Journal of thoracic disease最新文献

{"title":"Occupational asbestos exposure and lung cancer: contemporary research trends, exploratory genetic evidence, and global burden from 1990 to 2021.","authors":"Yufan Chen, Chen Gao, Xinjing Lou, Ziqing Han, Linfeng Shao, Tanghuan Feng, Shouliang Miao, Linyu Wu","doi":"10.21037/jtd-2026-0975","DOIUrl":"https://doi.org/10.21037/jtd-2026-0975","url":null,"abstract":"<p><strong>Background: </strong>Asbestos exposure is a confirmed risk factor for lung cancer, but its causal relationship with different subtypes and its global disease burden remain poorly characterized. This study aims to comprehensively evaluate the association between occupational asbestos exposure and lung cancer through multidimensional analysis, integrating bibliometric analysis, mendelian randomization, and Global Burden of Disease data to identify research trends, explore potential subtype-specific associations, and characterize global disease burden patterns.</p><p><strong>Methods: </strong>This study included a bibliometric analysis of publications from the Web of Science Core Collection on asbestos-related lung cancer. Mendelian randomization was performed using OpenGWAS data to investigate whether asbestos exposure is differentially associated with specific lung cancer subtypes. Global Burden of Disease 2021 data were analyzed to estimate the asbestos-related lung cancer burden by age and sex. Future burden was projected using the Bayesian age-period-cohort model.</p><p><strong>Results: </strong>Bibliometrics revealed fluctuating publication trends, with a thematic shift toward molecular mechanisms. Mendelian randomization analysis identified a suggestive causal relationship between asbestos exposure and lung adenocarcinoma [odds ratio (OR) =4.901, 95% confidence interval (CI): 1.150-20.881, P=0.03], but no significant causal links were observed with overall lung cancer or other subtypes. None of the instrumental variables demonstrated horizontal pleiotropy or heterogeneity. Global Burden of Disease analysis showed a higher asbestos-related lung cancer burden in males and older populations, with the greatest attributable burden in high socio-demographic index regions. Projections indicate a continued decline in global burden by 2036.</p><p><strong>Conclusions: </strong>The mendelian randomization results offer genetic evidence supporting a specific causal role of asbestos in lung adenocarcinoma development. Despite a decline in burden due to control policies, ongoing exposure in developing countries and legacy asbestos in buildings remain serious challenges. Future research should focus on larger genetic studies and analysis tailored to subtypes, while global efforts need to prioritize a comprehensive asbestos ban, improved screening for high-risk groups, and enhanced international cooperation to eliminate asbestos-related diseases.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1034"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182859","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":"Echocardiography-based multimodal models for thromboembolic risk prediction in atrial fibrillation: a narrative review.","authors":"Lei Liu, Aiyue Chen, Linqi Liu, Pakezhati Maimaitijiang, Xinyi Wang, Lihui Zheng","doi":"10.21037/jtd-2026-1700","DOIUrl":"10.21037/jtd-2026-1700","url":null,"abstract":"<p><strong>Background and objective: </strong>The congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, sex category (CHA₂DS₂-VASc) score is fundamental for assessing thromboembolic risk in atrial fibrillation (AF). However, its limitations arise from relying solely on clinical parameters, without considering individual cardiac structural and functional changes. This review aims to explore the development and implementation of multimodal risk prediction models that integrate echocardiographic parameters with clinical data and biomarkers to achieve a more precise and individualized risk assessment.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using relevant electronic databases (e.g., PubMed, Web of Science and Embase) to identify studies focusing on echocardiographic parameters, AF, and thromboembolic risk prediction models published up to May 2026.</p><p><strong>Key content and findings: </strong>Echocardiographic parameters evaluating the left atrium and left atrial appendage (LAA; size, function, and morphology) have emerged as significant predictors of both prevalent thrombus formation and future thromboembolic events. This review details these key parameters and critically assesses various multimodal approaches, including those combining clinical-echocardiographic scores with artificial intelligence (AI) techniques. Importantly, these models demonstrate enhanced predictive accuracy for specific clinical endpoints over traditional clinical scores.