scholarly journals Number of metastatic lymph nodes and zones as prognostic factors in non-small-cell lung cancer

2020 ◽  
Vol 31 (3) ◽  
pp. 305-314
Author(s):  
Tomohiro Maniwa ◽  
Akiisa Ohmura ◽  
Takashi Hiroshima ◽  
Akihiro Ike ◽  
Toru Kimura ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Small Cell ◽  
Recurrence Free Survival ◽  
Small Cell Lung ◽  
Free Survival ◽  
Nsclc Patients ◽  
Relationship Of ◽  
The Relationship

Abstract OBJECTIVES Characterizing pathological nodes (pNs) by location alone is sometimes inadequate as patients with pN1 or pN2 non-small-cell lung cancer (NSCLC) show prognostic heterogeneity. We aimed to assess the relationship of the number of metastatic lymph nodes (LNs) and zones with prognosis in NSCLC patients. METHODS We analysed 1393 patients who underwent lobectomy with mediastinal LN dissection for NSCLC at the Osaka International Cancer Institute between January 2006 and December 2015. Patients were classified into 3 groups according to the number of LNs: n1–3, n4–6 and n7–. We investigated the relationship of prognosis with the number of metastatic LNs and metastatic zones. RESULTS In the multivariable analyses, the number of metastatic LNs and zones were not independent factors for overall survival or recurrence-free survival in patients with pN1 disease after adjustment for age, sex, tumour histology and tumour diameter. However, n4–6 (ref. n1–3) was an independent prognostic factor for overall survival [hazard ratio (HR) 4.148, P < 0.001] in those with pN2 disease. There were no significant differences in overall survival and recurrence-free survival between pN1 (HR 0.674, P = 0.175) and pN2n1–3 disease (HR 1.056, P = 0.808). Moreover, patients with pN2 disease with a higher number of metastatic zones had a poor prognosis for recurrence-free survival [3 zones (ref. 1): HR 1.774, P = 0.051, and 4 zones (ref. 1): HR 2.173, P < 0.047]. CONCLUSIONS The number of metastatic LNs and metastatic zones were useful prognostic factors in NSCLC patients. The findings could help in establishing a new pN classification.

scholarly journals Determination of prognostic factors of surgically treated pathological Stage IIIA non-small cell lung cancer

2020 ◽  
Vol 28 (3) ◽  
pp. 496-504
Author(s):  
Muhammet Sayan
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Disease Free Survival ◽  
Small Cell ◽  
Small Cell Lung ◽  
Free Survival ◽  
Disease Free

Background: This study aims to identify the prognostic factors in Stage IIIA non-small cell lung cancer and to investigate whether there was a significant difference in terms of overall survival and disease-free survival among the subgroups belonging to this disease stage. Methods: Between January 2010 and December 2018, a total of 144 patients (125 males, 19 females; median age 60 years; range, 41 to 80 years) who were operated for non-small cell lung cancer in our clinic and whose pathological stage was reported as IIIA were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, histopathological diagnosis, the standardized uptake value of the mass on positron emission tomography-computed tomography, tumor diameter, type of surgery, lymph node metastasis status, visceral pleural invasion, and overall and disease-free survival rates were recorded. Results: The median survival was 39 (range, 27.8 to 46.1) months and the five-year overall survival rate was 28%. The mean tumor diameter was 4.3±2.7 cm. The median disease-free survival was 37 (range, 28.1 to 48.6) months and the five-year disease-free survival rate was 26.9%. In the multivariate analysis, overall survival and disease-free survival in T2N2M0 subgroup were significantly worse than the other subgroups. The other poor prognostic factors of survival were the standardized uptake value of the tumor, pneumonectomy, and histopathological subtypes other than squamous cell carcinoma and adenocarcinoma. Parietal pleural invasion was significantly associated with worse disease-free survival rates. Conclusion: Our results showed that there may be significant survival differences between subgroups created by tumor histopathology, lymph node invasion and the type of surgery in a heterogeneous lung cancer stage.

