Background: We aim to establish neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) related nomograms based on the clinical data and peripheral blood markers to predict the survivals of patients with limited-stage small-cell lung cancer (LS-SCLC). Methods: A total of 299 LS-SCLC patients after surgery were enrolled in this study. Univariate and multivariate analyses were conducted to select independent prognostic factors to develop the nomograms and then subjected to bootstrap internal validation. The optimal cutoff value of NLR and PLR before surgery was calculated by X-tile (version 3.6.1) and the overall survival (OS) was analyzed by Kaplan-Meier method and compared by log-rank test. Results: According to the X-tile calculation, the NLR value and PLR cutoff values are 2.6 and 156.7, respectively. The prognosis of patients with elevated NLR or PLR value was significantly worse than patients with lower NLR (HR =1.798, 95% CI: 1.284–2.518, P=0.001) or PLR (HR =1.781, 95% CI: 1.318–2.407, P<0.001) value. Two Nomograms were developed according to the two multivariate cox regression models based on NLR and PLR. Concordance index (C-index) curves and calibration curves show that the two models have a better effect in predicting prognosis. At the same time, compared with the tumor node metastasis (TNM) staging system, our models also show better accuracy and stability. Conclusions: Elevated NLR and PLR predict poor prognosis in their respective nomograms in patients with LS-SCLC.

Background: To determine the clinical prognosis after sublobectomy versus lobectomy in elderly patients ≥75 years old with stage I invasive lung adenocarcinoma ≤3 cm in size. Methods: In patients ≥75 years old, 255 patients were diagnosed with stage I invasive lung adenocarcinoma ≤3 cm in size between 2010 and 2014 in Shanghai Chest Hospital, they were all treated with sublobectomy or lobectomy. Potential confounding factors that consisted in the baseline characteristics of these two groups was balanced by the method of propensity score matching (PSM). The stratified analysis was conducted to compare the relapse-free survival (RFS) and lung cancer special survival (LCSS) rates in the sublobectomy and lobectomy groups. Results: As for the 255 patients, 112 cases conducted sublobectomy and 143 with lobectomy. Significant difference existed in RFS before (P=0.002) and after (P=0.010) PSM. Similarly, we still recognized significant difference in LCSS between the two groups before (log-rank P<0.001) or after (log-rank P=0.002) PSM. We still identified different RFS or LCSS rates between the stratified tumor size group and the stratified lymph node dissection group after adjustment of PSM. Conclusions: Lobectomy showed a survival advantage for sublobectomy for patient ≥75 years old with stage I lung adenocarcinoma ≤3 cm in size. Considering that lobectomy could get a better prognosis, it should be preferable for the treatment of patient ≥75 years old with stage I lung adenocarcinoma ≤3 cm in size.

Background: The clinicopathological features, immunohistochemical (IHC) characteristics and survival outcomes of primary lung adenocarcinoma with signet ring cells (LAdSRCs) component were analyzed. Methods: A retrospective analysis of primary LAdSRCs consecutively collected from 2010 to 2014 was performed and compared with lung adenocarcinoma (ADC). We investigated the survival outcomes and the expression of cytokeratin 7 (CK7), CK20, thyroid transcription factor-1 (TTF-1) and villin in these 35 cases of primary LAdSRCs. Results: We identified 1,715 patients in total, 35 (2.0%) of whom had signet ring cell (SRC) component. Excepting for 2 cases without IHC information, a CK profile (CK7+/CK20–) were identified in 69.7% (23/33) of LAdSRC; 22 (66.7%) of 33 LAdSRCs exhibited positive TTF-1 expression, but no other TTF-1 positive was found in signet ring cell carcinoma (SRCC) of other organs, and villin was not identified in these 33 cases. Age, sex, tumor size, surgery resection, smoking history, tumor stage, nodal stage, predominant histology subtype, pathology and adjuvant therapy were all significant predictors of relapse-free survival (RFS) and overall survival (OS) in univariable analysis. Compared to lung ADC, the lung ADCs with SRC component had an inferior prognosis. In multivariable analysis, sex, tumor size, tumor stage, nodal stage, predominant histology subtype and adjuvant therapy were still significant predictors for both RFS and OS while the pathology [RFS: hazard ratio (HR), 0.918; 95% confidence interval (CI), 0.581–1.492; P=0.712; OS: HR, 1.392; 95% CI, 0.820–2.364; P=0.221, respectively] was not. Conclusions: Univariable analysis revealed primary LAdSRC is a rare ADC subtype with a worse prognosis compared with ADC. The high percentage expression of TTF-1 and immunostaining profiles CK7+/CK20- in primary LAdSRC is significant to identify the source of SRCCs.

