Background Cytomegalovirus (CMV) infection is a leading cause of morbidity and mortality after transplantation. This study aimed to investigate CMV seroprevalence, infection, and disease in Chinese thoracic organ transplant recipients. Methods The clinical data of the patients who underwent lung and/or heart transplantation between January 2015 and October 2020 were retrospectively collected from four transplantation centers in China. Results A total of 308 patients were analyzed. The CMV serostatus was donor positive (D+) recipient negative (R−) in 19 (6.17%) patients, D+/R+ in 233 (75.65%), D−/R+ in 36 (11.69%), and D−/R− in 20 (6.50%). CMV DNAemia was detected in 52.3% of the patients and tissue-invasive CMV disease was diagnosed in 16.2% of the patients. Only 31.8% of the patients adhered to the postdischarge valganciclovir therapy. The D+/R− serostatus (odds ratio [OR]: 18.32; 95% confidence interval [CI]:1.80-188.68), no valganciclovir prophylaxis (OR: 2.64; 95% CI: 1.05–6.64), and higher doses of rabbit anti-human thymocyte globulin (> 2 mg/kg) (OR: 4.25; 95% CI: 1.92–9.42) were risk factors of CMV disease. Conclusion CMV seroprevalence was high in Chinese thoracic organ transplant donors and recipients. The low adherence rate to the postdischarge CMV prophylaxis therapy in Chinese patients is still an unresolved issue.
Background: The characteristics and roles of microbes in the occurrence and development of pulmonary nodules are still unclear. Methods: We retrospectively analyzed the microbial mNGS results of BALF from 229 patients with pulmonary nodules before surgery, and performed a comparative analysis of lung flora between lung cancer and benign nodules according to postoperative pathology. The analysis also focused on investigating the characteristics of lung microbiota in lung adenocarcinomas with varying histopathology. Results: There were differences in lung microbiota between lung cancer and benign lung nodules. Bacterial diversity was lower in lung cancer than in benign lung nodules. Four species (Porphyromonas somerae, Corynebacterium accolens, Burkholderia cenocepacia and Streptococcus mitis) were enriched in lung cancer compared with the benign lung nodules. The areas under the ROC curves of these four species were all greater than 0.6, and the AUC of Streptococcus mitis was 0.702, which had the highest diagnostic value for differentiating lung cancer from benign lung diseases. The significantly enriched microbiota varied with the different pathological subtypes of lung adenocarcinoma. Streptococcus mitis, Burkholderia oklahomensis and Burkholderia latens displayed a trend of increasing from the benign lung disease group to the AIS group, MIA group and IAC group, whereas Lactobacillus plantarum showed a downward trend. Conclusion: Changes in the abundance of lung microbiota are closely related to the development of infiltrating adenocarcinoma. Our findings provide new insights into the relationship between the changes in lung microbiota and the development of lung cancer.
Objectives: This study aims to investigate the efficacy and safety of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) as adjuvant therapy for resected non-small cell lung cancer (NSCLC) patients harboring EGFR mutations compared with adjuvant chemotherapy or placebo, including the latest updated data.Methods: A comprehensively systematic search for relevant randomized controlled trials (RCTs) was performed. Hazard ratios (HRs) and 95% confidence intervals (CI) were used to analyse disease-free survival (DFS) and overall survival (OS). For dichotomous data, risk ratio (RR) of severe adverse events and relapse patterns was calculated as effect measures. Results: Nine RCTs involving 1,835 completely resected patients with NSCLC with EGFR mutations were included in the meta-analysis. The use of EGFR-TKIs resulted in a significant improvement in DFS when compared to non-EGFR-TKIs based treatment (HR:0.45; 95% CI=0.29–0.71, P < 0.0005), but no OS benefit was shown (HR:0.79; 95%CI=0.54–1.16, P =0.23). In subgroup analyses, adjuvant EGFR-TKIs elevated DFS significantly compared to single-agent chemotherapy (HR: 0.50; 95%CI = 0.30–0.82, P = 0.006). Adjuvant EGFR-TKIs following chemotherapy also improved DFS significantly compared with single-agent chemotherapy (HR:0.34; 95%CI=0.16–0.69, P=0.003). No differences were found in DFS between adjuvant EGFR-TKIs versus placebo (HR:0.51; 95% CI=0.18 –1.47, P=0.21). Patients with a median treatment time over 12 months (HR:0.42; 95% CI=0.20–0.86; P =0.02) or diagnosed with stage III non-small cell lung cancer NSCLC (HR:0.42;95% CI = 0.20–0.86; P =0.02) induced better DFS. Elevated DFS from adjuvant EGFR-TKIs was still observed regardless of EGFR Mutation Status. Nevertheless, in subgroup analysis, neither subgroup analysis of therapeutic strategies nor median treatment duration observed any benefit from adjuvant EGFR-TKIs in OS. Moreover, adjuvant EGFR-TKIs decreased the risk of lung recurrence (RR: 0.63 ;95%CI=0.44 –0.89). Rash (RR:15.28; 95% CI = 4.71–49.55), Diarrhea (RR:3.08; 95% CI = 1.26–7.52) and ALT or AST increase (RR:8.85; 95% CI = 4.14–18.90) were several common grades 3 or higher adverse events (AEs) of EGFR-TKIs treatment.Conclusions: EGFR-TKIs treatment exhibited significant improvement in DFS with fewer manageable toxicities for NSCLC patients with EGFR mutations completely resection compared with non-EGFR-TKIs treatment. However, prolonged DFS did not produce any benefits for the OS.
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