Rationale: With the advancement of targeted therapies, epidermal growth factor receptor tyrosine kinase inhibitors have become the preferred initial treatment for patients with advanced epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer. Osimertinib, a third-generation epidermal growth factor receptor tyrosine kinase inhibitor, is effective against exon 19 and 21 mutations as well as the T790M mutation. It has been approved by both the food and drug administration and European Medicines Agency for the treatment of non-small cell lung cancer patients with locally advanced or metastatic EGFR-mutated tumors, including those who have acquired T790M mutations. Patient concerns: To evaluate the effectiveness of osimertinib in treating patients with EGFR-mutated advanced lung adenocarcinoma and bone metastases, we present the treatment outcomes of 3 patients with EGFR 19 deletion-mutated advanced lung adenocarcinoma and bone metastases who received osimertinib treatment in recent years. All 3 cases involved elderly female patients, aged 62, 62, and 54, respectively. Diagnoses: All 3 cases exhibited a diagnosis of pulmonary adenocarcinoma accompanied by osseous metastases, with genetic testing revealing the presence of an EGFR 19del mutation. Interventions: In the first case, following 17 months of gefitinib therapy, disease progression prompted a switch to osimertinib treatment. In the second case, bone metastases were detected after 20 months of pemetrexed-carboplatin chemotherapy, leading to a transition to osimertinib therapy. In the third case, after 11 months of erlotinib treatment, bone metastases were identified. Subsequent interventions, including radiation therapy, pemetrexed-carboplatin chemotherapy, pemetrexed-bevacizumab maintenance therapy, and docetaxel chemotherapy, failed to arrest the progression of bone metastases. As a result, a combination of osimertinib and anlotinib targeted therapy was administered. Outcomes: All 3 patients experienced relatively good and favorable survival outcomes, with a progression-free survival of 22.7 months, 12 months, and 17.7 months, respectively. Lessons: These cases suggest that osimertinib is a promising treatment option for patients with EGFR 19 deletion-mutated lung adenocarcinoma and bone metastases, although further clinical studies are needed to confirm its efficacy.

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Background: Lymph node assessment is essential for determining treatment and evaluating the surgical scope in patients with lung cancer, thus significantly impacting survival prognosis. Surgical resection and endoscopic biopsy are the primary methods for obtaining lymph node samples, yet it remains controversial to determine which approach can provide greater benefit. This study aims to analyze the prognosis and survival outcomes of lung cancer patients who undergo assessment through the examination of resected regional lymph nodes, assessment via endoscopic examination, or assessment based on imaging modalities. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database, comprising 222,563 participants, were analyzed. The outcome variables were overall survival (OS) and lung cancer-specific mortality, while the primary variable was the method of lymph node assessment. Life table, Kaplan-Meier survival, and Cox proportional hazards analyses were conducted, with log-rank Mantel-Cox, Breslow generalized Wilcoxon, and Tarone-Ware tests being applied for intergroup comparisons. Results: Compared to endoscopic biopsy, lymph node resection examination reduced the risk of death by 15.7% (P<0.001) and the lung cancer-specific mortality rate by 15.5% (P<0.001). Lung cancer patients who underwent regional lymph node resection examination had higher OS rates at 1, 2, 3, 5, 10, and 15 years by 44%, 49%, 47%, 42%, 28%, and 20%, respectively, compared to those who underwent endoscopic biopsy. Additionally, their cancer-specific survival rates were higher at the corresponding time points by 13%, 16%, 17%, 17%, 18%, and 13%, respectively. The mean OS period for patients who underwent endoscopic lymph node biopsy was 25.071 months, whereas for lung cancer patients who underwent regional lymph node resection examination, the average OS was 87.403 months. Conclusions: In patients with lung cancer, lymph node resection examination significantly reduces mortality and improves survival as compared to endoscopic biopsy.

Pulmonary function, one of the main indicators of respiratory system assessment, is difficult to measure in specific cases. The study investigated the association between serum iron levels and pulmonary function. The cross-sectional study was conducted using data from 5319 participants from the 2010–2012 National Health and Nutrition Examination Survey. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and forced expiratory flow from 25% to 75% of FVC were used as indicators of pulmonary function to analyze the relationship of serum iron and pulmonary function. Univariate and stratified analyses, multiple equation regression analysis, smoothed curve fitting analysis, and threshold effect analysis were performed to explore the relationship between pulmonary function and serum iron concentrations. Threshold effect analysis revealed a nonlinear relationship between serum iron levels and FVC, as well as FEV1, with inflection points observed at 8.1 (µmol/L) and 8.4 (µmol/L), respectively. When serum iron concentrations fell below the inflection point, there was no statistically significant relationship between serum iron and FVC (P = .065) or FEV1 (P = .095) (P > .005). However, when serum iron concentrations exceeded the inflection point, both FVC (β = 6.87; 95% confidence interval [CI] = 3.95, 9.79; P < .0001) and FEV1 (β = 7.09; 95% CI = 4.54, 9.64; P < .0001) exhibited a positive correlation with increasing serum iron levels. Additionally, forced expiratory flow from 25% to 75% of FVC (mL/s) demonstrated a positive association with serum iron (β = 6.72; 95% CI = 2.30, 11.13; P = .0029). Serum iron level was positively correlated with pulmonary function within a certain range of serum iron concentration. Serum iron level may be a protective factor for pulmonary function.

Background: In this study, we developed the concept of “minimally invasive lung squamous cell carcinoma” (LUSC), analyzed gender disparities in the overall survival (OS) of patients with this condition, and constructed a survival prediction model for patients with this subtype using data from the Surveillance, Epidemiology, and End Results Program (SEER) database. Methods: The retrospective study analyzed 654 patients diagnosed with minimally invasive LUSC (LUSC meeting the criteria for T1mi in SEER database) between January 2018 and December 2020. Kaplan-Meier survival curves, univariate analysis, and stratified multivariate analysis were applied to evaluate the survival outcomes. A nomogram was created to estimate 14-month survival probabilities, with its effectiveness evaluated via the area under the receiver operating characteristic curve (AUC). Results: The OS rate for patients with minimally invasive LUSC was 65.14% over a maximum follow-up of 35 months. Female patients exhibited significantly better survival outcomes than did males, with a mean survival of 16.28±9.94 and 14.62±10.72 months, respectively (P=0.03). Stratified multivariate analysis revealed that males had a 40% higher risk of mortality than did females [hazard ratio (HR) =1.40, 95% confidence interval (CI): 1.06–1.85; P=0.02]. This disparity was more pronounced in the subgroups, including in male patients aged 60–69 years (HR =2.09; P=0.03) and those with moderately differentiated tumors (HR =2.31; P=0.003), among others. The survival prediction model, which incorporated 13 variables, achieved an AUC of 0.73, indicating good discriminatory performance. Conclusions: This study established concept of minimally invasive LUSC and identified gender as an independent prognostic factor, revealing that male patients have poorer OS. The proposed survival prediction model provides a tool for individualized prognostic assessment and treatment-related decision-making. These findings highlight the need for further refinement of LUSC classification and tailored treatment strategies to improve patient outcomes.