scholarly journals Clinical Associations of Preoperative and Postoperative Serum CEA and Lung Cancer Outcome

2021 ◽  
Vol 8 ◽  
Author(s):  
Zonglin Jiao ◽  
Shoubo Cao ◽  
Jianhua Li ◽  
Nan Hu ◽  
Yinghui Gong ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Prognostic Factor ◽  
Multivariate Analyses ◽  
Stage I ◽  
Adverse Prognostic Factor ◽  
Serum Carcinoembryonic Antigen ◽  
Group A ◽  
Serum Cea ◽  
Group B ◽  
Independent Adverse Prognostic Factor

Background: Serum carcinoembryonic antigen (CEA), a classic tumour marker, is widely used in lung cancer in clinical practice. Nevertheless, few studies have elucidated the influence of dynamic changes in CEA in the perioperative phases, as a prognostic indicator, on lung cancer prognosis.Methods: This retrospective cohort analysis included consecutive patients with stage I-III lung cancer who underwent curative resection between December 2010 and December 2014. The patients were grouped into three cohorts: group A included patients with normal preoperative CEA, group B included patients with elevated preoperative CEA but normal postoperative CEA, and group C included patients with elevated preoperative and postoperative CEA. Five-year overall survival (OS) was estimated by Kaplan-Meier analysis (log-rank test). Multivariate analyses were performed with Cox proportional hazard regression.Results: A total of 1662 patients with stage I-III lung cancer were enrolled in our study. Patients with normal preoperative CEA had 15.9 and 20.1% better 3- and 5-year OS rates than the cohort with elevated preoperative CEA (p < 0.001). Furthermore, group C had 36.0 and 26.6% lower 5-year OS rates (n = 74, 32.4%) than group A (n = 1188, 68.4%) and group B (n = 139, 59.0%) (p < 0.001). Group B had poorer OS than group A (p = 0.016). For patients with different pathological TNM stages, subgroup analyses showed that group C had the shortest OS in stages I and II (p < 0.05), and patients with a post-preoperative CEA increment had poorer OS than those without an increment (p = 0.029). Multivariate analyses suggested that group C (HR = 2.0, 95% CI, 1.5–2.7, p < 0.001) rather than the group with normalized postoperative CEA (HR = 1.2, 95% CI, 0.9–1.5, p = 0.270) was an independent prognostic factor. In subgroup analysis of adenocarcinoma (ADC), survival analyses suggested that group C predicted a worse prognosis. Multivariate analysis of ADC indicated that group C was an independent adverse prognostic factor (HR = 1.9, 95% CI, 1.4–2.7, p < 0.001).Conclusions: Combined elevated preoperative and postoperative CEA is an independent adverse prognostic factor for stage I-III lung adenocarcinoma. Additionally, routine perioperative detection of serum CEA can yield valuable prognostic information for patients after lung cancer surgery.

Comparative effectiveness assessment of a lung cancer multidisciplinary practice to improve patient care.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16523-e16523
Author(s):  
Hamid R. Mirshahidi ◽  
Elvin Hernandez ◽  
Matthew Ta ◽  
Sheley M Baylon ◽  
Minh Thy Pham ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Early Stage ◽  
Stage Iv ◽  
Stage I ◽  
Tumor Board ◽  
Survival Difference ◽  
Group A ◽  
One Year ◽  
Group B

