The Prognostic Value of Programmed Death-ligand 1 (PD-L1) in Patients who Received Neoadjuvant Chemoradiation Therapy Followed by Surgery for Locally Advanced Non-small Cell Lung Cancer

Background/Aim: We analyzed the prognostic efficacy of programmed death-ligand 1 (PD-L1) in locally advanced non-small cell lung cancer (LA-NSCLC) patients. Patients and Methods: During 2005-2016, 211 patients underwent neoadjuvant concurrent chemoradiation therapy (CCRT) followed by surgical resection for LA-NSCLC at Asan Medical Center. PD-L1 expression and CD8+ tumor infiltrating lymphocytes (TIL) were measured pre-and post-neoadjuvant CCRT and analyzed using immunohistochemical staining. Results: In total, 39 patients were enrolled. Overall survival (OS) and disease-free survival (DFS) were significantly longer in patients with increased PD-L1 expression and increased CD8+ TIL density postneoadjuvant CCRT. Univariate Cox regression analysis confirmed that increased levels of PD-L1 and increased CD8+ TIL density were prognostic factors for OS and DFS. Multivariate Cox regression analysis confirmed that increased levels of PD-L1 was a prognostic factor for OS and increased CD8+ TIL density for DFS. Conclusion: Relative changes in PD-L1 expression post-neoadjuvant CCRT can be utilized to predict the prognosis of LANSCLC patients

Clinico-cytopathologic analysis of 574 Pericardial Effusion Specimens: Application of the international system for reporting serous fluid cytopathology (ISRSFC) and long-term clinical follow-up

Abstract Introduction: A pericardial effusion (PE) has a variable etiology and the primary role is diagnosis of metastatic malignancy. We analyzed the PE cytology in a large cohort in accordance with the international system for reporting serous fluid cytopathology (ISRSFC) and evaluated the long-term patient outcomes. Methods: PE specimens from 2010 to 2014 with an available clinical history, cytologic data, and pericardial biopsy results were collected. Results: A total of 574 PE specimens were obtained from 486 patients, representing 1.5% (574/38,589) of all body fluid specimens. Three hundred and eighty-two (66.6%) cases were "negative," 54 (9.4%) cases were "atypia of undetermined significance," 10 (1.7%) cases were "suspicious for malignancy," and 128 (22.3%) cases were "malignancy". The most common origin for malignant PE was the lung (82.1%), in both men (70.5%) and women (50.6%). Breast cancer (20%) in women and gastric cancer (4.9%) in men were the second most common malignant PE, respectively. The mean interval from the occurrence of malignant PE to death was 10.06 months (range; 0-116.03 months, median 3.5 months), and the 1-year survival rate was 16.7%. In addition, the 1-year survival rates after malignant PE onset were 0% for gastric cancer, 13.9% for lung cancer, 19.8% for breast cancer, and 21.1% for the other cancers (p = 0.011). Conclusion: Our present study is the first to our knowledge to classify the pericardial fluid from 574 cases in accordance with the recently published ISRSFC, and to present the long-term outcomes of patients with malignant PE at the same time. Moreover, we report for the first time that it is gastric and not lung cancer patients that have the poorest prognosis after the occurrence of malignant PE

Hepatoid thymic carcinoma: a case report of a rare subtype of thymic carcinoma

Hepatoid thymic carcinoma is an extremely rare subtype of primary thymus tumor resembling “pure” hepatoid adenocarcinomas with hepatocyte paraffin 1 (Hep-Par-1) expression. A 53-year-old man presented with voice change and a neck mass. Multiple masses involving the thyroid, cervical and mediastinal lymph nodes, and lung were detected on computed tomography. Papillary thyroid carcinoma was confirmed by biopsy, and the patient underwent neoadjuvant chemoradiation therapy. However, the anterior mediastinal mass was enlarged after the treatment whereas the multiple masses in the thyroid and neck decreased in size. Microscopically, polygonal tumor cells formed solid sheets or trabeculae resembling hepatocytes and infiltrated remnant thymus. The tumor cells showed immunopositivity for cytokeratin 7, cytokeratin 19, and Hep-Par-1 and negativity for α-fetoprotein. Possibilities of germ cell tumor, squamous cell carcinoma, and metastasis of thyroid papillary carcinoma were excluded by immunohistochemistry. This report on the new subtype of thymic carcinoma is the third in English literature thus far

Serial changes of CT findings in patients with chronic hypersensitivity pneumonitis: imaging trajectories and predictors of fibrotic progression and acute exacerbation

Objectives: To evaluate the longitudinal changes of chest CT findings in patients with chronic hypersensitivity pneumonitis (HP) and identify risk factors for fibrotic progression and acute exacerbation (AE). Methods: This retrospective study included patients with chronic HP with follow-up CT. Baseline and serial follow-up CT were evaluated semi-quantitatively. Fibrosis score was defined as the sum of the area with reticulation and honeycombing. The modified CT pattern of Fleischner Society idiopathic pulmonary fibrosis diagnostic guidelines was evaluated. Cox proportional hazards regression was performed to determine significant variables associated with fibrotic progression and AEs. Results: Of 91 patients, mean age was 59.1 years and 61.5% were women. The median follow-up period was 4.9 years. Seventy-nine patients (86.8%) showed fibrotic progression with persistent areas of mosaic attenuation, finally replaced by fibrosis, and 20 (22.0%) developed AE. Baseline fibrosis score and CT pattern of usual interstitial pneumonia (UIP)/probable UIP were independent risk factors for predicting fibrotic progression (hazard ratio [HR] = 1.05, 95% confidence interval [CI] = 1.02?1.09, p < 0.001, for fibrosis score; HR = 2.50, CI = 1.50?4.16, p < 0.001, for CT pattern) and AEs (HR = 1.07, CI = 1.01?1.13, p = 0.019, for fibrosis score; HR = 5.47, CI = 1.23?24.45, p = 0.026, for CT pattern) after adjusting clinical covariables. Conclusion: Fibrotic progression and AE were identified in 86.8% and 22.0% of patients with chronic HP. Fibrosis score and CT pattern of UIP/probable UIP on baseline chest CT may predict fibrotic progression and AE. Key Points: ? Most patients (87%) showed fibrotic progression on long-term follow-up with persistent areas of mosaic attenuation that were finally replaced by fibrosis at a later stage. ? One-fifth of patients (22%) experienced acute exacerbation associated with worse prognosis. ? Fibrosis score (sum of reticulation and honeycombing) and CT pattern of UIP/probable UIP on baseline CT were independent predictors for predicting fibrotic progression and acute exacerbation