Resected Lung Cancer Patients Research Articles

Adjuvant chemotherapy in non-small cell lung cancer: state-of-the-art.

Adjuvant chemotherapy (AC) plays now a significant role in the treatment of resected non-small cell lung cancer (NSCLC) patients and has become standard in clinical practice. It took more than two decades of clinical research to show its value, but it is has been well established that its benefit translates into a 4-5% absolute increase in 5-year survival according to published meta-analysis. This improvement is obtained with two-drug, Cisplatin-based regimens (multiples choices are acceptable but vinorelbine is the drug with more reported evidence) and usually four courses are recommended. Survival increase is restricted to cases in which there is involvement of lymph nodes (both N1 and N2 levels). For N0 cases AC might be considered, with a lower level of evidence, for tumors larger than 4 cm in diameter. At the present time, molecular predictive factors and gene signatures are investigational. Patient selection is of paramount importance. Proper recovery from surgery and the absence of major comorbidities are essential features. Toxicity is significant, but manageable and transient. Neutropenia is the most relevant side effect due to the risk of febrile neutropenia. The role of timing of administration, adjuvant radiotherapy (RT) and of newer drugs under evaluation is also reviewed.

The impact of combined pulmonary fibrosis and chronic obstructive pulmonary disease on long-term survival after lung cancer surgery.

The purpose of this study was to determine the impact of pulmonary fibrosis (PF) on postoperative complications and on long-term survival after surgical resection in lung cancer patients with chronic obstructive pulmonary disease (COPD). A retrospective chart review was conducted of 380 patients with COPD who had undergone pulmonary resection for lung cancer at the University Hospital between 1990 and 2005. The definition of COPD was a preoperative forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio of less than 70%; PF was defined as obvious bilateral fibrous change in the lower lung fields, confirmed by computed tomography. PF was present in 41 patients (10.8%) with COPD; the remaining 339 patients (89.2%) did not have PF. The preoperative FVC/FEV1 was significantly lower in the group of patients with PF than in the group without (p < 0.05). Acute lung injury and home oxygen therapy were significantly more common in the PF group; however, the 30-day mortality was similar between the groups. The cumulative survival at 3 and 5 years was 53.6 and 36.9%, respectively, in the PF group and 71.4 and 66.1%, respectively, in the non-PF group (p = 0.0009). Increased age, decreased body mass index, advanced pathologic stage, and the existence of PF were identified as independent risk factors for decreased survival. PF is a risk factor for decreased survival after surgical treatment in lung cancer patients with COPD.

High expression of Hsp90-beta and GRP 94 association with poor survival in resected non-small cell lung cancer patients.

e13522 Background: O6-methylguanine–DNA methyltransferase (MGMT), a DNA repair enzyme, has been well-characterized to be a therapeutic determinant of O6-alkyalting drugs. Recently, we and others fo...

Association of high expression of Hsp90-beta and GRP 94 with poor survival in resected non-small cell lung cancer patients.

e22183 Background: Heat Shock Protein 90 (Hsp90) is an ATP-dependent molecular chaperone that was required for the stability and function of more than 200 signaling proteins that promote cancer cel...

Circulating tumor cells in peripheral and pulmonary venous blood and long-term survival in surgically resected non-small cell lung cancer patients.

e22039 Background: We tested the hypothesis that the circulating tumor cells (CTCs) in preoperative peripheral blood (PPB) and intraoperative pulmonary venous blood (IPVB) could predict poor long t...