scholarly journals The prognostic impact of obstructive lung disease on survival of never smokers with resected non-small-cell lung cancer: a comparison with smokers

2019 ◽  
Vol 28 (5) ◽  
pp. 735-743
Author(s):  
Takaki Akamine ◽  
Tetsuzo Tagawa ◽  
Mototsugu Shimokawa ◽  
Taichi Matsubara ◽  
Yuka Kozuma ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Small Cell ◽  
Recurrence Free Survival ◽  
Small Cell Lung ◽  
Cancer Specific Survival ◽  
Free Survival ◽  
Never Smokers ◽  
Nsclc Patients

Abstract OBJECTIVES The proportion of never smokers among non-small-cell lung cancer (NSCLC) patients has steadily increased in recent decades, suggesting an urgent need to identify the major underlying causes of disease in this cohort. Chronic obstructive pulmonary disease is a risk factor for lung cancer in both smokers and never smokers. The aim of this study was to investigate the association between obstructive lung disease and survival in never smokers and smokers with NSCLC after complete resection. METHODS We retrospectively reviewed data from 548 NSCLC patients treated at our institution. The effects of obstructive lung disease on recurrence-free survival and cancer-specific survival following the resection of NSCLC were determined by univariable and multivariable Cox regression analyses. RESULTS Among the 548 patients analysed, 244 patients (44.5%) were never smokers and 304 patients (55.4%) were current or former smokers. In the never-smoker group, 48 patients (19.7%) had obstructive lung disease, 185 patients (75.8%) were women and 226 patients (92.6%) had adenocarcinoma. Obstructive lung disease was significantly associated with shorter recurrence-free survival (P = 0.006) and cancer-specific survival (P = 0.022) in the never smokers, but not the smokers, on both univariable and multivariable analyses. The associations between obstructive lung disease and prognosis in never smokers remained significant after propensity score matching. CONCLUSIONS Obstructive lung disease is an independent prognostic factor for recurrence-free survival and cancer-specific survival in never smokers, but not in smokers, with NSCLC. Based on this finding, further examination is warranted to advance our understanding of the mechanisms associated with NSCLC in never smokers.

scholarly journals PIOS (Patras Immunotherapy Score) Score Is Associated with Best Overall Response, Progression-Free Survival, and Post-Immunotherapy Overall Survival in Patients with Advanced Non-Small-Cell Lung Cancer (NSCLC) Treated with Anti-Program Cell Death-1 (PD-1) Inhibitors

Cancers ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1257
Author(s):  
Foteinos-Ioannis Dimitrakopoulos ◽  
Achilleas Nikolakopoulos ◽  
Anastasia Kottorou ◽  
Fotini Kalofonou ◽  
Elias Liolis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Cell Death ◽  
Prognostic Value ◽  
Progression Free Survival ◽  
Small Cell ◽  
Small Cell Lung ◽  
Free Survival ◽  
Nsclc Patients ◽  
Program Cell Death

Immunotherapy with immune checkpoint inhibitors (ICIs) has changed the therapeutic management of advanced non-small cell lung cancer (aNSCLC) over the last decade. However, there is an unmet need for clinically useful biomarkers in this patient subgroup. The aim of this study was to combine baseline clinical characteristics of aNSCLC patients, in the form of a scoring system, and to investigate its predictive and prognostic value in NSCLC patients treated with ICIs. A total of 112 patients with advanced (stages IIIA to IV) NSCLC, treated with nivolumab or pembrolizumab, were enrolled in this study. Patras Immunotherapy Score (PIOS) was developed based on four of the studied parameters (performance status (PS), body mass index (BMI), age, and lines of treatment (LOT), which were incorporated into our formula (PS × BMI/ LOT × age). PIOS score was strongly associated with best overall responses (BOR), with those patients having benefit/good response (stable disease (SD) or partial (PR) or complete response (CR), achieving a higher score compared to patients who developed progressive disease (PD) (p < 0.001). Furthermore, PIOS score was associated with progression-free survival (PFS), since high-score patients had longer PFS (p < 0.001, hazard ratio (HR) = 0.469). Moreover, PIOS was associated with post-immunotherapy overall survival (OS), with high-score patients having improved OS (log-rank p = 0.019). This study suggests that a combination of baseline parameters, which give rise to PIOS score, may predict the best response of NSCLC patients treated with anti-program cell death -1 (PD-1) monotherapy as well as it may have a potent prognostic value for PFS and post immunotherapy OS.