</p><p><strong>Conclusions: </strong>Utilizing a multimodal approach provides a promising supplementary tool for refined risk assessment, rather than replacing guideline-based anticoagulation decisions. Future directions should focus on standardizing echocardiographic measurements, expanding the use of AI for automated analysis, and conducting prospective interventional trials to confirm clinical benefit.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1057"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169772","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":"Single-lumen tube cuff tamponade and dynamic positioning for bronchoscopy-associated massive airway hemorrhage: a case series.","authors":"Mingyuan Yang, Qinghao Cheng","doi":"10.21037/jtd-2026-1720","DOIUrl":"10.21037/jtd-2026-1720","url":null,"abstract":"<p><p>Bronchoscopy-associated acute massive airway hemorrhage (BAMAH) is an uncommon but life-threatening emergency, as rapid airway flooding can compromise bronchoscopic visualization, ventilation, oxygenation, and circulation. Conventional bronchoscopic and lung-isolation methods may be difficult to deploy when visualization is lost, whereas bronchial artery embolization and surgery cannot provide immediate airway stabilization. This brief report describes a rescue strategy guided by a simplified ABCDE framework that combines a cuffed single-lumen endotracheal tube with cuff tamponade, lung isolation, and dynamic positioning. We retrospectively reviewed eight patients who developed BAMAH during therapeutic rigid bronchoscopy under general anesthesia at a tertiary hospital between January 2004 and December 2021. The framework utilized airway and bleeding assessments, concurrent oxygenation and circulatory resuscitation, direct bronchoscopic control, and escalation to endotracheal rescue when visualization was lost, bronchoscopic hemostasis was no longer feasible, or when rapid physiological deterioration occurred. Depending on the bleeding site, the tube was advanced beyond a tracheal lesion or into the contralateral non-bleeding main bronchus, and the cuff was positioned to provide temporary tamponade and lung isolation. Trendelenburg positioning and lateral tilt were adjusted according to bleeding control and oxygenation. All eight patients developed severe hypoxemia during hemorrhage, and five patients experienced cardiac arrest. After intubation, immediate airway stabilization was achieved in all patients, with temporary compression hemostasis, lung isolation, and recovery of monitor-displayed peripheral oxygen saturation (SpO₂) to at least 90%. No intraoperative death occurred during the rescue procedure. Three patients subsequently underwent emergency bronchial artery embolization. Four patients died within 48 hours from disseminated intravascular coagulation and multiple organ failure. As a result, this strategy should be viewed as a practical temporizing rescue method that provides patients with time for further treatment, rather than a definitive therapy.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1055"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170026","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":"Prognostic impact of surgical-side pulmonary artery diameter in patients with non-small cell lung cancer undergoing lobectomy.","authors":"Shunta Tsuchida, Joji Samejima, Masashi Wakabayashi, Makoto Tada, Tomohiro Miyoshi, Kenta Tane, Keiju Aokage","doi":"10.21037/jtd-2026-1627","DOIUrl":"10.21037/jtd-2026-1627","url":null,"abstract":"<p><strong>Background: </strong>A surgical-side pulmonary artery diameter (ssPAD) ≥23 mm has been linked to postoperative complications after lobectomy for non-small cell lung cancer (NSCLC), but its prognostic significance remains unclear. This study evaluated whether ssPAD ≥23 mm serves as an independent prognostic factor and a useful indicator for preoperative risk assessment.</p><p><strong>Methods: </strong>We retrospectively analyzed 438 patients who underwent lobectomy for NSCLC between 2016 and 2017. Patients were classified by ssPAD: ≥23 mm (n=116) and <23 mm (n=322). Survival outcomes and clinicopathological variables were compared. The prognostic performance of ssPAD was assessed using C-statistics against main pulmonary artery diameter (MPAD) ≥28 mm and pulmonary artery-to-aorta (PA/A) ratio >1.</p><p><strong>Results: </strong>The ssPAD ≥23 mm group showed lower 5-year recurrence-free survival (RFS; 61% <i>vs.</i> 71%, P=0.047) and overall survival (OS; 69% <i>vs.</i> 81%, P=0.001). Lung cancer-specific mortality (24% <i>vs.</i> 13%, P=0.03) and non-cancer mortality (15% <i>vs.</i> 7.1%, P=0.042) were higher, while adjuvant therapy was less frequent due to dyspnea. In multivariable analysis, ssPAD ≥23 mm remained an independent predictor of OS [hazard ratio (HR) 1.84, 95% confidence interval (CI): 1.22-2.79, P=0.004].</p><p><strong>Conclusions: </strong>Preoperative ssPAD ≥23 mm may be an independent prognostic marker after lobectomy for NSCLC and a simple computed tomography (CT)-based tool for risk stratification.