Purpose To observe the risk of large pneumothorax after CT-guided percutaneous lung biopsy and analyze its associated factors. Materials and Methods This study was a prospective cohort design,enrolling 1732 patients who underwent CT-guided percutaneous lung biopsy in Beijing Hospital from January 2017 to December 2023. Patients were divided into three groups based on the occurrence and severity of pneumothorax:non-pneumothorax group (1361 cases),minor pneumothorax group (277 cases) and large pneumothorax group (94 cases). Baseline clinical data,puncture-related parameters and lesion characteristics were collected,and risk factors for major pneumothorax were analyzed. Results There were significant differences in terms of age,heart failure,lesion size,distance from the chest wall and presence of pulmonary bullae/emphysema among the three groups (F/x2=12.878,15.115,14.208,6.293,19.492,all P<0.05). Multivariate Logistic regression analysis identified the following as significant independent factors for large pneumothorax,including age≥65 years (OR=1.204,P=0.007),heart failure (OR=1.449,P=0.016),lesion size≤2 cm (OR=1.378,P=0.003),distance from chest wall≥2 cm (OR=1.311,P=0.012),presence of pulmonary bullae/emphysema (OR=2.079,P<0.001) and puncture depth≥5 cm (OR=1.405,P=0.003). Conclusion The occurrence of large pneumothorax following CT-guided percutaneous lung biopsy is closely associated with factors such as age,heart failure,lesion size,distance from the chest wall and the presence of pulmonary bullae/emphysema.

Objective:To investigate the incidence and influencing factors of pneumothorax in elderly patients(aged ≥65 years)undergoing CT-guided percutaneous lung biopsy(PLB).Methods:A prospective cohort study was conducted, enrolling elderly patients who underwent CT-guided PLB at Beijing Hospital from January 2017 to December 2023.Pneumothorax occurrence was assessed through two CT scans performed immediately post-procedure and at 48 hours post-PLB.Based on pneumothorax status, patients were categorized into a pneumothorax group and a non-pneumothorax group.Baseline clinical and procedural data were compared between the two groups, and multivariate logistic regression analyses were conducted to identify factors associated with pneumothorax.Results:Among the 647 elderly patients who underwent PLB, 152 cases(23.5%, 152/647)developed pneumothorax, with 101 cases(15.6%)presenting with minor pneumothorax and 51 cases(7.9%)with major pneumothorax.Compared with the non-pneumothorax group, patients in the pneumothorax group had a higher incidence of chronic obstructive pulmonary disease(COPD), higher frailty proportion, smaller lesions, lesions located further from the chest wall, more frequent bronchial involvement, and a higher rate of puncture depth ≥5 cm(all P<0.05).Multivariate logistic regression analysis revealed the following as significant risk factors for minor pneumothorax: COPD( OR=1.256, 95% CI: 1.014-1.558, P=0.033), lesion size ≤2 cm( OR=1.345, 95% CI: 1.075-1.659, P=0.022), lesion-to-chest-wall distance ≥2 cm( OR=1.372, 95% CI: 1.105-1.703, P=0.007), presence of pulmonary bullae or emphysema( OR=1.524, 95% CI: 1.223-1.899, P<0.001), ground-glass opacity density( OR=1.313, 95% CI: 1.072-1.839, P=0.014), bronchial involvement( OR=1.211, 95% CI: 1.047-1.694, P=0.038), and needle insertion depth ≥5 cm( OR=1.312, 95% CI: 1.024-1.749, P=0.038).For major pneumothorax, significant risk factors included age( OR=1.286, 95% CI: 1.021-1.819, P=0.041), COPD( OR=1.248, 95% CI: 1.098-1.753, P=0.035), heart failure( OR=1.312, 95% CI: 1.027-1.956, P=0.042), frailty( OR=1.301, 95% CI: 1.063-1.981, P=0.036), lesion size ≤2 cm( OR=1.345, 95% CI: 1.040-1.872, P=0.039), lesion-to-chest-wall distance ≥2 cm( OR=1.482, 95% CI: 1.116-1.738, P=0.032), presence of bullae or emphysema( OR=1.705, 95% CI: 1.316-2.431, P=0.024), and puncture depth ≥5 cm( OR=1.343, 95% CI: 1.058-1.763, P=0.037). Conclusions:Elderly patients undergoing CT-guided PLB have a high risk of pneumothorax.Personalized predictive strategies are necessary to reduce the risk of pneumothorax, particularly major pneumothorax.

