Resected Lung Cancer Patients Research Articles

Comprehensive analysis of risk factors for surgical site infections following thoracoscopic radical resection in patients with lung cancer.

Surgical site infections (SSIs) post-thoracoscopic radical resection in lung cancer patients pose significant clinical challenges. This study aims to comprehensively identify the independent risk factors that influence the occurrence of SSIs following thoracoscopic radical resection for lung cancer. The study employed a retrospective analysis of 130 patients who underwent thoracoscopic radical resection for lung cancer. Inclusion and exclusion criteria were clearly defined, and ethical approvals were obtained. Patients were monitored for SSIs via clinical and biochemical markers, with data comprehensively gathered from electronic health records. Statistical analysis was rigorously conducted using SPSS v27.0, with methodologies including t-tests, Chi-square tests and logistic regression. The study aimed to identify independent risk factors for SSIs and incorporated a multidimensional assessment approach to provide robust, clinically relevant findings. Univariate analysis revealed surgical duration ≥3 h, non-usage of antibiotics, presence of diabetes and elevated levels of C-reactive protein (CRP) and procalcitonin (PCT) as significant correlates for SSIs. Multivariate analysis substantiated these factors as independent risk variables: surgery duration (odds ratio [OR] = 9.698, p < 0.05), presence of diabetes (OR = 6.89, p < 0.05), elevated CRP (OR = 7.306, p < 0.05) and elevated PCT (OR = 6.838, p < 0.05). Conversely, antibiotic administration served as a protective factor (OR = 0.572, p < 0.05). Surgical duration of 3 h or more, diabetes and elevated levels of CRP and PCT significantly heighten the risk for SSIs after thoracoscopic radical resection in lung cancer patients. Perioperative antibiotic administration acts as a protective factor. Clinicians should implement tailored preventative strategies to mitigate these identified risks.

The impact of oncogenic driver mutations on neoadjuvant immunotherapy outcomes in patients with resectable non-small cell lung cancer.

Neoadjuvant immunotherapy has been demonstrated to be effective and safe in resectable non-small cell lung cancer (NSCLC) patients. However, the presence of different oncogenic driver mutations may affect the tumor microenvironment and consequently influence the clinical benefit from immunotherapy. This retrospective study included consecutive NSCLC patients (stage IIA to IIIB) who underwent radical surgery after receiving neoadjuvant immunotherapy at a single high-volume center between December 2019 and August 2022. Pathological response and long-term outcomes were compared based on the driver oncogene status, and RNA sequencing analysis was conducted to investigate the transcriptomic characteristics before and after treatment. Of the 167 patients included in this study, 47 had oncogenic driver mutations. KRAS driver mutations were identified in 28 patients, representing 59.6% of oncogenic driver mutations. Of these, 17 patients had a major pathological response, which was significantly higher than in the non-KRAS driver mutation group (60.7% vs. 31.6%, P = 0.049). Multivariate Cox regression analysis further revealed that the KRAS driver mutation group was an independent prognostic factor for prolonged disease-free survival (hazard ratio: 0.10, P = 0.032). The median proportion of CD8+ T cells was significantly higher in the KRAS driver mutation NSCLCs than in the non-driver mutation group (18% vs. 13%, P = 0.030). Furthermore, immune-related pathways were enriched in the KRAS driver mutation NSCLCs and activated after immunotherapy. Our study suggests that NSCLC patients with KRAS driver mutations have a superior response to neoadjuvant immunotherapy, possibly due to their higher immunogenicity. The findings highlight the importance of considering oncogenic driver mutations in selecting neoadjuvant treatment strategies for NSCLC patients.