e16523 Background: Multidisciplinary focused-care teams have shown beneficial outcomes in diagnosis and treatment in cancer patients as well as assist in providing accessible, cohesive and continuous care. The multidisciplinary team specializing in thoracic cancer at our institution includes thoracic surgeons, pulmonologists, medical oncologists, radiation oncologists, pathologists, radiologists and a weekly tumor board with the inclusion of a dietician, a pharmacist, and a psych/social worker. This study examined the effectiveness of a multidisciplinary focused program in improving overall care in lung cancer patients. Methods: Lung cancer patient data between January 2000-December 2009 were abstracted from the institutional cancer registry. Patient demographics, treatment received, and survival (1-year and 2-year) were compared between Group A (January 2000-July 2005) and Group B (August 2005-December 2009) using Fisher’s exact test. Results: 1202 patients (Group A = 760; Group B = 442) were evaluated. Majority of patients were > 60 years old, male, and has stage IV adenocarcinoma. Missing stage was less in Group B (13.8% vs 17.4%). Early stage patients in Group B received more surgeries and less inappropriate treatments. More palliative chemotherapy/radiation treatments were given in Group B late stage disease. More stage II (21.1% vs 2.3%) and IIIA (12% vs 1.5%) patients in Group B were treated with wedge resection and chemotherapy. One-year survival differences were seen between 2 groups in stage I, IIIA, and IV (P <0.05). 2-year survival difference was seen in stage IV disease (P<0.05). Conclusions: Introduction of multidisciplinary lung care team between 2005-2009 was associated with an increased patients being staged and more appropriate treatments. One year survival almost doubled in stage I patients where stage IV pts experienced up to 4 times improvement in 1- and 2-year survival. The results of the present evaluation appear to confirm the value of a multidisciplinary approach to the management of patients with lung cancer.

scholarly journals Comparison of Extended Segmentectomy with Traditional Segmentectomy for Stage I Lung Cancer

2021 ◽  
Author(s):  
Ya-Fu Cheng ◽  
Yueh-Che Hsieh ◽  
Yu-Jun Chang ◽  
Ching-Yuan Cheng ◽  
Chang-Lun Huang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Resection Margin ◽  
Thoracoscopic Surgery ◽  
Stage I ◽  
Tumor Diameter ◽  
Surgical Methods ◽  
Group A ◽  
Stage I Lung Cancer ◽  
Group B ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background For stage I non-small cell lung cancer (NSCLC), lobectomy and segmentectomy are still controversial operations. Extended segmentectomy was proposed to make larger safe margins than segmentectomy. Image-guided video-assisted thoracoscopic surgery (iVATS) is useful to accomplish extended segmentectomy. We aimed to compare the effects of iVATS extended segmentectomy to the effects of traditional segmentectomy for stage I NSCLC. Methods This study is a retrospective analysis in a single institute. Patients with stage I NSCLC who received segmentectomy between January 2017 and September 2020 were included. Patients were distributed to iVATS extended segmentectomy (group A), and traditional segmentectomy (group B). The impacts of the different surgical methods on resection margin were assessed. Results There were 116 patients enrolled in this study. Sixty-two patients distributed in group A, and the other 54 patients in group B. The resection margin to a staple line was 17.94 mm in group A versus 14.15 mm in group B, p = 0.037. The margin/tumor diameter ratio was 2.08 in group A versus 1.39 in group B, p = 0.003. The enough margin rate was 75.81% and 57.41%, respectively, for group A and group B. The subgroup analysis of iVATS extended segmentectomy showed that T1a lesions had larger margin distances than did T1b lesions (19.85 mm vs. 14.83 mm, p = 0.026). Conclusions The iVATS extended segmentectomy can provide more resection margin than traditional segmentectomy. Segmentectomy is more suitable to perform when the nodule’s diameter is less than 10 mm.

scholarly journals Clinical Significance of Serum Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 Levels Before Surgery and During Postoperative Follow-Up in Colorectal Cancer

2018 ◽  
Vol 103 (7-8) ◽  
pp. 322-330
Author(s):  
Harunobu Sato ◽  
Yoshikazu Koide ◽  
Miho Shiota ◽  
Hiroshi Takahashi ◽  
Zenichi Morise ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Carcinoembryonic Antigen ◽  
Disease Free Survival ◽  
Carbohydrate Antigen ◽  
Preoperative Serum ◽  
Serum Carcinoembryonic Antigen ◽  
Group A ◽  
Serum Cea ◽  
Group B