Purpose To observe the risk of large pneumothorax after CT-guided percutaneous lung biopsy and analyze its associated factors. Materials and Methods This study was a prospective cohort design,enrolling 1732 patients who underwent CT-guided percutaneous lung biopsy in Beijing Hospital from January 2017 to December 2023. Patients were divided into three groups based on the occurrence and severity of pneumothorax:non-pneumothorax group (1361 cases),minor pneumothorax group (277 cases) and large pneumothorax group (94 cases). Baseline clinical data,puncture-related parameters and lesion characteristics were collected,and risk factors for major pneumothorax were analyzed. Results There were significant differences in terms of age,heart failure,lesion size,distance from the chest wall and presence of pulmonary bullae/emphysema among the three groups (F/x2=12.878,15.115,14.208,6.293,19.492,all P<0.05). Multivariate Logistic regression analysis identified the following as significant independent factors for large pneumothorax,including age≥65 years (OR=1.204,P=0.007),heart failure (OR=1.449,P=0.016),lesion size≤2 cm (OR=1.378,P=0.003),distance from chest wall≥2 cm (OR=1.311,P=0.012),presence of pulmonary bullae/emphysema (OR=2.079,P<0.001) and puncture depth≥5 cm (OR=1.405,P=0.003). Conclusion The occurrence of large pneumothorax following CT-guided percutaneous lung biopsy is closely associated with factors such as age,heart failure,lesion size,distance from the chest wall and the presence of pulmonary bullae/emphysema.

Objective:To investigate the incidence and influencing factors of pneumothorax in elderly patients(aged ≥65 years)undergoing CT-guided percutaneous lung biopsy(PLB).Methods:A prospective cohort study was conducted, enrolling elderly patients who underwent CT-guided PLB at Beijing Hospital from January 2017 to December 2023.Pneumothorax occurrence was assessed through two CT scans performed immediately post-procedure and at 48 hours post-PLB.Based on pneumothorax status, patients were categorized into a pneumothorax group and a non-pneumothorax group.Baseline clinical and procedural data were compared between the two groups, and multivariate logistic regression analyses were conducted to identify factors associated with pneumothorax.Results:Among the 647 elderly patients who underwent PLB, 152 cases(23.5%, 152/647)developed pneumothorax, with 101 cases(15.6%)presenting with minor pneumothorax and 51 cases(7.9%)with major pneumothorax.Compared with the non-pneumothorax group, patients in the pneumothorax group had a higher incidence of chronic obstructive pulmonary disease(COPD), higher frailty proportion, smaller lesions, lesions located further from the chest wall, more frequent bronchial involvement, and a higher rate of puncture depth ≥5 cm(all P<0.05).Multivariate logistic regression analysis revealed the following as significant risk factors for minor pneumothorax: COPD( OR=1.256, 95% CI: 1.014-1.558, P=0.033), lesion size ≤2 cm( OR=1.345, 95% CI: 1.075-1.659, P=0.022), lesion-to-chest-wall distance ≥2 cm( OR=1.372, 95% CI: 1.105-1.703, P=0.007), presence of pulmonary bullae or emphysema( OR=1.524, 95% CI: 1.223-1.899, P<0.001), ground-glass opacity density( OR=1.313, 95% CI: 1.072-1.839, P=0.014), bronchial involvement( OR=1.211, 95% CI: 1.047-1.694, P=0.038), and needle insertion depth ≥5 cm( OR=1.312, 95% CI: 1.024-1.749, P=0.038).For major pneumothorax, significant risk factors included age( OR=1.286, 95% CI: 1.021-1.819, P=0.041), COPD( OR=1.248, 95% CI: 1.098-1.753, P=0.035), heart failure( OR=1.312, 95% CI: 1.027-1.956, P=0.042), frailty( OR=1.301, 95% CI: 1.063-1.981, P=0.036), lesion size ≤2 cm( OR=1.345, 95% CI: 1.040-1.872, P=0.039), lesion-to-chest-wall distance ≥2 cm( OR=1.482, 95% CI: 1.116-1.738, P=0.032), presence of bullae or emphysema( OR=1.705, 95% CI: 1.316-2.431, P=0.024), and puncture depth ≥5 cm( OR=1.343, 95% CI: 1.058-1.763, P=0.037). Conclusions:Elderly patients undergoing CT-guided PLB have a high risk of pneumothorax.Personalized predictive strategies are necessary to reduce the risk of pneumothorax, particularly major pneumothorax.

