Journal of thoracic disease最新文献

{"title":"Optimizing transcatheter aortic valve implantation work-up: the role of preprocedural computed tomography for the screening of concomitant coronary artery disease.","authors":"Hussein Sliman, Hugo M Aarts, Ronak Delewi","doi":"10.21037/jtd-24-182","DOIUrl":"10.21037/jtd-24-182","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 7","pages":"4392-4394"},"PeriodicalIF":1.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847234","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":"Percutaneous versus surgical tracheostomy in mechanically ventilated ICU patients: a bibliometric review and visual analysis (1990-2024).","authors":"Raffaele Merola, Stefania Troise, Federica Calabria, Carmine Iacovazzo, Antonio Romano, Maria Vargas","doi":"10.21037/jtd-2025-306","DOIUrl":"10.21037/jtd-2025-306","url":null,"abstract":"<p><strong>Background: </strong>Tracheostomy is a frequently performed procedure for critically ill patients requiring prolonged mechanical ventilation. This study aims to analyze the literature comparing percutaneous and surgical tracheostomy techniques using bibliometric methods to explore trends in research, key contributors, and clinical outcomes.</p><p><strong>Methods: </strong>A bibliometric analysis was conducted on publications comparing percutaneous and surgical tracheostomy using the Scopus database. Data on publication trends, authorship, citations, and co-occurrence of keywords were analyzed using VOSviewer software.</p><p><strong>Results: </strong>A total of 51 articles were included, focusing on the safety, efficacy, and outcomes of the two techniques. The analysis revealed a steady increase in publications over the past two decades, with recent studies expanding to compare patient quality of life and healthcare resource utilization. Key authors such as Dulguerov <i>et al.</i> and institutions like the University of Geneva and University of Zurich were identified as significant contributors. The most cited paper was \"Percutaneous or surgical tracheostomy: A meta-analysis\" by Dulguerov <i>et al.</i> (<i>Critical Care Medicine</i>, 1999). <i>Critical Care Medicine</i> emerged as the most active and cited journal. The paper titled \"Comparative clinical trial of standard operative tracheostomy with percutaneous tracheostomy\" by Hazard <i>et al.</i>, published in <i>Critical Care Medicine</i> in 1991, was the most cited reference.</p><p><strong>Conclusions: </strong>The bibliometric analysis of publications comparing percutaneous and surgical tracheostomy, although limited to a single database search, provides a fairly comprehensive overview of the available literature on the topic.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 7","pages":"5309-5319"},"PeriodicalIF":1.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847236","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":"Epidemiological features and risk factors of SARS-CoV-2 reinfection: a retrospective cohort analysis in Xiamen, China.","authors":"Yunkang Zhao, Yao Wang, Yidun Zhang, Zeyu Zhao, Buasiyamu Abudunaibi, Kang Fang, Huimin Qu, Qiao Liu, Yanhua Su, Chenghao Su, Zhinan Guo, Tianmu Chen","doi":"10.21037/jtd-24-1703","DOIUrl":"10.21037/jtd-24-1703","url":null,"abstract":"<p><strong>Background: </strong>Recently, surges in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfections in China have raised public concern. We investigated the epidemiological features and risk factors for SARS-CoV-2 reinfection in China.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in Xiamen, China (2021-2023) with two subcohorts: Delta-Omicron (cohort 1) and Omicron-Omicron (cohort 2). Descriptive analysis and ensemble modeling were employed to evaluate reinfections.</p><p><strong>Results: </strong>A total of 327 cases without fatalities were included. Reinfections accounted for 14.68% of cases, with 22.51% in cohort 1 and 3.68% in cohort 2. Compared with primary infections (PIs) (99.69% symptomatic, 56.54% hospitalized), reinfections were less severe, with fewer symptomatic instances (47.92%) and hospitalizations (4.65%). The majority of reinfections (83.33%) occurred following the relaxation of strict public health and social measures. The median time interval between PI and reinfection was longer for cohort 1 (462 days) than for cohort 2 (280 days). Reinfection risks were noted among lesser developed regions, those without persistent PI, those with primary Delta variant infection, government and hospital workers, and unvaccinated individuals.</p><p><strong>Conclusions: </strong>SARS-CoV-2 reinfections are generally less severe and are influenced by the relaxation of control measures, viral evolution, and changing patterns of population immunity and contact; this underscores the need for ongoing surveillance and targeted public health strategies to manage future infection waves.