Crit Rev Oncol Hematol. 2026 Sep;225:105483. doi: 10.1016/j.critrevonc.2026.105483. Epub 2026 Jul 10.

ABSTRACT

Low-dose CT (LDCT) lung cancer screening significantly reduces mortality but has dramatically increased the detection of pulmonary nodules. Most of these nodules are benign, leading to a high false-positive rate that triggers unnecessary invasive procedures and patient anxiety, underscoring the need for more precise noninvasive diagnostic tools. Critically, single-modality liquid biopsy biomarkers, including circulating tumor cells, cell-free DNA mutations, or individual microRNAs, have demonstrated insufficient sensitivity or specificity for independent clinical deployment when used in isolation. This necessitates a paradigm shift toward multimodal molecular integration, wherein complementary biomarker classes are combined to overcome the inherent limitations of any single analyte. Traditional clinical prediction models (Mayo, VA, Brock, Herder) assist in estimating malignancy risk, yet their accuracy remains modest. Emerging approaches harness radiomics and artificial intelligence (AI) to extract high-dimensional imaging features from chest CT scans, improving risk stratification beyond human assessment alone. In parallel, minimally invasive liquid biopsy biomarkers offer complementary avenues to detect occult malignancy signals. Additionally, bronchial airway gene expression classifiers leverage the "field-of-injury" effect in normal respiratory epithelium to help identify lung cancer even when the nodule itself cannot be directly sampled via biopsy. Integrating these radiologic and molecular data streams into a multi-omics framework has the potential to enhance diagnostic precision for indeterminate pulmonary nodules, enabling more confident discrimination between benign and malignant lesions. However, most of these emerging tools have not yet been validated in large prospective trials and face technological barriers as well as challenges in real-world implementation. This review focuses primarily on LDCT screening detected pulmonary nodules, while incorporating evidence from incidentally detected and other indeterminate nodule cohorts when relevant to broader CT based management. By synthesizing advances in radiomics, AI, liquid biopsy, airway classifiers, and multi-omics integration, we highlight the need for prospective validation and multidisciplinary collaboration to translate these approaches into clinically useful pathways that improve early lung cancer detection, reduce unnecessary interventions, and enhance patient outcomes.

PMID:42431477 | DOI:10.1016/j.critrevonc.2026.105483

Pharmacol Res. 2026 Apr 9:108186. doi: 10.1016/j.phrs.2026.108186. Online ahead of print.

ABSTRACT

Community-acquired pneumonia (CAP) remains a major global public health challenge with substantial morbidity and mortality. Although preclinical studies suggest that Maxing Huoqiao (MXHQ) granule may have therapeutic potential for pneumonia, high-quality clinical evidence is still limited. We conducted a multicenter, double-blind, randomized, placebo-controlled trial at two tertiary hospitals in China to evaluate the clinical efficacy of MXHQ as adjunctive therapy and to explore its potential mechanisms in adults with nonsevere CAP receiving standard moxifloxacin treatment. A total of 96 patients were enrolled and randomized (1:1:1) to receive standard-dose MXHQ, low-dose MXHQ, or placebo in addition to moxifloxacin for 7 days, with a 14-day follow-up. The primary endpoint was clinical cure, defined as composite recovery of major respiratory symptoms, lung rales, and fever; secondary endpoints included symptom relief, radiographic improvement, and safety. Compared with placebo, standard-dose MXHQ was associated with a higher day-14 clinical cure rate (30.78% vs. 68.97%; RR = 0.45, 95% CI = 0.24-0.83; P < 0.01). Furthermore, the standard-dose intervention was correlated with a shorter time to relief and recovery of cough and sputum (P < 0.05), as well as improvements in symptom scores (P < 0.05) and promoting lesion absorption on chest CT (P < 0.05). Low-dose MXHQ showed no significant clinical benefit, whereas safety profiles were comparable across all groups. Transcriptomic analyses of peripheral blood mononuclear cells, complemented by a Streptococcus pneumonia animal model, indicated that the clinical benefits of MXHQ are linked to the modulation of inflammation and innate immunity. These omics and in vivo observations suggest a potential mechanism underlying the protective effects of MXHQ against inflammatory injury and promotion of tissue repair, involving the regulation of anti-inflammatory mediators and tissue repair-related factors. (Chictr.org.cn, ID Number: ChiCTR2400082095).

PMID:41966499 | DOI:10.1016/j.phrs.2026.108186