Background: Accurate preoperative prediction of the invasiveness of lung nodules on computed tomography (CT) can avoid unnecessary invasive procedures and costs for low-risk patients. While previous studies approached this task using cross-sectional data, this study aimed to utilize the commonly available longitudinal data of lung nodules through sequential modeling based on long short-term memory (LSTM) networks. Methods: We retrospectively included 171 patients with lung nodules that were followed-up at least once and pathologically diagnosed with adenocarcinoma for model development. Pathological diagnosis was the gold standard for deciding lung nodule invasiveness. For each nodule, a handful of semantic features, including size intensity and interval since first discovery, were obtained from an arbitrary number of CT scans available to individual patients and used as input variables to pre-operatively predict nodule invasiveness. The LSTM-based classifier was optimized by extensive experiments and compared to logistic regression (LR) as baseline with five-fold cross-validation. Results: The best LSTM-based classifier, capable of receiving data from an arbitrary number of time points, achieved better preoperative prediction of lung nodule invasiveness [area under the curve (AUC), 0.982; accuracy, 0.924; sensitivity, 0.946; specificity, 0.881] than the best LR (AUC, 0.947; accuracy, 0.906; sensitivity, 0.938; specificity, 0.847) classifier. Conclusions: The longitudinal data of lung nodules, though unevenly spaced and varying in length, can be well modeled by the LSTM, allowing for the accurate prediction of nodule invasiveness. Given that the input variables of the sequential modelling consist of a few semantic features that are easily obtained and interpreted by clinicians, our approach is worthy further investigation for the optimal management of lung nodules.

BACKGROUND:We investigated the correlation between cavity formation, prognosis, and tumor stage for pathologic stage I invasive lung adenocarcinomas (IADCs) ≤3 cm in size. MATERIAL AND METHODS:2106 candidates with pathologic stage I IADC were ident...

Background: We aimed to study the clinical features and survival outcomes of patients with early-stage primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma who underwent surgery.Methods: This is a retrospective, single-center study including 32 patients with early-stage primary pulmonary MALT lymphoma. Univariate and multivariate Cox analyses were performed to select independent prognostic factors. The overall survival (OS) was analyzed by the Kaplan-Meier method and was compared with the log-rank test.Results: Among the 32 patients included, there were 16 men (50.0%) and 16 women (50.0%). The average age was 59.2 years old. Ten patients had non-specific clinical symptoms including cough, expectoration, and chest pain, and four patients had B symptoms. CT images are not specific and can be shown as peripheral, central, solid, and ground glass but more peripheral (93.8%) and solid (75.0%). In prognostic analysis, univariate analysis showed that tumor stage and size were associated with relapse-free survival (RFS) and OS [hazard ratio (HR) = 1.105, 95% CI: 1.021–1.197, P = 0.011; HR = 1.211, 95% CI: 1.158–1.968, P = 0.003, respectively]. It seems to indicate that higher stage and larger size indicate a worse prognosis, but we could not find statistically significant predictors in multivariate analysis. Sublobectomy was performed in 21 (65.6) cases, lobectomy was performed in the other 11 (34.4) cases, both of them can achieve good prognosis (5-year RFS and OS are both 100%), and there is no significant difference between them.Conclusions: The clinical manifestation of early-stage primary pulmonary MALT lymphoma is not significantly specific, and surgical resection is an effective treatment.