Journal of thoracic disease最新文献

{"title":"Predictors of pleurodesis success after combined outpatient thoracoscopic talc poudrage and tunneled indwelling pleural catheter placement.","authors":"Moath Bani Salem, Osama Al Zoubi, Tatiana Maser, Alexandria Iakovidis, Miguel Castro, Karthik Vijayan, Pankit Patel, Hiren J Mehta","doi":"10.21037/jtd-2026-1845","DOIUrl":"https://doi.org/10.21037/jtd-2026-1845","url":null,"abstract":"<p><strong>Background: </strong>Combined ambulatory thoracoscopic talc poudrage and tunneled indwelling pleural catheter (TIPC) placement may facilitate early pleurodesis while preserving outpatient management for malignant pleural effusion (MPE). Predictors of pleurodesis success after this combined approach remain incompletely defined. In this study, we aimed to identify the predictors of successful pleurodesis after this combined approach among patients with expandable and non-expandable lung subgroups.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of 100 patients who underwent outpatient thoracoscopic talc poudrage with TIPC placement for MPE. Pleurodesis success was assessed at 3 and 6 months. Multivariable logistic regression was used to identify predictors of success among 97 evaluable patients. Additional analyses were performed in the non-expandable lung subgroup.</p><p><strong>Results: </strong>Among 97 patients, 77 (79.4%) had expandable lungs. In multivariable analysis, lung expandability was independently associated with pleurodesis success at 3 months [odds ratio (OR), 15.2; 95% confidence interval (CI): 4.22-71.0; P<0.001] and 6 months (OR, 7.97; 95% CI: 2.07-33.9; P=0.003). Cancer group was associated with 3-month success in adjusted analysis (global P=0.046): compared with the lung/mesothelioma group, the other-malignancy group had lower odds of success (OR, 0.19; 95% CI: 0.04-0.73), whereas breast cancer did not differ significantly. No group difference persisted at 6 months (global P=0.46). Lung/mesothelioma-associated MPE had higher early pleurodesis success than other malignancy groups, but not at 6 months. In the non-expandable lung subgroup, complete visceral restriction, airway obstruction and adhesions were associated with lower 6-month pleurodesis success on univariate analysis.</p><p><strong>Conclusions: </strong>Lung expandability was the strongest independent predictor of pleurodesis success after combined outpatient thoracoscopic talc poudrage and TIPC placement. Selected patients with non-expandable lung may still achieve successful pleurodesis.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1011"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative antiplatelet strategies and coronary artery bypass graft outcomes: bleeding and cardiovascular events in 41,696 patients with acute coronary syndrome.","authors":"Rui Liu, Ze Zhang, Lili An, Meice Tian, Rui Liu, Chun Liu, Xiumeng Hua, Han Han, Xianqiang Wang","doi":"10.21037/jtd-2026-0597","DOIUrl":"https://doi.org/10.21037/jtd-2026-0597","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study wasto evaluate the clinical effects of preoperative antiplatelet therapy (APT) discontinuation timing on major bleeding and adverse cardiac events in patients undergoing coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from Fuwai Cardiac Surgery Database (FCSD), specifically from 41,689 patients with acute coronary syndrome undergoing isolated CABG (2009-2019). A comparison was conducted between 10,739 patients treated with continuation APT (AP group; discontinued ≤7 days preoperation; including aspirin alone, clopidogrel alone, or aspirin + clopidogrel) and 30,950 patients with discontinuation therapy (NAP group; >7 days preoperation). Major bleeding events were defined according to the Bleeding Academic Research Consortium-CABG criteria. Composite adverse events (30-day all-cause mortality, stroke, myocardial infarction, and acute renal failure) were assessed. Multivariable logistic regression was applied to estimate effects.</p><p><strong>Results: </strong>Adverse cardiac events occurred in 7.8% of patients in the AP group and 9.1% in the NAP group (P<0.001), but there was no difference in the incidence of major bleeding events. Multivariable analysis showed that continuation therapy significantly decreased the risk of adverse cardiac events [odds ratio (OR) 0.832; 95% confidence interval (CI): 0.754-0.918; P<0.001] without increasing the risk of major bleeding events (OR 1.006; 95% CI: 0.926-1.093; P=0.88). Subgroup analysis identified certain strategies for reducing adverse events without bleeding.