BACKGROUND: Neoadjuvant immunochemotherapy has emerged as an indispensable therapeutic modality for non-small cell lung cancer (NSCLC). However, its clinical application experience remains limited, and the associations between various clinical factors and treatment benefits remain undefined. This study aims to evaluate the efficacy and safety of neoadjuvant immunochemotherapy in patients with stage IB-IIIB NSCLC in a real-world setting, analyze survival outcomes among subgroups with diverse clinical characteristics, and identify potential clinical predictive factors for pathological response. METHODS: This study included patients with stage IB-IIIB NSCLC who underwent radical lung resection after 2-4 cycles of neoadjuvant immunochemotherapy at Peking University People's Hospital between August 2019 and March 2024. Medical records and follow-up information were collected to analyze therapeutic response, adverse events and survival outcomes. Logistic analysis was used to identify clinical predictors of pathological response. RESULTS: Among 183 enrolled patients, 116 (63.4%) were stage III. Grade 3-4 immune-related adverse events (irAEs) occurred in 39 (21.3%) patients. Radiographic complete response (CR) or partial response (PR) was achieved in 118 (64.5%) patients. R0 resection was achieved in 180 (98.4%) patients. Major pathologic response (MPR) was observed in 107 (58.5%) patients, with 78 (42.6%) achieving pathologic complete response (pCR). Squamous cell carcinoma and radiographic objective response were associated with pathological response (pCR/MPR). With a median follow-up of 22.1 [interquartile range (IQR): 18.3-32.2] months, the 2-year event-free survival (EFS) and overall survival (OS) rates were 82.5% and 90.4%, respectively. Achievement of pathological response (pCR/MPR) was correlated with prolonged survival outcomes. CONCLUSIONS Neoadjuvant immunochemotherapy is safe and effective for patients with stage IB-IIIB NSCLC. Patients achieving pCR or MPR exhibit significantly better survival benefits from neoadjuvant immunochemotherapy. Squamous cell carcinoma and radiographic objective response can serve as clinical predictors of pathological response.
Humans ; Carcinoma, Non-Small-Cell Lung/mortality* ; Male ; Lung Neoplasms/mortality* ; Female ; Middle Aged ; Neoadjuvant Therapy/adverse effects* ; Aged ; Neoplasm Staging ; Adult ; Immunotherapy/adverse effects* ; Treatment Outcome ; Retrospective Studies

Objective:To explore the medication and prescription rules in ancient Chinese medicine books in the treatment of premature ejaculation based on Traditional Chinese Medicine (TCM) Inheritance Supporting Platform.Methods:Search for the relevant literature concerning treating premature ejaculation with TCM in the ancient books before 1949, conduct data mining with Traditional Chinese Medicine Inheritance Supporting Platform, analyze the medication and the prescription rules, so as to summarize the academic thoughts of the ancient physicians in treating premature ejaculation.Results:Among 39 selected eligible ancient books, a total of 45 prescriptions were included, involving 118 kinds of Chinese medicines. Among them, 14 Chinese medicines were used more than 10 times. The top five Chinese medicines were Ginseng radix et rhizoma, Schisandrae chinensis fructus, Dioscoreae rhizoma, Polygalae radix, Atractylodis macrocephalae rhizoma; in the classification of Chinese medicines tonic Chinese medicine, tranquilizers, and astringent are used frequently. The most frequently used Chinese medicine pairs were Corni fructus- Ginseng radix et rhizoma, Ginseng radix et rhizoma- Dioscoreae rhizoma, Ginseng radix et rhizoma- Atractylodis macrocephalae rhizoma; 33 core combinations of 3 Chinese mediciness and 4 core combinations of 4 Chinese medicines were obtained. Conclusion:The medication that could treat premature ejaculation in the ancient TCM books are mainlythe kidney, liver, and heart meridian. The main principle is to invigorate the kidney, replenish the essence, and replenishing qi and soothing the nerves. It can provide reference for clinical treatment of premature ejaculation.