Objective:To investigate the efficacy and adverse effects of first-line immunotherapy combined with chemotherapy in elderly patients with small cell lung cancer(SCLC)in population of real world.Methods:A total of 148 elderly SCLC patients(age ≥65 years old)underwent pathological diagnosis were retrospectively analyzed from January 2013 to June 2023.103 patients received chemotherapy(chemotherapy group), and 45 patients received immunotherapy combined with chemotherapy(combination group). Patients were divided into senior group(≥75 years old)and younger group(<75 years old)by age.To compare the efficacy of different regimens in first-line treatment, the expression of programmed death-ligand 1(PD-L1)and tumor mutational burden(TMB)were evaluated.Response evaluation criteria in solid tumors(RECIST)version 1.1 was used to evaluate the efficacy, and common terminology criteria for adverse events(CTCAE)version 4.03 was used to evaluate immune-related adverse.Kaplan-meier and Log-rank test were performed.Cox regression was used in prognostic analysis.Results:The overall response rate(ORR)of the first-line combination group in elderly SCLC patients was 79.1%(34/43), which was higher than that of the chemotherapy group 63.2%(60/95), but the difference did not reach statistical significance( χ2=3.451, P=0.063). ORR was significantly higher in the combination group than in the chemotherapy group for patients in the ≥75-year-old group, 87.5%(7/8) vs.48.6%(17/35), respectively( χ2=4.001, P=0.045). The difference in median progression-free survival time(mPFS)in the combination group compared with the chemotherapy group was not statistically significant in the overall patients(5.43 months vs.6.07 months, P=0.660). The combination group prolonged patients' median overall survival time(mOS)compared with the chemotherapy group, but the difference did not reach statistical significance(13.63 months vs.11.97 months, P=0.205). In patients ≥75 years old, mPFS was lower in the combination group than in the chemotherapy group(2.97 months vs.6.47 months), but mOS was prolonged compared with that in the chemotherapy group(13.50 months vs.11.40 months), and none of the differences reached statistical significance(both P>0.05). The differences in mPFS and mOS between the combination group and the chemotherapy group were not statistically significant in patients <75 years old(both P>0.05). In elderly patients with severe comorbidities, mPFS and mOS were lower in the combination group than in the chemotherapy group(5.40 months vs.7.30 months and 10.70 months vs.12.27 months, both P>0.05). In patients without severe comorbidities, the difference in mPFS between the combination group and the chemotherapy group was not statistically significant( P>0.05), but the mOS was significantly longer in the combination group(20.57 months vs.11.57 months, P=0.054). Elderly SCLC patients had a positive PD-L1 tumor cell positive proportion score(TPS)rate(≥1%)of 23.5%(4/17)and a high TMB(≥9 mut/Mb)expression rate of 69.0%(11/16). The overall incidence of immune-related adverse reactions was 71.0%(32/45), grade 3 or higher 33.3%(15/45), and the most common grade 3 adverse reactions were rash, immune-related pneumonia and malaise. Conclusions:First-line immune-combination chemotherapy improves ORR and mOS over chemotherapy in elderly SCLC patients; mOS benefit of immune-combination chemotherapy is more pronounced in patients ≥75 years of age without severe comorbidities, low PD-L1 positivity and high TMB expression are present in elderly SCLC patients, and immune-related adverse effects are generally manageable in elderly patients.

