BackgroundLymph node (LN) metastasis is crucial in non-small cell lung cancer (NSCLC) prognosis and treatment, but the TNM system lacks LN quantity consideration. Our goal is to investigate the role of positive LNs (nPLN) and positive LN rate (LNR) in overall survival (OS) and assess whether they offer higher value in prognostic assessment of NSCLC than N-stage.MethodsPatients were stratified into four subgroups using X-Tile software. Statistical analysis was conducted using the Kaplan-Meier method, univariate analysis, and multivariate Cox regression analysis. Model performance was evaluated using the Harrell consistency index (C-index), Akaike information criterion (AIC), and Bayesian information criterion (BIC). The prognostic performance of the nodal classification was validated using overall survival as the endpoint.ResultsThe survival curves demonstrate distinct disparities between each nPLN and LNR category. A pronounced trend toward deteriorating overall survival from N-PLN 1 to N-PLN 2+ was observed across all tumor size categories. However, the differences between each LNR category were only significant for tumors & LE;3 cm and 5-7 cm. Notably, both nPLN and LNR classifications displayed a higher C-index, lower AIC, and lower BIC compared with the N staging. Furthermore, the LNR classification provided superior prognostic stratification when compared with the nPLN classification.ConclusionsOur results demonstrate that nPLN and LNR classifications may offer improved prognostic performance compared with the current N classification for LN-positive NSCLC patients. Nonetheless, more studies are needed to assess the feasibility of incorporating these classifications into the next TNM staging system. In this paper, we report on that the significant prognostic value of number of positive lymph nodes (nPLN) and lymph nodes rate (LNR) in predicting survival outcomes for LN-positive NSCLC patients who undergo surgery and these classifications may offer improved prognostic performance compared with the current N classification.image

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.

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.