</p><p><strong>Conclusions: </strong>Preoperative continued APT significantly reduces the risk of 30-day adverse cardiac events post-CABG without increasing the risk of major bleeding. Optimal strategies include clopidogrel alone (discontinued <3 days preoperatively) and dual-antiplatelet therapy (aspirin + clopidogrel discontinued 5-7 days preoperatively).</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1013"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond pulmonary hypertension: expanding the therapeutic frontier in chronic thromboembolic disease.","authors":"Leo Gozdecki, Stanley Swat, Manreet Kanwar","doi":"10.21037/jtd-2026-1642","DOIUrl":"https://doi.org/10.21037/jtd-2026-1642","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1078"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automatic transesophageal echocardiographic evaluation of patients with mitral valve prolapse: comparison with patients without structural cardiac chamber remodeling (an exploratory study).","authors":"Marcelo Luiz Campos Vieira, Ana C T Rodrigues, Edgar Daminello, Adriana Reche, Gustavo P de Almeida, Alessandra J Oliveira, Luiz O A Santos, Rafael B Piveta, Rodrigo A C Meirelles, Cláudia G Monaco, Fernando C Oliveira, Fernando A Solis, Wercules Oliveira, Alessandro C Lianza, Adriana Sanudo, Edgar B Lira Filho, Sérgio A F Curcio, Robinson Poffo, Cláudio H Fischer, Samira S Morhy","doi":"10.21037/jtd-2026-1300","DOIUrl":"https://doi.org/10.21037/jtd-2026-1300","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of information concerning automatic mitral valve apparatus (MVA) analysis of patients with mitral valve prolapse (MVP). We aimed to study with an automatic three-dimensional (3D) transesophageal echocardiography (TEE)-dedicated software, patients with moderate and severe mitral regurgitation when compared to patients with no structural cardiac chamber alterations [patients with patent foramen ovale (PFO) who underwent TEE].</p><p><strong>Methods: </strong>We employed TEE software dedicated to automatic analysis of 34 parameters of the MVA, comparing MVP patients with moderate and severe mitral regurgitation and patients with PFO without cardiac chamber structural alterations. Mitral valve effective regurgitant orifice (ERO) and regurgitant volume were correlated to automatic MVP parameters.</p><p><strong>Results: </strong>Fifty-nine MVP patients and 43 PFO patients were analyzed. All MVP patients presented P2 MVP, 15 (25.4%) with both posterior and anterior prolapse. Twenty-seven automatic parameters (79%) were different concerning MVP and PFO patients (P<0.05): diameters, area, perimeter, height, angle, coaptation width, length, closure line length, and annulus. ERO was 0.43±0.11 cm², and regurgitant volume was 62.9±14.9 mL/beat. Automatic analysis correlated to 75^th percentile ERO MVP patients (ERO >0.48 cm²): posterior leaflet area (r=0.74, P=0.03); posterior leaflet length (r=0.73, P=0.03); tenting area (r=0.41, P=0.048).</p><p><strong>Conclusions: </strong>Automatic mitral valve parameters differed significantly between patients with MVP and those without structural cardiac chamber remodeling. In exploratory analysis, patients in the upper range of ERO values (≥75^th percentile) showed patterns involving posterior leaflet geometry that were consistent with the associations observed in continuous-variable analysis. These findings support the potential role of automated 3D assessment in the anatomical characterization of MVP.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1038"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative analgesic strategies for video-assisted thoracoscopic lobectomy: a systematic review and meta-analysis.","authors":"Asimuguli Kadier, Xiaoxuan Du","doi":"10.21037/jtd-2026-2068","DOIUrl":"https://doi.org/10.21037/jtd-2026-2068","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Video-assisted thoracoscopic surgery (VATS) lobectomy is the standard of care for early-stage lung cancer, yet 20-30% of patients still experience moderate-to-severe acute postoperative pain. A wide range of perioperative analgesic strategies-regional blocks, systemic adjuncts, cryoanalgesia, and multimodal combinations-have been evaluated, but their comparative effects on clinically meaningful endpoints such as postoperative complications remain uncertain. The aim of this systematic review and meta-analysis was to evaluate the comparative efficacy and safety of perioperative analgesic strategies for VATS lobectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) (PROSPERO CRD420251186565), following