Operable Lung Cancer Patients Research Articles

Family resilience and vulnerability of patients at diagnosis of lung cancer: A qualitative study.

To explore and analyse the adaptation process of patients and their families at the point of lung cancer diagnosis. Totally 23 operable lung cancer patients were included in this study. Colaizzi's method of phenomenology was employed for data analysis. This study found two different aspects of family adaptation at the diagnosis of lung cancer. For family resilience, three themes emerged: (1) Positive family belief systems (giving meaning to a cancer diagnosis and maintaining a positive/optimistic attitude), (2) Flexible family organizational patterns (maintaining the stability of family structure and function, adjusting the relationship between patients and family members and receiving external support and help) and (3) Good communication and problem-solving strategies (open communication on an equal basis, positive and open expression of emotions and collaborative problem-solving). For family vulnerability, three themes were as follows: (1) Negative family belief systems (negative attitudes and concealment and self-isolation due to stigma), (2) Rigid family organizational patterns (adaptation lost, conflicts between family support and patients' willingness and pressure upon social support) and (3) Unhealthy communication and problem-solving (poor communication, emotional asymmetry of family members and tendency to solve problems alone). The study highlights the existence of the family resilience and family vulnerability at the point of lung cancer diagnosis and provides patient's perspective for understanding family resilience in specific cultural contexts. The data were collected through face-to-face interviews. ChiCTR2300074801.

'Staying cool, calm and positive': A dialogical narrative analysis of emotional reactions in narratives about operable lung cancer.

Patients with lung cancer suffer from physical, psychosocial and particularly emotional challenges. Twenty-five percent of patients with lung cancer are offered surgery as a potential cure. Nevertheless, 40% of surgically treated patients will experience recurrence. Paradoxically, research shows a dominant narrative of operable lung cancer patients 'being lucky', which silences other narratives about suffering, worries and emotional challenges. To explore narratives about operable lung cancer, particularly emotional reactions to illness and suffering in these narratives. A qualitative design was applied. Six women and four men diagnosed with operable lung cancer were included from one university hospital in Denmark and interviewed 1 month after surgery using active interviews. The interviews were subject to dialogical narrative analysis. The theoretical foundation is social constructivism, with socio-narratological inspiration. A typology of three emotional narratives emerged: 'staying cool', 'staying calm' and 'staying positive'. All three types of narrative are characterised by managing emotional reactions. Staying cool is characterised by not showing emotional reactions; staying calm narratives acknowledge emotional reactions, but that they need to be managed so that they do not burden relatives; and the last, staying positive, is characterised by managing emotional reactions in a positive direction. Together this typology of three emotional narratives revealed that operable lung cancer patients are under normative pressure from these socially preferred narratives of ideal emotional reactions to lung cancer. A typology of three emotional narratives were identified and can be called 'feeling rules' that guide patients after lung cancer surgery to manage their emotions. Consequently, if patients do not live up to these three emotional narratives of staying cool, calm and positive, they may be socially isolated and restricted from access to support.

The Impact of the COVID-19 Pandemic on the Diagnosis and Treatment Characteristics of Operated Lung Cancer Patients

The Impact of the COVID-19 Pandemic on the Diagnosis and Treatment Characteristics of Operated Lung Cancer Patients

Ten-year trends of the clinicopathological characteristics, surgical treatments and survival outcomes of operable lung cancer patients in monocenter: a retrospective cohort study.

Lung cancer is one of the cancers with the highest morbidity and mortality. During the last decade, the trends of clinical characteristics, surgical treatments and survival of lung cancer patients in China have remained unclear. All lung cancer patients operated on from 2011 to 2020 were identified in a prospectively maintained database of Sun Yat-sen University Cancer Center. A total of 7,800 lung cancer patients were included in this study. Within the past 10 years, the average age at diagnosis of the patients remained stable, the proportion of asymptomatic, female and nonsmoking patients increased, and the average tumor size decreased from 3.766 to 2.300 cm. In addition, the proportion of early stage and adenocarcinoma increased, while that of squamous cell carcinoma decreased. Among the patients, the proportion of patients having video-assisted thoracic surgery increased. More than 80% of the patients underwent lobectomy and systematic nodal dissection over the 10 years. Additionally, both the average postoperative length of stay and 1-, 3-, and 6-month postoperative mortality decreased. Moreover, the 1-, 3-, and 5-year overall survival (OS) rates of all the operable patients increased from 89.8, 73.9, and 63.8% to 99.6, 90.7, and 80.8%, respectively. The 5-year OS rates of the patients with stage I, II, and III lung cancer were 87.6, 79.9, and 59.9%, respectively, which were higher than those in other published data. There were significant changes in the clinicopathological characteristics, surgical treatments and survival outcomes of the patients with operable lung cancer from 2011 to 2020.