Study of the Effectiveness of Personalized Rehabilitation for Resectable Lung Cancer Patients

Увеличение продолжительности жизни больных операбельным немелкоклеточным раком легкого (НМРЛ) после комплексного лечения сопряженно с нарушениями психологического и физического функционирования, снижающими общее качество жизни. В статье приводится оценка эффективности реабилитационных программ у больных операбельным НМРЛ с учётом рекомендованных технологий (РТ) физической и реабилитационной медицины (персонализированный подход) в сравнении со стандартным подходом к реабилитации. Материалы и методы. В исследование были включены 240 пациентов с операбельным НМРЛ в возрасте от 45 до 71 года (медиана 60,2 года), получавших реабилитацию в рамках комбинированного/комплексного лечения в ФГБУ «НМИЦ онкологии им. Н.Н. Петрова» Минздрава России в период с 2017 по 2022 гг. Пациентам в экспериментальной группе применялась персонализированная модель реабилитации. Согласно дизайну исследования в контрольную группу (стандартные реабилитационные мероприятия) были подобраны попарно пациенты, соответствующие больным экспериментальной группы по основным характеристикам: полу, возрасту, функциональному состоянию, гистологическому подтипу, стадии заболевания, объёму лечения. Динамика показателей пациентов была исследована в пред-/послеоперационный период, непосредственно после реализации программ реабилитации и через 1 год, включала оценку показателей клинического статуса (Шкала mMRC, Шкала COMP, ВАШ, 6-минутный тест ходьбы), функциональных (ФВД) и психофизиологических показателей (Шкала MFI-20, Шкала HADS), показателей качества жизни (EORTC-QLQ30). Результаты. Анализ показателей эффективности реабилитации больных НМРЛ показал, что в экспериментальной группе (персонализированная модель реабилитации), реабилитация была эффективна у 86 % пациентов, в то время как в контрольной группе (стандартные программы реабилитации) — в 76 % случаев. Основными детерминантами, влияющими на формирование лечебного эффекта после применения реабилитационных программ, составленных с учётом выбранных РТ, являются параметры функции внешнего дыхания (ЖЕЛ — жизненная емкость легких, МОС — максимальная объемная скорость на выдохе, СОС — средняя объемная скорость при выдохе), показатели теста 6-минутной ходьбы, шкал выраженности одышки (Modified Medical Research Council, mMRC) и выполнения повседневной деятельности (Canadian Occupational Performance Measure, COMP). Вывод. Выделенные детерминанты позволят заблаговременно спрогнозировать эффективность реабилитационных технологий у конкретной модели пациентов операбельным НМРЛ с учётом исходных параметров.

P1.26-04 Increased Risk of Death from Other Causes After Lobectomy Compared with Sublober Resection in Lung Cancer Patients

P1.26-04 Increased Risk of Death from Other Causes After Lobectomy Compared with Sublober Resection in Lung Cancer Patients

EP01.01-04 Postoperative Course of Surgically Resected Lung Cancer Patients in Preserved Ratio Impaired Spirometry

EP01.01-04 Postoperative Course of Surgically Resected Lung Cancer Patients in Preserved Ratio Impaired Spirometry

Oral uracil-tegafur compared with intravenous chemotherapy as adjuvant therapy for resected early-stage non-small cell lung cancer patients.

Studies comparing the effectiveness of either adjuvant oral uracil-tegafur (UFT) or intravenous chemotherapy on early-stage (stage I and II) non-small cell lung cancer (NSCLC) patients treated with complete surgical treatment remain limited. From January 2011 to December 2017, patients with early-stage NSCLC (defined as tumor size >3 cm without mediastinal lymph node involvement or any distant metastasis) receiving either adjuvant oral UFT or intravenous chemotherapy after surgical resection were identified from the Taiwan Cancer Registry. Overall survival (OS) and relapse-free survival (RFS) were the primary and secondary outcomes, respectively. Propensity matching was used for controlling confounders. A total of 840 patients receiving adjuvant therapy after surgery (including 595 oral UFT and 245 intravenous chemotherapy) were enrolled. Before matching, patients using oral UFT had significantly longer OS (HR: 0.69, 95% CI: 0.49-0.98, p = 0.0387) and RFS (HR: 0.79, 95% CI: 0.61-0.97, p = 0.0392) than those with intravenous chemotherapy. A matched cohort of 352 patients was created using 1:1 propensity score-matching. In the Cox regression analysis, the UFT and the matched chemotherapy groups had similar OS (HR: 0.80, 95% CI: 0.48-1.32, p = 0.3753) and RFS (HR: 0.98, 95% CI: 0.72-1.34, p = 0.9149). Among subgroup analysis, oral UFT use was associated with longer RFS among the subgroups of non-drinker (HR: 0.66, 95% CI: 0.34-0.99, p = 0.0478) and patients with stage IB disease (HR: 0.67, 95% CI: 0.42-0.97, p = 0.0341). This population-based study in the real-world setting of Taiwan demonstrates comparable effectiveness between oral UFT and intravenous chemotherapy in terms of clinical outcomes for early-stage NSCLC patients after surgery.

