Surgery For Non-small Cell Lung Cancer Research Articles

Postoperative prognostic nutritional index as a prognostic factor after non-small cell lung cancer surgery.

The prognostic nutritional index (PNI) is an immunonutrition index. Although preoperative PNI (pre-PNI) has been reported as a prognostic factor for patients with surgically resected non-small cell lung cancer (NSCLC), it is unclear whether postoperative PNI (post-PNI) and perioperative PNI change is a prognostic factor. Clinicopathological data from 262 consecutive patients who underwent lobectomy for NSCLC were collected. Pre-PNI and post-PNI were calculated within 1month before surgery and at 1month after surgery, respectively. We investigated which clinicopathological factors contributed to the post-PNI, the differences in prognosis according to the post-PNI status, and the impact of perioperative PNI change on prognosis. We set 50 and 45 as an optimal cutoff value of pre-PNI and post-PNI for OS using a receiver operating characteristic curve. Patients who were older and male and who had lower pre-PNI, larger thoracotomy size, longer operative duration, larger blood loss during surgery, and postoperative pulmonary complications showed significantly lower post-PNI. The 5-year overall survival (OS), lung cancer-specific survival, and recurrence-free survival rates for the high/low post-PNI groups were 87.4%/58.4% (P < 0.001), 92.0%/74.8% (P = 0.001), and 80.5%/55.3% (P < 0.001). respectively. Multivariate analysis showed that the post-PNI was a significant prognostic factor (P < 0.001). We further revealed the equivalent OS with "low pre-PNI and high post-PNI" patients or "high pre-PNI and high post-PNI" patients. Post-PNI status was a significant prognostic factor and perioperative PNI changes could play a significant role in the survival of patients with NSCLC after surgery.

Role of T0 status in overall survival for unresectable stage III non-small cell lung cancer: A NCDB analysis

ObjectivesOccult primary non-small cell lung cancer (NSCLC) with mediastinal involvement is a known but rare clinical condition. Very limited retrospective data are available in the literature. Its prognosis and response to systemic chemotherapy have not been investigated with large scale data. Materials and methodsUsing National Cancer Database (NCDB), cases that had undergone radiation therapy without surgery for N2-3M0 NSCLC were selected. Demographics and survival data were compared between T0 and T1-4 groups. Survival analyses were conducted with Kaplan-Meier and log-rank tests. Cox proportional hazard models were used for univariate and multivariate analyses. ResultsBetween 2004 and 2016, 84,263 and 458 cases met criteria for unresectable stage III NSCLC with T1-4 and T0 stage, respectively. T0 status was associated with younger age, recent diagnosis (year 2010–2016), adenocarcinoma histology, N3 stage, and use of chemotherapy. Survival analysis demonstrated that those with T0 status had prolonged overall survival as compared to T1-4 counterparts in both overall and chemotherapy groups (p < 0.0001 for each). Five-year overall survival rates for T0 and T1-4 groups were 30.5% and 12.7% in all groups, and 33.6% and 14.6% in chemotherapy groups, respectively. Propensity score matching also demonstrated a statistically significant difference in overall survival (p < 0.0001). These findings are confirmed by independent analysis using Surveillance, Epidemiology, and End Results Program (SEER). ConclusionThis large hospital-based study demonstrates the favorable prognosis for T0 status in the setting of unresectable stage III NSCLC. Researchers may consider it as distinct stage (e.g., stage IIC) for future studies.

Prognostic Value of 6-Min Walk Test to Predict Postoperative Cardiopulmonary Complications in Patients With Non-small Cell Lung Cancer

