P3.16-012 Lung Cancer: System Approach

Abstract

Search of optimal diagnosis and treatment strategies for non-small cell lung cancer (LC) patients (LCP) (T1-4N0-2M0) realized. We analyzed data of 708 consecutive LCP (age=57.5±8.3 years; tumor size=4.3±2.4 cm) radically operated (R0) and monitored in 1985-2017 (m=613, f=95; lobectomies=461, pneumonectomies=247, mediastinal lymph node dissection=708; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=192; only surgery-S=563, adjuvant chemoimmunoradiotherapy-AT=145: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=269, T2=251, T3=131, T4=57; N0=460, N1=130, N2=118, M0=708; G1=178, G2=216, G3=314; squamous=394, adenocarcinoma=266, large cell=48; early LC=164, invasive LC=544. Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. Overall life span (LS) was 2196.3±1764.1 days and cumulative 5-year survival (5YS) reached 71.1%, 10 years – 63%, 20 years – 43.4%. 451 LCP lived more than 5 years (LS=3125.7±1560.3 days), 128 LCP – more than 10 years (LS=5123.1±1547.9 days). 195 LCP died because of LC (LS=560±372.1 days). AT significantly improved 5YS (58.3% vs. 34.1%) (P=0.001 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, RH, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time, weight (P=0.000-0.030). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), healthy cells/CC (3), lymphocytes/CC (4), thrombocytes/CC (5), eosinophils/CC (6), erythrocytes/CC (7), segmented neutrophils/CC (8), glucose (9), monocytes/CC (10), stick neutrophils/CC (11), leucocytes/CC (12). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic and cardiothoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.