the PRISMA 2020 statement. PubMed/MEDLINE and Web of Science Core Collection were searched from 1 January 2010 to 26 June 2026. Two reviewers independently screened records, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool per outcome. Postoperative complications were pooled as risk ratios (RR) with 95% confidence intervals (CIs) using a random-effects model with restricted maximum-likelihood (REML) estimation. Studies were grouped by intervention type for subgroup analysis. Sensitivity was assessed with leave-one-out analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Seven trials (n=505) met inclusion criteria. The evidence base was clinically heterogeneous: included comparisons encompassed regional technique variations [paravertebral block (PVB), serratus anterior plane block (SAPB), intercostal nerve block (ICNB), and their combinations], systemic adjunctive analgesics (nefopam), and intercostal cryoanalgesia. Only three trials reported usable complication data for quantitative synthesis (n=245). The overall pooled RR for postoperative complications was 0.84 (95% CI: 0.65-1.08; P=0.18), but this estimate was dominated by a single trial (Koliakos 2025, 75.2% weight). Between-study heterogeneity was absent (I&lt;sup&gt;2&lt;/sup&gt;=0%, τ&lt;sup&gt;2&lt;/sup&gt;=0; Q=0.39, df =2, P=0.82). Subgroup analyses by intervention class (regional techniques, systemic adjuncts, cryoanalgesia) did not yield statistically significant pooled estimates. Leave-one-out exclusion of the largest study shifted the point estimate to RR 0.95 (95% CI: 0.57-1.58), confirming strong dependence on a single trial. With fewer than 10 studies, formal publication bias assessment was not performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The available evidence on perioperative analgesic strategies for VATS lobectomy consists of small, heterogeneous trials comparing diverse interventions. No single strategy has been shown to consistently reduce postoperative complications. The evidence base is insufficient to guide clinical practice. Adequately powered, multicentre RCTs with standardised interventions, composite complication endpoints, and extended follow-up are needed.&lt;/p","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1021"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune checkpoint inhibitors (ICIs) for second-line retreatment in esophageal cancer progressing after first-line immunotherapy: a single-center retrospective cohort study.","authors":"Yixin Kang, Youjia Mi, Ce Zhang, Wenyao Li, Junqiang Yang, Jun Yao, Dianbao Zhang","doi":"10.21037/jtd-2026-2110","DOIUrl":"https://doi.org/10.21037/jtd-2026-2110","url":null,"abstract":"<p><strong>Background: </strong>Controversy continues regarding whether immunosuppressive agents can be used across treatment lines after disease progression on first-line immunotherapy for advanced esophageal cancer. The aim of this study is to evaluate the efficacy and safety of immune checkpoint inhibitor (ICI) retreatment through real-world data.</p><p><strong>Methods: </strong>The clinical data of patients with esophageal cancer treated at The First Affiliated Hospital of Henan University of Science and Technology were retrospectively collected. All patients received first-line combination therapy with programmed cell death protein 1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitors for more than 3 months, and following disease progression, received second-line therapy with PD-1/PD-L1 inhibitors for at least two cycles. Treatment efficacy and safety were evaluated.</p><p><strong>Results: </strong>In the overall population, the median overall survival (mOS) was 10.0 months [95% confidence interval (CI): 9.5-10.5] and the median progression-free survival (mPFS) was 4.4 months (95% CI: 4.1-4.5). The objective response rate (ORR) was 33.2%, and the disease control rate (DCR) was 65.9%. The Cox regression model analysis identified first-line PFS >6 months as an independent prognostic factor for both second-line PFS and OS. Safety was manageable, and no treatment-related deaths occurred.</p><p><strong>Conclusions: </strong>The results of this study suggest that ICI retreatment showed measurable activity in a selected real-world cohort and deserves further evaluation in comparative studies.