Background: The role of mast cells in malignancies remains unclear, and there is no clear correlation between mast cells and tumor microvessels, tumor growth, or lung adenocarcinoma (LUAD) prognosis. This study aims to explore the association between mast cell density (MCD) and intratumoral microvessel density (MVD), clinicopathological parameters, and prognosis in LUAD, by evaluating mast cell infiltration characteristics and their prognostic significance. Methods: This retrospective investigation involved 238 patients with LUAD undergoing complete resection. Tumor and normal lung tissue sections outside the tumor were immunohistochemically stained for MCD in the intratumoral and outside regions, respectively. CD34 polyclonal antibody was used to measure intratumoral MVD. Results: Intratumoral regions of LUAD had a higher MCD (P < 0.001) than normal lung tissue. In the intratumoral region, MCD and CD34-MVD were positively correlated (r = 0.411, P < 0.001). Intratumoral MCD correlated with sex, smoking history, tumor differentiation, pathological subtype, and tumor size. Female sex (P = 0.012), no smoking history (P = 0.002), acinar predominant type (P = 0.012), and tumor size ≤ 3 cm (P = 0.009) were associated with a higher MCD, whereas poorly differentiated (P = 0.039) and solid/micropapillary predominant types (P = 0.001) were associated with a lower MCD. Higher intratumoral MCD exhibited a marginally improved overall survival, and individuals with higher MCD infiltration ratios (intratumoral MCD/outside the MCD) had higher disease-free and overall survival rates (log-rank P < 0.001). A high MCD infiltration ratio was associated with decreased risk of tumor progression and death following complete resection. Conclusion: The tumor microenvironment controls mast cell infiltration in LUAD, and patients with increased intratumoral mast cell infiltration have better prognosis.

Background: In order to improve survival outcomes in resectable non‐small cell lung cancer (NSCLC), strategies for neoadjuvant therapy need to be revisited. We evaluated and compared the efficacy of different neoadjuvant therapeutic modalities in a real‐world setting.Methods: A total of 258 patients with clinical stage IIA to IIIB NSCLC was included. All the patients underwent surgical resection after one to four cycles of neoadjuvant treatment consisting of chemotherapy (83), immunotherapy (23), and immunotherapy plus chemotherapy (152).Results: The radiologic response rate in the combined immunochemotherapy group was 67.8%, higher than that of 48.2% in the chemotherapy group and 4.3% in the immunotherapy group (p < 0.001). An improved major pathological response (MPR) was also achieved in the combined therapy group compared with the chemotherapy group and the immunotherapy group (53.9% vs. 10.8% vs. 8.7%, p < 0.001). Patients in the combined therapy group had a significant trend toward longer disease‐free survival than those in the chemotherapy alone group (3‐year disease‐free survival [DFS] of 68.79% vs. 50.81%; hazard ratio [HR] for progression or death, 0.477; p = 0.003). Multivariate Cox analysis identified radical surgery (HR, 0.328; p = 0.033), ypN0–1 stage (HR, 0.591; p = 0.038) and MPR result (HR, 0.362; p = 0.007) to be independent prognostic factors for DFS.Conclusions: Neoadjuvant treatment with a combination of immunotherapy plus chemotherapy appears to achieve higher radiological and pathological responses than monotherapy for IIA‐IIIB NSCLC. Log‐rank analysis showed that a better outcome could be expected in patients with the addition of immunotherapy to neoadjuvant chemotherapy if compared with patients with chemotherapy alone in terms of DFS.

Rationale: Numerous immune checkpoint inhibitors have been approved for clinical use in metastatic advanced esophageal cancer. While immunotherapy brings therapeutic benefits, immune-related adverse events (irAEs) should nevertheless not be overlooked. This paper reports on the first documented case of Autoimmune hemolytic anemia (AIHA) caused by anti-programmed cell death protein-1 therapy in esophageal squamous cancer. Patient concerns: An 84-year-old female patient with metastatic squamous esophageal cancer developed chest tightness, generalized weakness, and a yellowing of the skin after 2 cycles of sintilimab treatment. Diagnoses: Initial examination revealed severe anemia with elevated levels of bilirubin, reticulocytes, lactate dehydrogenase, decreased levels of haptoglobin, and a positive direct antihuman globulin test. The patient was diagnosed with immunotherapy-associated AIHA. Interventions: The patient was promptly treated with corticosteroids and human immunoglobulin, supportive transfusion with washed erythrocytes. Outcomes: Her AIHA was controlled after treatment. Subsequent immunotherapy was not continued, and there was no recurrence of AIHA. Lessons: We have identified a rare case of serious adverse reaction caused by anti-PD-1 therapy. We summarize the clinical presentations, diagnosis, and treatment of this case of immunotherapy-related AIHA and discuss the pathogenesis and therapeutic advances in immunotherapy-related AIHA, as well as sintilimab-induced irAEs, in detail. These findings underscore the importance of the early detection, diagnosis, and treatment of these rare and potentially fatal irAEs.

Cancer remains the second most common cause of death worldwide, with its burden steadily rising over the past decades [1]. In 2022, approximately 20.0 million new cancer cases and 9.7 million cancer-related deaths were reported globally [2]. Concerningly, these figures translated to approximately one in five men or women developing cancer during their lifetime, with […]

Background: Castleman disease (CD) is a rare lymphoproliferative disorder associated with immune dysregulation that may increase the risk of malignancy. Synchronous multiple primary cancers are uncommon, and their etiology remains largely unclear. The coexistence of CD with synchronous multiple primary malignancies is exceptionally rare; therefore, the underlying mechanisms and optimal treatment strategies deserve further investigation.Case Presentation: A 72-year-old male was diagnosed with Castleman disease in the hepatogastric space concomitant with synchronous primary rectal and prostate cancers. The patient underwent resection of the Castleman lesion, followed by four cycles of neoadjuvant FOLFOX chemotherapy for rectal cancer, simultaneous external beam radiotherapy for both rectal and prostate cancers, a Dixon procedure for rectal cancer, and three cycles of adjuvant FOLFOX chemotherapy. During a 2-year follow-up period, serial measurements of total and free prostate-specific antigen (PSA) remained within normal limits, and contrast-enhanced computed tomography (CT) revealed no evidence of recurrence or metastasis. The patient remains clinically stable.Conclusion: Three tumors in the same patient are extremely rare. The comprehensive treatment plan, including surgery, neoadjuvant chemoradiotherapy, and endocrine therapy may serve as a useful clinical reference for managing similar cases.