Utility of 18F-FDG uptake in predicting major pathological response to neoadjuvant immunotherapy in patients with resectable non‑small cell lung cancer

PurposeThe aim of present study was to investigate the efficiency of 18F-FDG uptake in predicting major pathological response (MPR) in resectable non-small cell lung cancer (NSCLC) patients with neoadjuvant immunotherapy. MethodsA total of 104 patients with stage I-IIIB NSCLC were retrospectively derived from National Cancer Center of China, of which 36 cases received immune checkpoint inhibitors (ICIs) monotherapy (I-M) and 68 cases with ICI combination therapy (I-C). 18F-FDG PET-CT scans were performed at baseline and after neoadjuvant therapy (NAT). Receiver‐operating characteristic (ROC) curve analyses were conducted and area under ROC curve (AUC) was calculated for biomarkers including maximum standardized uptake value (SUVmax), inflammatory biomarkers, tumor mutation burden (TMB), PD-L1 tumor proportion score (TPS) and iRECIST. ResultsFifty-four resected NSCLC tumors achieved MPR (51.9%, 54/104). In both neoadjuvant I-M and I-C cohorts, post-NAT SUVmax and the percentage changes of SUVmax (ΔSUVmax%) were significantly lower in the patients with MPR versus non-MPR (p < 0.01), and were also negatively correlated with the degree of pathological regression (p < 0.01). The AUC of ΔSUVmax% for predicting MPR was respectively 1.00 (95% CI: 1.00–1.00) in neoadjuvant I-M cohort and 0.94 (95% CI: 0.86–1.00) in I-C cohort. Baseline SUVmax had a statistical prediction value for MPR only in I-M cohort, with an AUC up to 0.76 at the threshold of 17.0. ΔSUVmax% showed an obvious advantage in MPR prediction over inflammatory biomarkers, TMB, PD-L1 TPS and iRECIST. Conclusion18F-FDG uptake can predict MPR in NSCLC patients with neoadjuvant immunotherapy.

Development and validation of a nomogram for predicting overall survival of resected N2 non-small cell lung cancer patients undergoing neoadjuvant radiotherapy.

Currently, the prognosis of resected N2 non-small cell lung cancer patients undergoing neoadjuvant radiotherapy is poor. The goal of this research was to develop and validate a novel nomogram for exactly predicting the overall survival (OS) of resected N2 NSCLC patients undergoing neoadjuvant radiotherapy. The data applied in our research were downloaded from the Surveillance, Epidemiology, and End Results (SEER) database. We divided selected data into a training cohort and a validation cohort using R software, with a ratio of 7:3. Univariate Cox regression and multivariate Cox regression were utilized to select significant variables to build the nomogram. To validate our nomogram, calibration curves, receiver operating characteristic curves (ROC), decision curve analysis (DCA), and Kaplan-Meier survival curves were employed. The nomogram model was also compared with the tumor-node-metastasis (TNM) staging system by utilizing net reclassification index (NRI) and integrated discrimination improvement (IDI). Eight variables-age, sex, operative type, LN removed number, chemotherapy, AJCC stage, M stage, histology-were statistically significant in the multivariate Cox regression analysis and were selected to develop our nomogram. Based on ROC curves, calibration curves, and DCA analysis, our novel nomogram demonstrated good predictive accuracy and clinical utility. Using Kaplan-Meier (KM) survival curves and log-rank tests, the risk stratification system was able to stratify patients based on their estimated mortality risk. The nomogram performed better than the TNM staging system based on the NRI and IDI indexes. We developed and validated a nomogram to predict prognosis of resected N2 NSCLC patients undergoing neoadjuvant radiotherapy. Using this nomogram, clinicians may find this nomogram useful in predicting OS of targeted patients and making more appropriate treatment decisions.