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 7","pages":"4732-4745"},"PeriodicalIF":1.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847239","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":"IgG4-related disease and pleural effusion: a systematic review.","authors":"Honorio J Martínez-Martínez, Lucía Ferreiro, Elisa Landín, Ainoa Fanego, Roi Soto-Feijóo, María Carreiras-Cuiña, Nuria Rodríguez-Núñez, María E Toubes, Luis Valdés","doi":"10.21037/jtd-2024-2192","DOIUrl":"10.21037/jtd-2024-2192","url":null,"abstract":"<p><strong>Background: </strong>Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition that rarely affects the pleura, with pleural effusion (PE) reported in only 4% of cases. The characteristics of PE in patients with IgG4-RD are unknown. The objectives of this systematic review were to document the histological and biochemical characteristics of PF and pleural tissue, assess its clinical course, and determine the most effective treatments for the management of PE.</p><p><strong>Methods: </strong>A PRISMA literature search was conducted for published articles describing the characteristics of PE in IgG4-RD and discussing the approach to PE in this setting.</p><p><strong>Results: </strong>A total of 46 articles [55 patients and 57 pleural fluid (PF) samples] were included. Median age was 66 years (range, 28-86 years), with a male/female ratio of 2.9:1. PE was predominantly right-sided or bilateral (81.3%) and usually occupied <2/3 of the hemithorax (78.9%). PF generally had a serous appearance (84.2%) and was an exudate in 94.6% of cases with predominance (≥50%) of mononucleated cells in 96% (24/25). A predominance of eosinophils (≥10%) was observed in 40% (4/10 cases). As many as 66.7% of patients presented values of adenosine deaminase (ADA) ≥35 U/L (18/27), pH values remained within normal range 7.35-7.45 (15.4%) in only two patients. Three patients had glucose values <60 mg/dL (12.5%) and the PF of two patients was a chylothorax. Pleural biopsy was consistent with diagnosis in 95.6% of cases (43/45). In total, 92.7% of patients (51/55) received treatment with corticosteroids, and 9 (17.6%) received immunosuppressants. Of the four cases left untreated, 2 underwent chest drainage. Clinical course was benign in 97.7% of patients (43/44; a patient died of unknown causes).</p><p><strong>Conclusions: </strong>Patients with IgG4-RD and PE are usually men over 50 years of age with small/moderate, right-sided or bilateral PE. PF is most commonly a lymphocytic exudate with elevated ADA values. Pleural biopsy can help establish diagnosis. Treatment with corticosteroids, combined or not with immunosuppressants, was usually effective.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 7","pages":"5320-5329"},"PeriodicalIF":1.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847246","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":"Sternal advancement surgery for pectus excavatum: a systematic review and meta-analysis of cardiac and respiratory function outcomes.","authors":"Alexis Belgacem, Cynthia Abane, Jeremy Tricard, Pierre Felix, Frederic Lavrand, Jérôme Laloze, Pauline Lopez, Philippe Bothorel, Emilie Auditeau, Laurent Fourcade, Quentin Ballouhey","doi":"10.21037/jtd-2025-347","DOIUrl":"10.21037/jtd-2025-347","url":null,"abstract":"<p><strong>Background: </strong>Pectus excavatum (PE) is the most common malformation of the anterior chest wall, affecting around 1 in 400 births, with a male/female sex ratio of 5:1. Even if the functional repercussions and management of PE are still the subject of many debates, the cardiorespiratory function improvement after surgical correction of PE with sternal advancement seem to be confirmed in the recent literature. This study aims to assess the impact of sternal advancement surgery-specifically minimally invasive repair of PE (MIRPE) and sternochondroplasty-on cardiorespiratory function at rest and during exercise in patients with PE.</p><p><strong>Methods: </strong>A meta-analysis was conducted on 21 studies reporting pre- and post-operative cardiac and/or respiratory function at rest and during exercise.</p><p><strong>Results: </strong>A total of 1,087 patients (mean age, 18.93 years) were included. Significant improvements were found in resting cardiac function, including cardiac output (P=0.04), cardiac index (P=0.03), left ventricular systolic ejection volume (LVSEV, P=0.001), and ejection fraction (P=0.03). Exercise capacity also improved significantly, with increases in VO₂max and O₂ pulse (both P<0.001). No significant changes were observed in respiratory parameters.</p><p><strong>Conclusions: </strong>Cardiac output assessment should be central to surgical decision-making in PE. Techniques involving sternal mobilization can yield meaningful improvements in cardiopulmonary function, unlike procedures that do not remodel the osteocartilaginous deformity.