Locoregional Recurrence via Mucus-Mediated Extension Following Lung Resection for Mucinous Tumors

Abstract Background Clinically, locoregional recurrences following mucinous tumor resection are often experienced. However, it is unclear whether mucinous tumors directly affect local recurrence or not, and if so, what the mechanism is. Therefore, we investigated whether mucinous tumors are associated with locoregional recurrence after pulmonary resection and whether mucus extension is a risk factor for locoregional recurrence. Methods The data of 90 patients who underwent pulmonary resection for metastases were reviewed. If mucus was partially or wholly present in the tumor based on macro- or microscopic identification, we assigned the tumor as mucinous. In mucinous tumors, if mucus was identified within the air spaces in the normal lung parenchyma, beyond the edge of the tumor, we assigned the tumor as positive for “mucus extension.” Results The 5-year cumulative incidence of locoregional recurrence in patients with mucinous tumors was 80.3%, which was significantly higher than the 15.5% observed in patients with non-mucinous tumors. Within the mucinous tumor, presence of mucus extension beyond the tumor edge was an independent risk factor for locoregional recurrence after pulmonary resection (hazard ratio, 8.08; P = 0.049). Conclusion During the resection of mucinous cancer, surgeons should maintain sufficient distance from the tumor edge to prevent locoregional recurrences.

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Locoregional recurrence via mucus-mediated extension following lung resection for mucinous tumors

BMC Cancer ◽

10.1186/s12885-021-08231-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yo Kawaguchi ◽

Jun Hanaoka ◽

Yasuhiko Ohshio ◽

Keigo Okamoto ◽

Ryosuke Kaku ◽

...

Keyword(s):

Risk Factor ◽

Locoregional Recurrence ◽

Pulmonary Resection ◽

Lung Resection ◽

Tumor Resection ◽

Lung Parenchyma ◽

Normal Lung ◽

Mucinous Tumor ◽

Sufficient Distance ◽

Tumor Edge

Abstract Background Clinically, locoregional recurrences following mucinous tumor resection are often experienced. However, it remains unclear whether mucinous tumors directly affect local recurrence or not, and if so, the mechanism is not known. Therefore, we investigated whether mucinous tumors are associated with locoregional recurrence after pulmonary resection and whether mucus extension is a risk factor for locoregional recurrence. Methods The data of 152 patients who underwent pulmonary resection for metastases were reviewed. When mucus was partially or wholly present in the tumor based on macro- or microscopic identification, we assigned the tumor as mucinous. In mucinous tumors, when mucus was identified within the air spaces in the normal lung parenchyma, beyond the edge of the tumor, we assigned the tumor as positive for “mucus extension.” Results The 5-year cumulative incidence of locoregional recurrence in patients with mucinous tumors was 48.1%, which was significantly higher than that observed in those with non-mucinous tumors (14.9%). Within the mucinous tumor, the presence of mucus extension beyond the tumor edge was an independent risk factor for locoregional recurrence after pulmonary resection (hazard ratio, 5.52; P = 0.019). Conclusions During the resection of mucinous cancer, surgeons should maintain sufficient distance from the tumor edge to prevent locoregional recurrences.

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Lamin A/C Mechanosensor Drives Tumor Cell Aggressiveness and Adhesion on Substrates With Tissue-Specific Elasticity

Frontiers in Cell and Developmental Biology ◽

10.3389/fcell.2021.712377 ◽

2021 ◽

Vol 9 ◽

Author(s):

Enrica Urciuoli ◽

Valentina D’Oria ◽

Stefania Petrini ◽

Barbara Peruzzi

Keyword(s):

