Objectives: The ratio of positive and resected lymph nodes (LN ratio) has been shown to be prognostic in non-small cell lung cancer (NSCLC). Contrary to the LN ratio, calculating the LN log-odds ratio (LN-LOR) additionally considers the total number of resected lymph nodes. We aim to evaluate LN-LOR between positive and resected lymph nodes as a prognostic factor in operable NSCLC. Methods: Patients with NSCLC who underwent curative intent lobectomy treated at two high-volume centers were retrospectively studied. LN-LOR was dichotomized according to impact on OS and further combined with N descriptors and correlated with clinical variables and survival. Results: 944 patients were included. Cut-off analysis revealed that an LN-LOR of −0.34 significantly discriminated patients according to OS (p < 0.001, chi-squared test 41.26). When combined with N1 and N2 descriptors, LN-LOR low risk (median OS not reached and 83 months) and LN-LOR high-risk patients (median OS 50 and 59 months) had similar survival irrespective of the anatomical location of the positive lymph nodes. Multivariable Cox regression analysis revealed that age (HR 1.02, 95% CI 1.001–1.032), sex (male, HR 1.65, 95% CI 1.25–2.19), histological subtype (HR 2.11, 95% CI 1.35–3.29), pathological stage (HR 1.23, 95% CI 1.01–1.45) and LN-LOR risk groups (low risk, HR 0.48, 95% CI 0.32–0.72) were independent prognostic factors for OS. Conclusions: This retrospective two-center analysis shows that LN-LOR is significantly associated with OS in resectable NSCLC and might better reflect the biological behavior of the disease, regardless of anatomical lymph node locations. This finding may additionally support the value of extensive LN dissection.

Background: Pleural mesothelioma (PM) is a rare type of cancer with poor prognosis. Prognostic and predictive biomarkers could improve treatment strategies in these patients. Programmed death ligand 1 (PD-L1), integrin-linked kinase (ILK) and breast cancer gene 1-associated protein (BAP-1) have been proposed to predict outcomes in PM, but existing data are limited and controversial. Design and Methods: This single-center, retrospective study analyzed data on expression patterns and the prognostic role of PD-L1, ILK and BAP-1 in consecutive patients diagnosed with PM. Results: Of all patients (n = 52) included, more than half showed a positive PD-L1 expression (52% TPS ≥ 1%, 65% CPS ≥ 1), 69% showed a BAP-1 loss and 80% an ILK ≥ 50%. Positive PD-L1 expression was more frequent in the non-epithelioid subtype (p = 0.045). ILK intensity (p = 0.032) and positive PD-L1 (p = 0.034) were associated with more advanced tumor stages. The median overall survival (OS) was 16.9 (95% CI 13.1–25.2) months. Multimodality therapy (MMT) including surgery and early stage were independent prognostic factors for longer OS (MMT: HR 0.347, 95% CI 0.13–0.90, p = 0.029; advanced stage: HR 4.989; 95% CI 1.64–15.13, p = 0.005). Patients with an expression of PD-L1 TPS ≥ 1% or BAP-1 positivity showed numerically worse survival with a median OS of 15.3 (11.5; 24.4) vs. 20.0 (11.2; 34.9) and 11.3 (5.6; 31.0) vs. 20.0 (15.2; 28.1) months, respectively. Furthermore, PD-L1 was associated with worse survival in patients receiving MMT (PD-L1 TPS ≥ 1%: 15.8 (12.1–25.4) vs. 31.3 (17.4–95.4) p = 0.053). ILK expression ≥50% did not influence survival. The combinations of CPS ≥ 1% with BAP-1 positivity or ILK expression ≥50% were associated with worse survival (p = 0.045, p = 0.019). Conclusions: In this real-world analysis, expressions of PD-L1 and BAP-1 were associated with worse survival in patients with PM. ILK showed no prognostic value. Further studies with larger cohorts are needed to identify prognostic and predictive biomarkers facilitating optimized individual treatment decision in this rare type of cancer.