THERAPEUTIC EFFECTIVENESS OF STEREOTACTIC BODY GAMMA KNIFE IN THE TREATMENT OF LUNG CANCER AT HUE UNIVERSITY HOSPITAL

Objective: Lung cancer occurs frequently in man and it is the most common cause of cancer related mortality in men and women. Objective: To identify the clinical and pathological characteristics and investigate the therapeutic effectiveness of noninvasive stereotactic body gamma knife in the treatment of lung cancer at Hue University Hospital. Patients And Methods: From 8/2006 to 12/2011 eligible patients included 117 patients clinically stage I and II, biopsy-confermed non-small cell lung cancer, were treated by Body Gamma knife, using a stereotactic body frame at Hue University Hospital. A prospective study, clinical trial non-cohort. Results: The most affected age group was 50-69 age, the mean age 61±11.4 with predominance of men over women in a 2.6:1 ratio. The mean disease duration was 3-6 months. The predominant clinical characteristics were increased cough 76.1%. The tumor size 3-5cm is the most common, represent 40.2%. Histologically, the most frequent types were squamous cell carcinoma 52.9% and adenocarcinoma 36.8%.On the staging, 41.1% at stage I, 58.9% at stage II. The total average dose was 5600-6000cGy. The results were followed: the complete response rate was 31.6%, partial response rate was 42.7%, stable disease 17.9% and progressive disease was 7.7%, local control was 92.3%. The median survival time was 32.1±1.6 months. Survival rates were 98.3%, 65.8%, 35.4% and 12.4 at 1, 2, 3 and 5 years respectively. There was no complication in the treatment. Conclusion: Surgery continues to offer the best chance of cure for resectable lung cancer patients; however, Stereotactic Body gamma knife offers an alternative to high-risk patients and the patients refusal resection to have a surgical procedure. It is a new treatment strategies including improved radiation therapy techniques promise better outcome in early stage. Key words: Lung cancer, body gamma knife

High Incidence of Ischemic Stroke Occurrence in Irradiated Lung Cancer Patients: A Population-Based Surgical Cohort Study

Background and PurposeA high risk of stroke occurrence has been reported in several types of irradiated cancer patients. However, clinical data are lacking in irradiated lung cancer patients. The present study intended to explore a risk level of ischemic stroke occurrence in irradiated lung cancer patients.MethodsA nationwide population-based database obtained from the Taiwan National Health Insurance was analyzed. Between 2003 and 2006, we recruited 560 resected lung cancer patients into two study groups: surgery-plus-irradiation (n = 112) and surgery-alone (n = 448). Patients treated with chemotherapy were excluded. Propensity score match was used for pairing cases with a ratio of 1∶4. Two-year ischemic-stroke-free survival was defined as the primary endpoint.ResultsThree observations supported a high risk of ischemic stroke occurrence in patients with postoperative irradiation when compared with those patients with surgery alone: first, a high incidence per 1,000 person-year (22.3 versus 11.2, 1.99 folds); second, a low two-year ischemic-stroke-free survival rate (92.2% versus 98.1%, P = 0.019); and third, a high adjusted hazard ratio (HR, 4.19; 95% CI, 1.44–12.22; P = 0.009). More notably, the highest risk of ischemic stroke occurrence was found in irradiated patients who had diabetes mellitus (HR, 34.74; 95% CI, 6.35->100; P<0.0001).ConclusionsA high incidence of ischemic stroke was observed in irradiated lung cancer patients, especially in those with diabetes mellitus. For these patients, close clinical surveillance and strict diabetes control should be considered. Further studies to define detail biological mechanisms are encouraged.

Epigenetic analysis of microRNA genes in tumors from surgically resected lung cancer patients and association with survival

Aberrant microRNA (miRNA) expression is involved in tumorigenesis of several cancers, including non-small cell lung cancer (NSCLC). Furthermore, expression of some miRNAs has been shown to be under epigenetic regulation. However, less is known regarding the role of miRNA methylation in NSCLC development or clinical outcomes. Therefore, we tested miRNA methylation patterns by quantitative real-time methylation-specific PCR for a panel of candidate miRNAs in 19 NSCLC paired tumor and adjacent normal tissues. For assessment of survival, methylation was measured in a total of 97 tumor tissues with complete clinical and follow-up data. Analysis was also performed for correlation with age at diagnosis, gender, smoking, and stage. Significant differences in methylation patterns were observed for 9 of the 12 miRNAs, all due to hypermethylation in the tumor tissue. Individuals with the highest levels of methylated miR-127 were at a significantly increased risk of dying with a hazard ratio of 1.93 (95% CI 1.17-3.19; P = 0.010), in univariate analysis and remained significant after adjusting for age, gender, and stage (HR 1.97; 95% CI 1.15-3.40; P = 0.014). This increase in risk due to increased methylation were accompanied by significant, dramatic difference in survival duration of 17 months (P = 0.0089). Six of the 12 miRNAs were significantly positively correlated with age at diagnosis. Additionally, methylation of miR-127 was significantly greater in higher stage tumors compared to lower stage tumors (P = 0.0039). However, no significant associations between smoking and gender with miRNA methylation were observed. Our results demonstrate that miRNA methylation plays a role in NSCLC tumorigenesis and prognosis.