Objective: Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are the most common colorectal cancer markers. We aimed to identify the appropriate clinical conditions for measuring serum CEA and CA19-9 levels before surgery and during follow-up. Methods: This study included 1275 colorectal cancer patients who were divided into 3 groups according to preoperative CEA levels (group A, ≤5 ng/mL; group B, &gt;5–≤11 ng/mL; group C, &gt;11 ng/mL). Each group was subdivided into 2 groups according to preoperative CA19-9 levels (cutoff level: ≤37 U/mL). Recurrence and survival rates were analyzed. Results: Recurrence rate, disease-free survival after curative surgery, and prognosis were significantly worse in group A and B patients with high CA19-9 levels. At recurrence, CEA levels showed a greater increase in group B and C patients; CA19-9 levels increased in group A patients with high CA19-9 levels. At recurrence, high serum CA19-9 levels were observed in group A patients with high preoperative serum CA19-9 levels, even if the serum CEA level did not increase. Preoperative CA19-9 levels could predict recurrence and prognosis in groups A and B. Conclusion: Periodic CA19-9 determination is useful for monitoring recurrence among group A patients with high CA19-9 levels.

scholarly journals Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC

2021 ◽  
Vol 28 (1) ◽  
pp. 593-605
Author(s):  
Camille Gauvin ◽  
Vimal Krishnan ◽  
Imane Kaci ◽  
Danh Tran-Thanh ◽  
Karine Bédard ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cell Death ◽  
Treatment Group ◽  
Programmed Cell Death ◽  
Prognostic Impact ◽  
Aggressive Treatment ◽  
Palliative Approach ◽  
Oligometastatic Disease ◽  
Group A ◽  
Group B

Background: Studies have shown that aggressive treatment of non-small cell lung cancer (NSCLC) with oligometastatic disease improves the overall survival (OS) compared to a palliative approach and some immunotherapy checkpoint inhibitors, such as anti-programmed cell death ligand 1 (PD-L1), anti-programmed cell death protein 1 (PD-1), and T-Lymphocyte-associated antigen 4 (CTLA-4) inhibitors are now part of the standard of care for advanced NSCLC. However, the prognostic impact of PD-L1 expression in the oligometastatic setting remains unknown. Methods: Patients with oligometastatic NSCLC were identified from the patient database of the Centre hospitalier de l’Université de Montréal (CHUM). “Oligometastatic disease” definition chosen is one synchronous metastasis based on the M1b staging of the eight IASLC (The International Association for the Study of Lung Cancer) Classification (within sixth months of diagnosis) or up to three cerebral metastasis based on the methodology of the previous major phase II randomized study of Gomez et al. We compared the OS between patients receiving aggressive treatment at both metastatic and primary sites (Group A) and patients receiving non-aggressive treatment (Group B). Subgroup analysis was performed using tumor PD-L1 expression. Results: Among 643 metastatic NSCLC patients, we identified 67 patients with oligometastasis (10%). Median follow-up was 13.3 months. Twenty-nine patients (43%) received radical treatment at metastatic and primary sites (Group A), and 38 patients (57%) received non-aggressive treatment (Group B). The median OS (mOS) of Group A was significantly longer than for Group B (26 months vs. 5 months, p = 0.0001). Median progression-free survival (mPFS) of Group A was superior than Group B (17.5 months vs. 3.4 months, p = 0.0001). This difference was still significant when controlled for primary tumor staging: stage I (p = 0.316), stage II (p = 0.024), and stage III (p = 0.001). In the cohort of patients who were not treated with PD-L1 inhibitors, PD-L1 expression negatively correlated with mOS. Conclusions: Aggressive treatments of oligometastatic NSCLC significantly improve mOS and mPFS compared to a more palliative approach. PD-L1 expression is a negative prognostic factor which suggests a possible role for immunotherapy in this setting.

scholarly journals The Role of Pathological Method and Clearance Definition for the Evaluation of Margin Status after Pancreatoduodenectomy for Periampullary Cancer. Results of a Multicenter Prospective Randomized Trial

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2097
Author(s):  
Gennaro Nappo ◽  
Domenico Borzomati ◽  
Alessandro Zerbi ◽  
Paola Spaggiari ◽  
Ugo Boggi ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Randomized Study ◽  
Periampullary Cancer ◽  
Significant Prognostic Factor ◽  
Prognostic Role ◽  
R1 Resection ◽  
Group A ◽  
Group B