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 7","pages":"4897-4908"},"PeriodicalIF":1.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847256","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":"Increased mortality in lung cancer patients with same-lobe, multi-lobe, or mixed nodules: a retrospective study of 166,097 participants from the SEER database.","authors":"Jiayue Ye, Jiacong Liu, Yucheng Ma, Yiqing Wang, Pinghui Xia, Wang Lv, Sheng Hu, Jian Hu","doi":"10.21037/jtd-2025-445","DOIUrl":"10.21037/jtd-2025-445","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer is a leading cause of cancer-related deaths globally, with a particularly high burden in China and a poor prognosis mainly due to late-stage diagnosis and limited effective treatments. Large-sample survival analyses are lacking for patients with lung cancer who nodules of present with same-lobe, multi-lobe, or mixed nodules, as well as those with multiple separate nodules. This study aimed to assess the survival rates of patients with lung cancer by focusing on overall survival and disease-specific survival.</p><p><strong>Methods: </strong>A large dataset of 166,097 patients with lung cancer was obtained from the Surveillance, Epidemiology, and End Results database. Survival analyses, including univariate, multivariate, and stratified analyses, and survival curves, were conducted using Empower Stats, SPSS 24, and GraphPad. Eight covariates, including age, sex, and race, were adjusted.</p><p><strong>Results: </strong>Compared to patients with a single-tumor, those with same-lobe nodules, multi-lobe nodules, or mixed-distribution nodules had a significantly increased mortality risk. Furthermore, stratified analysis indicated that, compared to patients with a single-tumor, the increase in mortality risk was substantially greater among patients who underwent surgical treatment than among those who did not receive surgery.</p><p><strong>Conclusions: </strong>Patients with lung cancer who have satellite nodules located in the same-lobe or in different lobes on the same side as the primary tumor have a significantly higher mortality risk than those with single tumors. Surgical intervention in these patients further increases this risk.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 7","pages":"4439-4472"},"PeriodicalIF":1.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847258","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":"Infectious morbi-mortality in thoracic surgery after major resections.","authors":"Marin Théry, Adrien Lemaignen, Thomas Flament, Francis Remérand, Quentin Langouet, Béatrice Lipan, Thierry Bourguignon, Antoine Legras","doi":"10.21037/jtd-2024-2219","DOIUrl":"10.21037/jtd-2024-2219","url":null,"abstract":"<p><strong>Background: </strong>Eight thousand major pulmonary resections are performed annually in France for bronchopulmonary cancer. This surgery is associated with a significant mortality rate, estimated at 3% within 30 days, mainly due to infectious pulmonary complications. In recent series, early mortality reaches 12.6% in cases of postoperative pneumonia (POP). Our case-control study aims to describe the incidence, mortality and risk factors of infectious complications in the Department of Thoracic, Cardiac, and Vascular Surgery, Tours University Hospital, France.</p><p><strong>Methods: </strong>We identified 404 major resection procedures from the EPITHOR database between January 2019 and December 2021, of which 60 required postoperative antibiotic therapy. Demographic and perioperative data were compared between the \"Antibiotic therapy\" group and the rest of the cohort to identify risk factors. Bacteriological and therapeutic data from the \"Antibiotic therapy\" group were analyzed subsequently.</p><p><strong>Results: </strong>The incidence of POP was 8.9%, associated with a hospital mortality rate of 11.3%. Extension of operative time (OT) over 180 minutes [odds ratios (OR) 1.95, 95% confidence interval (CI): 1.01-3.75, P=0.06], right upper lobectomy (RUL) (OR 2.53, 95% CI: 1.31-4.86, P=0.005), thoracotomy approach (OR 2.68, 95% CI: 1.44-4.97, P=0.002), impairment of diffusing capacity of the lungs for carbon monoxide (DLCO) below 50% (OR 3.68, 95% CI: 1.58-8.53, P=0.002), and prolonged air leaks (OR 7.98, 95% CI: 2.87-22.2, P<0.001) were associated with higher rates of post-operative pneumonia. <i>H. influenzae</i> was the most frequently responsible bacteria, identified in 14% of cases. Overall sensitivity of these identified bacteria to amoxicillin-clavulanic acid was 75%.</p><p><strong>Conclusions: </strong>Our results are consistent with literature regarding the incidence, mortality and risk factors of infectious complications after major pulmonary resection. The main risk factors identified were prolonged OT over 180 minutes, thoracotomy approach, RUL, preoperative impairment of DLCO below 50% and prolonged air leaks. Moreover, most of the bacteria responsible for POP have an amoxicillin-clavulanic acid sensitivity.