Feasibility of aspirin continuation during the perioperative period for pulmonary resection in lung cancer patients: a retrospective study at a single institute in Japan

To evaluate the feasibility of aspirin continuation during the perioperative period for pulmonary resection in lung cancer patients. A retrospective study was conducted in 46 patients who were taking aspirin and underwent pulmonary resection. The indications for aspirin were generally a cardiovascular or cerebrovascular comorbidity. Whether to continue or discontinue aspirin was determined based on the severity of the cardiovascular or cerebrovascular comorbidity, along with the patient's overall condition. The intraoperative and postoperative outcomes were compared between patients continuing and those discontinuing aspirin. Twenty patients continued (group C) and 26 patients discontinued (group D) aspirin. The length of the operation (226 ± 97 min in group C vs. 189 ± 90 min in group D), intraoperative bleeding (234 ± 232 vs. 204 ± 367 g) and average pleural discharge on postoperative days 1, 2 and 3 (331, 230 and 215 vs. 304, 210 and 174 ml/day) showed no significant differences between the two groups. The postoperative complication rates were also not significantly different between the two groups [eight patients (40%) in group C vs. nine patients (35%) in group D]. Continuous administration of aspirin during the perioperative period for pulmonary resection in lung cancer patients appears to be clinically feasible in the Japanese population.

Evaluation of the impact of radical tumor resection in lung cancer patients on the activity of selected antioxidant enzymes.

IntroductionOxidative stress appears to play an essential role as a secondary messenger in such physiological processes as apoptosis and survival as well as in proliferative signaling pathways. Oxidative damage is also considered to play a pivotal role in ageing, several degenerative diseases, and carcinogenesis. Lung cancer is the most common type of cancer, resulting in over 1.3 million deaths each year worldwide.AimThe aim of this study was to evaluate the activity of selected antioxidative enzymes in patients with lung cancer before and after radical surgery.Material and methodsThe study included 20 patients in the study group and 10 healthy volunteers in the control group. In the study group, blood samples were collected twice: one day before and one day after the operation. In the control group, blood samples were collected once. We estimated the activity of catalase (CAT), glutathione peroxidase (GPX), and superoxide dismutase (SOD) in erythrocytes. The total antioxidant status in blood plasma was also determined.ResultsThe activity of the selected antioxidative enzymes was greater in the case of GPX and CAT after surgery; the results were statistically significant in the study group. The activity of SOD remained at a comparable level. The total antioxidant status also increased after surgery in the study group in comparison to its preoperative level.

A Gene Signature Combining the Tissue Expression of Three Angiogenic Factors is a Prognostic Marker in Early-stage Non-small Cell Lung Cancer

Angiogenesis and lymphangiogenesis are key mechanisms for tumor growth and dissemination. They are mainly regulated by the vascular endothelial growth factor (VEGF) family of ligands and receptors. The aim of this study was to analyze relative expression levels of angiogenic markers in resectable non-small cell lung cancer patients in order to asses a prognostic signature that could improve characterization of patients with worse clinical outcomes. RNA was obtained from tumor and normal lung specimens from 175 patients. Quantitative polymerase chain reaction was performed to analyze the relative expression of HIF1A, PlGF, VEGFA, VEGFA165b, VEGFB, VEGFC, VEGFD, VEGFR1, VEGFR2, VEGFR3, NRP1 and NRP2. Univariate analysis showed that tumor size and ECOG-PS are prognostic factors for time to progression (TTP) and overall survival (OS). This analysis in the case of angiogenic factors also revealed that PlGF, VEGFA, VEGFB and VEGFD distinguish patients with different outcomes. Taking into account the complex interplay between the different ligands of the VEGF family and to more precisely predict the outcome of the patients, we considered a new analysis combining several VEGF ligands. In order to find independent prognostic variables, we performed a multivariate Cox analysis, which showed that the subgroup of patients with higher relative expression of VEGFA plus lower VEGFB and VEGFD presented the poorest outcome for both TTP and OS. The relative expression of these three genes can be considered as an angiogenic gene signature whose applicability for the selection of candidates for targeted therapies needs to be further validated.