Objective:To investigate the application of low-dose chest CT(LDCT) in the screening of pulmonary subsolid nodules in population and the application value of artificial intelligence.Methods:People who received chest LDCT screening between January 2015 and December 2017 were included. A retrospective study was developed to analyze the enrolled population features , detection of pulmonary subsolid nodules and independent predictors of subsolid nodules , and to evaluate the accuracy of the artificial intelligence reading method.Results:Result of three cross-sectional studies reveals that the detection rates of pulmonary subsolid nodules were 0.42%, 0.69% and 0.92% in three rounds. 726 cases who completed the three rounds of screening were included in the cohort study. The cohort population was predominantly male(83.2%), with a median age of 43 years, and nearly half of the subjects(47.0%) had a history of smoking. GEE revealed that the patient's family history of lung cancer( OR=8.753, 95% CI: 1.877-40.816, P=0.006) was an independent predictor of the detection of subsolid nodules. In the 110 kVp tube voltage group, AUC of AI model was 0.740, and AUC of the manual reading method was 0.721, no significant differences were observed( P=0.502); when the preseted cutoff value of AI model was 0.75, the NRI was -0.15, indicating the accuracy of AI model was inferior to manual method( P=0.006). In the 130 kVp tube voltage group, AUC of the model was 0.888, and AUC of the manual reading method was 0.756, no significant differences were observed( P=0.128); and the NRI was 0.19, indicating the accuracy of AI model was not inferior to manual method( P=0.123). Conclusion:This population' s detection rates of pulmonary subsolid nodules were 0.42%-0.92%. Family history of lung cancer was an independent predictor of subsolid pulmonary nodules. The result of AI pulmonary nodule detection model could be a reference when the training set data parameters match the actual application parameters.

BACKGROUND: With the increase of lung cancer screening, more and more patients have been diagnosed as sub-centimeter (≤1 cm) lung adenocarcinoma. Sub-centimeter lung adenocarcinoma is mostly early stage lung cancer, but the research on sub-centimeter lung adenocarcinoma is still insufficient. This study analyzed the clinical characteristics and prognosis of patients with sub-centimeter lung adenocarcinoma in order to provide the basis for the diagnosis and treatment of such patients. METHODS: A retrospective study was performed to analyze patients with sub-centimeter lung adenocarcinoma who underwent VATS in Peking University People's Hospital from January 2012 to December 2016. Patients were divided into pure ground-glass nodules (pGGN) group, mixed ground-glass nodules (mGGN) group and solid nodules (SN) group according to the features of nodular imaging. The clinical characteristics of the three groups were compared and the subgroup analysis of nodules in different diameter was performed. We also performed multivariate logistic regression analyses to identify the risk factors for sub-centimeter lung invasive adenocarcinoma. RESULTS: The study included 182 patients (57 men and 125 women) with a median age of 54 (27-75) years. Female sub-centimeter lung adenocarcinoma patients had a significantly lower proportion of non-smoking history than males (P<0.001). All patients with 1 mm-10 mm pGGN, 1 mm-5 mm mGGN and 1 mm-5 mm SN had no other pathologically positive findings except for the primary lesion. Of the 46 patients with 6 mm-10 mm mGGN, 3 had pleural invasion and 1 had vascular tumor thrombus. Of the 39 patients with 6 mm-10 mm SN, 5 had pleural invasion, 2 had vascular tumor thrombus and 2 had lymph node metastasis. The pathological type in each patient with pleural invasion, vascular tumor thrombus or lymph node metastasis was invasive adenocarcinoma. Logistic regression analysis indicated that smoking history (OR=4.727, P=0.009), previous tumor history (OR=3.408, P=0.015), mGGN (OR=3.735, P=0.004), SN (OR=8.921, P<0.001) and tumor diameter >5 mm (OR=4.241, P=0.001) were independent risk factors for sub-centimeter lung invasive adenocarcinoma. The median follow-up time was 44 (22-82) months. The 5-year recurrence-free survival rate was 100.0% and the overall survival rate was 98.9%. CONCLUSIONS Patients with sub-centimeter lung adenocarcinoma have a relatively earlier onset age. Sub-centimeter lung invasive adenocarcinoma patients with 6 mm-10 mm mGGN and 6 mm-10 mm SN may be involved in pleural invasion or lymph node metastasis. Smoking history, previous tumor history, mGGN, SN and tumor diameter >5 mm are independent risk factors for sub-centimeter lung invasive adenocarcinoma. For patients with sub-centimeter lung adenocarcinoma, early detection and appropriate surgical intervention can lead to a good prognosis.

