Journal of thoracic disease最新文献

{"title":"Single pass specimen adequacy in endobronchial ultrasound-guided transbronchial needle aspiration.","authors":"Yongkang Huang, Zengli Zhang","doi":"10.21037/jtd-2026-2318","DOIUrl":"https://doi.org/10.21037/jtd-2026-2318","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1069"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182508","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":"The relationship between hemoglobin concentration and mortality in patients receiving venovenous extracorporeal membrane oxygenation support: a single-center retrospective cohort study.","authors":"Xinyi Luo, Yin Xi, Jinquan Xie, Zhangwei Liang, Xiaoli Chen, Yuelin Liu, Ying Zhu, Juan Ouyang, Jie Zhang, Weiqun He, Xiaoqing Liu, Haibo Zhang, Yimin Li, Yonghao Xu, Ya Wang","doi":"10.21037/jtd-2026-1038","DOIUrl":"https://doi.org/10.21037/jtd-2026-1038","url":null,"abstract":"<p><strong>Background: </strong>Restrictive red blood cell (RBC) transfusion strategies are increasingly used during venovenous extracorporeal membrane oxygenation (VV ECMO), but the prognostic implications of sustained exposure to low hemoglobin concentrations remain uncertain. We investigated the associations of longitudinal hemoglobin exposure with 60-day mortality and successful ECMO weaning in patients receiving VV ECMO.</p><p><strong>Methods: </strong>We retrospectively analyzed adults receiving VV ECMO for at least 48 hours at a single center between January 2015 and May 2024. Patients who were pregnant or had received ECMO for >3 days at an outside hospital before transfer were excluded. Time-weighted average hemoglobin (TWA-Hb) was calculated from serial venous complete blood count measurements by weighting each hemoglobin value according to the time interval represented by that measurement. Patients were categorized as <70, 70-<80, 80-<90, and ≥90 g/L. The proportion of ECMO support time with hemoglobin <70 g/L was calculated as an exploratory measure of cumulative severe-anemia exposure. The primary outcome was 60-day mortality.</p><p><strong>Results: </strong>Among 182 patients, the median age was 59 years, 74.2% were male, and 97.3% received RBC transfusions (median 20 units). Seventy-five patients (41.21%) died within 60 days. Compared with the ≥90 g/L group, TWA-Hb <70 g/L was associated with a higher hazard of 60-day mortality [adjusted hazard ratio (HR) 3.47, 95% confidence interval (CI): 1.00-12.03, P<i>=</i>0.049]. In adjusted logistic regression, the odds ratios (ORs) for successful ECMO weaning within 60 days were 0.13 (95% CI: 0.04-0.38, P<0.001) for the <70 g/L group and 0.26 (95% CI: 0.09-0.72, P=0.01) for the 70-<80 g/L group, compared with the ≥90 g/L group.</p><p><strong>Conclusions: </strong>TWA-Hb <70 g/L during VV ECMO was associated with higher 60-day mortality and a lower likelihood of successful ECMO weaning. Sustained exposure to severe anemia below 70 g/L warrants particular clinical attention and should be minimized when feasible. These findings support further prospective evaluation of hemoglobin-management strategies aimed at reducing prolonged severe-anemia exposure during VV ECMO.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1010"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182658","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":"Erratum: Factors associated with upstaging in patients with resectable non-small cell lung cancer: a modern institutional sample.","authors":"","doi":"10.21037/jtd-20262-08","DOIUrl":"https://doi.org/10.21037/jtd-20262-08","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.21037/jtd-2025-1728.].</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1082"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182671","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":"<i>TMEM171</i> is a potential biomarker associated with lung injury and lung adenocarcinoma.","authors":"Yiran He, Huan Wang, Yi Huang, Jie Gu, Linli Wang, Di Ge, Lizhen Xuan, Minjie Ju","doi":"10.21037/jtd-2026-1116","DOIUrl":"https://doi.org/10.21037/jtd-2026-1116","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer therapy frequently induces lung injury, leading to treatment interruption and poor prognosis; however, specific biomarkers linking cancer therapy and therapy-related lung injury remain poorly defined. This study aimed to identify a biomarker relevant to both lung cancer progression and lung injury, with emphasis on prognostic significance and immune infiltration.