Prospective validation of quantitative NSE mRNA in pleural fluid of non-small cell lung cancer patients

Although the survival of lung cancer patients has improved significantly due to the development of early detective tools, lung cancer remains a leading cause of cancer-related death after curative surgery. So it is extremely important for cancer patients to predict early metastasis, especially pleural dissemination, the most frequent type of recurrence in patients after surgery. Based on a retrospective study of 86 curatively resected lung cancer patients (training set), we determined a cutoff value of NSE mRNA using receiver-operating characteristic curve. Then, we prospectively used this cutoff value to validate the risk of pleural recurrence in a new cohort of 81 lung cancer patients (validation set) between April 2009 and June 2010 by real-time reverse transcriptase-polymerase chain reaction. During the median 27 months of postoperative surveillance, 16 of the 81 patients died, and 9 of the 16 developed pleural metastases. Multivariate analysis with the Cox proportional hazards model showed that positive NSE mRNA was a significant independent risk factor with both overall survival and pleural recurrence-free survival (both P < 0.0001) as end points which were significantly worse in patients with positive NSE mRNA (P < 0.0001). These results indicate that quantitative NSE mRNA in pleural fluid is a reliable prognostic indicator of pleural recurrence in the clinical setting.

High expression of PRDM14 correlates with cell differentiation and is a novel prognostic marker in resected non-small cell lung cancer

PR (PRDI-BF1 and RIZ) domain containing proteins (PRDM) have been indicated to play important roles in several human cancers. The objectives of this study were to determine the frequency and prognostic significance of PRDM1 and PRDM14 expression in a cohort of surgically resected non-small cell lung cancer (NSCLC) patients. Immunohistochemistry and Western blotting was used to detect the expression status of PRDM1 in primary tumors and PRDM14 for both primary lung cancers and matched lymph node metastases. Univariate and multivariate analysis were performed to determine the association between PRDM expression and prognosis. PRDM1 expression was observed in all NSCLC patients' tumor samples. PRDM14 was found to be increased expression in 35.65 % cases (46/129) for primary tumors and 39.68 % cases (25/63) for paired metastatic lymph nodes. Increased expression of PRDM14 correlated with differentiation of tumor cells significantly (P = 0.008). Western blotting analysis verified that PRDM14 associated with cell differentiation in NSCLC. The overall survival rates of patients with high PRDM14 expression and low PRDM14 expression were 41.30 and 65.06 %, respectively (hazard ratio: 3.051, 95 % CI: 1.752, 5.312, P < 0.0001). The progression-free survival rates were 34.78 % for patients in the high expression group and 59.03 % for patients in the low OLC1 expression group (hazard ratio: 2.775, 95 % CI: 1.648, 4.675, P < 0.0001). Thus, our study showed that increased expression of PRDM14 correlated with cell differentiation of NSCLC cells. PRDM14 was a potential biomarker for predicting unfavorable prognosis in NSCLC.

Prognostic value of epidermal growth factor receptor gene amplification in surgically resected non-adenocarcinoma lung cancer patients.

e18553 Background: The purpose of this study is to investigate the prognostic role of genomoic gain and expression for epidermal growth factor receptor (EGFR) gene in surgically resected non-adenocarcinoma of non-small-cell lung cancer (NA-NSCLC). Methods: This retrospective study included 115 NA-NSCLC consecutive patients with available tumor tissue and survival data, median follow up period of 6.4 years. EGFR gene copy number and protein expression was evaluated using by fluorescent in situ hybridization (FISH) and immunohistochemistry (IHC) in tissue microarray sections, respectively. Results: Among 115 patients, 99 patients (86.1 %) were with squamous cell carcinoma histology. EGFR gene amplification and high polysomy (EGFR FISH+) were observed in 57 (49.6%) and 45 (39.1%) patients, respectively. Patients with EGFR FISH+ had significantly shorter overall survival [median, 41 months vs. not reached (&gt;70 months), P = 0.011]. Multivariable model confirmed that patients with EGFR FISH+ had a significantly greater risk of death than those with EGFR FISH-negative after adjusting pathologic staging, presence of pleural invasion, venous invasion and adjuvant chemotherapy (hazard ratio = 2.11, 95% confidence interval 1.23-3.61, P = 0.006). EGFR IHC expression did not associate with overall survival in same group. Conclusions: EGFR increased gene copy number is an independent negative prognostic factor in surgically resected NA-NSCLC.