Baseline systemic inflammatory immune index may predict overall survival and progression-free survival in patients with non-small cell lung cancer patients on immune checkpoint inhibitors.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21202-e21202
Author(s):  
John P. Palmer ◽  
Yenong Cao ◽  
Samer Ibrahim ◽  
Natasha Dhawan ◽  
Muhammad Zubair Afzal ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Progression Free Survival ◽  
Small Cell ◽  
Small Cell Lung ◽  
Free Survival ◽  
The Mean ◽  
Nsclc Patients

e21202 Background: Increased systemic inflammatory state and increased inflammation within tumor micro-environment (TME) have been associated with a worse prognosis and lower responsiveness to immune checkpoint inhibitors (ICI). Systemic inflammatory immune index (SII) reflects the changes in the systemic inflammatory matrix. Studies have shown the association of SII with cancer survival and treatment outcomes. We aim to study the effect of SII on treatment outcomes in non-small cell lung cancer (NSCLC) patients being treated with ICI. Methods: We conducted a retrospective analysis on 178 NSCLC patients treated with ICIs (pembrolizumab, nivolumab, ipilimumab/nivolumab or atezolizumab) alone or in combination with chemotherapy. SII is the product of platelets multiplied by neutrophils divided by lymphocytes. Baseline and 8-week SIIs were obtained. Radiographic response, duration of radiographic response (date of best response to radiographic progression), overall survival (OS), and progression-free survival (PFS) were evaluated. A high SII was defined as a value greater than the median SII. Cox regression univariate and multivariate analyses were performed. Logistic regression, t-test, and Chi-square tests were applied. Results: Overall, 81% patients had adenocarcinoma and 19% patients had squamous, adenosquamous or large cell carcinoma. The majority of the patients were female (56.2% vs. 43.8%). Median SII at baseline was 1335. The objective response rate (ORR) was 45.1%. The disease control rate was 75.8%. The ORR was 51% in patients receiving ICI first-line compared to 35% in those who received ICI as a second-line therapy. At baseline, there was no difference in the mean SII between responders and non-responders (2146.2 vs. 1917.5, P = 0.5); however at 8 weeks, the mean SII was significantly lower in responders compared to non-responders (1198.8 vs. 2880.2, P = 0.02). A total of 15 (10.9%) patients were found to have pseudoprogression or mixed response on follow-up imaging. Among these, 11(73.3%) patients had low SII at 8 weeks (P = 0.04). The median OS was significantly higher in patients with low SII at baseline (29.6 months vs. 10.1 months, P = 0.001 95% CI 10.6 – 22.1). Similarly, there was a significant difference in median PFS in patients with low SII (14.6 months vs. 6.7 months, P = 0.002, 95% CI 5.6 – 11.6). There was no correlation between high or low SII on the incidence of immune-related adverse events. Conclusions: SII may have significant impact on OS and PFS and could be serially monitored to assess the response to ICI. A low SII may help to differentiate pseudoprogression vs. true progression. Prospective studies are needed to validate these findings. Further, it will be interesting to see if SII could be incorporated into predictive models to determine the duration of cytotoxic therapy in selected patients.

