BMC Pulmonary Medicine最新文献

{"title":"Pulmonary alveolar proteinosis diagnosed during leuprorelin acetate therapy for ovarian endometrioma: a case report.","authors":"Xin Gao, Lei Wang, Zhiwei Li, Jing Zhou, Fuqiang Ren","doi":"10.1186/s12890-026-04507-5","DOIUrl":"10.1186/s12890-026-04507-5","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disorder characterized by impaired surfactant clearance due to alveolar macrophage dysfunction. Leuprorelin acetate, a gonadotropin-releasing hormone agonist, is widely used in the treatment of ovarian endometriosis; however, pulmonary findings associated with this therapy have not been well characterized. We report a case of PAP diagnosed during leuprorelin acetate therapy for ovarian endometrioma and describe its temporal relationship with treatment.</p><p><strong>Case presentation: </strong>A 29-year-old woman underwent laparoscopic surgery for an ovarian endometrioma in August 2025 and initiated leuprorelin acetate therapy three days postoperatively. A routine chest computed tomography (CT) performed one month later revealed scattered bilateral ground-glass opacities (GGOs), which persisted on repeat CT in November 2025. Although the patient remained asymptomatic, video-assisted thoracoscopic surgery (VATS) lung biopsy was performed to obtain a histopathological diagnosis and confirmed PAP. Serum anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) antibody testing was negative (3.2 µg/mL; reference range, ≤ 5 µg/mL), not supporting autoimmune PAP. During treatment, the patient developed transient Common Terminology Criteria for Adverse Events (CTCAE) grade 2 leukopenia (white blood cell nadir, 2.94 × 10⁹/L), which resolved spontaneously after completion of leuprorelin acetate therapy without intervention. Hematological evaluation did not suggest an underlying clonal disorder, including myelodysplastic syndrome. Because baseline chest imaging was unavailable, pre-existing subclinical PAP could not be excluded. Follow-up CT performed three months after completion of therapy showed regression of GGOs.</p><p><strong>Conclusion: </strong>This case shows a temporal relationship between leuprorelin acetate therapy and non-autoimmune PAP. However, causality cannot be inferred in the absence of baseline imaging. Only a temporal association can be observed. This observation is hypothesis-generating and highlights a potential rare pulmonary finding observed in the context of gonadotropin-releasing hormone agonist therapy.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468926","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":"Cumulative intraoperative oxygen exposure acts as a predictor for postoperative acute exacerbation of interstitial lung disease: a retrospective cohort study.","authors":"Ryotaro Katsuya, Naoki Ozeki, Tomohito Okubo, Kiichi Tatakawa, Chihiro Furuta, Hideaki Note, Toyofumi Fengshi Chen-Yoshikawa, Takayuki Fukui","doi":"10.1186/s12890-026-04482-x","DOIUrl":"10.1186/s12890-026-04482-x","url":null,"abstract":"<p><strong>Background: </strong>Excessive oxygen administration during surgery may induce lung damage via oxidative stress; however, limited evidence exists on how intraoperative oxygen usage and preoperative pulmonary function predict acute exacerbation (AE) in patients with interstitial lung disease (ILD). This study evaluated whether intraoperative oxygen use and preoperative pulmonary function could predict postoperative AEs in patients with ILD who underwent lung surgery.</p><p><strong>Methods: </strong>We retrospectively analyzed 78 patients with ILD who underwent lung surgery between 2014 and 2022. Clinical variables, including intraoperative oxygen usage and preoperative pulmonary function tests, were assessed for their association with AEs occurring within 1 month (1mAE) and 1 year (1yAE) postoperatively using Firth's bias-reduced logistic regression.</p><p><strong>Results: </strong>Eight patients (10%) had 1mAE, and 14 (18%) had 1yAE. Multivariable analysis showed that lower %vital capacity (%VC) consistently predicted both 1mAE and 1yAE, whereas lower %diffusing capacity for carbon monoxide (%DLCO) significantly predicted only 1yAE. Notably, total oxygen administration > 990 L exhibited a marginal association with 1mAE (OR 2.12, 95% CI: 0.93-4.99, p = 0.071). Even after adjusting for operative and anesthesia durations, total oxygen volume remained a significant independent predictor for 1yAE (OR 2.29, 95% CI: 1.09-4.93, p = 0.029). No significant associations were found between AEs and factors such as the mean fraction of inspired oxygen (FiO₂), forced expiratory volume in 1 s, sex, preoperative steroid use, computed tomography patterns, serum Krebs von den Lungen-6 levels, or surgical procedures.