FACTORS AFFECTING SURVIVAL AND RECURRENCE IN PATIENTS WITH OPERATED NON-SMALL CELL LUNG CANCER

Introduction: The most serious problem after curative treatment of non-metastatic lung cancer is disease recurrence. This study was designed to detect markers affecting disease recurrence and survival in operated lung cancer patients. Materials and Methods: In this study, the data of 109 patients diagnosed with lung cancer were analyzed retrospectively. Cut-off values for neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), Alkaline phosphatase (ALP), and Gamma Glutamyl Transpeptidase (GGT) were determined by performing Roc Curve analysis. According to these cut-off values, the patients were divided into two groups. Based on the cut-off value of the markers, their effects on both overall survival (OS) and disease-free survival (DFS) were examined. Results: In this study, the median OS of the patients was 53.9 months, and the median DFS was 20.6 months. The patients were re-evaluated by targeting the cut-off value of 2.35 for NLR obtained by Roc analysis. Below this value, mOS and mDFS were calculated as 78.2 and 43.2 months, respectively. Above this value, it was determined as 35.6 and 20.6 months, respectively. A similar evaluation was made for the PLR. As a result of the Roc analysis, the cut-off value was determined as 124.7. Below this value, mOS and mDFS were calculated as 72.4 and 36.9 months, respectively. Above this value, it was determined as 41.7 and 21.8 months, respectively. Both results were statistically significant (p<0.05). Discussion: This study showed that NLR and PLR predict statistical significance for OS and DFS.

Prognostic Markers in Operated Non-Small Cell Lung Cancer Patients

Objective: The overall survival (OS) of operable lung cancer patients is directly related to clinicopathological features and some laboratory parameters. In this study, we aimed to examine the factors affecting the survival of the operated patients. Methods: In our study, we retrospectively analyzed 202 operated-on patients diagnosed with lung carcinoma who were in stages I–IIIA at the time of diagnosis. The clinico-pathological features and some laboratory parameters of the patients included in our study were retrospectively analyzed. The effects of those parameters on the overall survival of the patients and their disease-free survival (DFS) have been investigated. Results: The age of the patient at the time of diagnosis and the presence of lymphovascular invasion (LVI) were found to be statistically significant in terms of OS (p<0,05). Pathological tumor size, LVI, and peri-neural invasion (PNI) parameters were statistically significant for DFS. In addition, neutrophil-lymphocyte ratio (NLR), which is an inflammatory indicator, is an important parameter with statistical significance in terms of both OS and DFS (p<0,05). Conclusions: Our study yielded that LVI and PNI parameters would be beneficial to estimate patients' survival and prognosis. In addition, NLR was observed to have a statistically significant effect on OS and DFS.

Characteristics of Indian stage IIIA and IIIB operable lung cancer patients. Do T-ratio and young age predict long-term outcomes?

Introduction: Young lung cancer patients are considered to be aggressive and inferior survival outcomes. However, the behavior of locally advanced (Stage IIIA-IIIB) young Indian lung cancer patients undergoing surgery has not been adequately evaluated.

The nomograms for predicting overall and cancer-specific survival in elderly patients with early-stage lung cancer: A population-based study using SEER database.