</p><p><strong>Methods: </strong>RNA-sequencing data from Gene Expression Omnibus (GEO) (GSE166340, GSE27128) were used to identify lung injury-related genes (LIRGs), and The Cancer Genome Atlas (TCGA) data were analyzed to evaluate their expression in lung adenocarcinoma (LUAD). Single-cell RNA-sequencing data (PRJNA846488) and <i>in vivo</i> lung injury models were used to validate <i>TMEM171</i> expression. Prognostic value was assessed using Kaplan-Meier analysis, univariate and multivariate Cox regression, and a least absolute shrinkage and selection operator (LASSO) prognostic model. Immune infiltration, immune checkpoint correlations, and pathway enrichment were analyzed using single-sample gene set enrichment analysis (ssGSEA). Functional effects of <i>TMEM171</i> were examined by <i>in vitro</i> knockdown experiments.</p><p><strong>Results: </strong>A total of 10 LIRGs were identified. <i>TMEM171</i> was significantly upregulated in LUAD tissues and immunotherapy-induced lung injury models. High <i>TMEM171</i> expression was an independent predictor of poor prognosis and was associated with <i>TP53</i> mutations, apoptosis, and inflammatory response pathways. <i>TMEM171</i> expression positively correlated with neutrophil infiltration and immune checkpoint expression. <i>TMEM171</i> knockdown suppressed malignant behavior of LUAD cells and induced G1/S cell-cycle arrest <i>in vitro</i>.</p><p><strong>Conclusions: </strong><i>TMEM171</i> represents a potential biomarker linking LUAD and therapy-related lung injury and may serve as a candidate for future mechanistic investigation.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1028"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182776","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":"Ultrasound interpretive consistency in radial endobronchial ultrasound: a prerequisite for interpreting the gains of multimodal biopsy.","authors":"Jingyi Huang, Meng Wu","doi":"10.21037/jtd-2026-2190","DOIUrl":"https://doi.org/10.21037/jtd-2026-2190","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1064"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182791","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":"Transcriptional factor KLF9 in pulmonary fibrosis: from molecular mechanisms to precision intervention-a narrative review.","authors":"Ayinuer Kelimujiang, Yanmei Lu","doi":"10.21037/jtd-2026-1767","DOIUrl":"https://doi.org/10.21037/jtd-2026-1767","url":null,"abstract":"<p><strong>Background and objective: </strong>Pulmonary fibrosis (PF) is a devastating and progressive respiratory disease characterized by extracellular matrix (ECM) remodelling and functional decline, yet current therapeutic options remain limited. Recent studies have highlighted the critical, albeit complex, role of Krüppel-like factor 9 (KLF9) in the pathogenesis of PF. This review aims to comprehensively integrate the existing fragmented mechanistic evidence, delineate the differential regulatory networks of KLF9, and outline forward-looking strategies to promote the transition of KLF9 from a mechanistic candidate molecule to a clinically translatable target.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted on databases including PubMed, Web of Science, and Embase for articles published up to March 14, 2026. The search focused on keywords such as (\"pulmonary fibrosis\" OR \"idiopathic pulmonary fibrosis\" OR \"lung fibrosis\") AND (\"Krüppel-like factor 9\" OR \"KLF9\" OR \"BTEB1\").</p><p><strong>Key content and findings: </strong>Evidence indicates that KLF9 exhibits differential regulatory networks in alveolar epithelial cells, fibroblasts, and macrophages. Based on its functional paradox across diverse cell types, conventional systemic interventions targeting KLF9 face inherent limitations, including the \"undruggable\" nature of transcription factors and physical barriers in fibrotic lungs. To overcome these obstacles, advanced targeted strategies are required.</p><p><strong>Conclusions: </strong>While KLF9 plays a pivotal role in the fibrotic microenvironment, realizing its therapeutic potential necessitates a paradigm shift in intervention methods. Forward-looking strategies, including single-cell/spatial multi-omics analysis, ligand-modified inhaled nano-delivery, and stage-dependent dynamic dosing systems [such as proteolysis-targeting chimera (PROTAC) technology], represent promising avenues for precise KLF9 targeting in PF.