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Background Targeted therapy, represented by epidermal growth factor receptor-targeting tyrosine kinase inhibitors (EGFR-TKIs) , has significantly prolonged the survival time of patients with EGFR mutations with relatively mild adverse reactions, and become a prior choice for advanced non-small cell lung cancer (NSCLC) patients with driver genes. Dynamic monitoring of treatment progress and gene mutations in NSCLC patients by means of gene detection will help to provide a more effective, long-term and stable individualized targeted therapy for such patients. Objective To compare the gene mutations before and after the progression of NSCLC, and to analyze the regularities of gene mutations dynamically monitored and related prognostic value in NSCLC patients. Methods NSCLC outpatients and inpatients undergoing genetic tests were selected from Department of Integrated Medicine and Lung Cancer Center of China-Japan Friendship Hospital from 2007 to 2021. Their data were collected and used to establish a lung cancer genes testing database. Tissue samples or peripheral blood circulating tumor DNA (ctDNA) before and after progression were obtained for full-coding area detection of lung cancer genes, and the number of gene mutations and testing results were recorded. We divided enrolled patients into gene clearance group and non-gene clearance group, and compared baseline characteristics and survival status between the groups. Results A total of 217 cases were enrolled and followed until their clinical endpoint. The total changes in gene mutations in tissue samples before and after the disease progression were as follows: the number of patients with wild type increased from 70 (32.3%) to 95 (43.8%) , the number of patients with mutant type decreased from 147 (67.7%) to 122 (56.2%) , the number of patients with 19DEL mutation increased from 64 (29.5%) to 67 (19.8%) , the number of patients with 21 L858R mutations decreased from 74 (34.1%) to 64 (24.0%) , the number of patients with T790M mutations increased from 2 (0.9%) to 45 (20.7%) , and the number of those with rare mutations or concomitant rare mutations such as TP53 increased from 20 (9.2%) to 84 (38.7%) . Gene clearance group (n=67) and non-gene clearance group (n=150) had significant differences in clinical features except the history of lung disease (P=0.032) and the history of targeted therapy (P=0.001) . The median progression-free survival (PFS) of patients in the two groups was 9.8 months and 11.8 months, respectively, with no significant difference〔HR=0.89, 95%CI (0.66, 1.20) , P=0.310〕. The median PFS of 134 patients with advanced NSCLC in two groups was 8.1 months and 9.8 months, respectively, with no significant difference〔HR=0.83, 95%CI (0.58, 1.19) , P=0.359〕. The median overall survival (OS) of patients in two groups was 50.5 months and 28.5 months, respectively, with statistically significant difference〔HR=0.56, 95%CI (0.41, 0.78) , P

Objective To evaluate the value and characteristics of 18F-FDG PET/CT and enhanced CT in primary pulmonary mucinous adenocarcinoma (PPMA), in order to provide reference for the clinical diagnosis and treatment of the disease. Methods Data of enhanced CT and 18F-FDG PET/CT imaging and clinical information of 25 patients with PPMA confirmed by pathology in China-Japan Friendship Hospital from July 2015 to February 2018 were retrospectively reviewed. Results A total of 25 PPMA patients were enrolled. Among them, 25 patients underwent the examination of 18F-FDG PET/CT imaging, and 6 cases underwent enhanced CT scan. Seven cases had one lesion, which morphologically manifested as a solitary lung lesion with lobulation signs, spinous processes on the edge, and uneven uptake of 18F-FDG with low or no uptake in hollow or cystic density areas; 18 cases showed diffuse multiple lesions in both lungs with different distribution, size and shape, including 5 cases with multiple nodules/masses, 5 with consolidations, and 8 with diversified lesions including nodules, masses, cavities, ground glass opacities, patches, and consolidations. Consolidation shadow is the most typical morphological manifestation of diffusely multiple PPMA (11 cases). The density of consolidation foci was extremely uneven, and all of them contain areas of cystic density. They had low CT value(-71-79 Hu), and characteristic features were found, including pulmonary lobe bulging sign (6 cases), pathological air bronchus sign (4 cases), angiographic sign (3 cases) and surrounding ground glass density(7 cases). The uptake of 18F-FDG varied with the density of lesions. The cystic component was lower than the solid component. Contrast-enhanced CT showed heterogeneous enhancement in 4 cases and no enhancement in 2 cases. The degree of 18F-FDG uptake in lesions dominated by nodules, masses or cavities was not linearly correlated with the degree of CT enhancement, but that in lesions dominated by consolidation was positively correlated with the degree of CT enhancement. Conclusions Contrast-enhanced CT shows PPMA lesions with no enhancement or heterogeneous enhancement. PPMA is often manifested as nodules, patchy shadows, and other space-occupying forms mixed with consolidation shadows on 18F-FDG PET/CT imaging, which has characteristic manifestations, including pulmonary lobe bulge and pathological air bronchi. Angiographic signs and the degree of metabolism are positively correlated with the density of lesions, which are used for differential diagnosis of pulmonary infectious diseases.

Objectives: Obesity and hypercholesterolemia are linked to unfavor clinical outcomes. Recent studies declared the paradox that high body mass index (BMI) and serum cholesterol were independently connected to better clinical outcome of immune checkpoint inhibitors (ICIs) monotherapy in non‐small cell lung cancer (NSCLC). The aim of the study is to investigate the prognosis of BMI and serum cholesterol in ICIs‐based therapy. Methods: This is a retrospective study of 95 NSCLC patients treated with ICIs‐based therapy at the Department of Oncology and Lung Cancer Center of China‐Japan Friendship Hospital. Treatment efficacy was assessed using durable clinical benefit (DCB) versus nondurable benefit (NDB), best response (active vs. nonactive), and progression‐free survival (PFS). The prognostic value of BMI, LDL‐C, and RC was determined by multivariate regression analyses, while controlling for confounding factors including age, gender, diabetes status, smoking history, and statin usage. BMI was considered a confounding factor in the analysis when examining the impact of lipoproteins. Results: In our study, we found that in the whole group, BMI ≥25 kg/m2 was linked to a higher risk of poor therapeutic response (OR = 5.92, 95% CI 1.99–19.51, p.val = 0.002) and shorter progression‐free survival (HR = 3.00, 95% CI 1.59–5.68, p.val = 0.001). In addition, low levels of RC were associated with better therapeutic response (OR = 0.12, 95% CI 0.02–0.64, p.val = 0.019), while low levels of serum LDL‐C were found to predict longer PFS (HR = 0.40, 95% CI 0.19–0.82, p.val = 0.012). These associations were consistent in advanced NSCLC patients receiving ICIs and chemotherapy. Conclusions: Our study suggest that BMI ≥25 kg/m2 and elevated levels of apoB‐containing lipoproteins, including LDL‐C and RC, could potentially serve as useful prognostic markers for predicting poor treatment outcomes in advanced NSCLC patients treated with the combination of chemotherapy and ICIs. [ABSTRACT FROM AUTHOR]