Indications and developments of video-assisted thoracic surgery in the treatment of lung cancer.

Learning ObjectivesAfter completing this course, the reader will be able to: Discuss the role of thoracoscopy in the evaluation of pulmonary nodules and pleural effusion.Describe the role of thoracoscopy in the staging of lung cancer.Discuss the role of thoracoscopy in surgical resection of early-stage lung cancer.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.co

Efficacy and safety of TachoSil® versus standard treatment of air leakage after pulmonary lobectomy,

Objectives:Alveolarair leakageremains a serious problemin lung surgery, beingassociatedwith increased postoperative morbidity, prolonged hospital stay and greater health-care costs. The aim of this study was to evaluate the sealing efficacy and safety of the surgical patch, TachoSil W , inlungsurgery.Methods:Patientsundergoingelectivepulmonarylobectomywhohad grade1 or 2air leakage(evaluatedbythewatersubmersion test) after primary stapling and limited suturing were randomised at 12 European centres to open-label treatment with TachoSil W or standard surgicaltreatment(resuturing, staplingor nofurthertreatmentat thesurgeons'discretion).Randomisationwas performedduringsurgeryusinga centralisedinteractive voice response system. Durationof postoperative air leakage (primary end point), reductionof intra-operative air leakage intensity (secondary end point) and adverse events (AEs), including postoperative complications, were assessed. Results: A total of 486 patients were screened and 299 received trial treatment (intent-to-treat (ITT) population: TachoSil W , n = 148; standard treatment, n = 151). TachoSil W resulted in a reduction in the duration of postoperative air leakage (p = 0.030). Patients in the TachoSil W group also experienced a greater reduction in intra-operative air leakage intensity (p = 0.042). Median time until chest drain removal was 4 days with TachoSil W and 5 days in the standard group (p = 0.054). There was no difference between groups in hospital length of stay. AEs were generally similar in both groups, including postoperative complications. Conclusions: TachoSil W was superior to standard surgical treatment in reducing both postoperative air leakage duration and intra-operative air leakage intensity in patients undergoing elective pulmonary lobectomy

Role of genomics and histology diagnosis in recurrent malignant pleural effusion

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Not everything is what it seems: malignant pleural mesothelioma mimicking lung cancer

Malignant pleural mesothelioma usually arises from the pleural surface and progressively encases the lungs. Pulmonary involvement generally occurs at an advanced stage, while intraparenchymal nodules, in the absence of pleural lesions, constitute a less frequent presentation. We describe the case of a patient with multiple bilateral pulmonary nodules, mediastinal lymphadenopathies and left pleural effusion in the absence of pleural lesions, simulating advanced stage lung cancer. Thoracoscopic inspection did not detect any lesions. Pathological examination on one pulmonary nodule revealed malignant pleural mesothelioma. Despite its rarity, intraparenchymal malignant pleural mesothelioma should always be taken into account, when  lung nodules are present, to prevent misdiagnosis and avoid delayed treatmen

Lung cancer stage distribution from before COVID-19 through 18 months of the pandemic: the experience of a large-volume oncological referral centre

We observed a significant decrease in early-stage cases at our national oncological referral centre for thoracic surgery and lung cancer screening. This cannot plausibly be ascribed to a lower lung cancer incidence. On the other end, the impact of lockdown measures on the reduction of early-stage lung cancer and other malignancies diagnoses should be investigated and addressed. People's fear of hospitals resulted in a diagnostic delay, whose most severe effects occurred in the first months of 2022. The COVID-19 pandemic has accelerated the need for a digital revolution in health car

High expression of octamer-binding transcription factor 4A, prominin-1 and aldehyde dehydrogenase strongly indicates involvement in the initiation of lung adenocarcinoma resulting in shorter disease-free intervals†