</p><p><strong>Conclusions: </strong>Cumulative intraoperative oxygen administration (rather than mean FiO2) serves as an independent predictor of long-term postoperative AEs in patients with ILD. These findings suggest that cumulative oxygen exposure may contribute to long-term postoperative risk through mechanisms related to oxidative stress.</p><p><strong>Trial registration: </strong>Aichi Medical University 2025-011.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468865","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":"Trends in mortality involving coexisting lung cancer and sepsis in the United States: a CDC WONDER analysis, 1999-2024.","authors":"Rasheeda Shehroz","doi":"10.1186/s12890-026-04470-1","DOIUrl":"10.1186/s12890-026-04470-1","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer and sepsis are major contributors to morbidity and mortality worldwide. Their coexistence represents a significant clinical challenge, as patients with lung cancer may be at increased risk of developing sepsis because of cancer-related immune dysfunction, treatment-related immunosuppression, and frequent healthcare exposure. Sepsis in these patients is associated with poor outcomes, increased health care utilization, and higher mortality rates.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of death certificates from the Centers for Disease Control and Prevention (CDC) WONDER database to evaluate mortality associated with the co-occurrence of lung cancer and sepsis among adults aged ≥ 45 years in the United States from 1999 to 2024. Age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) were calculated and stratified by year, sex, race/ethnicity, census region, state, and metropolitan status.</p><p><strong>Results: </strong>AAMR increased from 1.6 to 2.0 per 100,000 population between 1999 and 2024. Among males, the AAMR increased from 2.3 in 1999 to 2.4 in 2024, while among females, it rose from 1.1 to 1.6 over the same period. Racial disparities were evident, with non-Hispanic Black or African American adults experiencing the highest AAMR (2.6). Regionally, the South had the highest mortality burden (AAMR 2.2), while Kentucky and Mississippi reported the highest state-level rates (3.98 and 3.14, respectively). Mortality rates were higher in non-metropolitan areas (AAMR 1.9) compared with metropolitan areas (1.7).</p><p><strong>Conclusions: </strong>Mortality associated with coexisting lung cancer and sepsis has increased over time, with notable disparities across demographic and geographic groups. These findings highlight the need for targeted public health strategies and improved access to care to reduce mortality in high-risk populations.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454614","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":"Sequential Talaromyces marneffei and Legionella pneumophila infections leading to the diagnosis of anti-interferon-γ autoantibody-associated immunodeficiency: a case report.","authors":"MingJing Yu, YuLing Xiao, Ya Liu, ZhongHao Wang, Haixia Zhou, YongJiang Tang","doi":"10.1186/s12890-026-04455-0","DOIUrl":"10.1186/s12890-026-04455-0","url":null,"abstract":"<p><strong>Background: </strong>Opportunistic infections caused by uncommon intracellular pathogens can serve as important clues to underlying immune dysfunction.</p><p><strong>Case presentation: </strong>We report a 57-year-old male who presented with chronic cough, dyspnea, fever, and weight loss. Chest imaging revealed diffuse pulmonary infiltrates and mediastinal lymphadenopathy, mimicking tuberculosis or lymphoma. Despite empirical anti-tuberculosis and broad-spectrum antibiotic therapy, his condition deteriorated. Metagenomic next-generation sequencing (mNGS) and culture confirmed Talaromyces marneffei infection. During antifungal therapy, he developed Legionella pneumophila pneumonia-an unusual sequential infection that raised suspicion of an immune defect. Comprehensive immunological evaluation revealed anti-interferon-γ (anti-IFN-γ) autoantibodies, supporting the diagnosis of AIGA-associated immunodeficiency. The patient had also shown repeatedly indeterminate interferon-γ release assay (IGRA) results, retrospectively suggesting impairment of the IFN-γ pathway.