PurposeLung cancer is the leading cause of death from cancer and the number of operable elderly lung cancer patients is increasing, with advanced age being associated with a poorer prognosis. However, there is no easy and comprehensive prognostic assessment method for these patients.MethodsClinicopathological data of patients aged 65 years or older with TNM stage I-II lung cancer from 2004 to 2018 were downloaded from the SEER database. Patients from 2004 to 2015 were randomized into a training group (n = 16,457) and a validation group (n = 7,048). Data from 2016 to 2018 (n = 6,231) were used for external validation. Two nomogram prognostic models were created after independent prognostic factors connected to both overall survival (OS) and cancer-specific survival (CSS) in the training set by using univariate and multivariate Cox proportional hazards regression analysis. In turn, overall survival (OS) and cancer-specific survival (CSS) were predicted for patients at 1, 3, and 5 years. Based on the concordance index (C-index), calibration curves, area under the receiver operating characteristics (ROC) curve (AUC), the time-dependent area under the ROC curve, the validity, accuracy, discrimination, predictive ability, and clinical utility of the models were evaluated. Decision curve analysis (DCA) was used to assess the clinical value of the models.ResultsA total of 29,736 patients were included. Univariate and multivariate analyses suggested that age, race, gender, marriage, disease grade, AJCC stage, T-stage, surgery, radiotherapy, chemotherapy, and tumor size were independent risk factors for patient prognosis. These 11 variables were included in nomogram to predict OS and CSS of patients. C-indexes of OS for the training, validation and external validation sets were 0.730 (95% CI, 0.709–0.751), 0.734 (95% CI, 0.722–0.746), and 0.750 (95% CI, 0.734–0.766), respectively. The AUC results for the training and validation sets indicated good accuracy for this nomogram. The calibration curves demonstrated a high degree of concordance between actual and anticipated values, and the DCA demonstrated that the nomograms had better clinical application than the traditional TNM staging approach.ConclusionThis study identified risk factors for survival in operable elderly lung cancer patients and established a new column line graph for predicting OS and CSS in these patients. The model has good clinical application and can be a good clinical decision-making tool for physicians and patients.

Robotic hilum-mediastinal lymph nodes dissection for operable non-small cell lung cancer (NSCLC) patients: state of art

Robotic hilum-mediastinal lymph nodes dissection for operable non-small cell lung cancer (NSCLC) patients: state of art

Prognostic Relevance of the Relative Presence of CD4, CD8 and CD20 Expressing Tumor Infiltrating Lymphocytes in Operable Non-small Cell Lung Cancer Patients.

Non-small cell lung cancer (NSCLC) is one of the most lethal tumors. Given the failure of conventional therapeutic strategies, immunotherapy has emerged as a promising treatment modality that may improve the survival of patients with operable and advanced disease. We examined the relative presence of CD20+ B-cells, CD8+ cytotoxic, and CD4+ helper/regulatory T-cells in the tumor-infiltrating lymphocyte (TIL)-population in a series of surgically-treated NSCLCs, and assessed their role as prognostic indicators after surgery. A high percent of CD4+ and CD8+ TILs in the tumor stroma was linked with poor (p=0.003) and good prognosis (p=0.01), respectively. High CD4/CD8 ratio defined a significantly worst prognosis [median survival 22 months vs. undefined, p=0.0002, hazard ratio (HR) 0.3 vs. 3.0]. Statistically significant results were also noted when the analysis was focused on the invading tumor front. In a multivariate model, the CD4/CD8-ratio assessed in the tumor stroma and the stage of disease were independent prognostic variables (p=0.0001, HR=4.1 and p=0.001, HR=1.5, respectively). The balance between CD4+ and CD8+ lymphocytes infiltrating the tumor stroma is a crucial factor defining anti-tumor immune surveillance, has strong prognostic value, and may be tested as a predictive biomarker for immunotherapy in operable NSCLC.

Clinicopathological and prognostic features of operable non-small cell lung cancer patients with diabetes mellitus.

The aim of this study was to investigate the clinicopathological and prognostic features of operable non-small cell lung cancer (NSCLC) patients with diabetes mellitus (DM). A total of 1231 surgically resected NSCLC patients were retrospectively reviewed. Clinicopathological characteristics were compared between patients with DM (DM group, n = 139) and those without DM (non-DM group, n = 1092). The clinical factors associated with postoperative complications and prognostic factors were identified. The DM group had distinct clinicopathological features. No significant differences in histological invasiveness or stage were found. The presence and control status of DM were independent predictors of postoperative complications. No significant differences in recurrence-free survival or cancer-specific survival were observed; however, the DM group had worse overall survival (OS). The DM group had a higher number of deaths from other diseases than the non-DM group, and these patients had significantly higher postoperative hemoglobin A1c levels than patients with cancer-related death. The presence and control status of preoperative DM are useful predictors of both postoperative complications and OS in operable NSCLC patients. Concomitant diabetes-related complications have a negative effect on long-term survival in diabetic NSCLC patients, and long-term glycemic control is important to prolong OS.