OBJECTIVES The increasing relevance of the cancer stem cell (CSC) hypothesis and the impact of CSC-associated markers in the carcinogenesis of solid tumours may provide potential prognostic implications in lung cancer. We propose that a collective genetic analysis of established CSC-related markers will generate data to better define the role of putative CSCs in lung adenocarcinoma (LAC). METHODS Sixty-four paired tumour and non-tumour biopsies from LAC patients were included in this study. Using the quantitative reverse transcriptase-polymerase chain reaction, we assessed the expression profiles of established CSC-related biomarkers: octamer-binding transcription factor 4 (OCT4A), CD133, aldehyde dehydrogenase (ALDH), BMI-1, ATP-binding cassette subfamily G, member 2 (ABCG2), SRY (sex-determining region Y)-box 2 (SOX2) and uPAR, and evaluated their relation to clinicopathological parameters and disease prognosis. RESULTS All of the above-mentioned CSC-related markers were detectable in both tumour and corresponding normal tissues. Importantly, expression levels of OCT4A, CD133, BMI-1, SOX2 and uPAR were significantly higher (OCT4A, P=0.0003; CD133, P=0.002; BMI-1, P=0.04; SOX2, P=0.0003; uPAR, P=0.03) in the tumour compared with those in the non-tumour tissues. By contrast, the quantities of ACBG2 and ALDH were markedly reduced (ACBG2, P=0.0006; ALDH, P=0.007) in the tumour relative to those in the normal biopsies. Using multivariate analysis, elevated ALDH and CD133 revealed significant associations in tumour stage (ALDH, P=0.03; CD133, P=0.007) and differentiation (ALDH, P=0.03; CD133, P=0.018). We observed that ALDH and OCT4A were associated with nodal status (ALDH, P=0.05; OCT4A, P=0.03) having lower mRNA levels in tumours with lymph node metastasis, N+, compared with that in N0. High OCT4A levels were significantly correlated with tumour size of 3cm (P=0.03). Kaplan-Meier correlation analyses, showed that OCT4A and CD133 were correlated to short disease-free intervals (OCT4A, P=0.047; CD133, P=0.033) over a period of 29 months. CONCLUSIONS Our study reveals that CSC-associated markers: OCT4A, CD133 and ALDH are involved in the initial phase of carcinogenesis of LAC, and can be used as predictors of early stage LAC and poor disease-free intervals. In addition, this work validates the relevance of the CSC hypothesis in LA

Decreased Immunoreactivity of CD99 Is an Independent Predictor of Regional Lymph Node Metastases in Pulmonary Carcinoid Tumors

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New and old biomarkers in the differential diagnosis of lung cancer: Pro-gastrin-releasing peptide in comparison with neuron-specific enolase, carcinoembryonic antigen, and CYFRA 21-1.

Background: Testing for circulating biomarkers in lung cancer is hampered by the insufficient specificity. We aimed to assess the relative diagnostic accuracy of pro-gastrin-releasing peptide (ProGRP) for the differential diagnosis of small cell lung cancer and compare it with more conventional biomarkers. Methods: We enrolled a cohort of 390 patients with a clinical suspicion of lung cancer and for whom a histologic assessment was available. Serum or plasma samples were assessed for ProGRP, carcinoembryonic antigen, CYFRA 21-2, and neuron-specific enolase. The performance of each biomarker in discriminating the small cell lung cancer and squamous cell carcinoma/adenocarcinoma from non-malignant lung disease, and small cell lung cancer from squamous cell carcinoma/adenocarcinoma, was assayed by receiver operating characteristic curve analysis. Results: At the cut-off levels suggested by the manufacturers, ProGRP and neuron-specific enolase showed an almost identical sensitivity of 55.2% and 55.6%, respectively, in discriminating small cell lung cancer with respect to non-malignant lung disease. In order to quantify the added value of ProGRP to other conventional markers, we ran a multivariable logistic regression analysis, but the results showed that no markers improve the performance of ProGRP. Conclusions: ProGRP and neuron-specific enolase individually appear more accurate than other conventional biomarkers for small cell lung cancer, but the union of two markers does not increase the accuracy. The very small target group of patients with small cell lung cancer is a limitation of this study, which can explain why ProGRP alone does not show a sensitivity higher than neuron-specific enolase, as reported by other authors