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 7","pages":"4524-4535"},"PeriodicalIF":1.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847259","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":"TTF-1 expression stratifies chemoimmunotherapy benefits in PD-L1-negative lung adenocarcinoma: a real-world biomarker validation.","authors":"Ning Yang, Lijuan Xiong, Ya Guo, Xiting Chen, Ning Wan, Bo Xie, Juan Zhou","doi":"10.21037/jtd-2025-644","DOIUrl":"10.21037/jtd-2025-644","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of immunotherapy in programmed death-ligand 1 (PD-L1)-negative advanced lung adenocarcinoma remains controversial, with responsive subgroups poorly characterized. This study aimed to identify predictive subgroups through thyroid transcription factor-1 (TTF-1) expression stratification.</p><p><strong>Methods: </strong>We retrospectively analyzed 253 consecutive PD-L1-negative advanced lung adenocarcinoma patients treated between January 2018 and January 2024. Outcomes of TTF-1-positive and TTF-1-negative patients receiving chemoimmunotherapy <i>vs.</i> chemotherapy alone were compared. Cox multivariate analysis evaluated the prognostic impact of treatment regimens.</p><p><strong>Results: </strong>In the overall cohort, chemoimmunotherapy improved median progression-free survival [PFS: 7.9 <i>vs.</i> 6.6 months, hazard ratio (HR) =0.74, P=0.03] and overall survival (OS: 17.5 <i>vs.</i> 15.4 months, HR =0.69, P=0.02) compared to chemotherapy. Stratified by TTF-1 status, TTF-1-negative patients (n=66) receiving chemoimmunotherapy exhibited significantly superior PFS (7.5 <i>vs.</i> 4.8 months, HR =0.44, P=0.002) and OS (16.2 <i>vs.</i> 11.5 months, HR =0.44, P=0.005), whereas TTF-1-positive patients (n=187) showed no significant survival differences (PFS: 8.0 <i>vs.</i> 7.3 months, HR =0.88, P=0.42; OS: 18.7 <i>vs.</i> 18.3 months, HR= 0.86, P=0.44). Multivariate analysis confirmed chemoimmunotherapy as an independent favorable prognostic factor for TTF-1-negative patients [PFS: adjusted HR (aHR) =0.44, 95% confidence interval (CI): 0.24-0.81, P=0.008; OS: aHR =0.48, 95% CI: 0.25-0.90, P=0.02], but demonstrated no significant association in the TTF-1-positive cohort (PFS: aHR =0.93, 95% CI: 0.68-1.28, P=0.66; OS: aHR =0.91, 95% CI: 0.62-1.35, P=0.64).</p><p><strong>Conclusions: </strong>TTF-1 expression may be a useful predictive biomarker for chemoimmunotherapy benefit in PD-L1-negative lung adenocarcinoma, pending further validation. TTF-1-negative patients demonstrated improved survival with chemoimmunotherapy (especially taxane-based regimens) compared to chemotherapy alone, while TTF-1-positive patients showed no survival benefit from immunotherapy combinations.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 7","pages":"4826-4836"},"PeriodicalIF":1.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847287","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":"Use of the PaO₂/FiO₂ ratio in acute pulmonary embolism: a simple and reliable parameter to predict the risk stratification.","authors":"Yanan Li, Xueqing Du, Ling Zhou, Jian Guan, Yidan Sun, Xianwen Sun, Yun Feng, Dong Liu, Yongjie Ding, Guochao Shi","doi":"10.21037/jtd-24-1821","DOIUrl":"10.21037/jtd-24-1821","url":null,"abstract":"<p><strong>Background: </strong>Acute pulmonary embolism (APE) is a common pulmonary vascular disease with its incidence rising year by year. Accurate diagnosis and early risk stratification of patients with APE are crucial for treatment follow-up, especially for patients with intermediate-to-high and high-risk. The aim of this study is to explore the value of blood gas parameters, especially arterial partial pressure of oxygen/fraction of inspired oxygen (PaO₂/FiO₂) ratio (P/F ratio), in evaluating the risk stratification of APE.</p><p><strong>Methods: </strong>A retrospective analysis of demographic data, complications, clinical symptoms, and laboratory data of 227 adult patients with APE treated at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Ruijin Hospital, from January 2016 to December 2021 was conducted. According to risk stratification, patients were divided into the intermediate-low risk and below group (low-risk group and intermediate-low-risk group), intermediate-high-risk and above group (intermediate-high-risk group and high-risk group), and the correlation between various indicators and risk stratification of APE was analyzed. Multivariate binary logistic regression was used to identify independent influencing factors for intermediate-high-risk and high-risk APE; receiver operating characteristic (ROC) curve analysis was used to evaluate the efficacy of P/F ratio in assessing intermediate-high-risk and high-risk APE.