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1023"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171817","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":"Central nervous system efficacy of third generation <i>vs.</i> first generation EGFR-TKIs in the first line treatment for <i>EGFR</i>-mutated non-small cell lung cancer with central nervous system metastases: a systematic review and meta-analysis of phase 3 randomized controlled trials.","authors":"Jiongli Gan, Shaofeng Zhu, Yan Fang, Jiaqiang Wang, Tiande Liu, Jing Cai","doi":"10.21037/jtd-2026-1571","DOIUrl":"https://doi.org/10.21037/jtd-2026-1571","url":null,"abstract":"<p><strong>Background: </strong>Epidermal growth factor receptor (<i>EGFR</i>)-mutant non-small cell lung cancer (NSCLC) with central nervous system (CNS) metastases poses significant treatment challenges, as first-generation EGFR-tyrosine kinase inhibitors (TKIs) (FGET) show limited CNS efficacy. Although third-generation EGFR-TKIs (TGET) exhibit superior CNS penetration, the optimal choice for first-line treatment remains debated. This meta-analysis aims to resolve this controversy by directly comparing the CNS efficacy of TGET <i>vs.</i> FGET in patients with <i>EGFR</i>-mutant NSCLC and CNS metastases.</p><p><strong>Methods: </strong>A thorough literature search was performed for phase 3 randomized controlled trials (RCTs) comparing TGET and FGET in patients with <i>EGFR</i>-mutated NSCLC and CNS metastases. The primary outcome was CNS-progression-free survival (PFS), and secondary outcomes included overall survival (OS), PFS, CNS response rates, and adverse events (AEs). The study was registered in PROSPERO (ID: CRD42024629581).</p><p><strong>Results: </strong>A total of 5 phase 3 RCTs (AENEAS, FLAURA, FURLONG, IBIO-103, and LASER301) met the inclusion criteria. TGET demonstrated superior efficacy in CNS-PFS [hazard ratio (HR): 0.44 (0.33, 0.58), P<0.001], PFS [HR: 0.44 (0.35, 0.54), P<0.001], CNS-objective response rate (ORR) [risk ratio (RR): 1.32 (1.15, 1.52), P<0.001], CNS-complete response (CR) [RR: 3.40 (1.39, 8.28), P=0.007], and CNS-duration of response (DOR) [HR: 0.39 (0.21, 0.73), P=0.003]. The CNS-PFS rate at 4-24 months and PFS at 10-24 months were significantly higher in the TGET group. OS data were available from only 2 of the 5 included phase 3 RCTs. In this analysis, OS numerically favored the TGET group but did not reach statistical significance [HR: 0.79 (0.55, 1.13), P=0.20]. At the cutoff time, more CNS progressions were found in the FGET [RR: 0.59 (0.44, 0.80), P=0.001]. Additionally, less grade 3-5 treatment-related AEs (TRAEs) were found in the TGET group [RR: 0.67 (0.46, 0.98), P=0.04].</p><p><strong>Conclusions: </strong>TGET appeared to be better than FGET for patients with <i>EGFR</i>-mutated NSCLC and CNS metastases, showing improved survival, CNS efficacy, and safety.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1009"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182748","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":"Pulmonary sclerosing pneumocytoma demonstrated heterogeneous tumor growth rate on serial CT: a retrospective cohort study.","authors":"Xiaoyu Zhen, Li Tu, Hong Xie, Yuting Wu, Shi Zhou, Xuehua Shen, Yushi Yang, Xiaowan Guo","doi":"10.21037/jtd-2026-0786","DOIUrl":"https://doi.org/10.21037/jtd-2026-0786","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pulmonary sclerosing pneumocytoma (PSP) is a rare benign tumor with various manifestations, posing a challenge for accurate diagnosis and appropriate management. Imaging, particularly computed tomography (CT), is crucial for the diagnosis of PSP, and imaging surveillance is adopted as a strategy for the management of PSP patients. However, the natural history and growth patterns of PSP remain poorly characterized, creating an urgent need for evidence-based surveillance protocols to guide clinical management. This study aimed to investigate the CT manifestations and tumor growth patterns of PSP to enhance understanding and provide evidence for the clinical management of PSP patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective observational cohort study was conducted among PSP patients diagnosed between August 2014 and August 2025 at a single tertiary hospital in southwestern China. Inclusion criteria were: (I) histopathologically diagnosed PSP registered in the pathology information system; (II) available preoperative chest CT; and (III) complete clinical records. Exclusion criteria included: (I) incorrect diagnosis of PSP; (II) incomplete CT data or CT of poor quality; and (III) prior lung surgery or malignancy affecting follow-up assessment. Baseline clinical factors (age, sex, symptoms, smoking history) and CT features (size, location, morphology, calcification, enhancement patterns) were systematically recorded. For 17 patients with serial CT scans, tumor volume doubling time (TVDT) was