Background: There is extreme heterogeneity in the available literature on the determination of R1 resection rate after pancreatoduodenectomy (PD); consequently, its prognostic role is still debated. The aims of this multicenter randomized study were to evaluate the effect of sampling and clearance definition in determining R1 rate after PD for periampullary cancer and to assess the prognostic role of R1 resection. Methods: PD specimens were randomized to Leeds Pathology Protocol (LEEPP) (group A) or the conventional method adopted before the study (group B). R1 rate was determined by adopting 0- and 1-mm clearance; the association between R1, local recurrence (LR) and overall survival (OS) was also evaluated. Results. One-hundred-sixty-eight PD specimens were included. With 0 mm clearance, R1 rate was 26.2% and 20.2% for groups A and B, respectively; with 1 mm, R1 rate was 60.7% and 57.1%, respectively (p > 0.05). Only in group A was R1 found to be a significant prognostic factor: at 0 mm, median OS was 36 and 20 months for R0 and R1, respectively, while at 1 mm, median OS was not reached and 30 months. At multivariate analysis, R1 resection was found to be a significant prognostic factor independent of clearance definition only in the case of the adoption of LEEPP. Conclusions. The 1 mm clearance is the most effective factor in determining the R1 rate after PD. However, the pathological method is crucial to accurately evaluate its prognostic role: only R1 resections obtained with the adoption of LEEPP seem to significantly affect prognosis.

scholarly journals Diagnostic Value of Imaging Combined With Tumor Markers in Early Detection of Lung Cancer

2021 ◽  
Vol 8 ◽  
Author(s):  
Su-Ju Wei ◽  
Li-Ping Wang ◽  
Jun-Yan Wang ◽  
Jing-Xu Ma ◽  
Feng-Bin Chuan ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Early Detection ◽  
Tumor Markers ◽  
Cancer Diagnosis ◽  
Diagnostic Value ◽  
Diagnostic Methods ◽  
Lung Cancer Diagnosis ◽  
Early Lung Cancer ◽  
Group A ◽  
Group B

Objective: The objective of this research is to explore the diagnostic value of imaging plus tumor markers in the early detection of lung cancer.Methods: Sixty patients with lung cancer treated in our hospital from January 2018 to January 2019 were selected as group A. They were matched with 60 patients with benign lung disease as group B and 60 healthy subjects examined in our hospital as group C. The carcino-embryonic antigen (CEA), CYFRA21-1, and neuron-specific enolase (NSE) were assessed, and the diagnostic value of tumor markers plus imaging in lung cancer diagnosis was explored.Results: The CEA, CYFRA21-1, and NSE in group A were evidently superior to those in groups B and C, and those in group B were superior to those in group C (all P &lt; 0.001). CEA had the highest sensitivity (56.7%), and NSE had the highest specificity (93.3%). The tumor markers plus imaging had the highest sensitivity for different types of lung cancer, and the sensitivity to early lung cancer (90%) was superior to other diagnostic methods (P &lt; 0.05).Conclusion: The tumor markers plus imaging is of great significance in early lung cancer diagnosis and provides a reference for judging the pathological classification.

Significance of isolated increases in total lactate dehydrogenase and its isoenzymes in serum of patients with bacterial pneumonia.

1988 ◽  
Vol 34 (7) ◽  
pp. 1503-1505 ◽  
Author(s):  
Z Rotenberg ◽  
I Weinberger ◽  
E Davidson ◽  
J Fuchs ◽  
O Sperling ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lactate Dehydrogenase ◽  
Recovery Time ◽  
Bacterial Pneumonia ◽  
Normal Limit ◽  
Liver Function Tests ◽  
Total Serum ◽  
Group A ◽  
Group B ◽  
Group D

Abstract Total lactate dehydrogenase (LD, EC 1.1.1.27) activity in serum and LD isoenzymes were quantified at the time of diagnosis in 320 patients with bacterial pneumonia. In eighty, LD activity was increased, but this was accompanied by either other pathological results for liver-function tests or associated diseases that could explain it. The remaining 240 patients were divided into four groups, based on their total serum LD values: group A, less than 225 U/L (normal limit); group B, 226-350 U/L; group C, 351-499 U/L; and group D, greater than 500 U/L. Total LD was above normal at diagnosis in 40% of the patients. Recovery time was twice as long in group D as in groups A, B, and C. In five patients from group D, the pneumonia reflected underlying lung cancer. In groups B and C, the LD-3 ratio was increased in comparison with group A; in group D, LD-4 and LD-5 were increased up to twice the normal limit. Evidently nearly half of patients with bacterial pneumonia may show isolated increases in total LD activity (mostly LD-3) in serum. In cases with high activity, prolonged recovery time is expected. Intensive follow-up and extensive investigation are warranted in these patients, because some may have underlying lung cancer.