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1061"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182816","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":"Late-onset thoracogastric airway fistula after esophagectomy for esophageal cancer: a narrative review.","authors":"Long Wang, Shaobin Li, Weixian Lin, Yuchen Luo, Wenfa Jiang, Ning Xie, Chenyang Xu, Kaican Cai, Siyang Feng","doi":"10.21037/jtd-2026-1489","DOIUrl":"https://doi.org/10.21037/jtd-2026-1489","url":null,"abstract":"<p><strong>Background and objective: </strong>Thoracogastric airway fistula (TGAF) is a life-threatening complication following esophagectomy with gastric conduit interposition. While early-onset TGAF has been well characterized, late-onset TGAF, which occurs months to years after surgery, remains underrecognized and lacks evidence-based diagnostic and management frameworks. This narrative review aims to synthesize current literature to address several high-priority clinical questions: which features should raise suspicion of lateonset TGAF; what is the optimal diagnostic pathway integrating imaging and endoscopy; and how to select between endoscopic and surgical intervention.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed from database inception to May 2026 using combinations of keywords related to TGAF and relevant etiological and therapeutic terms. Reference lists of included articles and relevant reviews were manually screened. Only peer-reviewed English-language publications were considered. Given the rarity and heterogeneity of late-onset TGAF, high-quality prospective studies are lacking, and a systematic review with meta-analysis is not feasible. We therefore adopted a narrative synthesis approach.</p><p><strong>Key content and findings: </strong>The evidence base for late-onset TGAF is limited to case reports, small series, and a few cohort studies, with no randomized trials identified. Diagnostic delay is common, driven by nonspecific symptoms and overlap with tumor progression. The pathogenesis is multifactorial, with peptic ulceration as the bestsupported mechanism. Management options include conservative support, endoscopic stenting or occluder devices, and surgical repair, though treatment decisions are guided largely by patient physiology, fistula characteristics, and institutional expertise rather than by comparative data. Long-term outcomes remain poorly characterized.</p><p><strong>Conclusions: </strong>This review presents an initial framework for managing late-onset TGAF. A high index of suspicion should be maintained in any post-esophagectomy patient presenting with recurrent pneumonia, chronic cough, or unexplained weight loss. Diagnostic workup should proceed with contrast esophagram and chest computed tomography (CT), followed by confirmatory bronchoscopy and gastroscopy. Endoscopic stenting is appropriate as firstline therapy in most patients, whereas surgical repair should be reserved for those with adequate physiological reserve and favorable local tissue conditions. The limited evidence base underscore the urgent need for prospective multicenter registries to establish standardized diagnostic algorithms and treatment guidelines for this rare but devastating complication.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1058"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182823","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":"Multifocal ground-glass opacities in lung cancer: a narrative review of genomic evolution, immune ecology, and biology-informed clinical management.","authors":"Xinlin Li, Yue Li, Jingwei Jiang, Huajian Peng, Guanqiang Yan, Dongsheng Lu, Zhanyu Xu, Baoshi Zheng, Nuo Yang","doi":"10.21037/jtd-2026-1871","DOIUrl":"https://doi.org/10.21037/jtd-2026-1871","url":null,"abstract":"<p><strong>Background and objective: </strong>Ground-glass opacity (GGO) is a computed tomography descriptor rather than a histologic diagnosis. Multifocal GGOs (mGGOs) are increasingly detected during lung cancer screening, yet their clonal origins, immune ecology, progression risk, and optimal management remain difficult to reconcile within conventional lung cancer frameworks. This narrative review evaluates genomic, immunologic, and clinical evidence relevant to mGGOs and examines how biological findings may inform surveillance and local treatment without encouraging overtreatment.