Since the publication of the two

Since the publication of the two review articles, three additional randomized trials that evaluated the role of postoperative rehabilitation in lung cancer patients were subsequently published. One was a prospective randomized controlled trial on 40 patients who were randomly assigned to one of four groups (three intervention groups and one control group). The postoperative exercise program comprised a supervised exercise program that involved resistance and high-intensity interval cardiorespiratory exercise, 2 h weekly for 12 weeks combined with individual counseling. The postoperative exercise was completed by 73% of the patients randomly assigned to this intervention. The study concluded that an early postoperative exercise program for patients with NSCLC was safe and feasible, but a preoperative home-based exercise program was not feasible for this population in a fast-track set up. Another study used a three-axis accelerometer for five to six days to measure the physical activity before and two months after surgery. Similar to the previous study, patients did not recover to the preoperative physical activity level two months after lung resection surgery. However, compared with the control group, there was an improvement in the postoperative physical activity level in patients, including older patients, who underwent outpatient pulmonary rehabilitation. The third study investigated the effects of high-intensity training (60 min, three times a week for 20 weeks) starting at five to seven weeks after surgery in the single-blind randomized controlled trial. The program included, among other standard postoperative care, 60 min, three times a week, 20 weeks strength and endurance training. After intervention, the authors concluded that the high intensity training was well-tolerated and induced a clinically significant increase in peak oxygen uptake during walking, DLCO, muscular strength, daily physical functioning and quality of life.
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Introduction Since Rudolf Virchow identified leukocytes in tumor tissues in 1863, inflammation has been intimately implicated in cancer development and progression. The presence of an inflammatory infiltrate in tumor tissue may represent inflammatory conditions preceding the development of malignancy. Studies have shown that an inflammatory milieu could contribute to proliferation and survival of malignant cells, sabotage adaptive immunity, and stimulate angiogenesis and metastasis. On the other hand, inflammatory infiltrates may represent the host response to the tumor. Heterogeneous immune infiltrates have been shown in diverse tissue types and may portend an improved prognosis. Different types of tumor-associated inflammatory fexofenadine hydrochloride have been identified in thyroid cancer. These consist of cells of the innate immune system (mainly macrophages, mast cells, and neutrophils) as well as cells associated with an adaptive immune response (T and B cells). In general, innate immune cells are more likely to have tumor-promoting properties. Previously, we have found that thyroid cancer patients in the higher tertile of neutrophil-to-lymphocyte ratio had a significantly larger tumor size and a high recurrence risk. In contrast, the role of adaptive immune cells is still a matter of debate. Several studies have shown that patients whose tumors are not infiltrated by lymphocytes present a high recurrence rate, suggesting that the presence of lymphocytes in the thyroid tumor microenvironment indicates a favorable prognosis. On the contrary, other researchers reported that thyroid cancer with tumor-associated lymphocytes exhibited higher disease stage and increased incidence of invasion and lymph node metastasis. Furthermore, the enrichment of CD8+ lymphocytes has been associated with disease recurrence. Lymphocytic infiltrates in thyroid cancer may suggest a background of chronic lymphocytic thyroiditis. Thyroiditis is characterized by a cellular immune response with dense lymphocytic infiltration of the thyroid gland, as well as by a humoral immune response leading to the production of autoantibodies against thyroid antigens. Recently, a meta-analysis investigated the correlation between papillary thyroid cancer and histologically proven Hashimoto\'s thyroiditis. The results revealed that thyroiditis was more frequently observed in papillary thyroid cancer than in benign thyroid diseases, and cancer patients with thyroiditis had a longer duration of recurrence-free survival. This seemingly paradoxical phenomenon deserves further investigation, because it may provide insight into the immune dysregulation involved in both disorders. In the present study, we examined the data of The Cancer Genome Atlas (TCGA) project in an attempt to define the relationship between lymphocyte infiltrates and clinical and molecular presentations.
Materials and methods Patient characteristics and preprocessed gene expression data of patients with papillary thyroid cancer were downloaded from Genomic Data Commons (https://gdc.cancer.gov/) in August 2016. The mRNA expression profile was obtained by Illumina HiSeq 2000 RNA sequencing version 2 level 3 data, and expressed as RNA-Seq by Expectation Maximization (RSEM) values. The information on new tumor event, disease status, and patient mortality was updated to incorporate the latest follow-up. Patients who had missing transcriptome profiling or who lacked tumor-infiltrating lymphocyte data were excluded from the analysis. Finally, a total of 497 patients were included in the study.