OBJECTIVE To construct a predictive model for evaluating the efficacy of a triple antiemetic regimen （neurokinin- 1 receptor antagonist+5-hydroxytryptamine 3 receptor antagonist+dexamethasone） for preventing nausea and vomiting induced by highly emetogenic chemotherapy （HEC） based on interpretable deep learning algorithms. METHODS Clinical data of cancer patients who received HEC and were treated with the standard triple antiemetic regimen in the oncology department of Tianjin Medical University General Hospital from January 2018 to December 2022 were collected retrospectively. Demographic， clinical and metabolism-related variables were integrated. After data pre-processing， two deep learning algorithms （deep random forest and dense neural network） and four machine learning algorithms （support vector machine， categorical boosting， random forest and decision tree） were used to build predictive models. Subsequently， model performance evaluation and model interpretability analysis were conducted. RESULTS Among the six candidate models， the deep random forest model demonstrated the best predictive performance on the test set， with an area under the receiver operating characteristic curve of 0.850， an accuracy of 0.911， a precision of 0.805， a recall of 0.783， an F1 score of 0.793， and a Brier score of 0.075. Interpretability analysis revealed that creatinine clearance rate （Ccr） was the key predictive factor， and low Ccr levels， female gender， younger age， highly emetogenic drugs （particularly cisplatin-containing chemotherapy regimens）， and anticipatory nausea and vomiting were positively correlated with the risk of HEC-related nausea and vomiting. CONCLUSIONS The deep random forest model exhibits the best performance in predicting the efficacy of triple antiemetic regimen for preventing HEC-related nausea and vomiting. The key predictors in this model primarily include Ccr，anticipatory nausea and vomiting， gender， age， and highly emetogenic drugs.

Combined small cell lung cancer(C-SCLC)accounts for approximately 20%of all SCLC cases,while the propotion of C-SCLC mixed with squamous cell carcinoma component comprises less than 3%.At the pathological level,accurate diagnosis requires to distinguish it from other lung tumor types,and even rely on molecular testing.This article presents a case of a 67-year-old patient initially diagnosed with a peripheral lung tumor.The patient underwent comprehensive multidisciplinary management,including surgical resection,postoperative pathological differential diagnosis,chemotherapy,thoracic radiotherapy,brain metastasis,cranial radiotherapy,dynamic follow-up of imaging changes after cranial radiotherapy,and cranial surgery.Molecular residual disease(MRD)monitoring was integrated at critical time points during dynamic monitoring to inform personalized treatment decisions.The early MDT has brought the patient′s condition under control,and the overall survival of the patient exceeded 30 months.Through the introduction of the diagnosis and treatment process of this patient,we aim to offer novel perspectives on clinical decision-making for C-SCLC.

Combined small cell lung cancer(C-SCLC)accounts for approximately 20%of all SCLC cases,while the propotion of C-SCLC mixed with squamous cell carcinoma component comprises less than 3%.At the pathological level,accurate diagnosis requires to distinguish it from other lung tumor types,and even rely on molecular testing.This article presents a case of a 67-year-old patient initially diagnosed with a peripheral lung tumor.The patient underwent comprehensive multidisciplinary management,including surgical resection,postoperative pathological differential diagnosis,chemotherapy,thoracic radiotherapy,brain metastasis,cranial radiotherapy,dynamic follow-up of imaging changes after cranial radiotherapy,and cranial surgery.Molecular residual disease(MRD)monitoring was integrated at critical time points during dynamic monitoring to inform personalized treatment decisions.The early MDT has brought the patient′s condition under control,and the overall survival of the patient exceeded 30 months.Through the introduction of the diagnosis and treatment process of this patient,we aim to offer novel perspectives on clinical decision-making for C-SCLC.