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Web of Science, Google Scholar, and selected guideline and trial sources were searched through 29 July 2026 for English-language studies published mainly from January 2020 to July 2026, supplemented by earlier landmark reports. Search concepts included mGGO, subsolid nodule, synchronous multiple primary lung cancer (SMPLC), clonality, single-cell and spatial transcriptomics (ST), immune microenvironment, active surveillance, and parenchyma-sparing surgery.</p><p><strong>Key content and findings: </strong>Many mGGO presentations are compatible with clonally independent synchronous primaries, although intrapulmonary metastasis (IPM) can occur and developmental mosaicism remains a single-study, selected-patient hypothesis. Early lesions may have low mutational burden and attenuated effector activity, but immunoediting, regulatory T-cell enrichment, dysfunctional CD8-positive T-cell states, and inhibitory non-classical antigen-presentation pathways can already be present in adenocarcinoma in situ or minimally invasive adenocarcinoma. We therefore use relative adaptive immune quiescence as a descriptive population-level term, not as evidence of absent immune pressure. Prospective ECTOP-1021 data support short-term feasibility of surveillance in a highly selected cohort, but do not establish comparative effectiveness.</p><p><strong>Conclusions: </strong>A biology-informed framework can refine risk discussion for selected patients with mGGOs, provided that radiologic terms are not treated as histologic diagnoses and mechanistic associations are not converted into clinical recommendations. Surveillance, local treatment, and parenchyma preservation should remain multidisciplinary and evidence-calibrated; biomarker-guided triage and interception strategies require prospective GGO-specific validation.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1063"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182829","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":"Skeletal muscle depletion during neoadjuvant chemoimmunotherapy predicts postoperative complications in non-small cell lung cancer: a retrospective cohort study.","authors":"Wei Feng, Xin Wang, Heng Du, Guowei Che","doi":"10.21037/jtd-2026-1911","DOIUrl":"https://doi.org/10.21037/jtd-2026-1911","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;For patients with resectable locally advanced non-small cell lung cancer (NSCLC), surgical resection preceded by neoadjuvant chemoimmunotherapy (nICT) has become the standard treatment strategy. However, the triple physiological burden imposed by chemotherapy, immunotherapy, and ongoing tumor metabolism may compromise functional reserve and increase surgical risk. Identifying patients at high risk for postoperative complications remains a critical challenge in perioperative management. This study aimed to characterize dynamic changes in skeletal muscle and adipose tissue during nICT, to identify independent predictors of postoperative complications, and to evaluate the incremental predictive value of dynamic body composition metrics over established clinical variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study included 160 patients with resectable NSCLC who underwent surgical resection following nICT between June 2024 and December 2025. Skeletal muscle index (SMI), skeletal muscle density (SMD), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) were quantified at the L3 vertebral level on computed tomography (CT) images obtained before and after treatment. Dynamic changes (Δ) were calculated as the difference between pre-treatment and post-treatment values. The primary outcome was postoperative complications of Clavien-Dindo (CD) grade ≥II. Three predictive models were constructed and compared using area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Following nICT, skeletal muscle metrics decreased significantly (median ΔSMI, -0.54 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt;; P=0.01; median ΔSMD, -0.90 HU; P=0.003), while adipose tissue areas increased significantly (median ΔVAT, 9.54 cm&lt;sup&gt;2&lt;/sup&gt;; P&lt;0.001; median ΔSAT, 8.06 cm&lt;sup&gt;2&lt;/sup&gt;; P&lt;0.001). No significant correlation was observed between ΔSMI and ΔVAT (Spearman ρ=0.087; P=0.27), indicating