Objective To determine the long-term impacts of major pulmonary complications ( MPCs) and identify the in-dependent risk factors in those non-small cell lung cancer(NSCLC)patients who underwent VATS lobectomy.Methods A ret-rospective study was developed to analyze the pulmonary complications of 574 non-small cell lung cancer patients who under-went VATS lobectomy in Peking University Hospital , the complications were graded according to TMM classification criteria . The effects of PCs on the long-term prognosis were analyzed by using the Kaplan-Meier method.Multivariate logistic regression analysis was used to determine the risk factors of MPCs.Results Of 574 patients, 106 had PCs, including 50(8.7％) MPCs, Postoperative pulmonary complications were associated with significantly longer drainage time (P<0.001) and hospital stays(P<0.001).Perioperative mortality was significantly increased in patients with PCs (4.0％ vs 0.6％; P =0.021). Those who develop a MPC had a reduced 3-year DFS and 5-year DFS(61.3％ vs.77.4％、42.2％ vs.69.3％;P=0.003), as well as the reduced 3-year OS and 5-year OS(78.5％vs.88.2％、62.4％ vs.79.2％;P=0.047).MPCs were independ-ent prognostic factors of patients with lung cancer .Multivariate logistic regression analysis showed that the independent risk fac-tors for MPCs were age, male, ASA grade.Conclusion Major pulmonary complications after VATS lobectomy are associated with a poorer long-time outcome.The independent risk factors for MPCs are age, male, and ASA grade.

Objective To use Wilks' lambda discriminant analysis for screening of the greatest influence factors in tooth extraction correction and to establish a method for validation.Methods A total of 100 orthodontic patients were selected,aged 14 to 40 years,with average age of 23.6 years,29 males and 76 females.The conventional cephalometry analysis was conducted.Statistical analysis was carried out with using SPSS 18.0 software package.Wilks' lambda statistical method was applied to filter the largest effect on tooth extraction treatment project.Results The UIE-AB and NA/PA calculation results showed statistical differences (P＜0.05),and it set up a tooth extraction rectification regression equation for y =0.125 × NA/PA+0.351 × UIE-AB-3.429;a combination of the initial validation accuracy was 82.6％,and cross validation accuracy was 81.03％.Conclusions Incisor to AB line distance and angle of NA/PA are good tooth extraction judgement indexes.

Objective To analyze the causes of misdiagnosis of esophageal leiomyoma.Methods The clinical data of 20 patients who were preoperatively misdiagnosed as esophageal leiomyoma at our hospital in 16 years were retrospectively analyzed.There were 11 males(55%) and 9 females(45%) with a mean age of(45.9 ± 16.4) years(range, 13-71 years).The initial presentations were obstructive symptoms in 12 patients(60%).CT imaging were performed in 9 patients(45%), of which 4 cases were enhanced CT(20%).Results The misdiagnosed patients included 5 cases of extraesophageal lesions(4 cases of paraesophageal lymph node tuberculosis and 1 case of lymph node hyperplasia), 8 cases of begin interstitial diseases(3 cases of neurinoma, 3 cases of inclusion cyst, 2 cases of angioma), 5 cases of malignant interstitial diseases(4 cases of GIST, 1 case of PNET), and 2 cases of esophageal cancer.The 4 cases of esophageal tuberculosis were misdiagnosed due to the absence of CT examination.The patients with esophageal cancer were treated with esophageal resection and reconstruction without clear staging of the tumor.This might be associated with the neglection of the rapid symptom development and the characteristic lumen stenosis under the gastroscope.The characteristic mucosal ulcer in patients with highly malignant GIST was overlooked.The disease relapsed postoperatively because only tumor enucleation was performed.Conclusion Preoperative diagnosis of esophageal leiomyoma is not uncommon.This disease is most often misdiagnosed as paraesophageal lymph node tuberculosis or esophageal GIST.CT examination is useful in distinguishing esophageal leiomyoma and paraesophageal lymph node tuberculosis.The roles of reoperation and adjuvant therapy in the surgical treatment of esophageal leiomyoma need further investigation.