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1053"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical research advances in pulmonary infections in 2025: a narrative review of multipathogen assessment, precision diagnosis, and integrated management.","authors":"Xiang Luo, Zhengtu Li, Feng Ye","doi":"10.21037/jtd-2026-1375","DOIUrl":"10.21037/jtd-2026-1375","url":null,"abstract":"<p><strong>Background and objective: </strong>The diagnosis and treatment of pulmonary infections have become increasingly complex owing to antimicrobial resistance, the growing population of immunocompromised patients, and the ongoing circulation of respiratory viruses. In this narrative review, the major clinical advances reported in 2025 are summarised, and evidence-based support for multipathogen assessment, precision diagnosis, individualized treatment, and integrated management of pulmonary infections is provided.</p><p><strong>Methods: </strong>PubMed, Web of Science, and the Chinese Medical Association Journal Database were searched for relevant English-language and Chinese-language publications. The search primarily focused on studies published in 2025 and was supplemented by the manual retrieval of relevant clinical studies and guidelines. Medical Subject Headings (MeSH) and free-text terms were used in PubMed, with corresponding free-text terms applied in the other databases. Clinically relevant publications were screened according to predefined criteria by two independent reviewers, and expert adjudication was used in the event of disagreements.</p><p><strong>Key content and findings: </strong>Metagenomic next-generation sequencing (mNGS), integrated biomarker assessment, and artificial intelligence (AI) have exhibited increasing clinical value in pathogen identification, differential diagnosis, and prognostic assessment. Therapeutic advances have been reported for drug-resistant bacterial and fungal infections, as well as for coronavirus disease 2019 (COVID-19) and influenza, supporting more precise and individualized treatment. Studies on the gut-lung axis and immune modulation have further clarified the potential role of host-directed approaches, although clinical evidence for microbiota-targeted interventions remains limited. The risks associated with coinfection received increasing attention, while improved identification of risk factors and stratified management supported more individualized care for high-risk populations.</p><p><strong>Conclusions: </strong>In 2025, the clinical management of pulmonary infections continued to transition towards precision-oriented and host-directed models. However, because a quantitative evidence synthesis was not included in this narrative review, pooled effect size estimates or formally graded clinical recommendations are not provided. The heterogeneity of the available studies also limits the overall strength and generalisability of the evidence. Future high-quality, multicentre studies are needed to further standardise clinical diagnosis and treatment strategies.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1062"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing respiratory deterioration is a patient-centered outcome!","authors":"Giovanni Landoni, Federico Mattia Oliva, Rosario Losiggio, Filippo Consolo, Stefano Turi","doi":"10.21037/jtd-2026-2270","DOIUrl":"https://doi.org/10.21037/jtd-2026-2270","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1070"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Day 3 blood urea nitrogen and discharge disposition in patients with pleural infection: a multicenter prospective study.","authors":"Takamasa Hotta, Tamio Okimoto, Masayuki Ishida, Eri Fujiwara, Tomoki Tamura, Shoichi Kuyama, Naoko Matsumoto, Masahiro Yamasaki, Masataka Taoka, Hisao Higo, Masaaki Inoue, Kosuke Hamai, Shinjiro Sakamoto, Nobuhiro Kanaji, Takeshi Isobe","doi":"10.21037/jtd-2026-1958","DOIUrl":"https://doi.org/10.21037/jtd-2026-1958","url":null,"abstract":"<p><strong>Background: </strong>Although the RAPID score (renal, age, purulence, infection source, and dietary factors) is a validated predictor of mortality in pleural infection, the prognostic value of laboratory measurements obtained during early treatment remains uncertain. We evaluated whether day 3 laboratory markers, particularly blood urea nitrogen (BUN), were associated with failure to return to the pre-admission residence or care environment.</p><p><strong>Methods: </strong>This multicenter prospective observational study included 81 patients with pleural infection across 13 hospitals in Japan. Patients with complete baseline and day 3 data for BUN, C-reactive protein (CRP), albumin, and creatinine were included in the primary analysis. Multivariable Firth logistic regression models evaluated each day 3 laboratory marker after adjustment for its corresponding baseline value, age, and Eastern Cooperative Oncology Group (ECOG) performance status. An exploratory sensitivity analysis excluded patients deemed unfit for surgery at baseline. The primary outcome was failure to return to the pre-admission residence or care environment at the end of the index hospitalization.