With the continuous development of imaging techniques such as magnetic resonance imaging,the detection rate of brain metastases is increasing.Although the incidence rate of cystic brain metastasis is far lower than that of solid brain metastasis,patients with cystic brain metastasis are in urgent condition and have obvious space occupying effect,which is an urgent clinical problem.Previous literature has reported that cystic brain metastasis is more common in breast cancer and lung adenocarcinoma,especially in lung cancer patients with positive driver gene.This article reports a case of small cell lung cancer with cystic brain metastasis,which started with neurological symptoms,and was clinically cured under a multidisciplinary diagnosis and treatment model.Through dynamic imaging evaluation and molecular residual lesion detection,the patient can avoid overtreatment and achieved a relatively higher quality of life on the basis of prolonging survival.

With the continuous development of imaging techniques such as magnetic resonance imaging,the detection rate of brain metastases is increasing.Although the incidence rate of cystic brain metastasis is far lower than that of solid brain metastasis,patients with cystic brain metastasis are in urgent condition and have obvious space occupying effect,which is an urgent clinical problem.Previous literature has reported that cystic brain metastasis is more common in breast cancer and lung adenocarcinoma,especially in lung cancer patients with positive driver gene.This article reports a case of small cell lung cancer with cystic brain metastasis,which started with neurological symptoms,and was clinically cured under a multidisciplinary diagnosis and treatment model.Through dynamic imaging evaluation and molecular residual lesion detection,the patient can avoid overtreatment and achieved a relatively higher quality of life on the basis of prolonging survival.

Objective:To determine the value of colonoscopy in the diagnosis and treatment of patients with immune checkpoint inhibitor-induced colitis.Methods:Patients who developed colitis and underwent colonoscopy after receiving immune checkpoint inhibitors(ICIs)therapy at Tianjin Medical University General Hospital between December 2020 and December 2023 were reviewed,according to the guidelines of the Chinese Society of Clinical Oncology for the management of ICI-related toxicity.The effect of the treatment and the rela-tionship between prognosis and the pathological features of colonoscopy were analyzed.Results:Patients with ICI-associated colitis who un-derwent colonoscopy had a more than 3 degrees diarrhea,and diffused inflammatory features such as mucosal erythema,exudate,erosion,loss of vascular markings,and edema were observed under the microscope,and the presence of ulcers greater than 1 cm in diameter and/or more than 2 mm deep indicate a poor prognosis for enteritis.Histopathological studies showed changes in glandular structures,such as cryptitis and crypt abscess.The pathological colonoscopic manifestations of patients with microscopic enteritis were inconsistent,and more deep samples should have been taken.Conclusions:The toxicity grading of ICI-associated colitis is not limited to clinical manifestations,but refers to the multi-dimensional analysis of colonoscopic features and histopathological characteristics.Soft colonoscopy can be used as an important follow-up method for patients with colitis,owing to its ease of operation and good tolerance.

Background and objective Malnutrition is commonly associated with poor prognosis in patients with malignant tumors.The neutrophil-to-lymphocyte ratio(NLR)is an indicator of inflammation in the body and predicts the risk of malnutrition in a variety of diseases;however,its association with malnutrition in lung cancer patients is unclear.The aim of this study is to clarify the association between NLR and nutritional status in stage Ⅳ primary lung cancer and to further deter-mine the optimal NLR cut-off that best predicts the risk of malnutrition.Methods A retrospective analysis of 209 patients ad-mitted to the Department of Medical Oncology,Tianjin Medical University General Hospital with a primary diagnosis of stageⅣ lung cancer from May 2019 to February 2021 was performed,and the nutritional risk screening 2002(NRS 2002)was used to examine their nutritional status.Patient demographic information,pathology,Karnofsky performance status(KPS)score,body mass index(BMI),comorbidities and clinical biochemical indicators were also included.The correlation between NLR and NRS 2002 was investigated.Receiver operating characteristic(ROC)curve was used to determine the best NLR cut-off predi cting malnutrition risk.Multivariable Logistic regression was used to assess the association between NLR and malnutrition risk.Results The rate of patients with stage Ⅳ primary lung cancer at nutritional risk was 36.36％(76/209).A significant positive correlation was observed between NLR values and NRS 2002 risk score(r=0.765,P＜0.001).The ROC curve analysis indicated that an NLR of 3.94 was the optimal cut-off for predicting malnutrition risk(area under the curve=0.747,95％CI:0.678-0.815,P＜0.001),which showed a sensitivity of 55％,a specificity of 86％,a positive predictive value of 68％,and a negative predictive value of 77％.Patients in the NLR＞3.94 group had a significantly higher risk of malnutrition compared to those in the NLR≤3.94 group(69.49％vs 23.33％,P＜0.00 1).Furthermore,NLR was identified as a risk factor for malnutrition in stage Ⅳ primary lung cancer patients.Conclusion NLR is associated with the risk of malnutrition in stage Ⅳ primary lung cancer,and NLR can be used as one of the indicators for screening nutritional risk in patients with stage Ⅳ primary lung cancer

