BACKGROUND: Stage III non-small cell lung cancer (NSCLC) is a highly heterogeneous stage due to its subgroups (IIIA-IIIC) comprising both resectable and unresectable tumors. Accurate determination of the extent of the disease is essential for excluding stage IV and choosing the optimal treatment regimen. Whole body positron emission tomography and computed tomography scan (PET/CT) is recommended as an initial staging imaging in locally advanced NSCLC. Despite international guidelines for NSCLC diagnosis and treatment, they are not always adhered to due to various reasons. Even in such a groundbreaking study, the phase 3 trial PACIFIC investigating the efficacy of durvalumab as consolidation therapy in patients with stage III NSCLC PET/CT was not mandatory. With the premise that whole body PET/CT of the trunk is essential for diagnosing stage III NSCLC, we performed a retrospective study evaluating the relationship of the use of PET/CT versus conventional staging with CT of the chest and abdomen, in terms of survival. METHODS: This retrospective study of stage III NSCLC patients used the Czech lung cancer registry LUCAS, which was established in June 2018. As of the data export (up to February 9, 2022), a total of 703 patients were eligible for the analysis. Overall survival (OS) was compared using Kaplan-Meier analysis and a Cox regression model. Continuous variables were tested using the Mann-Whitney test, and categorical variables using the Pearson's Chi-square or Fisher's exact test. RESULTS: A total of 703 patients were included in the cohort with an average age of 69 years. PET/CT was performed on 354 patients, and conventional staging using chest and abdominal CT on 349 patients. The median OS among patients with PET/CT was 20.9 months [95% confidence interval (CI): 18.1-23.7], and it was statistically significantly higher (P<0.001) than among patients without PET/CT, where the median OS was 9.0 months (95% CI: 7.3-10.6). The observed effect of PET/CT was also statistically significant when comparing individual stages (IIIA, IIIB, IIIC). The multivariate Cox model confirmed the use of PET/CT as an independent prognostic factor. The most common reason for omission of PET/CT was the local or time unavailability of the examination. CONCLUSIONS: Omission of PET/CT can mean a significant decrement in survival for the patients in stage III NSCLC, likely due to poor staging and suboptimal treatment. Routine use of PET/CT is strictly recommended for the optimal management of stage III NSCLC patients even outside the high-income countries.
- Publikační typ
- časopisecké články MeSH
V tomto přehledovém článku jsou popsané možnosti i limitace standardní léčby stabilizované chronické plicní nemoci (CHOPN) tak, jak ji v současnosti v České republice provádíme. Dále uvádím i nové možnosti tzv. biologické léčby CHOPN ovlivněním zánětu 2. typu inhibicí interleukinů (IL4, L5, IL13). Tento typ zánětu se vyskytuje u 20-40 % nemocných s CHOPN a jeho hlavním biomarkerem je zvýšený absolutní počet eozinofilů nad 300/μL. Nejvíce dat z pre- i z klinických studií máme o dupilumabu, který inhibicí IL-4 a IL-13 významně potlačuje aktivaci buněk zánětu druhého typu, především eozinofilů. Jsou uvedeny výsledky dvou klinických studií fáze 3 BOREAS a NOTUS. Tyto studie na vysoce selektovaných souborech nemocných s nekontrolovanou CHOPN prokázaly schopnost dupilumabu přidaného k maximální léčbě (LAMA/LABA/ICS) nemocných s CHOPN významně snížit počty akutních exacerbací o 30 % a 34 %, zlepšit jejich plicní funkce, snížit respirační symptomy a zlepšit kvalitu života.