calculated using the modified Schwartz formula. Growth patterns were classified as stable or no growth [volume doubling time (VDT) &gt;6,000 days], slow or indolent (600-6,000 days), and rapid (&lt;600 days) according to the TVDT. The predefined primary outcome was tumor growth kinetics; secondary outcomes included CT characteristics and postoperative recurrence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The cohort was predominantly female, with a mean age of 48.4±12.5 years at the time of diagnosis. Most patients were asymptomatic. All of the PSP lesions manifested as solitary, well-circumscribed nodules or masses, predominantly in the lower lobes. The top three most common CT features observed in PSP included oval shape, calcification, and significant enhancement after contrast administration. Twenty-five out of 68 patients were correctly diagnosed as PSP preoperatively. Among 17 cases with serial CT, 5 (29.4%) showed no growth, 6 (35.3%) showed slow growth, and 6 (35.3%) showed rapid growth. All patients underwent surgical resection with no recurrence or metastasis observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study indicates that PSP might have characteristic features, and radiological features may suggest the diagnosis of PSP. PSP exhibits heterogeneous growth patterns ranging from no growth to slow-growing and rapid-growing rates. These findings suggest that individualized surveillance intervals should be adopted for PSP-suspicio","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1048"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182066","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":"Real-world survival outcomes following multimodal surgical treatment for stage IIIA non-small cell lung cancer.","authors":"William P Carroway, Elaine Liang, Sheng-Fang Jiang, Alberto Jarrin Lopez, Kenneth Williams, Jeffrey B Velotta","doi":"10.21037/jtd-2026-1715","DOIUrl":"https://doi.org/10.21037/jtd-2026-1715","url":null,"abstract":"<p><strong>Background: </strong>Stage IIIA non-small cell lung cancer (NSCLC) is a heterogeneous disease, and the role of surgery within multimodality treatment remains controversial. With the emergence of immunotherapy, there is a need to re-evaluate surgical outcomes in real-world populations. This study compares overall survival (OS) between surgical and non-surgical approaches for stage IIIA NSCLC from a multicenter cohort.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 598 stage IIIA NSCLC patients diagnosed between January 1, 2010, and June 30, 2021, across 21 Kaiser Permanente Northern California (KPNC) hospitals. Patients were categorized into surgical and non-surgical groups; the surgical group was further divided into surgery alone, surgery first (adjuvant therapy), and surgery later (neoadjuvant or perioperative therapy).</p><p><strong>Results: </strong>The surgical group had higher 5-year OS (52.6% <i>vs.</i> 30.8%, P<0.001) and longer median survival (5.77 <i>vs.</i> 2.17 years). All surgical subgroups were independently associated with reduced mortality after adjusting for age, sex, body mass index (BMI), smoking status, Charlson Comorbidity Score (CCS), and race: surgery later [adjusted hazard ratio (AHR) =0.50; 95% confidence interval (CI): 0.34-0.74], surgery alone (AHR =0.58; 95% CI: 0.39-0.89), and surgery first (AHR =0.48; 95% CI: 0.37-0.62). Age >80 years (AHR =1.65; 95% CI: 1.07-2.55; P=0.02) and male sex (AHR =1.64; 95% CI: 1.30-2.06; P<0.001) were independently associated with increased mortality.</p><p><strong>Conclusions: </strong>Surgery, when integrated into multimodal treatment, is associated with significantly improved survival in stage IIIA NSCLC. These findings support continued consideration of surgery in appropriately selected patients and highlight the need for prospective studies to clarify its role in NSCLC management.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1036"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182351","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 prognostic model for cancer-specific survival in elderly patients with metastatic non-small cell lung cancer: a SEER-based study.","authors":"Xiange Pan, Mingxian Xu, Rongyu Jin, Changbin Zhou, Buyuan Xu, Wei Lin","doi":"10.21037/jtd-2026-1475","DOIUrl":"https://doi.org/10.21037/jtd-2026-1475","url":null,"abstract":"<p><strong>Background: </strong>The prognosis of elderly patients with distant metastasis (stage M1) of non-small cell lung cancer (NSCLC) is poor. This study aimed to develop and internally validate a prognostic model for estimating cancer-specific survival (CSS) in elderly patients with metastatic NSCLC.