Objective:To estimate the probability of N2 lymph node metastasis and to assist physicians in making diagnosis and treatment decisions.Methods:We reviewed the medical records of 739 patients with computed tomography-defined stage Ⅰ non-small cell lung cancer ( NSCLC ) that had an exact tumor-node-metastasis stage after surgery.A random subset of three fourths of the patients ( n =554 ) were selected to develop the prediction model.Logistic regression analysis of the clinical characteristics was used to estimate the independent predictors of N2 lymph node metastasis.A prediction model was then built and externally validated by the remaining one fourth ( n=185 ) patients which made up the validation data set.The model was also compared with 2 previously described models.Results:We iden-tified 4 independent predictors of N2 disease:a younger age, larger tumor size, central tumor location, and adenocarcinoma or adenosquamous carcinoma pathology.The model showed good calibration ( Hos-mer-Lemeshow test:P=0.923) with an area under the receiver operating characteristic curve (AUC) of 0.748 (95%confidence interval, 0.710-0.784) .When validated with all the patients of group B, the AUC of our model was 0.781 (95% CI: 0.715 -0.839) and the VA model was 0.677 (95% CI:0.604-0.744) (P =0.04).When validated with T1 patients of group B, the AUC of our model was 0.837 (95%CI:0.760 -0.897) and Fudan model was 0.766 (95% CI: 0.681 -0.837) (P <0.01) .Conclusion:Our prediction model estimated the pretest probability of N2 disease in computed tomography-defined stageⅠNSCLC and was more accurate than the existing models.Use of our model can be of assistance when making clinical decisions about invasive or expensive mediastinal staging procedures.

Objective To evaluate the efficacy and safety of induction concurrent chemoradiation therapy with weekly docetaxel and cisplatin(DP) for stage Ⅲ A-N2 lung cancer.Methods Eighteen patients diagnosed of stage Ⅲ A-N2 NSCLC in our center were enrolled from March,2011 to November,2013.The induction regimen consisted of 5 cycles of docetaxel(20 mg/m2) and cisplatin(20 mg/m2) administered intravenously on days 1,8,15,22 and 29 with concurrent thoracic radiotherapy in fractions of 1.8Gy,to a total dose of 45Gy.Patients proceeded to surgery,if no progressive disease occurred,followed by adjuvant chemotherapy with DP strategy.Results Eighteen patients were enrolled and 12 underwent surgery.The tumor response for the induction therapy was 1 CR,10 PRs,6 SDs and 1 PD.Five of 18 patients presented with level 3 or above adverse effects,among which were 2 neutropenia,1 liver toxicity,1 anemia and 1 lymph node infection.The median operation time was 290 min,intraoperative blood loss was 350 ml,length for postoperative drainage was 5 d,and time to discharge was 7 d.The mediastinal lymphnodedownstaging rate was 50％ (3 pN0 cases and 3 pN1 ones),92％ of the operated patients reached complete resection.One-year survival was 75.9％ and 1-year progression free survival was 49.2％.Conclusion Weekly docetaxel and cisplatin strategy in induction concurrent chemoradiotherapy for stage Ⅲ A-N2 NSCLC patients has been validated to be safe and effective.

Objective To summarize and analyze the clinical features of familial spontaneous pneumothorax.Methods During April 2001 to March 2013,the clinical data of 65 familial spontaneous pneumothorax from 21 families were retrospected and summarized.Contrasting with previous literature,the clinical features of familial spontaneous pneumothorax were analyzed.Results Patients in one family vary from 2 to 6,average 3.1.Families in which patients distribute in one generation,two generations and three generations were 19.0％,61.9％ and 19.0％ respectively.Male/female ratio of patients was.Mean onset age was 36.2 ± 12.2 ; Body mass index (BMI) of male and female patients were 24.0 ± 2.6 and 22.6 ± 3.0.32.7％ patients suffered bilateral pneumothorax.The recurrence rate after non-operative treatment was 50.0％.Conclusion Compared with sporadic spontaneous pneumothorax,Familial spontaneous pneumothorax has the following features:The incidence in man and woman was more similar; The onset age was older; Lanky body is less common; More were bilateral pneumothorax; Multiple pulmonary bullae are more common; Patients with non-surgical treatment have a higher recurrence rate.