Abstract
The aim of this study was to compare overall survival (OS) rates at different pN stages of NSCLC depending on tumor characteristics and to assess the applicability of saliva biochemical markers as prognostic signs. The study included 239 patients with NSCLC (pN0-120, pN1-51, pN2-68). Saliva was analyzed for 34 biochemical indicators before the start of treatment. For pN0, the tumor size does not have a prognostic effect, but the histological type should be taken into account. For pN1 and pN2, long-term results are significantly worse in squamous cell cancer with a large tumor size. A larger volume of surgical treatment reduces the differences between OS. The statistically significant factors of an unfavorable prognosis at pN0 are the lactate dehydrogenase activity <1294 U/L and the level of diene conjugates >3.97 c.u. (HR = 3.48, 95% CI 1.21–9.85, p = 0.01541); at pN1, the content of imidazole compounds >0.296 mmol/L (HR = 6.75, 95% CI 1.28–34.57, p = 0.00822); at pN2 levels of protein <0.583 g/L and Schiff bases >0.602 c.u., as well as protein >0.583 g/L and Schiff bases <0.602 c.u. (HR = 2.07, 95% CI 1.47–8.93, p = 0.04351). Using salivary biochemical indicators, it is possible to carry out stratification into prognostic groups depending on the lymph node metastasis.
Highlights
85% of lung cancers are non-small cell lung cancer (NSCLC)
We have previously shown that several biochemical indicators of saliva can act as prognostic signs in NSCLC [10]
In the absence of metastases in regional lymph nodes, the size of the primary tumor has no significant prognostic effect; the histological type of tumor should be taken into account
Summary
85% of lung cancers are non-small cell lung cancer (NSCLC). The most important parameters that determine treatment and survival in this group are the stage of the disease and metastases in the lymph nodes [1,2]. The degree of lymphogenous metastasis of NSCLC affects the prognosis of patients, and largely determines the optimal treatment tactics [1]. At stage pN0–1 the first and main stage of treatment is surgery, at pN3 -chemotherapy and radiotherapy. The tactics of treating patients with pN2 have not yet been fully determined and are the subject of active discussion in the literature [3,4]. Recent practice guidelines consider chemotherapy and radiation therapy to treat patients with pN2 , and do not recommend isolated or primary surgery [5]. Some supporters of reducing the volume of surgery consider it possible to apply individual schemes of lymph node dissection, focusing on the frequency of metastasis, the size and location of the tumor, the form of growth, and topography of the lymph nodes [6,7]
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