</p><p><strong>Conclusions: </strong>This case illustrates that recurrent or sequential infections with intracellular pathogens, particularly Talaromyces marneffei and Legionella pneumophila, should prompt evaluation for cell-mediated immunodeficiency such as AIGA syndrome. Early recognition may facilitate tailored antimicrobial therapy, immunological follow-up, and consideration of immunomodulatory treatment in selected patients.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468952","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":"Progressive pulmonary fibrosis criteria predict mortality in treated idiopathic pulmonary fibrosis: a prospective cohort study.","authors":"Yu-Cheng Wu, Chen-Yu Wang, Yi-Luen Shen, Chiann-Yi Hsu, Yi-Hsuan Yu, Pin-Kuei Fu","doi":"10.1186/s12890-026-04501-x","DOIUrl":"10.1186/s12890-026-04501-x","url":null,"abstract":"<p><strong>Background: </strong>The 2022 ATS/ERS/JRS/ALAT criteria for progressive pulmonary fibrosis (PPF) were developed for fibrotic interstitial lung diseases other than idiopathic pulmonary fibrosis (IPF). Whether this multidimensional framework has prognostic value in patients with treated IPF remains uncertain. We evaluated the prevalence of PPF-defined progression and its association with mortality in patients with IPF receiving antifibrotic therapy.</p><p><strong>Methods: </strong>This prospective cohort study included patients with multidisciplinary discussion-confirmed IPF enrolled in the Registry of Interstitial Lung Disease (REGILD) between 2018 and 2022. Disease progression was assessed one year after initiation of antifibrotic therapy using the 2022 PPF criteria. The primary outcome was 3-year all-cause mortality. Cox regression and nested Cox model analyses were performed to identify prognostic factors and evaluate incremental prognostic value beyond the GAP score.</p><p><strong>Results: </strong>Ninety patients were included, of whom 50 (55.6%) fulfilled PPF criteria after one year of antifibrotic therapy. During a median follow-up of 3.6 years, 28 patients (31.1%) died. Three-year mortality was significantly higher in patients with PPF-defined progression than in those with stable disease (46.0% vs. 12.5%, p = 0.001). In multivariable analysis, lower baseline body mass index (BMI) (HR 0.87, 95% CI 0.78-0.96, p = 0.006) and PPF-defined progression (HR 3.39, 95% CI 1.23-9.34, p = 0.018) were independently associated with mortality. Addition of PPF-defined progression to a model containing the GAP score significantly improved model fit (Δχ² = 5.610, p = 0.018).</p><p><strong>Conclusions: </strong>PPF-defined progression and lower baseline BMI were independently associated with mortality in patients with IPF receiving antifibrotic therapy. PPF-defined progression provided incremental prognostic information beyond the GAP score, suggesting that assessment of longitudinal disease trajectory may complement conventional baseline risk stratification in treated IPF.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468890","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":"An interpretable prognostic model for early unfavorable outcomes after bronchiectasis surgery.","authors":"Yichen Hou, Qibatu Wu, Long Ma, Liwei Zhang, Yanchao Deng","doi":"10.1186/s12890-026-04508-4","DOIUrl":"10.1186/s12890-026-04508-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Bronchiectasis is a heterogeneous airway disorder characterized by irreversible bronchial dilatation, chronic sputum production, recurrent infections, and acute exacerbations. Although lung resection remains a valuable option for patients with localized, refractory disease despite optimized medical therapy, early postoperative recovery varies substantially among individuals. An interpretable tool for individualized risk stratification remains lacking in clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study enrolled patients who underwent bronchiectasis-related lung resection at our center between January 2020 and August 2025 (n = 142). The primary endpoint was a composite outcome assessed at approximately 1 month postoperatively. A favorable outcome was defined as the absence of Clavien-Dindo grade II or higher complications in conjunction