Ratios between VEGF ligands and receptors in tumor and stroma have impact on the outcome in resectable NSCLC.

e22147 Background: In tumor angiogenesis there is a complex interplay between endothelial, stromal and tumor cells. Some key regulators of this process are the members of the vascular endothelial growth factor (VEGF) family of ligands and receptors and the neuropilins (NRP). This study analyzes the correlations between the expression of these angiogenic factors in tumor cells and tumor stroma, and their prognostic role in tissue samples from resected non-small cell lung cancer (NSCLC) patients. Methods: Representative tumor and stroma areas from FFPE tissue samples of 125 early-stage NSCLC patients were carefully micro-dissected. RNA isolated from the samples was retrotranscripted and preamplified. RTqPCR was performed using hydrolysis probes (TaqMan, Applied Biosystems) and relative quantification was calculated using GAPDH and CDKN1B as endogenous controls. Results were normalized against a human cDNA (Clontech) as a reference. All statistical analyses were considered significant at p&lt;0.05. Results: Paired Wilcoxon test revealed differences between tumor and stroma gene expression for VEGFB (p&lt;0.0001), VEGFC (p&lt;0.0001), VEGFR-1 (p&lt;0.0001), VEGFR-2 (p=0.020), VEGFR-3 (p&lt; 0.0001), NRP-1 (p=0.001) and NRP-2 (p&lt; 0.0001). Survival analyses showed that those patients with higher levels of the Ratio Stromal-VEGFA/ Tumoral-VEGFR-2 had worse time to progression (TTP) (median 26.23 months vs NR, p=0.013) and overall survival (OS) (median 29.50 months vs NR, p=0.001). Similarly, those patients with higher levels of the Ratio Stromal-VEGFC/Tumoral-VEGFR-3 had worse TTP (median 23.30 vs 70.53 months, p=0.015) and OS (median 37.20 months vs NR, p=0.023). Conclusions: Our results show significant differences in the expression of VEGF family members between tumor and stromal cells. This may indicate the importance of the tumor-stroma interaction when trying to understand the angiogenic process. Furthermore, the combination of the ligands expression in stroma and their receptors in tumor may have a prognostic value in NSCLC patients. Supported by grants PS09-01149 and RD06/0020/1024 from ISCIII.

High expression levels of class III β-tubulin in resected non-small cell lung cancer patients are predictive of improved patient survival after vinorelbine-based adjuvant chemotherapy

The aim of the present study was to determine the frequency and predictive value of the expression of tumor microtubule components in patients with resected non-small cell lung cancer (R-NSCLC) subsequently treated with vinorelbine-based adjuvant chemotherapy. The expression of the microtubule components was evaluated in 85 R-NSCLC tumor samples using immunohistochemistry. All patients received vinorelbine-based chemotherapy. The predictive value of microtubule protein expression for disease-free survival (DFS) and overall survival (OS) was assessed. The expression of the microtubule components was not associated with any baseline clinicopathological factors in the R-NSCLC patients. High tumor expression levels of class III β-tubulin were correlated with an improved DFS (P=0.033) and a trend towards a longer OS (P=0.226). Class II and IV β-tubulins were not correlated with patient outcome. Multivariate analysis of factors, including gender, age, histology, stage and class II, III and IV β-tubulin expression demonstrated that high levels of class III β-tubulin expression were correlated independently with DFS (P= 0.031). These findings suggest that high class III β-tubulin expression levels in resected tumors are predictive of improved DFS in R-NSCLC patients receiving vinorelbine-based chemotherapy.

Adjuvant treatment of resected nonsmall cell lung cancer

Approximately 50% of surgically resected early stage lung cancer patients will relapse and die of recurrent disease within 5 years. In order to reduce the risk of relapse and improve survival, efforts have been focused on the use of chemotherapy before or after surgery. The benefit of adjuvant cisplatin-based chemotherapy is widely accepted for patients with resected stage II-IIIA, although its impact on survival is limited. There is, therefore, a need to find other strategies to further improve survival outcomes. In recent years, there has been a marked increase in the development of novel therapeutic strategies targeting signaling pathways, such as epidermal growth factor receptor, angiogenesis, and immunotherapy in stage IV nonsmall cell lung cancer. The potential contribution of these strategies in the adjuvant setting is now being analyzed in randomized clinical trials. At present, the challenge for research in early stage disease is to define subsets of patients who benefit from certain targeting agents and establish how to integrate such agents into the adjuvant setting.