The risk stratification value of the 6-min walk test (6MWT) to decide the feasibility of surgical resection is not well elucidated in patients with non-small cell lung cancer (NSCLC) and moderately decreased lung function. This study aimed to determine the role of the 6MWT in predicting postoperative cardiopulmonary complications in patients with NSCLC who underwent lobectomy and had moderately decreased lung function. The data were obtained from a prospective cohort study called Coordinate Approach to Cancer Patient's Health for Lung Cancer (CATCH-LUNG). Patients who underwent lobectomy for NSCLC were classified into two groups according to predicted postoperative pulmonary function (low-risk group or moderate-risk group); each group was then further classified into short-distance (< 400 m) or long-distance (≥ 400 m) groups according to a 6-min walk distance. The main end point of this study was the incidence of postoperative cardiopulmonary complications occurring within the first 30 postoperative days. A multivariable logistic regression model was used to compare the postoperative cardiopulmonary complications among the four groups. The adjusted ORs for any postoperative pulmonary complications, postoperative cardiac complications, and postoperative cardiopulmonary complications in patients with moderate-risk/short-distance relative to those with low-risk/long-distance were 10.26 (95%CI, 2.37-44.36), 5.65 (95%CI, 1.39-22.90), and 7.84 (95%CI, 2.24-27.46), respectively. However, these complications were not different between the patients with moderate-risk/long-term distance and those with low-risk/long-distance. Among patients in the moderate-risk group, those in the short-distance group had a significantly higher risk of postoperative cardiopulmonary complications compared with those in the long-distance group (adjusted OR, 4.95; 95%CI, 1.37-17.93). Patients with NSCLC with moderate-risk/short-distance were at greater risk of developing postoperative cardiopulmonary complications; it may be feasible, however, for patients with NSCLC and moderate-risk/long-distance to undergo lobectomy compared with those with low-risk/long-distance. Our study suggests that the 6MWT could provide additional information in identifying optimal candidates for lung resection surgery of NSCLC. ClinicalTrials.gov; No.: NCT03705546; URL: www.clinicaltrials.gov.

Pulmonary aspergillosis as a late complication after surgery for locally advanced non-small cell lung cancer treated with induction chemoradiotherapy.

Some long-term survivors after surgery for locally advanced non-small cell lung cancer (NSCLC) treated with induction chemoradiotherapy (trimodality treatment) develop chronic pulmonary aspergillosis (CPA). The aim of our study was to assess the characteristics and outcomes of CPA that develops after trimodality treatment. We retrospectively reviewed the data of 187 NSCLC patients who underwent trimodality treatment between 1999 and 2018. Six male ever-smoker patients developed CPA. All 6 patients had undergone extended resection for NSCLC and had a history of either adjuvant chemotherapy (n = 3) or radiation pneumonitis (n = 4). Among the 4 patients with CPA localized in a single lung, 3 patients were treated surgically (completion pneumonectomy or cavernostomy) and 1 patient was treated with antifungal therapy alone. Both treatments led to the improved control of CPA. In contrast, patients with CPA in both lungs were not candidates for surgery, and died of CPA. The survival rates after trimodality treatment in the CPA group and the group without CPA were comparable (10-year survival rate, 50.0% vs. 57.6%, P = 0.59). The early diagnosis of CPA localized in a single lung after NSCLC surgery is critical to improving control and survival in patients with CPA.

Analysis of Risk Factors for Bronchopleural Fistula after Surgical Treatment of Lung Cancer.

Purpose: Bronchopleural fistula (BPF) is a potential serious complication of lobectomy or more radical surgery for non-small-cell lung cancer (NSCLC). We aimed to evaluate the risk factors for BPF.Methods: The study cohort comprised 635 patients who had undergone lobectomy or more radical surgery for NSCLC from March 2005 to December 2017. We examined the following risk factors for BPF: surgical procedure, medical history, preoperative treatment, and surgical management.Results: In all, 10 patients (1.6%) had developed postoperative BPFs. Univariate logistic regression analysis showed that surgical procedure, medical history (arteriosclerosis obliterans [ASO]), and bronchial stump reinforcement were significant risk factors. Multivariate analysis showed that only surgical procedure (right lower lobectomy, p = 0.011, odds ratio = 17.4; right middle lower lobectomy, p = 0.003, odds ratio = 59.4; right pneumonectomy, p <0.001, odds ratio = 166.0) was a significant risk factor. Multivariate analysis confined to the surgical procedure of lobectomy showed that right lower lobectomy (p = 0.011, odds ratio = 36.5) and diabetes (HbA1c ≥8.0) (p = 0.022, odds ratio = 31.7) were significant risk factors.Conclusion: When lobectomy or more radical surgery is performed for NSCLC, right lower lobectomy, middle lower lobectomy, and right pneumonectomy are significant risk factors for postoperative BPF. Thoracic surgeons should acquire the techniques of bronchoplasty and angioplasty to avoid such invasive procedures.