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BACKGROUND AND METHOD: To determine the current situation and trends in bronchology in the Czech Republic (CR), a questionnaire survey has been conducted by the Czech Pneumological and Phthisiological Society (CPFS). RESULTS: In 2020, 158 bronchoscopists conducted 26,700 BRS procedures, 927 of them were rigid. 2,869 procedures were done under general anaesthesia. Of diagnostic methods, the use of endobronchial ultrasound (EBUS) is rising, being available in 35 % BRS facilities in 2020. Interventional bronchology procedures are conducted in 17 facilities and 1,517 were executed in 2020. The numbers of cryocauterizations and stenting are growing. In the questionnaire we asked also about biomarkers of lung carcinoma that are examined at 47 out of 49 facilities. Since 1975 when 11,194 bronchoscopies were conducted in the CR, their numbers increased to 33,282 in 2009, then dropping slightly to 26,700 in 2020. At present, 254 bronchoscopies are conducted per 100,000 inhabitants in a year. CONCLUSIONS: Based on the BRS survey in 2020 it can be concluded that Czech bronchology is developing in the right direction and is well equipped with both, staff and technical devices. We are adopting new methods without delays and we expand the use of those working well (EBUS) (Tab. 4, Ref. 13).
- MeSH
- bronchoskopie * metody přístrojové vybavení statistika a číselné údaje trendy MeSH
- lidé MeSH
- průzkumy a dotazníky MeSH
- zdravotnická zařízení statistika a číselné údaje trendy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND/AIM: Due to some interconnectedness at the molecular level, this study assessed the possible influence of laboratory parameters associated with systemic inflammatory environment on programmed death-ligand 1 (PD-L1) expression in non-small cell lung carcinoma (NSCLC). PATIENTS AND METHODS: We assessed effects of c-reactive protein (CRP), albumin, haemoglobin, neutrophil, and lymphocyte levels on PD-L1 expression in NSCLC. Patient data were obtained retrospectively from LUCAS, the Czech registry of patients with lung carcinomas. Correlations of two continuous parameters (PD-L1 expression and laboratory parameters) were analysed by correlation coefficient. Differences in continuous parameters between two or more groups were tested by Mann-Whitney or Kruskal-Wallis tests. Independence of two categorical parameters was tested by chi-square test. RESULTS: We demonstrated no influence of the investigated laboratory parameters on PD-L1 expression in NSCLC, either in continuous or categorical division of variables. CONCLUSION: Inflammatory laboratory parameters at time of NSCLC diagnosis are unlikely to affect the determination of PD-L1 expression.
- MeSH
- antigeny CD274 analýza MeSH
- C-reaktivní protein analýza MeSH
- hemoglobiny analýza MeSH
- lidé středního věku MeSH
- lidé MeSH
- lidský sérový albumin analýza MeSH
- lymfocyty imunologie MeSH
- nádorové biomarkery analýza MeSH
- nádory plic imunologie patologie MeSH
- nemalobuněčný karcinom plic imunologie patologie MeSH
- neutrofily imunologie MeSH
- registrace MeSH
- retrospektivní studie MeSH
- senioři MeSH
- staging nádorů MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Background/Aim: This study aimed at contributing to a better diagnosis of lung cancer by analyzing the patient's symptoms and their linkage to other characteristics. Patients and Methods: We analyzed the data of 3,322 patients from LUCAS (LUngCAncerfocuS) National Registry of the Czech Republic. Overall survival was assessed using the Kaplan-Meier method. Results: The most common symptoms were cough (47.5%), dyspnea (45.6%), pain (27.3%), and weight loss (25.7%). Among all patients, 16% were asymptomatic. We demonstrated the negative prognostic significance of increasing number of lung cancer symptoms, that was significant after adjustment for age, TNM stages, and performance status, and morphological types of the cancer. Conclusion: Monitoring the severity and type of symptoms in patients with lung cancer can help in the diagnostics of the disease and the estimation of prognosis.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Programmed death-ligand 1 (PD-L1) expression is a standard predictor in the selection of immunotherapy for locally advanced/advanced non-small cell lung cancer (NSCLC). However, comedication with corticosteroids or non-steroidal anti-inflammatory drugs (NSAIDs) may influence the effectiveness of this treatment as documented in several previous studies. Due to certain molecular linkages between PD-L1 and corticosteroids or NSAIDs, we therefore addressed the question of whether there is a relationship between PD-L1 expression in NSCLC and the use of this comedication. METHODS: This is a retrospective study using the Czech tumor registry LUng CAncer focuS (LUCAS), from which patient data were drawn. Independence of two categorical parameters was tested by Pearson's chi-square test. RESULTS: In our group of 1,148 patients, we observed no significant relationship between PD-L1 expression and the use of corticosteroids or NSAIDs. CONCLUSIONS: According to our data, treatment with corticosteroids or NSAIDs during biopsy does not affect the expression of PD-L1 and it is therefore not necessary to take this treatment into account in this regard.
