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The improvement of treatment for patients with 'driver-gene-negative' lung adenocarcinoma (LUAD) remains a critical problem to be solved. We aimed to explore the role of methylation of N6 adenosine (m6A)-related long noncoding RNA (lncRNA) in stratifying 'driver-gene-negative' LUAD risk. Patients negative for mutations in EGFR, KRAS, BRAF, HER2, MET, ALK, RET, and ROS1 were identified as 'driver-gene-negative' cases. RNA sequencing was performed in 46 paired tumors and adjacent normal tissues from patients with 'driver-gene-negative' LUAD. Twenty-three m6A regulators and relevant lncRNAs were identified using Pearson's correlation analysis. K-means cluster analysis was used to stratify patients, and a prognostic nomogram was developed. The CIBERSORT and pRRophetic algorithms were employed to quantify the immune microenvironment and chemosensitivity. We identified two clusters highly consistent with the prognosis based on their unique expression profiles for 46 m6AlncRNAs. A risk model constructed from nine m6A lncRNAs could stratify patients into high- and low-risk groups with promising predictive power (C-index = 0.824), and the risk score was an independent prognostic factor. The clusters and risk models were closely related to immune characteristics and chemosensitivity. Additional pan-cancer analysis using the nine m6AlncRNAs showed that the expression of DIO3 opposite strand upstream RNA (DIO3OS) is closely related to the immune/stromal score and tumor stemness in a variety of cancers. Our results show that m6AlncRNAs are a reliable prognostic tool and can aid treatment decision-making in 'driver-gene-negative' LUAD. DIO3OS is associated with the development of various cancers and has potential clinical applications.

BackgroundStudies have reported that Long Non-coding RNA Vimentin antisense RNA1(VIM-AS1) is related to progression and prognosis in several cancers. Although the relationship between VIM-AS1 and the clinical features of lung adenocarcinoma has been described, their studies are incomplete. Therefore, a comprehensive analysis was performed to identify the role and potential clinical value of VIM-AS1 in LUAD progression.MethodsThe expression of VIM-AS1 in LUAD was identified based on Cancer Genome Atlas database (TCGA) and genotypic tissue expression (GTEx). Survival analysis and COX regression analysis were performed to evaluate the clinical value of VIM-AS1 in the prognosis of LUAD patients, and to construct a prognostic nomogram. Correlation and COX regression analysis were performed to filter prognosis-related VIM-AS1 co-expression genes, and to construct the correlation column chart and the prognostic risk model. Correlation analysis was also used to explore the relationship between VIM-ASI expression and LUAD immune microenvironment.ResultsVIM-AS1 expression levels were significantly downregulated in LUAD tissues and significantly associated with short OS, DSS, significant PFI, late T and pathological staging, lymph node metastasis, gender male and complete resection in LUAD patients. Decreased expression of VIM-AS1 was an independent risk factor for poor prognosis in LUAD patients. VIM-AS1 co-expressed genes SLC15A2, ZNF56, FAM76A, GNG7, UCK2, and ADIPOR2 were significantly associated with OS, DSS, and PFI in LUAD patients. The nomogram and risk models constructed based on VIM- AS1 co-expressed genes were associated with the prognosis of LUAD patients. K-M survival analysis showed that high-risk patients were significantly associated with short OS, DSS, and PFI in LUAD patients. VIM- AS1 expression was related to the estimate, immune and stromal scores, and highly associated with immune cells -TFH, Th1 cells, T cells, Tcm, B cells, T helper cells, cytotoxic cells, macrophages, pDC, iDC, aDC, mast cells, DC, Tem, NK CD56dim cells, Tgd and Th2 cells, and significantly correlated with levels of immune cell markers HLA-DPB1, HLA-DRA, CCR7, and other markers.ConclusionVIM-AS1 was significantly downregulated in LUAD tissues, which was significantly associated with poor prognosis and immune microenvironment in LUAD patients. The nomogram and risk models of VIM-AS1 were expected to be tools to assess the prognosis of LUAD patients.

Background Preservation or dissection of the inferior pulmonary ligament (IPL) during performing upper lobectomy by video-assisted thoracoscopic (VATS) remains controversial. Also, whether dissecting 50%IPL can combine the advantages of both preservation and dissection or not remains controversial as well. This retrospective study analyzed the short-term clinical effects of preservation, dissection of 50%IPL, and dissection of 100%IPL during VATS for upper lobectomy. Methods A total of 104 patients with lung cancer who underwent VATS of upper lobectomy from May 2019 to December 2020 were selected and divided into three groups, 34 cases of preserving IPL as control group A, 35 cases of dissecting 50% IPL as group B, and 35 cases of dissecting 100% IPL as group C. This study mainly analyzed surgery time, intraoperative blood loss and intraoperative infusion volume, postoperative outcomes such as drainage time, hospital stay, and complications such as atelectasis, pneumothorax, pleural effusion, and white blood cell count (WBC), and neutrophils (NEU) in these cases. Results No significant differences were identified in surgery time(P = 0.526). Intraoperative blood loss was significantly lower in groups B and C than in group A (P = 0.000). Intraoperative infusion volume in group B was significantly lower than that in group C and group A (P = 0.009). The postoperative drainage time of group B was similar to that in group C, and was significantly lower than that of group A (P = 0.001). Group B had the shortest duration of postoperative hospital stay, and group C was slightly lower than group A (P = 0.001). No significant differences were demonstrated in atelectasis, pneumothorax, pleural effusion, postoperative WBC and postoperative NEU (P = 0.133,0.596,0.361,0.305, and 0.278 respectively). However, the prevalence of total complications in group B was the lowest, and in Group C was slightly lower than that in group A (P = 0.038). The results were similar in the left and right upper lungs. Conclusions The drainage time, hospital stay, and postoperative complications of dissecting 50%IPL were less than those of dissecting 100%IPL and IPL preservation. The intraoperative blood loss and postoperative drainage time of dissecting 100%IPL were slightly lower than preservation, and the intraoperative infusion volume and complications were similar to preservation.