with a Quality of Life Questionnaire-Bronchiectasis Respiratory Symptoms Scale (QoL-B-RSS) score &gt; 50; all other cases were classified as unfavorable outcomes. Candidate predictors (n = 40) were prespecified before model development. Elastic Net-penalized logistic regression was employed as the primary modeling approach, based on which a nomogram was constructed. Nested cross-validation was used for hyperparameter tuning and internally unbiased performance evaluation. Out-of-fold (OOF) predicted probabilities were used to assess discrimination (area under the curve [AUC]), overall accuracy (Brier score), calibration, and clinical utility via decision curve analysis (DCA). A random forest (RF) model, using identical outer-fold partitions, was developed as a direct comparator, and a conventional multivariable logistic regression model was additionally fitted using the predictors retained in the primary model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The incidence of early unfavorable outcomes was 57.7% (82/142). The final Elastic Net model retained five predictors: pCO₂, left ventricular ejection fraction (LVEF), forced expiratory volume in 1 s as a percentage of predicted (FEV1%pred), maximal voluntary ventilation as a percentage of predicted (MVV%pred), and total Bronchiectasis Severity Index (BSI) score. Internal OOF validation yielded an AUC of 0.820 and a Brier score of 0.173 for the primary model, compared with an AUC of 0.831 and a Brier score of 0.179 for the RF model. Overall, the RF model did not demonstrate a meaningful performance advantage over the primary model. Calibration analysis indicated good agreement between predicted and observed probabilities, and DCA suggested potential net clinical benefit across a range of threshold probabilities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This internally validated Elastic Net-based nomogram showed good discrimination, acceptable calibration, and potential clinical utility for predicting early unfavorable outcomes after bronchiectasis surgery. Based on routinely available preoperative variables, the model may provide","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468846","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":"Biomarkers associated with post-operative pneumonia: a systematic review and meta-analysis.","authors":"Fiona Howroyd, Amanda Veiga Sardeli, Fang Gao Smith, Tonny Veenith, Niharika A Duggal, Zubair Ahmed","doi":"10.1186/s12890-026-04486-7","DOIUrl":"10.1186/s12890-026-04486-7","url":null,"abstract":"<p><strong>Background: </strong>Post-operative pneumonia is a commonly occurring surgical complication associated with poor patient outcomes. This study aimed to synthesise pre-operative and post-operative blood-based biomarkers associated with post-operative pneumonia.</p><p><strong>Methods: </strong>Electronic databases were searched up to April 14th, 2026. Primary studies investigating blood-based biomarkers in adults hospitalised after surgery were included. Meta-analysis was performed using the random effects model to compare pooled data for pneumonia and no-pneumonia groups using standardised mean difference. Risk of bias was assessed using the ROBINS-E tool.</p><p><strong>Results: </strong>Thirty-seven studies (n = 15,842 patients) were included, with an overall pneumonia rate of 17.8% [15.8-20.0%]. One hundred and fifteen biomarkers were identified. Meta-analysis identified that patients who developed post-operative pneumonia had significantly lower platelet-to-neutrophil ratio (p < 0.0001), red blood cell count (p = 0.001), haemoglobin (p = 0.002), albumin (p = 0.005) and lymphocyte count (p = 0.008) and significantly higher monocyte-to-lymphocyte ratio (p < 0.0001), systemic immune inflammation index (p < 0.001), systemic inflammatory response index (p < 0.0001) and blood urea nitrogen (p = 0.0001) at pre-operative baseline, compared to those without pneumonia. Patients who developed post-operative pneumonia were associated with significantly higher procalcitonin (PCT) at post-operative day one (p = 0.03), two (p = 0.0001), three (p = 0.0004) and six (p < 0.0001); higher C-Reactive Protein (CRP) at day two (p = 0.02), four (p < 0.0001) and five (p < 0.0001); higher interleukin (IL)-6 at day three (p = 0.001) and four (p = 0.0002); and higher white blood cell (WBC) count at day three (p = 0.01) and day four (p = 0.001) post-operatively, compared to those without pneumonia. In addition, pre-operative CRP was associated with mortality within the patients who later developed post-operative pneumonia (r = 0.70, p = 0.0009).