Curative surgery followed by adjuvant osimertinib according to pathological stage (pStage) is standard for resectable epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC). Nevertheless, recurrence remains a concern even in Stage IA, for which adjuvant osimertinib is not indicated. We evaluated the utility of circulating tumor DNA (ctDNA) to predict recurrence in patients with resected pStage I-III EGFR-mutated NSCLC and examined prognostic value of preoperative biomarkers and pathological features. Between January 2017 and May 2020, 382 patients with lung tumors underwent surgery at Kanazawa University Hospital, including 88 with NSCLC harboring common EGFR mutations. Preoperative ctDNA was analyzed using droplet digital PCR, targeting EGFR mutations. Patients were followed for up to 6.4 years, and disease-free survival (DFS) and overall survival (OS) were evaluated. Preoperative ctDNA positivity was detected in 26.1 % and venous invasion in 39.8 %. ctDNA-positive patients had lower 60-month DFS (54.1 % vs. 84.1 %; HR = 3.25; 95 % CI, 1.13-9.21; p = 0.028) and 60-month OS (65.1 % vs. 95.9 %; HR = 6.10; 95 % CI, 1.11-33.46; p = 0.037). Venous invasion was independently associated with poorer DFS (HR = 8.73; 95 % CI, 1.81-41.93; p = 0.0068). In combined analyses, no recurrences occurred in the double-negative, whereas the double-positive had a lower 60-month DFS than the single-positive (HR = 3.61; 95 % CI, 1.19-10.93; p = 0.023). Preoperative ctDNA detection and pathological venous invasion provide complementary prognostic information, and venous invasion is an independent predictor of recurrence risk in EGFR-mutated NSCLC. Combined assessment may refine postoperative risk stratification and inform perioperative management.

Subacute cough is subdivided and distinguished from chronic cough, because post-infectious cough is considered to be the main cause of subacute cough and differs from acute and chronic cough. However, the details of the spectrum and frequency of causes of subacute cough remain unclear because only two studies on subacute cough have been published. Patients who presented with cough that lasted for 3-8 weeks and visited respiratory clinics or hospitals affiliated with the Japan Cough Society during 2 years were studied. A total of 148 patients were prospectively enrolled, and those who did not meet the definition of subacute cough were excluded. Ninety-seven (68.3%) patients with subacute cough progressed to chronic cough, and the main causative diseases were cough variant asthma in 44 patients, atopic cough in 24 patients, sinobronchial syndrome in 13 patients, and post-infectious cough in seven patients. Patients with cough variant asthma complicated by atopic cough and those in whom the cause of subacute cough was unknown tended to develop chronic cough. This study shows that post-infectious cough is less common than previously thought and the main causes of subacute cough are cough variant asthma, atopic cough, and sinobronchial syndrome and their complications. Cough variant asthma in combination with atopic cough also can be a precursor of refractory chronic cough. The careful diagnosis and treatment of two or more causative diseases is required in patients with subacute cough.

Turkthoracj, Turkish Thoracic Journal