1219P AI-powered prediction of 2-year relapse-free survival in operable NSCLC patients using peritumoral radiomic features according to tumour size in chest CT images

To evaluate the ability of radiomic features inside and outside the tumor and the effect of the external range according to the size of the tumor in predicting 2-year relapse-free survival of operable non-small cell lung cancer (NSCLC) patients from chest CT images.

Stereotactic Ablative Body Radiotherapy in Non-small Cell Carcinoma Lung in Elderly: Initial Experience from a Rural Tertiary Cancer Centre

Aim: The aim of this study was to evaluate the efficacy and outcome of early stage non-small cell lung carcinoma in elderly patients treated with SABR in a tertiary care cancer centre in rural India. Materials and methods: This was a retrospective study. All cases of histopathologically proven, stage 1 lung cancer patients in whom surgical management was not feasible due to various reasons were included. It included patients treated from 2013 to 2018 at our centre. Case records and radiation treatment plans were reviewed and data was collected. All were T1/T2N0 cases. Dose schedules employed were 48 Gy in 4 fractions, 60 Gy in 5 fractions and 60 Gy in 3 fractions. The primary end point was the tolerance and toxicity profile. Results: A total of 5 patients were treated at our center from 2013 to 2017. All were males. Mean age was 72 years. One had squamous cell and four had adenocarcinoma histology. The dose fractionation schedules employed where 48 Gy in 4 fractions, 60 Gy in 5 fractions and 60 Gy in 3 fractions. All tolerated treatment well. No grade 3 or 4 toxicities were observed. Conclusion: SABR is a feasible alternative curative treatment modality in stage 1 NSCLC. It is feasible and was tolerated well even in the elderly age group. This can be offered to medically inoperable patients as a curative treatment and is possible in a resource constrained setting also. This modality is a promise to future for operable stage 1 NSCLC also. But more randomized studies need to be carried out before applying it to operable lung cancer patients.

The pathway to diagnosis and treatment for surgically managed lung cancer patients.

Most lung cancer is diagnosed at an advanced stage, resulting in poor survival. This study examined diagnostic pathways for patients with operable lung cancer to identify factors contributing to early diagnosis. Surgically treated lung cancer patients (aged ≥40, within 6 months of diagnosis), approached via the population-based Cancer Registry, with their primary care physicians (PCPs) and specialists completed cross-sectional surveys assessing symptoms, diagnostic route (symptomatic or 'investigation' of other problem), tests, key event dates and treatment. Time intervals to diagnosis and treatment were determined, and quantile regression examined differences between the two diagnostic routes. Cox proportional hazard regression analyses examined associations between survival and diagnostic route adjusting for stage, sex and age. One hundred and ninety-two patients (36% response rate), 107 PCPs and 55 specialists participated. Fifty-eight per cent of patients had a symptomatic diagnostic route reporting an average of 1.6 symptoms, most commonly cough, fatigue or haemoptysis. Symptomatic patients had longer median primary care interval than 'investigation' patients (12 versus 9 days, P < 0.05) and were more likely to report their PCP first-ordered imaging tests. Secondary care interval was shorter for symptomatic (median = 43 days) than investigation (median = 62 days, P < 0.05) patients. However, 56% of all patients waited longer than national recommendations (6 weeks). While survival estimates were better for investigation than symptomatic patients, these differences were not significant. Many operable lung cancer patients are diagnosed incidentally, highlighting the difficulty of symptom-based approaches to diagnosing early stage disease. Longer than recommended secondary care interval suggests the need for improvements in care pathways.

MA17.01 A Sense of Understanding and Belonging When Life Is at Stake – Operable Lung Cancer Patients’ Lived Experiences of Participation in Exercise

MA17.01 A Sense of Understanding and Belonging When Life Is at Stake – Operable Lung Cancer Patients’ Lived Experiences of Participation in Exercise

P1.16-37 Clinicopathological Characteristics and Prognostic Factors of Operable Non-Small Cell Lung Cancer Patients with the Diabetes Mellitus

P1.16-37 Clinicopathological Characteristics and Prognostic Factors of Operable Non-Small Cell Lung Cancer Patients with the Diabetes Mellitus