Rationale: The success of tyrosine kinase inhibtors in the neoadjuvant and adjuvant setting provides a rationale for exploring selpercatinib in the perioperative setting to improve patient outcomes in early-stage lung cancer. However, selpercatinib is currently only approved as first-line treatment for advanced rearrangement during transfection (RET) fusion-positive non-small cell lung cancer (NSCLC), limiting its use and potential benefit for earlier stage patients. Hence, this case report explores selpercatinib’s potential use in early-stage disease to address this treatment gap and improve patient outcomes. Patient concerns: We report the case of a 75-year-old female with no history of smoking who was referred to our institute with a chest computed tomography scan revealing a mass in the right lower lung lobe. Diagnoses: The patient was diagnosed with RET fusion-positive lung adenocarcinoma based on findings from radiologic findings from computed tomography (CT) and positron emission tomography-CT scans, histopathological examination, and molecular profiling through next-generation sequencing. Interventions: The patient was treated with 4 cycles of carboplatin and pemetrexed. A follow-up CT scan revealed the progression of the mediastinal lymph node, leading to the decision to initiate selpercatinib treatment. Due to a major size reduction of the primary lesion and the absence of tumor cells in the lymph nodes, the patient underwent curative lobectomy and lymphadenectomy. Outcomes: Preoperative selpercatinib induced tumor regression, enabling surgical resection. Histopathological examination of the resected tumor revealed a major pathological response to preoperative selpercatinib treatment. Lessons: This case highlights the potential of selpercatinib in the perioperative setting, suggesting that it induces tumor regression and enabling of curative surgery in early-stage RET fusion-positive NSCLC. Our findings support the further investigation of selpercatinib in early stages and provide a rationale for future treatment strategies of early-stage RET fusion-positive NSCLC patients.

Background: Primary mediastinal liposarcoma is a rare malignancy of mesenchymal origin with local aggressive biological behavior which is often diagnosed as an incidental finding without any symptoms. Chemoresistance and low radiosensitivity of these tumors favors surgical resection as the only option for radical treatment. The potential need for extended resections of adjacent structures is not uncommon and could be challenging. Only a limited number of cases with successful vascular reconstruction for the treatment of mediastinal liposarcoma has been reported so far. Case Description: A 69-year-old female patient was admitted to our department with dry cough and a huge mediastinal mass for further investigation and treatment. Based on the results of preoperative examinations a mediastinal liposarcoma was suspected. The tumor was resected through median sternal incision with resection of the pericardium with subsequent mesh replacement and “en bloc” resection of the innominate vein with vascular graft reconstruction. The postoperative course was uneventful. Six months follow-up after surgery showed no signs of local recurrence or dissemination. Conclusions: Extended resection and vascular reconstruction for the surgical treatment of primary mediastinal liposarcoma is often necessary to ensure adequate radicality and to reduce the risk of local recurrence. Therefore, these patients should be treated in high-volume centers with sufficient experience.

Background: Disease recurrence is common after surgery for pleural mesothelioma (PM), and the evidence guiding post-recurrence management remains limited. Methods: We conducted a retrospective, single-center cohort study including patients with PM treated within a curative-intent multimodality treatment pathway including surgery aiming for a macroscopic complete resection when feasible between 2001 and 2024. Post-recurrence treatments were categorized as best supportive care only (BSC), systemic therapy alone, or local with or without systemic therapy. Survival and disease-free outcomes were analyzed in relation to treatment patterns and clinical prognostic factors. Results: Among 67 patients with a median follow-up time of 107 months from surgery, 58 (86.6%) developed disease recurrence. At first recurrence, 21 patients (36%) received local with or without systemic therapy, 26 (45%) systemic therapy alone, and 11 (19%) BSC. The median post-recurrence survival was 21.7 months for patients receiving local with or without systemic therapy, 10.8 months for systemic therapy alone, and 1.6 months for BSC. Lung-sparing surgery and a disease-free interval of at least 12 months were associated with improved post-recurrence survival and post-recurrence progression-free survival. Conclusions: In this real-world cohort of patients with PM and extended follow-up, active post-recurrence treatment was associated with longer post-recurrence survival in selected patients. However, conclusions regarding their comparative effectiveness are limited by the retrospective design, incomplete recurrence-related data, and patient selection at recurrence.

Background: Disease recurrence is common after surgery for pleural mesothelioma (PM), and evidence guiding post-recurrence management remains limited. Methods: We conducted a retrospective, single-center cohort study including patients with PM treated within a curative-intent multimodality treatment pathway including surgery aiming for macroscopic complete resection when feasible between 2001 and 2024. Post-recurrence treatments were categorized as best supportive care only (BSC), systemic therapy alone, or local with or without systemic therapy. Survival and disease-free outcomes were analyzed in relation to treatment patterns and clinical prognostic factors. Results: Among 67 patients with a median follow-up time of 107 months from surgery, 58 (86.6%) developed disease recurrence. At first recurrence, 21 patients (36%) received local with or without systemic therapy, 26 (45%) systemic therapy alone, and 11 (19%) BSC. Median post-recurrence survival was 21.7 months for patients receiving local with or without systemic therapy, 10.8 months for systemic therapy alone, and 1.6 months for BSC. Lung-sparing surgery and a disease-free interval of at least 12 months were associated with improved post-recurrence survival and post-recurrence progression-free survival. Conclusion: In this real-world cohort of patients with PM with extended follow-up, active post-recurrence treatment was associated with longer post-recurrence survival in selected patients. However, conclusions regarding comparative effectiveness are limited by the retrospective design, incomplete recurrence-related data, and patient selection at recurrence.