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

Although counties are the smallest geographic level for comprehensive health-care delivery analysis, little is known about county-level variations in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) and factors contributing to such variations in the United States. A total of 179,189 patients aged≥ 35 years who were diagnosed with stage I to II NSCLC between 2007 and 2014 in 2,263 counties were identified from 39 states, the Districtof Columbia, and Detroit population-based cancer registries; the data were compiled by the North American Association of Central Cancer Registries. The percentage of patients who underwent surgery was calculated for each county with≥ 20 cases. Adjusted risk ratios were generated by using generalized estimating equation models with modified Poisson regression. Receipt of surgery for early-stage NSCLC during 2007 to 2014 according to county ranged from 12.8%to 48.6%in the lowest decile of counties, to 74.3%to 91.7%in the highest decile of counties. There were pockets of low surgery receipt rate counties within each state. For example, there was a 25%absolute difference between the lowest and highest surgery receipt rate counties in Massachusetts. Counties in the lowest quartile for receipt of surgery were those with a high proportion of non-Hispanic black subjects, high poverty and uninsured rates, low surgeon-to-population ratio, and nonmetropolitan status. Receipt of curative-intent surgery for early-stage NSCLC varied substantially across counties in the United States, with pockets of low receipt counties in each state. Low surgery receipt counties were characterized by unfavorable area-level socioeconomic and health-care delivery factors.

Surgery and stereotactic body radiotherapy for early-stage non-small cell lung cancer: prospective clinical trials of the past, the present, and the future.

Stereotactic body radiotherapy (SBRT) may be a potential alternative to surgical resection in high-risk operable patients with early-stage non-small cell lung cancer (NSCLC). A number of clinical studies have been undertaken to answer this question, although the conclusion has remained undetermined. Although three randomized clinical trials have failed, currently several prospective clinical trials are ongoing on SBRT versus surgery for early-stage NSCLC. This review article was designed to overview the previous and ongoing clinical trials and to discuss the future perspectives in the comparisons.

Comparative Effectiveness of Robotic-Assisted Surgery for Resectable Lung Cancer in Older Patients

Robotic-assisted surgery (RAS) is a novel surgical approach increasingly used for patients with non-small cell lung cancer (NSCLC). However, data comparing the effectiveness and costs of RAS vsopen thoracotomy and video-assisted thoracoscopic surgery (VATS) for NSCLC are limited. Patients > 65 years old with stage I to IIIA NSCLC treated with RAS, VATS, or open thoracotomy were identified from the Surveillance, Epidemiology, and End Results-Medicare database and matched according to age, sex, stage, and extent of resection. Propensity score methods were used to compare adjusted rates of postoperative complications, adequate lymph node staging, survival, and treatment-related costs. In this matched study cohort of 2,766 patients with resected NSCLC, RAS was associated with lower complication rates (OR, 0.57; 95%CI, 0.42-0.79) compared with open thoracotomy, and similar complication rates (OR, 1.02; 95%CI, 0.76-1.37) compared with VATS. Patients undergoing RAS were as likely to have adequate lymph node sampling as those undergoing open thoracotomy (OR, 1.28; 95%CI, 0.94-1.74) or VATS (OR, 0.88; 95%CI, 0.66-1.18). There was no significant difference in overall survival after RAS vsopen thoracotomy (hazard ratio, 0.81; 95%CI, 0.63-1.04) or VATS (hazard ratio, 0.91; 95%CI, 0.70-1.18). Costs were similar for RAS ($54,702) vsopen thoracotomy ($57,104; P= .08), and higher compared with VATS ($48,729; P= .02). RAS led to improved operative outcomes compared with open thoracotomy but may not offer an advantage over VATS. The comparative effectiveness of RAS should be further evaluated prior to widespread adoption.

P1.13-14 Prognosis and Clinicopathologic Characteristics of Skip N2 Metastasis in Completely Resected Non-Small Cell Lung Cancer

