J Thorac Dis. 2026 Aug 31;18(8):950. doi: 10.21037/jtd-2026-1704. Epub 2026 Aug 28.

ABSTRACT

BACKGROUND AND OBJECTIVE: Traditionally, two primary systems have been employed for staging small cell lung cancer (SCLC): the Veterans Administration Lung Study Group (VALG) system and the International Association for the Study of Lung Cancer (IASLC) tumor, node, metastasis (TNM) system. The term "limited disease" is defined differently: VALG characterizes it as disease encompassed within a single tolerable radiation field, while IASLC defines it as the lack of distant metastases (M0). Patients with N3 disease frequently satisfy VALG extensive-stage (ES) criteria while meeting IASLC limited-stage (LS) criteria, resulting in a notable staging discrepancy. Therefore, this review aims to clarify the clinical challenges posed by this staging overlap and provide insights for standardizing staging terminology and optimizing therapeutic decision-making in N3 SCLC.

METHODS: A narrative review utilizing a systematized search strategy was conducted. While strict adherence to PRISMA guidelines was not pursued because the extensive heterogeneity of the literature precluded a formal meta-analysis, rigorous search criteria were applied to minimize selection bias. Databases including PubMed, Web of Science, Embase, the Cochrane Library, and China National Knowledge Infrastructure (CNKI) were searched for literature from January 2000 to March 2026. Studies examining stage N3 SCLC, spatial metastatic burden, and definitional inconsistencies between the VALG and IASLC staging systems were analyzed to assess their effects on treatment dosimetry, systemic therapy, and survival outcomes.

KEY CONTENT AND FINDINGS: The staging overlap in N3 SCLC leads to heterogeneous clinical management depending on its spatial metastatic burden, and this highly variable cohort can be stratified into distinct prognostic subgroups based on the anatomical distribution (single-region vs. multi-region) of the involved lymph nodes.

CONCLUSIONS: These findings should guide clinical trial design and terminology. Clinical decision-making must transcend historical paradigms and technical constraints. Future strategies must incorporate spatial evaluations of metastatic burden alongside innovative multimodal tools, such as artificial intelligence (AI) and multi-omics, to facilitate tailored therapy for SCLC.

PMID:42724560 | PMC:PMC13559235 | DOI:10.21037/jtd-2026-1704

J Thorac Dis. 2026 Aug 31;18(8):950. doi: 10.21037/jtd-2026-1704. Epub 2026 Aug 28.

ABSTRACT

BACKGROUND AND OBJECTIVE: Traditionally, two primary systems have been employed for staging small cell lung cancer (SCLC): the Veterans Administration Lung Study Group (VALG) system and the International Association for the Study of Lung Cancer (IASLC) tumor, node, metastasis (TNM) system. The term "limited disease" is defined differently: VALG characterizes it as disease encompassed within a single tolerable radiation field, while IASLC defines it as the lack of distant metastases (M0). Patients with N3 disease frequently satisfy VALG extensive-stage (ES) criteria while meeting IASLC limited-stage (LS) criteria, resulting in a notable staging discrepancy. Therefore, this review aims to clarify the clinical challenges posed by this staging overlap and provide insights for standardizing staging terminology and optimizing therapeutic decision-making in N3 SCLC.

METHODS: A narrative review utilizing a systematized search strategy was conducted. While strict adherence to PRISMA guidelines was not pursued because the extensive heterogeneity of the literature precluded a formal meta-analysis, rigorous search criteria were applied to minimize selection bias. Databases including PubMed, Web of Science, Embase, the Cochrane Library, and China National Knowledge Infrastructure (CNKI) were searched for literature from January 2000 to March 2026. Studies examining stage N3 SCLC, spatial metastatic burden, and definitional inconsistencies between the VALG and IASLC staging systems were analyzed to assess their effects on treatment dosimetry, systemic therapy, and survival outcomes.