</p><p><strong>Results: </strong>Among 81 patients, 25 (30.9%) did not return to their pre-admission residence or care environment. Day 3 BUN was not significantly associated with failure to return in the primary analysis [adjusted odds ratio (OR) per 5 mg/dL, 1.12; 95% confidence interval (CI): 0.91-1.47; P=0.30]. Day 3 CRP, albumin, and creatinine were also not significantly associated with the outcome. Older age was significantly associated with failure to return in all four models. In the exploratory sensitivity cohort of 70 patients, higher day 3 BUN was associated with failure to return (adjusted OR per 5 mg/dL, 1.60; 95% CI: 1.08-2.62; P=0.02).</p><p><strong>Conclusions: </strong>Day 3 BUN and other routinely measured laboratory markers were not significantly associated with discharge disposition in the primary adjusted analysis. The association observed for day 3 BUN in the restricted sensitivity analysis should be considered hypothesis-generating and requires validation.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1032"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and internal validation of a clinicopathological and CT radiomics based prediction model for extracranial distant metastasis after radical resection in early-stage non-small cell lung cancer.","authors":"Yimei Zhang, Biwei Liu, Qiyu Nian, Yicong Chen, Liying Yang, Xiaorong Sun, Ligang Xing","doi":"10.21037/jtd-2026-1263","DOIUrl":"https://doi.org/10.21037/jtd-2026-1263","url":null,"abstract":"<p><strong>Background: </strong>Wide use of low-dose chest CT detects more early NSCLC, though recurrence (mostly extracranial distant metastasis) still occurs. This study aimed to establish and validate computed tomography (CT) radiomics models that can be used for predicting the risk of extracranial distant metastasis (EDM) after radical resection in early-stage non-small cell lung cancer (e-NSCLC).</p><p><strong>Methods: </strong>This retrospective study included 312 patients with e-NSCLC who underwent radical surgery at Shandong Cancer Hospital from 2014 to 2019. The cases were randomly divided into a training set (n=200) and a validation set (n=112). The study excluded patients who received neoadjuvant therapy, had interrupted follow-up, or died of non-tumor-related causes. The patients were followed up for an average of 30.6 months after the first postoperative CT examination. This study defined EDM as distant metastasis in other organs other than brain metastasis after surgery, and accounted for 78.6% of all metastatic cases. The region of interest (ROI) was delineated, and the radiomics features were selected by using least absolute shrinkage and selection operator (LASSO) logistic regression models to construct radiomics signatures. The association between the radiomics signature and the occurrence of EDM was also evaluated. A combined nomogram incorporating the selected radiomics and clinical-pathological predictors was constructed using multivariable regression. The concordance index (C-index) was used to evaluate the performance of the model. To determine the clinical effectiveness of nomogram in radiomics, the decision curve analysis (DCA) was performed.</p><p><strong>Results: </strong>A total of 75 patients (24.0%) experienced metastasis, with EDM accounting for 78.6%. In the overall cohort, radiomics signature were significantly associated with the occurrence of the EDM. The discrimination performance of the radiomics nomogram is significantly better than the clinical-pathologic nomogram (P<0.001), with the C-indexes 0.818 [95% confidence interval (CI): 0.780-0.856] and 0.823 (95% CI: 0.769-0.877) in the training and validation cohorts, respectively. Analysis of the calibration and decision curves indicated that the comprehensive nomogram was superior to the clinical-pathological and radiomics nomogram in predicting EDM survival.</p><p><strong>Conclusions: </strong>CT radiomics features have the potential to predict postoperative EDM and may assist in preliminarily identifying patients at high metastatic risk, which could provide a reference for individualized postoperative adjuvant decision-making in e-NSCLC.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1051"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}