</p><p><strong>Conclusions: </strong>The results identify blood-based biomarker signals associated with post-operative pneumonia. However, interpretation is limited by heterogeneous pneumonia definitions and inconsistent reporting of diagnosis timing across studies. The certainty of evidence is therefore limited, and thus these biomarkers cannot currently be used for prediction or diagnosis in clinical practice. Further high‑quality, prospective studies are required to establish clinically meaningful thresholds.</p><p><strong>Protocol registration: </strong>PROSPERO: CRD42024570654.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468854","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":"An integrated host vulnerability score is associated with survival in advanced NSCLC treated with nivolumab: a PET/CT-based real-world study.","authors":"Vali Aliyev, Murad Guliyev, Mehmet Cem Fidan, Zeliha Birsin, Murat Günaltılı, Emir Çerme, Selin Cebeci, Hamza Abbasov, Said Erkam Bıyıkoğlu, Onur Erdem Şahin, Muhammet Sait Sağer, Nebi Serkan Demirci, Özkan Alan","doi":"10.1186/s12890-026-04496-5","DOIUrl":"10.1186/s12890-026-04496-5","url":null,"abstract":"<p><strong>Background: </strong>Clinical outcomes in advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors remain heterogeneous, and simple prognostic tools for patient stratification are limited. We aimed to evaluate a multidimensional host vulnerability score integrating systemic inflammation, nutritional status, and skeletal muscle depletion in patients receiving second-line nivolumab in a real-world setting.</p><p><strong>Methods: </strong>In this retrospective study, 110 patients with advanced NSCLC treated with second-line nivolumab were included. A composite score was constructed using neutrophil-to-lymphocyte ratio (NLR), serum albumin, and skeletal muscle index (SMI) derived from pretreatment PET/CT. Patients were stratified into lower-risk (score 0-1) and higher-risk (score 2-3) groups. Survival outcomes were assessed using Kaplan-Meier analysis, Cox proportional hazards models, and model discrimination analyses.</p><p><strong>Results: </strong>High-risk patients had significantly shorter progression-free survival (median 3.4 vs. 5.9 months; HR 1.68, 95% CI 1.10-2.59; p = 0.017) and overall survival (median 7.2 vs. 14.5 months; HR 2.08, 95% CI 1.30-3.31; p = 0.002) compared with the low-risk group. In model comparison analyses, the ordinal composite score showed the clearest improvement in prognostic discrimination for overall survival, whereas its incremental value for progression-free survival was more modest.</p><p><strong>Conclusion: </strong>A multidimensional host vulnerability score integrating inflammatory, nutritional, and body composition domains was associated with survival outcomes in advanced NSCLC treated with nivolumab. This score may support real-world prognostic risk stratification, particularly for overall survival, but requires prospective and external validation before clinical implementation.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454695","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":"Diagnostic and prognostic value of the injury-inflammation-fibrosis serum biomarker panel (KL-6, SAA, YKL-40) in lung cancer treatment-associated ILD.","authors":"Shuilian Wu, Jing Jin, Lingli Wu, Xiangjiang Zeng, Qiang Hou, Lei Shu","doi":"10.1186/s12890-026-04479-6","DOIUrl":"10.1186/s12890-026-04479-6","url":null,"abstract":"<p><strong>Objective: </strong>Cancer therapy-related interstitial lung disease (CT‑ILD) is a serious and potentially fatal complication in lung cancer patients treated with radiotherapy or antineoplastic agents, characterized by high mortality and limited treatment options. Early recognition remains challenging due to the absence of sensitive and specific biomarkers. This study aimed to establish a tripartite serum biomarker panel-KL‑6 (lung injury), SAA (inflammation), and YKL‑40 (fibrosis)-representing the \"injury-inflammation-fibroproliferation\" axis, and to evaluate its diagnostic and prognostic value for CT‑ILD.