The Relationship between Prognostic Factors and Overall Survival in Small Cell Lung Cancer Patients: a Single Centre Experience

2012 ◽  
Vol 13 (2) ◽  
pp. 60-64
Author(s):  
Bala Basak Oven Ustaalioglu ◽  
Ahmet Bilici ◽  
Mesut Seker ◽  
Taflan Salepci ◽  
Recep Ustaalioglu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Cancer Patients ◽  
Small Cell ◽  
Small Cell Lung ◽  
Single Centre ◽  
Lung Cancer Patients ◽  
Single Centre Experience ◽  
The Relationship

scholarly journals Overall Survival Analyses following Adjuvant Chemotherapy or Nonadjuvant Chemotherapy in Patients with Stage IB Non-Small-Cell Lung Cancer

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Zegui Tu ◽  
Tian Tian ◽  
Qian Chen ◽  
Caili Li
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Tumor Size ◽  
Small Cell ◽  
Small Cell Lung ◽  
Stage Ib ◽  
Subgroup Analyses ◽  
Lemeshow Test ◽  
Nsclc Patients

Background. Adjuvant chemotherapy (ACT) can improve prognosis for stages II-IIIA patients with non-small-cell lung cancer (NSCLC), but its implication in stage I patients is still an intractable puzzle. This study aims to seek ACT candidates for stage IB NSCLC and establish a nomogram to predict overall survival (OS) of specific patient for clinician’s decision. Method. We performed a retrospective study on 16,765 patients (ACT group: n = 2,187; non-ACT group: n = 14,578) from the Surveillance, Epidemiology, and End Results (SEER) database. Overall survival was assessed in two groups. We performed propensity-score matching for risk adjustment. The risk factors were identified and used to create nomogram. Concordance index (C-index), Hosmer–Lemeshow test, and calibration were applied to evaluate model performance. To further evaluate the influence of tumor size on the selection of potential ACT candidates for patients with stage IB NSCLC, subgroup analyses were executed. Result. Survival analysis for the entire study cohort showed that ACT had better OS than non-ACT (HR = 0.800, CI: (0.751–0.851), P < 0.0001 ). In matched cohort, ACT also presented better OS than non-ACT (HR = 0.775, CI: (0.704–0.853), P < 0.0001 ). Univariate and multivariate Cox regression analysis revealed that eight prognostic factors, including gender, age, grade, pathological subtype, tumor size, visceral pleural invasion, surgical procedure, and the number of removed lymph nodes, were significantly correlated with OS. The nomogram was further constructed based on these prognostic factors. The C-index of nomogram was 0.639 (95%CI: 0.632–0.646). The Hosmer–Lemeshow test, and calibration presented good congruence between the predictions and actual observations. Subgroup analyses of tumor size group showed that ACT shared similar OS to non-ACT in NSCLC patients with tumor size ≤20 mm ( P > 0.05 ). However, for NSCLC patients with 20 mm < size ≤30 mm (HR = 0.845, 95%CI (0.724–0.986), P = 0.032 ) and 30 mm < size ≤40 mm (HR = 0.912, 95%CI (0.833–1.000), P = 0.049 ), ACT associated with better OS. Conclusion. In this study, we found that ACT had better OS than non-ACT in patients with stage IB NSCLC. The nomogram provided an individual prediction of OS for patients after surgical resection. Patients with tumor size >20 mm and ≤40 mm may be potential candidates for ACT.

scholarly journals Operative invasiveness does not affect the prognosis of patients with non-small cell lung cancer

2020 ◽  
Author(s):  
Nozomu Motono ◽  
Shun Iwai ◽  
Yoshihito Iijima ◽  
katsuo Usuda ◽  
Hidetaka Uramoto
Keyword(s):  
Lung Cancer ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Operation Time ◽  
Small Cell ◽  
Small Cell Lung ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Nsclc Patients ◽  
Wound Length