</p><p><strong>Results: </strong>There were significant differences in dyspnea, syncope, and fever among the two groups (P<0.05). There were significant differences in P/F ratio, partial pressure of carbon dioxide (PaCO₂), pulse oxygen saturation/fraction of inspired oxygen (SpO₂/FiO₂) among the two groups (P<0.05). Correlation analysis showed that dyspnea, syncope, fever, P/F ratio, PaCO₂, and SpO₂/FiO₂ were correlated with the risk stratification (P<0.05). Multivariate binary logistic regression analysis showed that P/F ratio was an independent risk factor for intermediate-high-risk and high-risk APE (P=0.01). The area under the curve (AUC) of P/F ratio for predicting APE in the intermediate-high-risk group and the high-risk group was 0.850, the cut-off value was 256.41, the sensitivity was 74.2%, and the specificity was 81.6%.</p><p><strong>Conclusions: </strong>The P/F ratio has certain evaluative value in risk stratification of APE and can serve as a rapid and convenient method for predicting intermediate-high-risk and high-risk APE.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 7","pages":"4681-4688"},"PeriodicalIF":1.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847301","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":"Curative intent therapy of stage I-III non-small cell lung cancer: a patient-centered precision approach to assess, measure, and interpret benefits and harms.","authors":"Duc M Ha, Melissa L New, Simran K Randhawa, Edward D Chan, Edward C Dempsey, Mark M Fuster, Scott M Lippman, James D Murphy, M Patricia Rivera","doi":"10.21037/jtd-2025-213","DOIUrl":"10.21037/jtd-2025-213","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The number of people diagnosed with stage I-III non-small cell lung cancer (NSCLC) is increasing, in part due to greater implementation of lung cancer screening and earlier detection. Definitive surgery, radiation, or chemoradiation are increasingly utilized along with adjunctive therapies that include chemotherapy, radiation, immune checkpoint inhibitors (ICIs), and receptor tyrosine kinase inhibitors (rTKIs). However, remedial and adverse effects exist for each modality that must be accounted for in individual treatment plans with curative intent. The objective of this study was to characterize the benefits and harms of curative intent therapy using a novel patient-centered precision approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We incorporated a precision medicine model to evaluate the benefits and harms using data from phase III randomized controlled trials (RCTs) or individual participant data meta-analyses of RCTs. We followed standard recommendations to assess benefit and harm with the absolute risk reduction (ARR) or absolute risk increase (ARI), and number needed-to-treat (NNT) for beneficial effect (NNTB) or NNT for harmful effect (NNTH). To measure the net effect of benefit and harm, we incorporated a novel summary statistic-the NNT for net effect (NNTnet), calculated as: 1/(ARR - ARI), or 1/(1/NNTB - 1/NNTH). We referenced guideline recommendations and interpreted results from the perspective of a hypothetical patient faced with choosing between treatment options; decision-making accounted for overall survival (OS) effects, what most patients have reported as acceptable mortality risk (≤2%) to gain 1 year of life, and guideline-endorsed treatment-associated mortality risk (≤5%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We illustrated the NNTnet in screening and diagnosis. In definitive treatment, we identified: (I) overtreatment with lobectomy compared to segmentectomy in peripheral stage IA1-2 NSCLC (5-year OS: ARI, 3.2%; NNTH, 32); and (II) overtreatment with definitive tri-modality treatment for stage III NSCLC (i.e., induction chemoradiation followed by surgery), compared with concurrent chemoradiation without surgery, due to an excessively high 7-10% postoperative mortality with definitive tri-modality treatment and potential subsequent increased mortality within 1-year (two RCTs). In addition, we identified overtreatment with adjuvant radiation, compared to no adjuvant radiation, following complete resection of stage I-IIIB NSCLC (5-year OS: ARI, 5%; NNTB, 20) (14 RCTs). Furthermore, the harm of adjuvant radiation more than offsets the benefit of adjuvant chemotherapy (5-year OS: ARR, 4%; NNTB, 25): 1/(1/25 - 1/20), or -100. In other words, 100 patients treated with surgery and adjuvant radiation and chemotherapy, compared with surgery only, would result in one treatment-related death by 5 years. Finally, across four RCTs evaluating neoadjuvant chemo-ICI therapy, one in five participants with resectable IB-III","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 7","pages":"4473-4500"},"PeriodicalIF":1.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847195","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}