divergent and independent metabolic trajectories. Of 160 patients, 58 (36.3%) developed CD grade ≥ II complications. Among the four dynamic body-composition measures, each evaluated in a separate multivariable model, only ΔSMI remained significantly associated with postoperative complications [adjusted odds ratio (OR) =0.806; 95% confidence interval (CI): 0.721-0.900; P&lt;0.001], whereas ΔSMD, ΔVAT, and ΔSAT did not. Traditional assessments, including body mass index (BMI) change, Eastern Cooperative Oncology Group (ECOG) performance status, pulmonary function, and systemic inflammatory and nutritional indices, likewise showed no significant associations. Adding ΔSMI to the clinical model significantly improved AUC from 0.595 to 0.710 (ΔAUC =0.115; P=0.007).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Dynamic loss of skeletal muscle during nICT, as assessed on routine CT images, was independently associated with postoperative com","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1018"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182595","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":"CDK4/6 inhibitor-related interstitial lung disease in breast cancer: a single-center case series and literature-based patient-level review.","authors":"Chunyu Liu, Xinyu Fu, Fang Wang, Wentao Ni, Ran Li, Zhancheng Gao","doi":"10.21037/jtd-2026-1560","DOIUrl":"https://doi.org/10.21037/jtd-2026-1560","url":null,"abstract":"<p><strong>Background: </strong>Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors are widely used in the treatment of breast cancer. CDK4/6 inhibitor-related interstitial lung disease (ILD) is uncommon but potentially serious, and its clinical manifestations, radiologic patterns, and outcomes remain incompletely characterized. This study aimed to characterize the clinical presentation, radiologic patterns, diagnostic evaluation, treatment, and outcomes of CDK4/6 inhibitor-related ILD using a Chinese single-center case series and an updated literature-based patient-level review.</p><p><strong>Methods: </strong>Seven patients with clinically diagnosed CDK4/6 inhibitor-related ILD were retrospectively identified at our center between November 2022 and February 2026. Clinical data, chest imaging, bronchoscopy and bronchoalveolar lavage fluid (BALF) findings when available, treatment, and outcomes were collected. An updated patient-level literature review was performed through May 30, 2026 using PubMed, Web of Science, and Google Scholar.</p><p><strong>Results: </strong>A total of 60 cases were analyzed, including seven institutional cases and 53 published cases. The median interval from CDK4/6 inhibitor initiation to ILD onset or diagnosis was 139 days among 59 cases with available latency data, and 24 cases (40.7%) occurred within 3 months. Thirty patients had received palbociclib, 22 had received abemaciclib, and eight had received ribociclib. Fatal outcomes occurred in nine patients. The most frequently reported symptoms were cough and dyspnea, whereas severe cases progressed to hypoxemic respiratory failure. Chest computed tomography (CT) findings were heterogeneous, including ground-glass opacities (GGOs), interlobular septal thickening, patchy consolidations, and radiologic patterns classified as nonspecific interstitial pneumonia (NSIP), organizing pneumonia (OP), hypersensitivity pneumonitis (HP)-like, and acute interstitial pneumonia/acute respiratory distress syndrome (AIP/ARDS)-like. Among eight patients with an AIP/ARDS-like pattern, five died and three had non-fatal outcomes. In the institutional cases, no pathogen was detected in available BALF cultures, and lymphocytic predominance was observed in cases with cell differential data.</p><p><strong>Conclusions: </strong>CDK4/6 inhibitor-related ILD should be considered when new respiratory symptoms or new CT abnormalities occur during CDK4/6 inhibitor therapy. Because its presentation is nonspecific, evaluation should focus on high-resolution CT (HRCT) assessment, exclusion of infection, tumor progression and radiation-related lung injury, and severity-based decisions regarding drug interruption or discontinuation. BALF is most useful when infection remains a major competing diagnosis.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1041"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182774","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}