ASO Author Reflections: Prognostic Impact of the Primary Tumor Resection for Lung Cancer Patients Diagnosed with Pleural Dissemination in the Perioperative Period-Importance of Biomarker-Based Treatment Decision Making.

ASO Author Reflections: Prognostic Impact of the Primary Tumor Resection for Lung Cancer Patients Diagnosed with Pleural Dissemination in the Perioperative Period-Importance of Biomarker-Based Treatment Decision Making.

Associations between Comorbidities and Acute Exacerbation of Interstitial Lung Disease after Primary Lung Cancer Surgery.

Acute exacerbation (AE) of interstitial lung disease (ILD) is a severe complication of lung resection in lung cancer patients with ILD (LC-ILD). This study aimed to assess the predictive value of comorbidities other than ILD for postoperative AE in patients with LC-ILD. We retrospectively evaluated 68 patients with LC-ILD who had undergone lung resection. We classified them into two groups: those who had developed postoperative AE within 30 days after resection and those who had not. We analyzed patient characteristics, high-resolution computed tomography findings, clinical data, pulmonary function, and intraoperative data. The incidence of postoperative AEs was 11.8%. In univariate analysis, performance status (PS), honeycombing, forced vital capacity (FVC), and high hemoglobin A1c (HbA1c) levels without comorbidities were significantly associated with postoperative AE. Patients were divided into two groups according to cutoff levels of those four variables as determined by receiver operating characteristic curves, revealing that the rates of patients without postoperative AE differed significantly between groups. The present results suggested that preoperative comorbidities other than ILD were not risk factors for postoperative AE in patients with LC-ILD. However, a high preoperative HbA1c level, poor PS, low FVC, and honeycombing may be associated with postoperative AE of LC-ILD.

Histology of the Primary Tumor Correlates with False Positivity of Integrated 18F-FDG-PET/CT Lymph Node Staging in Resectable Lung Cancer Patients.

This study aimed to evaluate the diagnostic accuracy and false positivity rate of lymph node (LN) staging assessed by integrated 18F-fluorodeoxyglucose positron emission computed tomography (18F-FDG-PET/CT) in patients with operable lung cancer to the tumor histology. In total, 129 consecutive patients with non-small-cell lung cancer (NSCLC) undergoing anatomical lung resections were included. Preoperative LN staging was evaluated in the relationship to the histology of the resected specimens (group 1: lung adenocarcinoma/LUAD; group 2: squamous cell carcinoma/SQCA). Statistical analysis was performed by the Mann-Whitney U-test, the chi2 test, and binary logistic regression analysis. To establish an easy-to-use algorithm for the identification of LN false positivity, a decision tree including clinically meaningful parameters was generated. In total, 77 (59.7%) and 52 (40.3%) patients were included in the LUAD and SQCA groups, respectively. SQCA histology, non-G1 tumors, and tumor SUVmax > 12.65 were identified as independent predictors of LN false positivity in the preoperative staging. The corresponding ORs and their 95% CIs were 3.35 [1.10-10.22], p = 0.0339; 4.60 [1.06-19.94], p = 0.0412; and 2.76 [1.01-7.55], and p = 0.0483. The preoperative identification of false-positive LNs is an important aspect of the treatment regimen for patients with operable lung cancer; thus, these preliminary findings should be further evaluated in larger patient cohorts.

Indwelling pleural catheters for persistent pleural effusions secondary to post lung resection for malignancies.