scholarly journals Pretreatment plasma d-dimer levels as an independent prognostic factor for overall survival among patients with advanced non-small-cell lung cancer

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096266
Author(s):  
Qianfei Liu ◽  
Jianbo He ◽  
Ruiling Ning ◽  
Liping Tan ◽  
Aiping Zeng ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Prognostic Factor ◽  
Small Cell Lung Cancer ◽  
Advanced Nsclc ◽  
Multivariate Analyses ◽  
Small Cell ◽  
Small Cell Lung ◽  
Kaplan Meier ◽  
D Dimer

Objective To evaluate the prognostic accuracy of d-dimer levels for advanced non-small-cell lung cancer (NSCLC). Methods This retrospective cohort study included 651 patients initially diagnosed with advanced NSCLC. Patients with d-dimer levels ≥0.5 mg/L were included in the high d-dimer group, whereas patients with lower levels were included in the normal group. Cumulative survival was estimated using Kaplan–Meier curves and compared using the log-rank test. Multivariate analyses were performed using the Cox proportional hazards model. Results The median plasma d-dimer level in the study cohort was 0.61 ± 0.49 mg/L. d-dimer levels were elevated in 60.98% of patients, and 80.1% of such patients had adenocarcinoma. Univariate and multivariate analyses identified d-dimer content as an independent factor for the prognosis of NSCLC (hazard ratio [HR] = 1.54, 95% confidence interval [CI] = 1.19–1.98). Kaplan–Meier analysis revealed that high plasma d-dimer levels were associated with shorter overall survival (HR = 1.48, 95% CI = 1.19–1.84). In addition, the receipt of <2 lines of treatment was associated with a higher risk of death than the receipt of >2 lines. Conclusion The present results imply that pretreatment plasma d-dimer levels could represent a prognostic factor for advanced NSCLC.

scholarly journals Association between number of dissected lymph nodes and survival in stage IA non-small cell lung cancer: a propensity score matching analysis

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Lei-Lei Wu ◽  
Jia-Jian Lai ◽  
Xuan Liu ◽  
Yang-Yu Huang ◽  
Peng Lin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Propensity Score ◽  
Tumor Size ◽  
Wedge Resection ◽  
Small Cell ◽  
Matched Cohort ◽  
Small Cell Lung ◽  
Group A ◽  
Stage Ia ◽  
Group B

Abstract Background For patients with stage IA non-small cell lung cancer (NSCLC) with tumor size ≤ 2 cm, the prognostic significance of the number of removed lymph nodes (NLNs) through different surgical methods remains unclear. To determine the association of NLNs with cancer-specific survival (CSS) and overall survival (OS) in patients with stage IA NSCLC with tumor size ≤ 2 cm who underwent different lung surgeries. Methods We retrospectively enrolled 7293 patients from the Surveillance, Epidemiology and End Results database. Median NLNs was used to classify the patients into two groups: group A with NLNs ≤ 5 and group B with NLNs > 5. Propensity score matching (PSM) was performed to decrease selection bias. Kaplan–Meier analysis and Cox regression analysis were performed to identify the association between NLNs and survival outcomes. Results Group B had better survival than group A in the unmatched cohort and matched cohort (all P < 0.05). Multivariable analyses revealed that the NLNs significantly affected CSS and OS of eligible cases in the unmatched cohort and matched cohort. Additionally, we found that the NLNs was a protective prognostic predictor of OS for patients who underwent wedge resection, segmental resection, or lobectomy. Conclusion The NLNs was a protective prognostic factor in NSCLC patients with tumor size ≤ 2 cm. We demonstrated that patients with > 5 NLNs in the cohort of wedge resection, segmental resection, or lobectomy exhibited a significantly better OS.

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