In our daily practice of non-small cell lung cancer (NSCLC) surgery, we sometimes encounter cases of pathological stage was up because of unexpected lymph node metastasis. If single-station N2 metastasis without N1 (skip-N2) of the tumor ≤ 5cm was noted postoperatively, it becomes stage IIIA like other N2 disease, and is to be poor prognosis in the current TNM staging system. The aim of this study is to analyze the impact for prognosis and clinicopathologic characteristics of skip-N2 disease. We identified 415 patients with <T3 N1-2 NSCLC who underwent anatomical lung resection completely between January 2000 and December 2018. The degree of lymph node metastasis was classified into three; N1, skip-N2 and the other N2 (N2). The prognosis and clinicopathologic characteristics of patients were analyzed comparing skip-N2 with N1 and N2. The median follow-up time was 45.7 months. Cases with N1 was 215 (51.8%), skip-N2 was 48 (11.6%) and N2 was 152 (36.6%). Among 48 cases of skip-N2, only 8 cases (16.7%) was diagnosed as N2 preoperatively. 5-year overall survival rate (5y-OS) for N1, Skip-N2 and N2 were 70.9%, 65.7% and 45.3% respectively. 5-year recurrence free survival rate (5y-RFS) for N1, Skip-N2 and N2 were 69.8%, 60.4% and 36.0% respectively. Prognosis of Skip-N2 had similar N1 (5y-OS; p=0.476, 5y-RFS; p=0.534) and had a tendency of better prognosis than N2 (5y-OS; p=0.08, 5y-RFS; p=0.01). As for clinicopathologic characteristics (patients characteristics, tumor marker, tumor size, tumor location, clinical stage and pathological characteristics), there were no significant differences between Skip-N2 disease and the other N1-2 disease. In skip-N2, 98% of cases were found within the extent of lobe specific lymph-node dissection. From clinicopathologic factors which can be obtained preoperatively, it is difficult to predict skip-N2. But the possibility of skip N2 among clinical N0 is not high, almost of skip N2 were detectable during surgery; lobe specific lymph node dissection is appropriate for clinical N0. The prognosis of skip N2 showed similar outcome of N1 rather than N2, but the prognosis is not enough; adjuvant chemotherapy is necessary for this population.

The influence of adjuvant therapy on survival in patients with indeterminate margins following surgery for non–small cell lung cancer

BackgroundThe significance of indeterminate margins following surgery for non–small cell lung cancer (NSCLC) is unknown. We evaluated the influence of adjuvant therapy on survival in patients whose cancer showed indeterminate margins. MethodsPatients whose cancer showed indeterminate margins following surgery for NSCLC were identified in the National Cancer Database between 2004 and 2015, and stratified by receipt of adjuvant treatment. The primary outcome was overall survival, which was evaluated with multivariable Cox proportional hazards. ResultsIndeterminate margins occurred in 0.31% of 232,986 patients undergoing surgery for NSCLC and was associated with worse survival compared with margin negative resection (adjusted hazard ratio, 1.53; 95% confidence interval, 1.40-1.67). Anatomic resection was protective against the finding of indeterminate margins in logistic regression. Amongst 553 patients with indeterminate margins, 343 (62%) received no adjuvant therapy, 96 (17%) received adjuvant chemotherapy, 33 (6%) received adjuvant radiation, and 81 (15%) received adjuvant chemoradiation. Any mode of adjuvant therapy was not associated with improved survival compared with no further treatment. ConclusionsThe finding of indeterminate margins is reported in 0.31% of patients undergoing curative-intent surgery for NSCLC. This was associated with worse overall survival compared with complete resection and not mitigated by adjuvant therapy. The risks and benefits of adjuvant therapy should be carefully considered for patients with indeterminate margins after surgery for NSCLC.

Preoperative respiratory muscle endurance training improves ventilatory capacity and prevents pulmonary postoperative complications after lung surgery.

Resection surgery is the main treatment for non-small cell lung cancer (NSCLC). Postoperative complications and mortality are mostly linked to respiratory failure consecutive to respiratory muscle overload. We aimed to evaluate the effect of preoperative respiratory muscle endurance training (RMET) on respiratory muscle capacity and postoperative complications in patients undergoing NSCLC resection. Randomized controlled trial. French university hospital. Patients eligible for NSCLC resection. The training group (T group) performed a 3-week preoperative RMET added to usual chest physical therapy while the control group (C group) had only the latter. The primary outcome was the change in respiratory muscle endurance. Secondary outcomes were postoperative complications and mortality. Assessments were performed similarly at baseline and after the intervention. We conducted multivariable analyses with analysis of covariance (ANCOVA) taking into account baseline values for isocapnic hyperpnoea endurance test, exercise capacity and pulmonary function tests. The number of pulmonary postoperative complication was analyzed by Fisher-exact test. We included 26 patients with NSCLC (14 in the T group and 12 in the C group). Respiratory muscle endurance significantly increased in the T group after the RMET compared with C group (+229±199 vs. -5±371 sec, P=0.001). This increase was associated with a significantly lower number of pulmonary postoperative complications (2 vs. 10, P=0.037). Preoperative RMET improved respiratory muscle endurance and decreased pulmonary postoperative complications after surgery for NSCLC. These positive results obtained after RMET may help improve the perioperative course for such patients. These results should be confirmed in larger randomized controlled trials, including higher number of patients especially with altered respiratory muscle function. Low-cost and easy to perform, RMET training could serve as complementary tool to usual chest physical therapy, before lung resection surgery.