Malignant and nonmalignant pleural effusions (NMPEs) such as those due to hepatic hydrothorax have been successfully treated with an indwelling pleural catheter (IPC) with a low complication rate. There is no literature on the utility or safety of this treatment modality for NMPE post lung resection. We aimed to assess the utility of IPC for recurrent symptomatic NMPE secondary to post lung resection in lung cancer patients over a period of 4 years. Patients who underwent lobectomy or segmentectomy as part of the treatment plan for lung cancer between January 2019 and June 2022 were identified, these patients were screened for post-surgical pleural effusion. A total of 422 underwent lung resection, of which 12 had recurrent symptomatic pleural effusions requiring IPC placement and were selected for final analysis. The primary end points were improved symptomatology and successful pleurodesis. Mean time to IPC placement was 78.4 days post-surgery. The mean length of IPC catheter was 77.7 days standard deviation (SD) 23.8. All 12 patients achieved spontaneous pleurodesis (SP), there was no second pleural intervention or re-accumulation of fluid on follow up imaging in any of the subjects after IPC removal. Two patients (16.7%) had skin infection related to catheter placement that was managed with oral antibiotics, there were no cases of pleural infections that required catheter removal. IPC is a safe and effective alternative in managing recurrent NMPE post lung cancer surgery with high rate of pleurodesis and acceptable complication rates.

Lung cancer resection in patients with underlying usual interstitial pneumonia: a meta-analysis

ObjectivePatients with lung cancer with underlying idiopathic pulmonary fibrosis and usual interstitial pneumonia (UIP) pattern on CT represent a very high-risk group in terms of postoperative UIP acute exacerbations (AEs)...

Utility of 18F-FDG PET/CT uptake values in predicting response to neoadjuvant chemoimmunotherapy in resectable non-small cell lung cancer

IntroductionReliable predictive markers are lacking for resectable non-small cell lung cancer (NSCLC) patients treated with neoadjuvant chemoimmunotherapy. The present study investigated the utility of SUVmax values acquired from PET/CT to predict the response to neoadjuvant chemoimmunotherapy for resectable NSCLC. Materal and methodsSUVmax, clinical and pathological outcomes, were collected from patients in 5 hospitals. Patients who received dynamic PET/CT surveillance were divided into cohorts A (chemoimmunotherapy) and B (chemotherapy), respectively, while cohort C (chemoimmunotherapy) comprised patients undergoing post-therapy PET/CT. Associations between SUVmax and major pathologic response (MPR) were evaluated through receiver operating characteristic (ROC) curves. ResultsA total of 129 cases with an MPR rate of 46.5 % was identified. In neoadjuvant chemoimmunotherapy, ΔSUVmax% (AUC: 0.890, 95 % CI: 0.761–0.949) and post-therapy SUVmax (AUC: 0.933, 95 % CI: 0.802–0.959) could accurately predict MPR. On the contrary, the baseline SUVmax was not associated with MPR (p = 0.184). Furthermore, an independent cohort C proved that post-therapy SUVmax could serve as an independent predictor (AUC: 0.928, 95 % CI: 0.823–0.958). In addition, robust predictive performance could be observed when we use the optimal cut-off point of both ΔSUVmax% (54.4 %, AUC: 0.912, 95 % CI: 0.824–0.994) and post-therapy SUVmax (3.565, AUC: 0.912, 95 % CI: 0.824–0.994) in neoadjuvant chemoimmunotherapy. The RNA data revealed that the expression of PFKFB4, a key enzyme in glycolysis, was positively correlated with SUVmax value and tumor cell proliferation after neoadjuvant chemoimmunotherapy. ConclusionThese findings highlighted that the ΔSUVmax% and remained SUVmax were accurate and non-invasive tests for the prediction of MPR after neoadjuvant chemoimmunotherapy.

Comparison between functional lung volume measurement and segment counting for predicting postoperative pulmonary function after pulmonary resection in lung cancer patients