Objective To investigate the clinical efficacy and safety of CT-guided percutaneous microwave ablation (MWA)in elderly patients with early-stage lung cancer who were unable to underwent surgery,and to evaluate the risk factors for prognosis.Methods A total of 51 patients with early stage(stages Ⅰ and ⅡA)non-small cell lung cancer (NSCLC)who underwent MWA in Beijing hospital from January 2016 to December 2018 were collected as the MWA group.And 50 patients with similar age and gender receiving lobectomy surgery were collected as the control group.In a retrospective follow-up study,the clinical efficacy and safety of treatment were compared between the study(n=51)and control(n=50)groups.Kaplan-Meier survival analysis was used to assess the overall survival and local recurrence-free survival.COX analysis was used to evaluate the risk factors.Results Of the 101 patients,62 were male(61.4％),aged 60-85 years(average,72.3± 11.6 years).There was no significant difference in baseline characteristics,including age,gender,smoking,medical history,lung function,tumor size,pathological type and histological grading,tumor position and clinical stage between the two groups(P＞0.05).There were no serious complications in the MWA group during perioperative period,and 14 cases (27.5％)had a small amount of pneumothorax after operation,which were absorbed after special treatment.Five cases (9.8％)had a small amount of hemoptysis,7 cases(13.7％)had a small amount of pleural effusion,9 cases(17.6％)had low fever (＜ 38.5 ℃),and 9 cases (17.6 ％) had postoperative mild pain.There were no serious complications in the control group.The follow-up period was up to December 31,2018,and the median follow-up time was 11.7 months(4.5 20.3 months).During the follow-up,local recurrence occurred in 10 patients(9.9％),including 7 patients(13.7％)in the MWA group and 3 patients(6.0％)in the control group.There was no significant difference between the MWA group and the control group in the 1-year overall survival rate(92.2％ or 47 cases vs.96.0％ or 48 cases,P =0.313),tumor-specific survivalrate(100.0％ vs.100.0％,P=1.00),local recurrence free survival rate(86.3％ or 44 cases vs.94.0％ or 47 cases,P =0.156).Multivariate COX regression analysis showed age (HR =1.22,95 ％CI:1.06-1.38,P =0.004),tumor size (HR =1.75,95 ％ CI:1.14-2.36,P =0.005) and clinical stage of tumor(HR =1.53,95 ％ CI:1.17-1.89,P =0.001) were risk factors for the local recurrencefree survival.Conclusions MWA is an effective and safe treatment for elderly patients with early-stage lung cancer who are not suitable for surgery.Age,tumor diameter and clinical stage are risk factors for local recurrence-free survival.

Objective To investigate the clinical characteristics,prognosis,and influencing factors of digestive system tumors in elderly patients complicated with acute pulmonary thromboembolism(PTE).Methods In this retrospective cohort study,we analyzed data from 86 elderly patients with digestive system tumors from the Oncology Department of Beijing Hospital from January 2007 to January 2017.Forty-one elderly patients who had digestive system tumors with PTE were assigned into an observation group and forty five without PTE into a control group.We analyzed the clinical characteristics of the two groups.Kaplan-Meier survival analysis was used to assess the median survival time;and Cox regression analysis was used to evaluate the influencing factors for prognosis.Results Eighty-six elderly patients with a mean age of(75.8 ± 13.7)years ranging from 60 to 92 years were enrolled.There was a statistically significant difference in the D-dimer level between the groups at baseline (P ＜ 0.05).In the observation group,the primary symptom was dyspnea(78.0％,n=67).Of all primary tumors complicated with PTE,colorectal cancers had the highest prevalence,accounting for 56.1％ (n =23),followed by gastric cancers,representing 31.7％ (n=13).Twenty-three patients in the observation group were complicated with deep venous thrombosis(56.1％,n-23),which mostly located in the lower limbs (56.5 ％,n =23).Meanwhile,90.2 ％ of PTE(n =37) occurred during chemotherapy or follow-up.Sixty-seven patients (77.9 ％) died during the follow-up,and the difference in mortality between the two groups was statistically significant(P ＜ 0.05).Kaplan Meier survival analysis showed a significant difference in median survival time between the two groups (3.7 vs.8.5 months,P ＜ 0.05).Cox regression analysis indicated that age,PTE,and metastasis were risk factors for median survival time(all P ＜0.05) Conclusions Elderly patients with digestive system tumors complicated with acute pulmonary thromboembolism show no typical characteristics and poor prognosis.Therefore,preventive measures and care should be taken to improve the prognosis,especially for patients at high risk of PTE.