Diagnostic value of CYFRA 21-1 and carcinoembryonic antigen in diagnosis of operable lung cancer from benign lung disease

Lung cancer is sometimes difficult to differentiate from benign lung diseases with nodular shadow in imaging scan. In these cases, exploratory operation is needed for the patients with highly suspected malignant disease. Therefore, there is an urgent demand to differentiate the benign lung disease from malignant lung nodules rather than invasive method. We evaluated the diagnostic value of two tumor markers in distinguishing operable lung cancer from benign lung disease. The serum levels of carcinoembryonic antigen (CEA) and CYFRA 21-1 were retrospectively analyzed in 236 lung cancer patients and 44 patients with benign lung disease. These benign lung diseases were presented with evidence of a high likelihood of having lung cancer. After surgical operation, diagnosis of lung cancer and benign lung disease were confirmed by histological examination. We found that the average level of tumor marker in operable lung cancer patients was higher than those in patients with benign lung disease. CYFRA 21-1 sensitivity and specificity for lung cancer diagnosis was 37.3% and 90.9%, respectively, while that for CEA was 22.0% and 90.9%. The combined value for the sensitivity and specificity of these two tumor markers was 47.5% and 81.8%, respectively. Our results indicate that the combination of these two tumor markers resulted in higher sensitivity compared to use CYFRA 21-1 or CEA along. Given its lower sensitivity and higher specificity, positive CYFRA 21-1 or positive CEA strongly supports lung cancer in patients with nodular shadow in imaging scan.

Physical behavior and associations with health outcomes in operable NSCLC patients: A prospective study

ObjectivesOur objectives were to 1) characterize daily physical behavior of operable non-small cell lung cancer (NSCLC) patients, from preoperative to six months postoperative using accelerometry, and explore if physical behavior preoperative or one month postoperative is associated with better health outcomes at six months postoperative. MethodsA prospective study with 23 patients (13 female) diagnosed with primary NSCLC and scheduled for curative lung resection was performed. Outcome measures were assessed two weeks preoperative, and one, three and six months postoperative, and included accelerometer-derived physical behavior measures and the following health outcomes: six minute walking distance (6MWD), questionnaires concerning health-related quality of life (HRQOL), fatigue and distress. ResultsOn group average, physical behavior showed significant changes over time. Physical behavior worsened following surgery, but improved between one and six months postoperative, almost reaching preoperative levels. However, physical behavior showed high variability between patients in both amount as well as change over time. More time in moderate-to-vigorous physical activity in bouts of 10 min or longer in the first month postoperative was significantly associated with better 6MWD, HRQOL, distress, and fatigue at six months postoperative. ConclusionAs expected, curative lung resection impacts physical behavior. Patients who were more active in the first month following surgery reported better health outcome six months postoperative. The large variability in activity patterns over time observed between patients, suggests that physical behavior ‘profiling’ through detailed monitoring of physical behavior could facilitate tailored goal setting in interventions that target change in physical behavior.

The potential role of postbronchoscopic fever on the postoperative outcomes in patients with non-small cell lung cancer.

Postbronchoscopic fever is a common adverse reaction in operable non-small cell lung cancer (NSCLC) patients. To explore the potential role of postbronchoscopic fever on the postoperative outcomes in patients with NSCLC. Patients diagnosed with NSCLC were enrolled in this study. Patients were divided into two groups: fever group (postbronchoscopic fever) and normal group (without postbronchoscopic fever). Seventy-five cases were enrolled. Twelve cases (16%) developed postbronchoscopic fever. The fever group was found to have longer postoperative fever time (1.9 vs. 0.8 days, P<0.05), more postoperative antibiotic use (3.4 vs. 2.5 days, P<0.05) and longer drainage (7.2 vs. 4.7 days, P<0.05). WBC counts of the fever group were higher than those of the no-fever group on the first (14.5 vs. 11.4×109/L, P<0.05) and third (11.0 vs. 9.2, P<0.05) postoperative day. Outcomes were different especially in the older subgroup (>60 years). Postbronchoscopic fever may be a predictor of longer postoperative fever, longer drainage and more antibiotic use in patients with NSCLC postoperatively.

Role of Serum Tumor Markers in Prognosis of Operable Non-small Cell Lung Cancer Patients

Role of Serum Tumor Markers in Prognosis of Operable Non-small Cell Lung Cancer Patients