Tumor Cell ◽

Tumor Cells ◽

Lung Parenchyma ◽

Normal Lung ◽

Lamin A ◽

Osteosarcoma Cell ◽

Adhesion Properties ◽

Tissue Specific ◽

Definition Of ◽

High Level

Besides its structural properties in the nucleoskeleton, Lamin A/C is a mechanosensor protein involved in perceiving the elasticity of the extracellular matrix. In this study we provide evidence about Lamin A/C-mediated regulation of osteosarcoma cell adhesion and spreading on substrates with tissue-specific elasticities. Our working hypothesis is based on the observation that low-aggressive and bone-resident SaOS-2 osteosarcoma cells express high level of Lamin A/C in comparison to highly metastatic, preferentially to the lung, osteosarcoma 143B cells, thereby suggesting a role for Lamin A/C in tumor cell tropism. Specifically, LMNA gene over-expression in 143B cells induced a reduction in tumor cell aggressiveness in comparison to parental cells, with decreased proliferation rate and reduced migration capability. Furthermore, LMNA reintegration into 143B cells changed the adhesion properties of tumor cells, from a preferential tropism toward the 1.5 kPa PDMS substrate (resembling normal lung parenchyma) to the 28 kPa (resembling pre-mineralized bone osteoid matrix). Our study suggests that Lamin A/C expression could be involved in the organ tropism of tumor cells, thereby providing a rationale for further studies focused on the definition of cancer mechanism of metastatization.

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A vision transformer for emphysema classification using CT images

Physics in Medicine and Biology ◽

10.1088/1361-6560/ac3dc8 ◽

2021 ◽

Author(s):

Yanan Wu ◽

Shouliang Qi ◽

Yu Sun ◽

Shuyue Xia ◽

Yudong Yao ◽

...

Keyword(s):

Lung Parenchyma ◽

Ct Images ◽

Normal Lung ◽

Massive Data ◽

Large Patch ◽

The Public ◽

Evaluation Approach ◽

Average Accuracy ◽

Public Dataset ◽

Aided Diagnosis

Abstract Objective: Emphysema is characterized by the destruction and permanent enlargement of the alveoli in the lung. According to visual CT appearance, emphysema can be divided into three subtypes: centrilobular emphysema (CLE), panlobular emphysema (PLE), and paraseptal emphysema (PSE). Automating emphysema classification can help precisely determine the patterns of lung destruction and provide a quantitative evaluation. Approach: We propose a vision transformer (ViT) model to classify the emphysema subtypes via CT images. First, large patches (61×61) are cropped from CT images which contain the area of normal lung parenchyma (NLP), CLE, PLE, and PSE. After resizing, the large patch is divided into small patches and these small patches are converted to a sequence of patch embeddings by flattening and linear embedding. A class embedding is concatenated to the patch embedding, and the positional embedding is added to the resulting embeddings described above. Then, the obtained embedding is fed into the transformer encoder blocks to generate the final representation. Finally, the learnable class embedding is fed to a softmax layer to classify the emphysema. Main results: To overcome the lack of massive data, the transformer encoder blocks (pre-trained on ImageNet) are transferred and fine-tuned in our ViT model. The average accuracy of the pre-trained ViT model achieves 95.95% in our lab’s own dataset which is higher than that of AlexNet, Inception-V3, MobileNet-V2, ResNet34, and ResNet50. Meanwhile, the pre-trained ViT model outperforms the ViT model without the pre-training. The accuracy of our pre-trained ViT model is higher than or comparable to that by available methods for the public dataset. Significance: The results demonstrated that the proposed ViT model can accurately classify the subtypes of emphysema using CT images. The ViT model can help make an effective computer-aided diagnosis of emphysema, and the ViT method can be extended to other medical applications.

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Preoperative resting heart rate: a novel risk factor for cardiopulmonary complications after lung resection

Journal of Thoracic Disease ◽

10.21037/jtd.2018.12.95 ◽

2019 ◽

Vol 11 (S3) ◽

pp. S356-S358

Author(s):

Xiaoshuang Zhou ◽

Wanyu Wang ◽

Lili Huang ◽

Bin Liu

Keyword(s):

Heart Rate ◽

Risk Factor ◽

Lung Resection ◽

Resting Heart Rate ◽

Cardiopulmonary Complications

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Influence of Comorbidity on Outcome after Pulmonary Resection in the Elderly

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230701500406 ◽

2007 ◽

Vol 15 (4) ◽

pp. 297-302 ◽

Cited By ~ 7

Author(s):

Morris Beshay ◽

Patrick Dorn ◽

Hans-Beat Ris ◽

Ralph A Schmid

Keyword(s):