BackgroundFunctional lung volume (FLV) obtained from computed tomography images was a breakthrough for lung imaging and functional assessment. We compared the accuracy of the FLV measurement method and the segment-counting (SC) method in predicting postoperative pulmonary function.MethodsA total of 113 patients who underwent two thoracoscopic surgeries were enrolled in our study. We predicted postoperative pulmonary function by the FLV measurement method and the SC method. Novel formulas based on the FLV measurement method were established using linear regression equations between the factors affecting pulmonary function and the measured values.ResultsThe predicted postoperative forced vital capacity (ppoFVC) and forced expiratory volume in 1 s (ppoFEV1) measured by the 2 methods showed high concordance between the actual postoperative forced vital capacity (postFVC) and the forced expiratory volume in 1 s (postFEV1) [r = 0.762, P < 0.001 (FLV method) and r = 0.759, P < 0.001 (SC method) for FVC; r = 0.790, P < 0.001 (FLV method) and r = 0.795, P < 0.001 (SC method) for FEV1]. Regression analysis showed that the measured preoperative pulmonary function parameters (FVC, FEV1) and the ratio of reduced FLV to preoperative FLV were significantly associated with the actual postoperative values and could predict these parameters (all P < 0.001). The feasibility of using these equations [postFVC = 0.8 × FVC − 0.784 × ΔFLV/FLV + 0.283 (R2 = 0.677, RSD = 0.338), postFEV1 = 0.766 × FEV1 − 0.694 × ΔFLV/FLV + 0.22 (R2 = 0.743, RSD = 0.265)] to predict the pulmonary function parameters after wedge resection was also verified.ConclusionsThe new FLV measurement method is valuable for predicting postoperative pulmonary function in patients undergoing lung resection surgery, with accuracy and consistency similar to those of the conventional SC method.

124P Phase II study of neoadjuvant concurrent chemo-immuno-radiation therapy followed by surgery and adjuvant immunotherapy for resectable stage IIIA-B N2 non-small cell lung cancer: SQUAT trial (WJOG 12119L)

Neoadjuvant chemo-immunotherapy (CheckMate 816 regimen) has become a standard of care in treatment of resectable non-small cell lung cancer (NSCLC) patients in some countries. Addition of radiation therapy (RT) may further improve local control in locally advanced NSCLC patients. Here, we report the primary endpoint, major pathologic response (MPR), of the SQUAT trial (WJOG 12119L, JapicCTI- 195069)-a multicenter, prospective, single-arm, phase II trial of neoadjuvant concurrent chemo-immuno-radiation therapy followed by surgical resection and adjuvant immunotherapy for resectable stage IIIA-B N2 NSCLC.

The efficacy of postoperative radiotherapy for patients with non-small cell lung cancer: An updated systematic review and meta-analysis.

The controversy over the efficacy of postoperative radiotherapy (PORT) has existed for a long time. The present study reassessed the overall survival (OS) and disease-free survival (DFS) data to investigate whether PORT can improve survival in resectable non-small cell lung cancer (NSCLC) patients. The following databases were used to perform literature search: PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Embase (from January 1, 1986 to July 5, 2021). The results of overall survival (OS) and disease-free survival (DFS) were calculated as hazard ratio (HR). Confidence intervals are chosen with 95% confidence intervals. A total of 12 RCTs and 19 retrospective cohort studies were found to meet the inclusion criteria. A significant DFS improvement was detected in the PORT group (4111 patients from 15 studies), although statistical difference was not detected for OS between the non-PORT and PORT groups (31 studies, 49,342 total patients). PORT prolonged OS in patients undergoing PORT plus postoperative chemotherapy (POCT) and in pN2 patients. Patients with a median radiation dose of 50.4 Gy and a median radiation dose of 54 Gy had a better OS after PORT. However, if the total radiotherapy dose went up to 60 Gy, PORT increased the risk of death in NSCLC patients. Significant difference in OS was not found in the results of studies with regard to treatment methods, pathologic stages, study type, radiation beam quality, and radiation dose. Patients undergoing postoperative chemoradiotherapy and pN2 patients can benefit from PORT. Patients exposed to median radiation doses of 50.4 and 54 Gy demonstrated relatively good efficacy. For patients with non-small-cell lung cancer, PORT has not been proven to extend OS, but its effect on DFS remains strong.

ASO Visual Abstract: A Sonic Hedgehog Pathway Score to Predict the Outcome of Resected Non-small Cell Lung Cancer Patients.

ASO Visual Abstract: A Sonic Hedgehog Pathway Score to Predict the Outcome of Resected Non-small Cell Lung Cancer Patients.

The use of adjuvant chemotherapy in resected stage IB-IIIA non–small cell lung cancer (NSCLC) and comparison to the TriNetX database.