</p><p><strong>Methods: </strong>Clinical data of stage M1 NSCLC patients (2010-2022) were extracted from the Surveillance, Epidemiology, and End Results database and randomly split into a training cohort and an internal validation cohort at a ratio of 7:3. The primary outcome was CSS, defined as death from NSCLC. Prespecified demographic, tumor, metastatic, and treatment-related variables were evaluated using univariate and multivariable Cox proportional hazards regression analyses, followed by bidirectional stepwise selection based on the Akaike information criterion. The cohort was randomly divided into training and internal validation cohorts at a ratio of 7:3. Model discrimination was assessed using the concordance indices (C-indexes) and time-dependent area under the receiver operating characteristic curve (AUC) at 1, 3, and 5 years, while calibration and decision curve analysis were used to evaluate model performance. A nomogram was developed based on the final model.</p><p><strong>Results: </strong>A total of 69,516 patients were randomly allocated in the training (n=48,661) and validation (n=20,855) cohorts. In the training cohort, Cox regression analysis identified independent prognostic factors for CSS (all P<i><</i>0.05), including age, gender, race, marital status, residential area, tumor size, primary tumor site, T stage, N stage, surgery, etc. The model showed moderate discrimination, with C-indices of 0.694 and 0.698 in the training and validation cohorts, respectively. The time-dependent AUCs at 1, 3, and 5 years were 0.740, 0.739, and 0.762 in the training cohort and 0.742, 0.739, and 0.766 in the validation cohort, respectively. The nomogram constructed based on the model could predict survival probability, and risk stratification showed significant differences in CSS among the three groups.</p><p><strong>Conclusions: </strong>This study developed and internally validated a prognostic model and corresponding nomogram for estimating 1-, 3-, and 5-year CSS in elderly patients with stage M1 NSCLC. The model showed moderate and relatively consistent discriminative ability and may assist prognostic risk stratification.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1025"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182423","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":"Routine intraoperative frozen section assessment of lymph nodes in clinical stage IA non-small cell lung cancer: towards a risk-stratified approach.","authors":"Andréanne Gagné","doi":"10.21037/jtd-2026-2064","DOIUrl":"https://doi.org/10.21037/jtd-2026-2064","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1076"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182429","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":"Does thermal ablation plus chemotherapy improve survival in small-cell lung cancer ineligible for surgery?","authors":"Mao Sun, Yu Zhang, Yangyang Tang, Shubo Han, Wanyi Zhang, Ming Xie","doi":"10.21037/jtd-2026-1382","DOIUrl":"https://doi.org/10.21037/jtd-2026-1382","url":null,"abstract":"<p><strong>Background: </strong>Thermal ablation (TA) is a safe and feasible alternative for the treatment of non-small cell lung cancer. However, data on the clinical efficacy of TA in patients with small-cell lung cancer (SCLC) are scarce. This study aimed to explore the clinical efficacy of TA plus chemotherapy (CHT) in treating SCLC.</p><p><strong>Methods: </strong>This is a population-based retrospective cohort study based on the Surveillance, Epidemiology and End Results (SEER) database. We collected data from the SEER database for 51,273 SCLC patients who received CHT from 2000 to 2019. Using propensity score matching (PSM), we balanced covariate differences between two treatment groups: CHT alone and TA plus CHT. Kaplan-Meier survival curves for overall survival (OS) and lung cancer-specific survival (LCSS) were generated. Cox regression analysis was conducted to assess independent prognostic indicators.</p><p><strong>Results: </strong>After PSM, the TA + CHT group exhibited superior OS and LCSS compared to the CHT-only group. Age subgroup analysis revealed that for patients aged ≥70 years, TA + CHT resulted in improved OS and LCSS compared to CHT alone. For patients <70 years, a survival benefit was observed, but the difference was not statistically significant. Tumor size subgroup analysis showed that for patients with tumor sizes of 0-3 cm, TA + CHT led to superior OS and LCSS compared to CHT alone, while no statistically significant differences were observed in other tumor size subgroups. N stage subgroup analysis indicated that for N0 and N1 patients, TA + CHT had better OS and LCSS compared to CHT alone, with no statistically significant differences in the N2 and N3 subgroups. Multivariable analysis indicated that TA + CHT was an independent favorable prognostic indicator for both OS and LCSS.</p><p><strong>Conclusions: </strong>TA + CHT may be a promising treatment option for patients with SCLC, especially those aged ≥70 years with tumor size ≤3 cm, and N0-1 disease.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1019"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182605","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}