor spread through air spaces (STAS) as a prognostic indicator of non-small cell lung cancer (NSCLC) through meta-analysis.MethodsPubMed, EMbase and Web of Science, from inception to February 2022 were searched by computer about the research of the 5-year overall survival (OS) and recurrence free survival (RFS) of NSCLC patients with or without STAS. The Newcastle-Ottawa scale (NOS) was used to evaluate the quality of each study.ResultsTotally 13 published articles were included with 4 647 patients, and1 424 (30.6%) patients had STAS. The NOS score of all studies≥6 points. The meta-analysis showed that compared with the NSCLC patients without STAS, those with STAS had a worse prognosis of 5-year RFS, and the combined HR was 1.89 (95%CI 1.61-2.23); they had a shorter 5-year OS, and the combined HR was 2.25 (95%CI 1.79-2.84). There was no statistical heterogeneity among studies.ConclusionThe presence of STAS may be a poor prognostic factor for patients with NSCLC, and enough attention should be paid. The STAS should be recorded in the pathological report to guide the comprehensive treatment and evaluate the prognosis of patients.
ObjectiveTo explore the mechanism by which LINC00636 promotes the proliferation and metastasis of non-small cell lung cancer (NSCLC) by targeting NM23-H1. MethodsBased on the Affymetrix® GeneChip Human Transcriptome Array 2.0 (HTA2.0), differentially expressed long non-coding RNA (lncRNA) in three pairs of NSCLC tissues with and without lymph node metastasis were analyzed, and LINC00636 was selected as the candidate gene. The effects of LINC00636 knockdown and overexpression on the proliferation, apoptosis, migration and subcutaneous tumorigenicity of PC9 cells were analyzed. The dual-luciferase assay was used to analyze the targeting regulation of LINC00636 on NM23-H1. ResultsThe expression of LINC00636 in the serum and tissues of NSCLC patients with lymph node metastasis was higher than that in patients without lymph node metastasis. LINC00636 knockdown could inhibit the invasion and proliferation of NSCLC cells. LINC00636 could target and regulate the expression of NM23-H1, and the expression of LINC00636 and NM23-H1 in NSCLC tissues and cells was negatively correlated. The inhibitory effect of NM23-H1 on the proliferation and invasion of PC9 cells could be partially reversed by LINC00636 overexpression. ConclusionLINC00636 promotes the proliferation and metastasis of NSCLC cells by inhibiting the expression of NM23-H1 and is a potential prognostic marker and therapeutic target for NSCLC.
We reported three cases of stageⅢ/N2 non-small cell lung cancer (NSCLC) treated with neoadjuvant immunotherapy and stereotactic body radiation therapy (SBRT) in our hospital, including 2 males and 1 female with a mean age of 65.7 years. The patients received two doses of the programmed cell death protein-1 inhibitor toripalimab after 1 week of SBRT. Thereafter, surgery was planned 4-6 weeks after the second dose. One patient achieved pathologic complete response, one achieved major pathologic response (MPR), and one did not achieve MPR with 20% residual tumor. There were few side effects of toripalimab combined with SBRT as a neoadjuvant treatment, and the treatment did not cause a delay of surgery.
Systemic therapy is the main treatment for advanced non-small cell lung cancer, but the effect of chemotherapy alone is not good. In recent years, with the discovery of the pathogenic targets of non-small cell lung cancer, new treatment methods such as targeted drugs and immune checkpoint inhibitors are available, which greatly improve the survival time and quality of life of patients with advanced non-small cell lung cancer. Genetic testing is recommended for all patients with advanced non-small cells lung cancer to obtain more precise and individualized treatment. This article focuses on different types of gene mutations and the corresponding molecular targeted drugs in advanced non-small cell lung cancer, in order to better guide clinical treatment.