Pulmonary Resection ◽

Preoperative Evaluation ◽

Lung Resection ◽

Survival Rates ◽

Age Groups ◽

The Elderly ◽

Major Complications ◽

Proper Patient Selection ◽

Significant Difference ◽

Group 3

The aim of this study was to determine the influence of comorbidity on outcome after pulmonary resection in patients over 75 years old. Three hundred and thirty-three patients with non-small-cell lung cancer operated on between 1998 and 2002 were divided into 3 age groups: < 60 years (group 1), 60–75 years (group 2), > 75 years (group 3). Overall operative mortality was 0.3%; 30-day mortality was 1%. There were more major complications with re-operation in groups 1 and 2, but minor complications occurred significantly more frequently in group 3 (36% vs 16%). Overall mean hospital stay was 12 days, with no significant difference among groups. Three-year survival rates were: 80%, 70%, and 65% in groups 1, 2, and 3, respectively, with no significant difference among groups. Age or the presence of comorbidity should not be considered contraindications for lung resection. With proper patient selection and careful preoperative evaluation, many major complications after pneumonectomy are avoidable.

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Left upper lobectomy is a risk factor for cerebral infarction after pulmonary resection: a multicentre, retrospective, case–control study in Japan

Surgery Today ◽

10.1007/s00595-020-02032-4 ◽

2020 ◽

Vol 50 (11) ◽

pp. 1383-1392

Author(s):

Keitaro Matsumoto ◽

◽

Shuntaro Sato ◽

Meinoshin Okumura ◽

Hiroshi Niwa ◽

...

Keyword(s):

Risk Factor ◽

Cerebral Infarction ◽

Pulmonary Resection ◽

Case Control Study ◽

Case Control ◽

Retrospective Case ◽

Left Upper Lobectomy ◽

Control Study

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Thoracoscopic partial lung resection following pneumonectomy: a report of three cases

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-019-1008-6 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Hidenori Goto ◽

Mingyon Mun ◽

Shohei Mori ◽

Joji Samejima ◽

Yosuke Matsuura ◽

...

Keyword(s):

Thoracoscopic Surgery ◽

Lung Resection ◽

Tumor Resection ◽

Tumor Localization ◽

Deep Part ◽

Manual Ventilation ◽

Pulmonary Tumor ◽

Tumor Lesion ◽

Respiratory Management ◽

Partial Lung Resection

Abstract Background The prognosis of patients who undergo unilateral pneumonectomy and subsequently develop a contralateral pulmonary tumor can be improved by tumor resection. Thus, surgery is a treatment option if the patient’s pulmonary function and performance status are satisfactory. To date, there have been only few cases reporting thoracoscopic lung resection for pulmonary tumor after contralateral pneumonectomy because of the difficulty in respiratory management during surgery. Thoracoscopic surgery requires the maintenance of the operative field to allow the lung to collapse, and in partial lung resection we need to identify tumor localization. The identification of a tumor lesion just inferior to the pleura is easy; however, the identification of a tumor lesion in the deep parts is difficult. The tumor in the deep part of the lung segments can be easily located if the tumor-affected lobe is allowed to completely collapse. Therefore, ventilation technique should be modified according to the tumor localization. Case presentation Here, we report three cases of thoracoscopic partial lung resections for pulmonary tumors that developed after contralateral pneumonectomy. Intermittent manual ventilation using a tracheal tube was performed in two cases with a lesion just inferior of the pleura. The tumors in both patients were resected using automatic suturing devices while arresting manual ventilation. The affected lobe was allowed to collapse using a bronchial blocker in one of the cases with a lesion in the deep part. Furthermore, she had contralateral pneumothorax with bullae on the right upper and lower lobes of the lung. The tumor in the deep part of the lung segment and ruptured bullae were easily located and resected using automatic suturing devices. The hemodynamic status of the patients was stable, and the intra- and postoperative courses were uneventful. Conclusions Our cases demonstrate that thoracoscopic lung resection after contralateral pneumonectomy can be performed if intermittent manual ventilation is utilized when the tumor is located just inferior to the pleura and if selective double ventilation using an intrabronchial blocker is utilized when the tumor is located in the deep part.

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