29 Background: Adjuvant cisplatin-based chemotherapy (AC) is the standard of care for completely resected stage IB (tumor size &gt; 4cm), II, and IIIA non small cell lung cancer (NSCLC) patients. Several randomized clinical trials have shown varying levels of survival benefit for patients treated with AC compared to surgery alone. Methods: A retrospective study was performed regarding the use of adjuvant chemotherapy comparing Charleston Area Medical Center (CAMC) patients to those in the TriNetX database in the years 1998-2017. Inclusion criteria were patients &gt; 18 years of age, completely resected (R0), stage IB (tumor size &gt; 4 cm) through stage IIIA (R0) NSCLC. SAS 9.3 was used for data analysis. Results: The populations included two hundred and thirty-six (CAMC) and 4,364 (TriNetX) patients. The CAMC population was 98% Caucasian, 63% male with an average age of 65±10 years. The TriNetX population was 66% Caucasian, 57% male with an average age of 67±10 years. The 5-year overall survival (OS) in the CAMC database between chemotherapy and non-chemotherapy groups was not statistically significant (49.5% vs 49.8%, p = 0.8, respectively). In the TriNetX database, the 5-year OS for the chemotherapy group was significantly higher compared to the non-chemotherapy groups (61.2% vs 54.0%, p &lt; 0.05, respectively). Cox proportional hazards model was used to determine the factors influencing 5-year OS in the CAMC population. Results showed that patients &gt;65 years of age were 2.2 times (95% CI: 1.53-3.2) more likely to be dead in 5-years. With each increase in stage patients were 1.3 times (95% CI: 1.0-1.8) more likely to be dead in 5-years. Moreover, patients without coronary artery disease were 1.7 times (95% CI: 1.2-2.4) more likely to be dead in 5-years. Conclusions: Regardless of treatment, about half of CAMC patients were alive at 5 years, while a higher OS was seen in the TriNetX chemotherapy group. Regression analysis of the CAMC population showed that chemotherapy was not a significant variable in 5-year OS. Differences in survival between CAMC and TriNetX could be due to the large number of comorbidities in the CAMC population, patient refusal to chemotherapy, particularly those &gt;65 years, and incomplete planned dose due to side effects of adjuvant chemotherapy. We conclude that several barriers may impact the use of adjuvant chemotherapy in non-trial settings in the CAMC population.

Exploration of the optimal number of regional lymph nodes removed for resected N0 NSCLC patients: A population-based study.

BackgroundThe aim of our study was to explore the optimal number of regional lymph nodes removed (LNRs) in resected N0 non-small cell lung cancer (NSCLC) patients and identify potential risk factors.MethodsIncluded in this study were 55,024 N0 NSCLC patients between 2004 and 2015 based on the Surveillance, Epidemiology, and End Results database (SEER). All the patients were divided into No LNR group (57.8%), 1-3 LNRs group (8.1%) and ≥4 LNRs group (31.4%). Relevant clinical and patient parameters including overall survival (OS), lung cancer-specific survival (LCSS), gender, race, year of diagnosis, primary site, T stage, AJCC stage, laterality, histological type, lymphadenectomy, radiation, chemotherapy, age at diagnosis, insurance status, marital status, family income.ResultsKaplan-Meier analysis demonstrated LNRs had significantly better OS and LCSS than No LNRs in all the N0 NSCLC patients with different T stages (Logrank p<.001). Univariate and multivariate analysis showed that both OS and LCSS in ≥ 4 LNRs group were better than those in <1-3 LNRs group (OS: ≥4 LNRs group: HR, 0.583; 95%CI, 0.556-0.610; P<.001 vs.1-3 LNRs group: HR, 0.726; 95%CI, 0.687-0.769; P<.001; LCSS: ≥4 LNRs group: HR, 0.514; 95%CI, 0.480-0.550; P<.001 vs.1-3 LNRs group: HR, 0.647; 95%CI, 0.597-0.702; P<.001). In addition, whites, males, not upper lobe, large cell carcinoma and others, advance T stage or AJCC stage, no surgery, no LNR, no radiation, no chemotherapy, elder age at diagnosis, singled marital status and low family income had negative impact on prognosis of N0 NSCLC patients.ConclusionsOur study suggests that ≥ 4 LNRs can yield better survival outcomes compared with 1-3 LNRs in N0 NSCLC patients.