</p><p><strong>Methods: </strong>In this single-center observational case-control study, we consecutively enrolled hospitalized patients with histologically confirmed lung cancer who underwent thoracic radiotherapy and/or systemic anti-neoplastic therapy between January 2024 and June 2025. Based on imaging findings, patients were classified into the ILD group (n = 73) or N‑ILD group (n = 67). Serum KL‑6, SAA, and YKL‑40 were quantified alongside conventional inflammatory markers (CRP, IL‑6). ROC analysis evaluated diagnostic performance. Logistic regression identified independent ILD correlates. Subgroup analyses delineated etiological differences, comparing radiotherapy-induced ILD (RT‑ILD) with drug-induced ILD (DI‑ILD), and further explored their associations with clinical benefit as an exploratory endpoint.</p><p><strong>Results: </strong>KL‑6, SAA, YKL‑40, and IL‑6 were significantly elevated in ILD compared with N‑ILD (all P < 0.05). ROC analysis yielded AUCs of 0.764 for KL‑6, 0.880 for SAA, and 0.718 for YKL‑40, with optimal cut‑offs of 349.5 U/L, 18.7 mg/L, and 71.65 ng/mL, respectively (all P < 0.001). Independent correlates of ILD included SAA > 18.7 mg/L (OR = 32.321), KL‑6 > 349.5 U/L (OR = 5.842), and YKL‑40 > 71.65 ng/mL (OR = 5.250). In the overall cohort, the combined model (KL-6 + SAA + YKL-40) showed good calibration (Hosmer-Lemeshow P > 0.05) but did not significantly outperform SAA alone in AUC (DeLong test, P > 0.05). SAA maintained high diagnostic value in both RT-ILD (AUC = 0.834) and DI-ILD (AUC = 0.891) subgroups. In exploratory analyses, higher KL-6 levels and the presence of multiple metastases were associated with a lack of durable clinical benefit (both P < 0.05).</p><p><strong>Conclusion: </strong>The KL‑6/SAA/YKL‑40 biomarker panel demonstrates exploratory utility for early CT‑ILD detection. SAA alone shows high diagnostic performance, while the combined model offers acceptable calibration. The panel may support risk stratification and timely individualized management during chemo‑/radiotherapy.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468879","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":"Association between corticosteroid exposure during chest-tube placement and pleurodesis failure in malignant pleural effusion: a retrospective analysis.","authors":"Kosuke Dobashi, Yuichiro Takeshita, Yoshikazu Utsu, Yuta Otake, Reiya Kono, Keita Katsuyama, Yuri Suzuki, Mitsuhiro Abe, Jiro Terada","doi":"10.1186/s12890-026-04480-z","DOIUrl":"https://doi.org/10.1186/s12890-026-04480-z","url":null,"abstract":"<p><strong>Background: </strong>Clinical evidence of the impact of corticosteroid use and pleurodesis outcomes in malignant pleural effusion (MPE) remains limited. This study aimed to explore the relationship between corticosteroid exposure and pleurodesis outcomes in patients with MPE.</p><p><strong>Methods: </strong>This retrospective cohort study included 138 consecutive patients with MPE who received pleurodesis between April 2012 and September 2024. Based on pleurodesis outcomes, the 138 patients were divided into two groups as follows: success group (n = 99) and failure group (n = 39). Failure was defined as recurrent pleural effusion within 28 days after chest-tube removal, tube removal owing to intolerance, or death with chest-tube in situ; the other outcomes were defined as constituting success. Patients who received systemic corticosteroids during chest-tube usage were classified as steroid users. The cumulative corticosteroid dose was calculated as the prednisolone (PSL)-equivalent dose multiplied by the duration of steroid administration.</p><p><strong>Results: </strong>Multivariate analysis of 138 patients demonstrated that poor performance status (PS), such as PS 3-4, and multi-day steroid use during chest-tube usage were associated with pleurodesis failure in patients with MPE. Furthermore, a subgroup analysis of 15 patients who received steroids during chest-tube usage showed that the cumulative steroid dosage was positively correlated with chest-tube usage duration.</p><p><strong>Conclusions: </strong>In this retrospective cohort study, multi-day corticosteroid exposure during chest-tube placement was associated with pleurodesis failure in patients with MPE. These findings should be considered hypothesis-generating and interpreted with caution because of potential confounding factors. Further prospective multicenter studies are needed to clarify this association.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}