Objective To investigate the efficacy of Zorifertinib in first-line treatment of patients with untreated epidermal growth factor receptor(EGFR)mutation in non-small-cell lung cancer(NSCLC)with central nervous system(CNS)metastases.Methods Two patients received Zorifertinib as first-line treatment.The response of tumor treatment was evaluated by response evaluation criteria in solid tumors version 1.1(RECEST v1.1)and RANO criteria for brain metastases(RANO-BM).Results Case 1 had EGFR exon 19del mutation and multiple brain metastases at baseline.After 51.4 months of treatment with Zorifertinib,case 1 still maintained partial response(PR)in lung lesions and complete response(CR)in intracranial lesions.Case 2 had EGFR exon 19del mutation and a single brain metastasis at baseline.Case 2 achieved PR in lung lesions and CR in intracranial lesions during the treatment with Zorifertinib.After 13.7 months,lung disease progression(PD)and new single brain metastases occurred.The comprehensive evaluation was PD.Case 1 had three-grade treatment-related adverse events(TRAEs),including dry skin,and other TRAEs were rash,abnormal liver function and diarrhea.The TRAEs were generally controllable.Conclusion Zorifertinib has a good effect on controlling intracranial and extracranial lesions in patients with EGFR-mutated NSCLC with CNS metastases.The efficacy of Zorifertinib is consistent with the EVEREST study.Zorifertinib can be one of the first-line initial treatment options.

Klotho gene was originally discovered as an anti-aging gene, Klotho protein encoded by Klotho gene is expressed in multiple human tissues, and its most prominent function is the regulation of phosphate homeostasis. Klotho protein possesses various activities, including inhibition of multiple signaling pathways, reducing oxidative stress and suppressing inflammation, and these activities are associated with cancer. Klotho protein is discovered as a universal tumor suppressor, and its expression is associated with tumorigenesis and prognosis of patients. Lung cancer is the most common malignancy tumor, and it is the leading cause of cancer deaths worldwide because of its high incidence and mortality. This article summarizes the research progress of the role of Klotho on pathogenesis, therapeutic effect and prognosis in lung cancer, in order to provide new biomarker and target for diagnosis, treatment and prognosis of lung cancer.
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Humans ; Lung Neoplasms ; Carcinogenesis ; Inflammation

In advanced non-small cell lung cancer (NSCLC), V-Raf murine sarcoma viral oncogene homolog B1 (BRAF) mutation is highly malignant and has poor prognosis, and currently Dabrafenib in combination with Trametinib is approved for first-line treatment of patients with BRAF V600 mutation. In addition to mutations, BRAF fusion can also occur. With the development of gene detection, the detection of BRAF fusion is gradually increasing, but there is a lack of effective therapeutic strategies for BRAF fusion. In this paper, we review the clinical characteristics, mechanism of action, and clinical treatment of BRAF fusion to provide a basis for the treatment of BRAF fusion in NSCLC patients.
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Humans ; Carcinoma, Non-Small-Cell Lung/pathology* ; Lung Neoplasms/pathology* ; Mutation ; Proto-Oncogene Proteins B-raf/genetics*