Long-Term Outcomes of Pulmonary Resection for Lung Cancer Patients with Chronic Kidney Disease

BackgroundThe survival outcome in lung cancer patients with chronic kidney disease (CKD) has not been well evaluated. The aim of this study was to evaluate the survival outcomes following non-small cell lung cancer (NSCLC) surgery in patients with CKD as a preoperative comorbidity.MethodsAmong 671 patients who underwent surgery for NSCLC between 2007 and 2014 at our hospital, 55 (8%) had CKD and we retrospectively analyzed the survival outcomes of these patients.ResultsMost patients with CKD were elderly and male. Patients with CKD had a higher frequency of smoking habit, cardiovascular disease, and pulmonary diseases, and a notably lower pulmonary function, resulting in receiving limited pulmonary resection. There were no marked differences in the frequency of surgical complications between patients with and without CKD (p = 0.16). Squamous cell carcinoma was more frequently diagnosed in patients with CKD than in those without it. The 5-year disease-free survival rates in patients with and without CKD were 60.0% and 69.7% (p = 0.06), respectively, and the 5-year overall survival rates were 68.9% and 80.0%, respectively, showing significant differences (p = 0.01). The rate of receiving supportive care was higher in patients with CKD when recurrence observed.ConclusionCKD is associated with a poorer overall survival in patients who undergo lung cancer resection for recurrent disease. As patients with CKD tend to have a poor respiratory function, thoracic surgeons should carefully select the resection type to balance the therapeutic benefit and invasiveness.

Let us not underestimate the long-term risk of SPLC after surgical resection of NSCLC

ObjectivesSeveral studies have reported that patients operated on for non-small cell lung cancer (NSCLC) are at high risk of second primary lung cancer (SPLC). However, widely varying estimates of this risk have been reported, with very few studies taking into account that these patients are at particularly high competing risk of death, due to recurrence of the initial disease and to comorbidities. Risk factor evaluation over time has significant repercussions on the post-surgery surveillance strategy offered for NSCLC. This study primarily sought to measure the risk of SPLC in a long-term follow-up series, using statistical methods considering competing risks of death. Materials and methodsThe cumulative SPLC risk was estimated using the cumulative incidence of patients with completely resected Stage I-III NSCLC diagnosed between 2002 and 2015 based on the Doubs and Belfort cancer registry (France). A proportional sub-distribution hazard model (sdRH) was used to investigate factors associated with SPLC risk in the presence of competing risks. ResultsAmong the 522 patients, adenocarcinoma and Stage I or II disease accounted for 52.3% and 75.7% of patients, respectively. Overall, 84 patients developed SPLC (16.1%). The cumulative risk of SPLC was 20.2% at 10 years post-surgery (95% confidence interval [CI]: 15.3–23.2), and 25.2% (CI: 19.4–31.3) at 14 years post-surgery. On multivariate analysis, the SPLC risk was significantly higher in patients with postoperative thoracic radiotherapy (sdRH 2.79; 95% CI: 1.41–5.52; p = 0.003). ConclusionThis study using appropriate statistical methods to consider competing risks showed that after complete NSCLC resection, the cumulative incidence function of SPLC was high, with patients receiving postoperative thoracic radiotherapy at higher risk. These data support the need for life-long follow-up of patients who undergo NSCLC surgery, with the objective of screening for SPLC.

Effect of sevoflurane-based or propofol-based anaesthesia on the incidence of postoperative acute kidney injury: A retrospective propensity score-matched analysis.

