ObjectiveTo explore the value of artificial intelligence (AI) diagnostic imaging system and three dimensional computed tomographic bronchoangiography (3D-CTBA) surgical planning system in the management of multiple primary lung cancer (MPLC).MethodsThe clinical data of 53 patients with MPLC treated surgically in our hospital from January 2018 to August 2020 were retrospectively analyzed, including 16 males and 37 females, with a median age of 60 (39-75) years. The patients' preoperative CT was analyzed by AI and manually, and the data of patients who underwent 3D-CTBA were compiled to evaluate the value of AI and 3D-CTBA in the diagnosis and treatment of MPLC, respectively.Results The sensitivity of AI screening for MPLC was 84.91%. The sensitivity (91.90% vs. 83.78%) and accuracy (85.60% vs. 84.00%) of AI diagnosis of high-risk MPLC infiltrative lesions were better than those of manual diagnosis. 3D-CTBA was used for planning the surgery in 12 patients, and the intraoperative situation was generally consistent with the reconstructed results.ConclusionAI is of high value in identifying infiltrative lesions of MPLC. 3D-CTBA reconstruction of anatomical structures is accurate and can guide preoperative planning.
Objective To observe the short-term efficacy and safety of neoadjuvant sintilimab combined with chemotherapy in the treatment of patients with locally advanced resectable esophageal squamous cell carcinoma (ESCC). MethodsClinical data were collected from patients with locally advanced resectable ESCC who received neoadjuvant immunotherapy combined with chemotherapy followed by surgical treatment at the Department of Thoracic Surgery of Jining First People's Hospital from April 2020 to April 2022. The endpoints included major pathological response (MPR), pathological complete response (pCR), R0 resection rate, safety, and postoperative survival. Results A total of 43 patients with ESCC who received at least one cycle of neoadjuvant immunotherapy before surgery were included. Among them, there were 31 males and 12 females, aged from 46 to 77 years, with a median age of 65 years. All patients successfully completed the surgery without any surgical delays. The pCR rate was 14.0% (6/43), the MPR rate was 58.1% (25/43), and the R0 resection rate was 97.7% (42/43). Patients exhibited reliable safety during neoadjuvant therapy and postoperatively. The 2-year overall survival and disease-free survival rates were 90.7% and 81.4%, respectively. Kaplan-Meier survival analysis and log-rank test revealed lower recurrence rates and better survival in the MPR group compared to the non-MPR group. Conclusion The combination of neoadjuvant sintilimab and chemotherapy in the treatment of patients with locally advanced resectable ESCC has demonstrated significant clinical efficacy, while also being safe and reliable.
Esophageal cancer is one of the malignant tumors that poses a threat to human health, with both high incidence and malignancy. Currently, surgery following neoadjuvant chemoradiotherapy is the standard treatment for locally advanced esophageal cancer; however, the long-term prognosis remains unsatisfactory. In recent years, inhibitors of programmed death protein-1 (PD-1) and its ligand (programmed death ligand-1, PD-L1) have achieved breakthrough progress in other solid tumors, and research on esophageal cancer is gradually being conducted. With the demonstration of good efficacy of PD-1/PD-L1 inhibitors in the first-line and second-line treatment of advanced unresectable esophageal cancer, their incorporation into neoadjuvant treatment regimens has become a hot topic. Therefore, this article reviews the mechanism of action of PD-1/PD-L1 inhibitors and their application in the neoadjuvant treatment of esophageal cancer.
Objective To evaluate the efficacy and safety of neoadjuvant immunotherapy combined with chemotherapy in patients with locally advanced resectable non-small-cell lung carcinoma. Methods The clinical data of patients with non-small cell lung cancer (NSCLC) who received neoadjuvant immunotherapy combined with chemotherapy and surgery after chemotherapy alone from April 2021 to January 2021 in the first People's Hospital, Jining, were retrospectively analyzed. According to the preoperative neoadjuvant regimen, the patients were divided into a combination group and a chemotherapy group, and the clinical data of the two groups were compared. ResultsA total of 66 patients were enrolled, including 61 males and 5 females. There were 53 patients in the combination group with an average age of 63.40±6.80 years, and 13 patients in the chemotherapy group with an average age of 58.62±8.30 years. There was statistical difference in age between the two groups (P=0.02), but no statistical difference in other baseline data (P＞0.05). MPR was 54.7% in the combination group and 23.1% in the chemotherapy group (P=0.042), and PCR was 39.6% in the combination group and 0.0% in the chemotherapy group (P=0.006). The combined group had a shorter operative time (P=0.039). There were no statistical differences in intraoperative bleeding, postoperative tube-carrying time, postoperative complications, OS or EFS between the two groups. Conclusion Surgery after neoadjuvant immunotherapy is safe and feasible, and long-term efficacy should be confirmed by further follow-up.
ObjectiveTo reveal the expression patterns of tertiary lymphoid structure (TLS)-related gene features in non-small cell lung cancer (NSCLC), and further construct a prognostic prediction model for NSCLC patients based on machine learning, as well as evaluate the correlation between the TLS risk score and tumor immune microenvironment characteristics and potential immunotherapy benefits. MethodsThe training cohort was derived from the NSCLC dataset of The Cancer Genome Atlas (TCGA) database, including 994 tumor samples with survival time >0 days (and 110 normal tissue samples for differential expression analysis). External validation cohorts were obtained from the Gene Expression Omnibus (GEO) database, including GSE30219 (n=289) and GSE72094 (n=398). Based on the expression levels of TLS-related genes, consensus clustering was performed to identify molecular subtypes associated with TLS. Weighted gene co-expression network analysis (WGCNA) was applied to screen co-expression modules significantly correlated with TLS subtypes. To construct the TLS prognostic model, 101 algorithm combinations comprising 10 machine learning algorithms were employed for model training and selection. A high-confidence TLS prognostic model was established and systematically evaluated for its predictive performance in both the training cohort and external validation cohorts. Additionally, associations between the model and clinical characteristics as well as immune microenvironment indicators were analyzed. ResultsConsensus clustering identified three TLS molecular subtypes in the TCGA-NSCLC cohort (n=994): C1 (n=441), C2 (n=263), and C3 (n=290). These subtypes exhibited distinct overall survival outcomes and demonstrated differences in clinical characteristics and immune infiltration levels. Under the soft threshold β=9 condition, WGCNA identified seven co-expression modules, among which the blue module (r=0.32) and yellow module (r=0.44) showed the highest correlations with TLS subtypes. From these two modules containing 758 genes, univariate Cox regression analysis selected 32 prognosis-related genes. Through optimization across 101 algorithm combinations, the optimal TLS prognostic model was established and validated in external cohorts. This model stratified patients into high-risk and low-risk groups, demonstrating stable prognostic discrimination capability in TCGA, GSE30219, and GSE72094 datasets. Immune infiltration analysis revealed significantly higher infiltration levels of multiple immune cell types in the low-risk group. Drug sensitivity analysis indicated that the low-risk group exhibited greater sensitivity to cisplatin, docetaxel, gemcitabine, and paclitaxel. Additionally, pharmacological screening identified four potential candidate drugs (BI-2536, GSK461364, Paclitaxel, SB-743921) in the Cancer Therapeutics Response Portal (CTRP) database and three candidates (Epothilone-b, Mitoxantrone, Volasertib) in the Profiling Relative Inhibition Simultaneously in Mixtures (PRISM) database for high-risk group patients. ConclusionThe TLS risk score serves as an independent prognostic factor effectively predicting NSCLC patient outcomes, representing a potential biomarker for NSCLC.