Abstract Background: The relationship between operative invasiveness and the prognosis in non-small cell lung cancer (NSCLC) patients who have undergone surgery has been controversial.Methods: Clinical data were analyzed for 463 NSCLC patients. Operative invasiveness was defined by wound length, operation time, and the postoperative C-reactive protein (postCRP) level. The operative approach was divided into video-assisted thoracic surgery (VATS) and thoracotomy.Results: The wound length and operation time were significantly correlated with the postCRP level (correlation coefficient (CC) = 0.39, p<0.01; CC = 0.54, p<0.01, respectively). The postCRP level in the VATS group was significantly lower than that in the thoracotomy group (12.2 mg/dl vs 20.58 mg/dl, p<0.01). The relapse-free survival differed significantly based on wound length (p<0.01), operation time (p=0.01), CRP level (p<0.01), and operative approach (p<0.01). The carcinoembryonic antigen level (hazard ratio [HR], 1.58; p = 0.02), pathological stage (pStage) (HR, 2.57; p < 0.01), vascular invasion (HR, 1.95; p = 0.01), and preoperative CRP level (preCRP) (HR, 1.91; p < 0.01) were identified as significant prognostic factors for relapse-free survival in a multivariate analysis. Furthermore, the multivariate analysis showed that smoking history (HR, 2.36; p = 0.03), pStage (HR, 3.26; p < 0.01), and preCRP level were significant prognostic factors for overall survival.Conclusion: Preoperative CRP level was associated with poor prognosis. Although the VATS approach might be less invasive procedure for NSCLC patients, operative invasiveness does not affect the prognosis. Trial registrationThe Institutional Review Boards of Kanazawa Medical University approved the protocol (approval number: I392), and written informed consent was obtained from all of the patients.

Meta-analysis of progression-free survival as a predictor of overall survival in locally advanced or metastatic non-small cell lung cancer trials.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 7604-7604
Author(s):  
Evadne Jane Turner ◽  
Philip McCloud ◽  
Peter Germanos ◽  
Francis Dehle ◽  
Sarah Norris ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Linear Regression ◽  
Rescue Therapy ◽  
Progression Free Survival ◽  
Small Cell ◽  
Small Cell Lung ◽  
Free Survival ◽  
Weighted Linear Regression ◽  
The Relationship

7604 Background: Access to new oncology treatments for non-small-cell lung cancer (NSCLC) could be expedited if progression free survival (PFS) was accepted by payers as a valid endpoint predictive for overall survival (OS). We investigated the relationship between PFS and OS in advanced NSCLC, which has previously been limited by available data. Methods: A systematic review of the published literature was conducted (1988 to August 2011; Medline/Embase/Cochrane). Identified studies were assessed against the following criteria for inclusion in the analysis: randomised design; NSCLC; advanced disease (Stage IIIb or IV); pharmacological treatment in 2 or more groups; reported outcomes included median OS and median PFS. For each pair of treatment groups compared, the median OS difference and the median PFS difference were calculated. The data were analysed with locally weighted least squares regression (LOWESS) to validate the linear relationship. Unweighted and weighted linear regression was used to test the significance of the relationship between OS difference and PFS difference. Results: A total of 124 clinical trials, with 40,568 patients, were included in the analysis. The studies ranged from middle aged cohorts to the elderly. Median performance status (ECOG/WHO) was 1. 70% of studies were first line and therapy type was predominantly chemotherapy (57%). 19 studies (15%) reported use of crossover or rescue therapy. Weighted linear regression demonstrated a highly significant linear relationship between OS difference and PFS difference (Table). The results suggest that a 1 month difference in PFS is associated with approximately 1.3 months difference in OS. Conclusions: Analysis of NSCLC trials showed the treatment effect on PFS was predictive of the treatment effect on OS. With increased use of multiple lines of treatment and crossover/rescue therapy in new NSCLC trials OS differences are frequently confounded, making PFS an important outcome for health care decision making. [Table: see text]

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