Propofol may help to protect against ischaemic acute kidney injury (AKI); however, research on this topic is sparse. The current study aimed to investigate whether there were differences in the incidence of postoperative AKI after lung resection surgery between patients who received propofol-based total intravenous anaesthesia (TIVA) and those who received sevoflurane-based inhalational anaesthesia. A retrospective observational study. A single tertiary care hospital. Medical records of patients aged 19 years or older who underwent curative lung resection surgery for nonsmall cell lung cancer between January 2005 and February 2018 were examined. After propensity score matching, the incidence of AKI in the first 3 postoperative days was compared between patients who received propofol and those who received sevoflurane. Logistic regression analyses were also used to investigate whether propofol-based TIVA lowered the risk of postoperative AKI. The analysis included 2872 patients (1477 in the sevoflurane group and 1395 in the propofol group). After propensity score matching, 661 patients were included in each group; 24 (3.6%) of the 661 patients in the sevoflurane group developed AKI compared with 23 (3.5%) of the 661 patients in the propofol group (95% confidence intervals of difference in incidence -0.019 to 0.022, P = 0.882). The logistic regression analyses revealed that the incidence of AKI was not different in the two groups (odds ratio 0.96, 95% confidence interval 0.53 to 1.71, P = 0.882). In this retrospective study, no significant difference was found in the incidence of postoperative AKI after lung resection surgery between patients who received propofol-based TIVA and those who received sevoflurane-based inhalational anaesthesia. Considering the methodological limitation of this retrospective study, further studies are required to confirm these results.

Stereotactic body radiation therapy or surgery for stage I–II non-small cell lung cancer treatment?—outcomes of a meta-analysis

Background: Stereotactic body radiotherapy (SBRT) has been increasingly recognized as a favourable alternative to surgical resection for early-stage non-small cell lung cancer (NSCLC). Many retrospective analyses compared the efficacy of SBRT with that of surgery for NSCLC. However, the difference in efficacy between SBRT and surgery in patients with early-stage NSCLC remains unclear. Methods: We searched PubMed, the Cochrane Library, EMBASE and the Chinese Biomedical Literature Database from inception to March 14, 2018, to identify studies comparing SBRT with surgery in the treatment of stage I/II NSCLC. STATA 12.0 software was used to perform the meta-analysis. Results: A total of 15 studies that carried out propensity score matching (PSM) were included. In this meta-analysis, patients with SBRT had worse overall survival (OS) than those with surgery, but the analysis restricting studies to the same adjustment factors showed that the difference in OS gradually decreased with the increase in comparable matching characteristics between the two groups and that there was eventually no significant difference. Patients treated with SBRT achieved similar cause-specific survival (CSS), local control, regional control, loco-regional control, and distant control compared with surgery. In addition, a separate analysis of 6 studies that compared SBRT with lobectomy also showed that with the increase in comparable matching characteristics between surgery and SBRT, the OS differences gradually decreased, and there was eventually no significant difference. Conclusions: In this study, we found more favourable OS for stage I/II NSCLC treated with surgery, but when there were increasing numbers of comparable matching characteristics between surgery and SBRT, the differences in the survival rate were reduced to the point that they were not significant. The CSS and recurrence (local, regional, or disseminated) differences between surgery and SBRT were also not significant. Therefore, SBRT has the potential to be an alternative to surgical treatment in patients with stage I/II NSCLC, but these findings need to be confirmed by large-sample, long-term follow-up randomized clinical studies.

Prognostic factors for survival in patients with completely resected pN2 non-small-cell lung cancer

Background This study examined the incidence of pathologic N2 (pN2) non-small-cell lung cancer (NSCLC) and prognostic factors affecting survival of these patients. Methods A total of 119 patients who underwent surgery for NSCLC (lobectomy and pneumonectomy) between January 2008 and December 2016 were evaluated retrospectively. The patients with pN2 included in this study were assessed in two groups; single pN2 and multiple pN2. Results The most common type of resection was lobectomy (56.3%). Ninety-four patients (79%) received adjuvant therapy. Eighty-six patients (72.3%) had single-station pN2 and 33 (27.7%) had multiple pN2. The 5-year survival rates were 29.3% overall, 38.6% in single-station pN2, and 11% in multiple-station pN2 (hazard ratio [HR]: 0.581, p = .037). There was no statistically significant difference in 5-year survival rates between patients with pN1N2 and those with pN0N2 involvement (39.1% vs. 37.1%) (p = .625). Not receiving adjuvant therapy was associated with poor survival prognosis (HR: 8.2 p < .001). The 5-year survival rate was 36.2% among patients with pN2 involvement with 2 or more positive lymph nodes and 19.5% among those with fewer than 2 positive lymph nodes (HR: 0.83, p = .463). Conclusions The most significant prognostic factors associated with survival were pN2 status. Non-skip metastases (pN1N2) and positive lymph node count were not associated with prognosis.