Prognosis of lung cancer resection in patients with previous extra-respiratory solid malignancies

Non-small-cell lung cancer (NSCLC) following pulmonary or pharyngolaryngeal malignancies has been widely studied, but only a few articles have focussed on lung cancers following other solid malignancies. Our purpose was to compare the characteristics and prognosis of patients with NSCLC according to the medical history of the extra-pulmonary and extra-pharyngolaryngeal solid malignancy. Patients who underwent surgery for NSCLC from January 1980 to December 2009 in two French thoracic centres were reviewed. We compared patients with no history of cancer (Group 1) and patients with a history of extra-pulmonary and extra-pharyngolaryngeal solid malignancy (Group 2). There were 4992 patients: 4603 (92%) in Group 1 and 389 (8%) in Group 2. In comparison with Group 1, Group 2 showed an increasing incidence over the last 3 decades (2-8%), an older population (65.9 vs 61 years, P < 0.001), a higher proportion of women (34 vs 18%, P < 0.001), non-smokers (20 vs 10%, P < 0.001), adenocarcinomas (53 vs 40%, P < 0.001), T1 (16 vs 14%, P = 0.047) and second nodule in the same lobe (4 vs 2%, P < 0.001). The overall survival was not significantly different between the two groups (P = 0.09). In multivariate analysis, older age, male gender, pneumonectomy, higher T, higher N, incomplete resection and history of extra pulmonary-extra pharyngolaryngeal solid malignancy were significantly associated with a worse prognosis. Despite an earlier diagnosis, a history of extra-pulmonary and extra-pharyngolaryngeal solid malignancy is associated with a worse prognosis in patients with NSCLC undergoing surgical resection. Overall survival is particularly low after a history of bladder and upper gastrointestinal malignancies.

CD4/CD8 co-expression shows independent prognostic impact in resected non-small cell lung cancer patients treated with adjuvant radiotherapy

BackgroundThough traditionally regarded as immunosuppressive, radiotherapy may also stimulate immune cells and facilitate an anti-tumor immune response. We therefore aimed to explore the prognostic significance of immune cell markers in non-small cell lung cancer (NSCLC) patients treated with postoperative radiotherapy (PORT). MethodsIn addition to demographic and clinicopathological information, tumor tissue samples were collected and tissue microarrays (TMAs) were constructed from 55 patients with stage I-IIIA NSCLC who received PORT. Tumor and stromal expression of CD1a+, CD3+, CD4+, CD8+, CD20+, CD56+, CD68+, CD117+ and CD138+ cells, as well as M-CSF and CSF-1R, was assessed by immunohistochemistry. ResultsIn univariate analysis, high co-expression of CD4+ and CD8+ T lymphocytes as well as high expression of CD1a+ dendritic cells in the tumor stroma correlated with improved disease-specific survival (DSS). In multivariate analysis patients with stromal ↓CD4/↓CD8 expression had a hazard ratio of 21.1 (CI95% 3.9–115.6, P<0.001) when compared to those with ↑CD4/↑CD8 expression. ConclusionsStromal ↓CD4/↓CD8 expression was an independent negative prognostic factor for survival in NSCLC patients receiving PORT, indicating a highly detrimental prognosis.

Post-operative rehabilitation for surgically resected non-small cell lung cancer patients: Serial pulmonary functional analysis

Post-operative pulmonary rehabilitation in patients who have undergone surgery for lung cancer is a subject of open debate. Clinical practice in this setting is based on the results of observational trials, such as the one described here. Prospective randomized controlled trials have been registered and recruitment is ongoing. From 2005 to 2008, 110 patients with surgical non-small cell lung cancer were entered into a post-operative inpatient pulmonary rehabilitation programme for 3 weeks. All patients were evaluated for pulmonary function after surgery (time 0; T0) and at the end of pulmonary rehabilitation programme (time 1; T1). Statistical analysis focused on improvement in pulmonary function parameters and physical performance in the 6-min walking test (6MWT). Mixed models multiple linear regression was used to identify parameters related to the primary end-points of this research. Patients' mean age was 70.1 years (standard deviation (SD) 8.5 years); male/female ratio 73/37. A total of 94 patients underwent lobectomy, 8 underwent pneumonectomy, and the remaining 8 underwent bilobectomy. Among the analysed parameters a significant improvement could be detected only with regards to the 6MWT (257.4 (SD 112.2) at T0 and 382.8 (SD 11.09) at T1). Post-operative pulmonary rehabilitation in patients with surgical non-small cell lung cancer is effective in terms of exercise tolerance.