Pleural and pulmonary M1a are not the same prognosis, and palliative care that starts before the end

The edition in brief

The ninth TNM edition groups pleural and contralateral pulmonary metastases together as M1a. In 5,632 Dutch patients treated between 2010 and 2022, that grouping conceals a consistent difference: two-year overall survival with contralateral lung metastases was 26.9% on chemotherapy, 49.5% on immunotherapy alone and 40.4% on chemo-immunotherapy, against 18.5%, 41.6% and 28.6% with pleural metastases, and 12.1%, 31.1% and 25.0% for those with both — a gap present regardless of systemic treatment. In 93 patients with chronic thromboembolic pulmonary hypertension, both pulmonary endarterectomy and balloon pulmonary angioplasty improved right ventricular afterload, function and exercise capacity at six months, with larger haemodynamic gains and more pronounced reverse remodelling after endarterectomy — though the groups differed substantially at baseline and were not randomised. Sputum metagenomes from 600 people with bronchiectasis across ten countries produced four Pseudomonas abundance subgroups that track disease severity and lung function, and four separate interaction subgroups that stratify exacerbation risk, two of them carrying about 1.45-fold higher exacerbation rates. The practice-changer is an implementation report of a nurse-led, interdisciplinary outpatient palliative care model for chronic respiratory disease — a group with a greater symptom burden than lung cancer patients and far less access to palliative care.