- Publikační typ
- časopisecké články MeSH
Covidová pneumonie byla v uplynulých dvou letech častou náplní práce pneumologických ambulantních i lůžkových zařízení. Ke stanovení reálného stavu péče o tyto nemocné jsme uspořádali retrospektivní studii. Zařadili jsme do ní 200 nemocných přijatých na Pneumologickou kliniku 2. LF UK a FN Motol v 1. a 4. vlně pandemie covid-19. Zemřelo 25 % pacientů z celého souboru, významně více v 1. vlně (podzim 2020) než ve 4. vlně (podzim 2021), 33 % versus 17 %. Průměrný věk zemřelých byl 76 roků, průměrný věk celého souboru byl 67 roků. Rizikovým faktorem pro přijetí byl vedle vyššího věku i větší počet komorbidit, 38 % z přijatých pacientů bylo obézních. Negativním prognostickým faktorem byl vysoký CRP. Méně nemocných zemřelo z těch, kteří byli léčeni remdesivirem (18 % vs. 30 %), a z těch, kteří měli BMI nad 31 (17 % vs. 30 %). ”Na“ covid-19 zemřely 2/3 nemocných, 1/3 zemřela “s” covid-19. Vakcinace měla příznivý vliv na nemocné z 4. vlny, významně méně nemocných zemřelo, byli významně častěji léčeni na standardu, méně často na ARO a měli významně méně často indikovanou UPV a ECMO. Covidová pneumonie je závažným, život ohrožujícím onemocněním, jehož průběh byl příznivě ovlivněn vakcinací, léčbou a promořeností populace.
- MeSH
- COVID-19 * komplikace MeSH
- lidé MeSH
- retrospektivní studie MeSH
- virová pneumonie * etiologie terapie MeSH
- Check Tag
- lidé MeSH
OBJECTIVES: With the increasing number of detected lung nodules and the need for morphological verification, the number of CT- controlled biopsies is increasing. The aim of this study was to assess the risks and benefits of these biopsies. METHODS: This is a prospective and observational study. We evaluated 101 punctures performed on a group of 90 consecutive patients in the Department of Radiology. RESULTS: In patients with a mean age of 66 years, with mostly accidentally detected lung nodules, we observed complications 38 times. The most common were minor pneumothoraxes or insignificant bleedings. In 6 patients, the complications were more serious, 5 times the pneumothoraxes required chest drainage, once massive hemoptysis was recorded. The lesions were successfully biopsied 78 times, the target was missed 23 times. The diagnosis of lung cancer (LC) was confirmed in 60 patients, 49 LCs were verified by puncture under CT control. 42% (25/60) of patients with LC were diagnosed in TNM stages I and II. 23% (14/60) of patients with LC were treated surgically. The remaining 30 patients most often suffered from lung metastazes (13/30), in 8 of them an inflammatory lung disease was diagnosed. 69 patients underwent bronchoscopy, in only 19% (13/69) it contributed to the diagnosis. In a model "screening like" group of 49 patients with only randomly detected lung deposits, we diagnosed LC in 76% (37/49). 49% (18/37) were in TNM stage I and II, 11 were treated surgically. CONCLUSIONS: CT-controlled biopsy of lung lesions is an effective and safe diagnostic method.