Apolipoprotein E is a predictive marker for assessing non-small cell lung cancer patients with lymph node metastasis

BackgroundApolipoprotein E (APOE) modulates lipid homeostasis in the systemic circulation and induces inflammatory immune responses in the tumor microenvironment. We evaluated APOE expression in order to assess tumor progression in non-small cell lung cancer (NSCLC). MethodsImmunohistochemical staining for APOE was performed on tissue microarray blocks from 148 patients who had undergone surgery for NSCLC. The staining intensity and the proportion of APOE-positive tumor cells (based on distinct membranous and cytoplasmic staining) were scored. The relationships between APOE expression and clinical (age, sex, and smoking history) and pathological (TNM stage and histological type) factors were evaluated. ResultsPositive APOE staining was observed in 93 (64.6%) patients. APOE expression patterns differed among NSCLC histological types (p-value = 0.016). Negative APOE expression was significantly associated with lymph node metastasis in NSCLC (p-value = 0.040). Both cases of N2 (stage IIIA) disease showed negative APOE expression. ConclusionsAPOE is a useful marker for assessing NSCLC patients with lymph node metastasis.

Surgery and stereotactic body radiotherapy for early stage non-small cell lung cancer: review of meta-analyses

Observational or randomized studies on survival outcome following surgery versus stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) demonstrated various results, and several meta-analyses on this topic have been published. The PubMed database was queried for meta-analyses comparing surgery and SBRT for early stage NSCLC. Six meta-analyses on this comparison were identified and 4 (66.7%) suggested that surgery be associated with significantly more favorable overall survival than SBRT, using odds ratio or hazard ratio (HR) as measures of effect. Most of the included studies in the meta-analyses were observational studies and those meta-analyses should be interpreted with caution.

Stereotactic body radiation therapy or surgery for stage I-II non-small cell lung cancer treatment?-outcomes of a meta-analysis.

BackgroundStereotactic body radiotherapy (SBRT) has been increasingly recognized as a favourable alternative to surgical resection for early-stage non-small cell lung cancer (NSCLC). Many retrospective analyses compared the efficacy of SBRT with that of surgery for NSCLC. However, the difference in efficacy between SBRT and surgery in patients with early-stage NSCLC remains unclear.MethodsWe searched PubMed, the Cochrane Library, EMBASE and the Chinese Biomedical Literature Database from inception to March 14, 2018, to identify studies comparing SBRT with surgery in the treatment of stage I/II NSCLC. STATA 12.0 software was used to perform the meta-analysis.ResultsA total of 15 studies that carried out propensity score matching (PSM) were included. In this meta-analysis, patients with SBRT had worse overall survival (OS) than those with surgery, but the analysis restricting studies to the same adjustment factors showed that the difference in OS gradually decreased with the increase in comparable matching characteristics between the two groups and that there was eventually no significant difference. Patients treated with SBRT achieved similar cause-specific survival (CSS), local control, regional control, loco-regional control, and distant control compared with surgery. In addition, a separate analysis of 6 studies that compared SBRT with lobectomy also showed that with the increase in comparable matching characteristics between surgery and SBRT, the OS differences gradually decreased, and there was eventually no significant difference.ConclusionsIn this study, we found more favourable OS for stage I/II NSCLC treated with surgery, but when there were increasing numbers of comparable matching characteristics between surgery and SBRT, the differences in the survival rate were reduced to the point that they were not significant. The CSS and recurrence (local, regional, or disseminated) differences between surgery and SBRT were also not significant. Therefore, SBRT has the potential to be an alternative to surgical treatment in patients with stage I/II NSCLC, but these findings need to be confirmed by large-sample, long-term follow-up randomized clinical studies.

The role of extended lymphadenectomy in left-sided non-small cell lung cancer surgery

Thanks to the advancements in diagnostic screening and imaging technologies, nowadays lung tumors can be identified at an ever earlier clinical stage than in the past. Surgical resection still represents the best curative choice in this setting.