KEY CONTENT AND FINDINGS: The staging overlap in N3 SCLC leads to heterogeneous clinical management depending on its spatial metastatic burden, and this highly variable cohort can be stratified into distinct prognostic subgroups based on the anatomical distribution (single-region vs. multi-region) of the involved lymph nodes.

CONCLUSIONS: These findings should guide clinical trial design and terminology. Clinical decision-making must transcend historical paradigms and technical constraints. Future strategies must incorporate spatial evaluations of metastatic burden alongside innovative multimodal tools, such as artificial intelligence (AI) and multi-omics, to facilitate tailored therapy for SCLC.

PMID:42724560 | PMC:PMC13559235 | DOI:10.21037/jtd-2026-1704

Curr Mol Med. 2026 May 11. doi: 10.2174/0115665240438824260113042223. Online ahead of print.

ABSTRACT

BACKGROUND: 5-aminoimidazole-4-carboxamide ribonucleotide formyltransferase/ IMP cyclohydrolase(ATIC) is a 64-kDa bifunctional enzyme, 5-aminoimidazole- 4-carboxamide ribonucleotide formyltransferase (AICART) and IMP cyclohydrolase, respectively. catalyzes the last two steps of the purine ab initio biosynthetic pathway. ATIC has been implicated in cancer progression, but its pan-cancer profile and specific prognostic utility in liver hepatocellular carcinoma (LIHC) remain incompletely defined.

METHODS: We analyzed TCGA RNA-seq data across 33 tumor types to assess ATIC expression, diagnostic performance (ROC/AUC), and prognostic associations (OS, DSS, PFI). We correlated ATIC expression with immune infiltration, TMB, MSI, and predicted neoantigen load, and constructed a LIHC-specific prognostic nomogram integrating ATIC and clinicopathologic features. Enrichment analyses (STRING, GO/KEGG, GSEA) and pharmacogenomic correlations (GDSC, CTRP) were performed to explore mechanisms and drug sensitivities.

RESULTS: ATIC was significantly upregulated in 16 tumor types, including LIHC (p<0.001). Pan-cancer ROC analyses showed high diagnostic accuracy in several cancers (examples: CHOL AUC=1.000, LIHC AUC=0.936, LUAD AUC=0.947). High ATIC expression associated with poorer OS in ACC, HNSC, LIHC, and PAAD (eg, LIHC: HR=1.39(1.04-1.85), p=0.028). In LIHC, ATIC correlated with advanced T stage, higher grade, elevated AFP, and shorter OS. Multivariable Cox regression identified ATIC expression and pathological T stage as independent predictors; time-dependent ROC for the LIHC nomogram showed AUCs of 0.711, 0.649, and 0.653 at 1, 3, and 5 years, respectively. GSEA indicated enrichment of PI3K-AKT-mTOR, MYC targets, and cell-cycle pathways in ATIC-high LIHC. High ATIC expression correlated with predicted increased sensitivity to sorafenib, doxorubicin, cisplatin, epothilone, and mitomycin in the TCGA-LIHC cohort.

DISCUSSION: ATIC upregulation across cancers links to tumor progression, immune modulation, and prognosis (LIHC), suggesting oncogenic roles in pan-cancer contexts. TCGA multi-omics show ATIC associates with immune/molecular subtypes, MSI/TMB/neoantigens, and predicts drug sensitivity, indicating diagnostic/prognostic potential.

CONCLUSION: ATIC is broadly upregulated across cancers and functions as an independent prognostic biomarker in LIHC. The ATIC-integrated nomogram shows modest predictive accuracy for LIHC survival. Our results implicate ATIC in oncogenic signaling (PI3K-AKT-mTOR, MYC, and cell-cycle) and suggest ATIC as a candidate biomarker to guide targeted and chemotherapeutic strategies in LIHC. Further in vitro and in vivo validation is warranted.

PMID:42152649 | DOI:10.2174/0115665240438824260113042223