Older patients more likely to die from cancer-related diseases than younger with stage IA non-small cell lung cancer: a SEER database analysis

BackgroundVarious reports showed some conflicting data on survival at different ages. This study aimed to investigate the main cause of death in older patients with lung cancer and to perform a comparison with younger patients in order to observe the differences between these two cohorts.MethodsOutcomes of patients with stage IA non-small cell lung cancer (NSCLC) ≤3 cm who underwent lobectomy without induction therapy in the Surveillance, Epidemiology, and End Results-18 (SEER-18; January 2004 to December 2016) database were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis.ResultsA total of 16,672 eligible NSCLC cases were found in the SEER database. The number of patients aged ≤60, 61–70, and ≥71 years was 3,930, 6,391, and 6,351, respectively. Among these patient groups, 527 (13.4%), 1,018 (15.9%), and 1,235 (19.4%) died of lung cancer during follow-up, while 357 (9.1%), 964 (15.1%) and 1,579 (25.2%) died of non-lung cancer diseases, respectively. The overall survival (OS) and lung cancer-specific survival (LCSS) rates of younger patients showed a significant survival advantage over older patients. After propensity-score matching (PSM) of patients aged ≤60 and ≥71 years using a ratio of 1:1, we found that 403 (12.9%) and 584 (18.7%) patients in the ≤60 and ≥71 years age groups died of lung cancer, respectively. The OS and LCSS rates of younger patients still exhibited a significant survival advantage over older patients.ConclusionsOlder patients with stage IA NSCLC have a worse prognosis compared with younger patients. Also, cancer-related causes were more frequent in older patients than non-cancer-related causes.     

Interstitial lung disease and wedge resection are poor prognostic factors for non-small cell lung cancer

BackgroundAlthough several prognostic factors in patients undergoing pulmonary resection with early-stage non-small cell lung cancer (NSCLC) have been reported, the risk factors are varied and have not been consistent among reports.MethodsClinical data of 540 patients with pathological stage IA NSCLC were analyzed. Patient factors, such as the sex, age, comorbidities, carcinoembryonic antigen (CEA) level, and smoking history, and surgical factors, such as the operative approach and procedure, were collected and analyzed.ResultsThere were significant prognostic differences in the relapse-free survival (RFS) depending on the presence of interstitial lung disease (P<0.0001), CEA level (P=0.007), and wedge resection (P=0.002). There were significant prognostic differences in the overall survival (OS) depending on the presence of interstitial lung disease (P=0.0015), CEA level (P<0.0001), and smoking history (P=0.0003). Interstitial lung disease [hazard ratio (HR): 7.725, P=0.003], the CEA level (HR: 1.923, P=0.045), and operative procedure (HR: 2.086, P=0.025) were risk factors for the RFS in a multivariate analysis. The smoking history (HR: 2.539, P=0.002) and CEA level (HR: 2.464, P=0.002) were risk factors for the OS in a multivariate analysis.ConclusionsInterstitial lung disease, the CEA level, and operative procedure were risk factors for the RFS, while the smoking history and CEA level were risk factors for the OS.     

Stereotactic body radiation therapy (SBRT) for patients with stage I non-small cell lung cancer is applicable to more tumors than sublobar resection

BackgroundVirtually all patients with medically inoperable stage I non-small cell lung cancer (NSCLC) can receive stereotactic body radiation therapy. However, the percentage of such patients in whom sublobar resection is technically feasible is unknown. This discrepancy can confound clinical trial eligibility and designs comparing stereotactic body radiation therapy vs. sublobar resection.MethodsA total of 137 patients treated with stereotactic body radiation therapy for lung lesions (3/2013–11/2017) underwent retrospective review. Diagnostic CT chest and PET/CT images, stereotactic body radiation therapy dates, and demographic data were collected on 100 of 137 patients. Two experienced board-certified thoracic surgeons independently reviewed anonymized patients’ pre-stereotactic body radiation therapy diagnostic imaging and completed a custom survey about the technical feasibility of sublobar resection for each patient. Interrater agreement was measured using Cohen’s kappa coefficient by bootstrap methodology. Summary statistics were performed for baseline demographics and tumor characteristics.ResultsOf the 100 patients, 57% were female, with median age of 75 years (range, 52–95 years) and Karnofsky Performance Status of 80 (range, 40–100). Most patients (61%) had Stage IA1, T1a tumors. For interrater agreement analysis, one patient was removed from each cohort due to inability to locate tumor on images, leaving 98 patients analyzed. Comparing Surgeon #1 vs. Surgeon #2, 64 (65.3%) vs. 69 (70.3%) of tumors were thought eligible for sublobar resection, respectively (κ=0.414).ConclusionsStereotactic body radiation therapy for stage I NSCLC is applicable to more tumors than sublobar resection, with ~30–35% of stereotactic body radiation therapy patients unable to undergo sublobar resection assessed by pretreatment diagnostic imaging based on technical grounds. This study illustrates that clinical trials comparing stereotactic body radiation therapy vs. sublobar resection are limited to only a subpopulation of patients with stage I NSCLC.     

Pulmonary lymphoepithelioma-like carcinoma: a Surveillance,Epidemiology, and End Results database analysis

Background

Pulmonary lymphoepithelioma-like carcinoma (LELC) is one of the rare histological non-small cell lung cancers. Only a few case reports have been published. The knowledge of its characteristics and prognosis in western population is limited. Based on the data of the Surveillance, Epidemiology, and End Results database (SEER), an analysis was performed to fill the gap of our knowledge.

Methods

Characteristics, treatment and outcomes of all pulmonary LELC patients was extracted both from the SEER database from 1973 to 2011 using SEER*Stat 8.2.1 statistical analysis was performed using SPSS 16.0 and GraphPad Prism 5.

Results

A total of 62 patients with pulmonary LELC are identified and analyzed. The median age at diagnosis is 65. Among them, the majority was male (64.4%). Early stage patients account for the largest proportion (67.8%). The median survival of all LELC patients is 107 months [95% confidence interval (CI), 67–147]. The 1, 3 and 5 years survival rates of LELC are 85.6%, 74.5% and 55.2%. In the comparisons incorporating with other types of large cell lung cancer (LCC), adenocarcinoma (AD) and squamous cell lung cancer (SQ), the overall survival (OS) of LELC is superior to others. Most of the early stage (localized and regional) LELC patients (37/45, 82.2%) received surgical resection as the primary treatment. Patients older than 65 years predicted a worse prognosis.

Conclusions

Pulmonary LELC is a rare pathological type of lung cancer. In this cohort, most LELC cases were male and in early stage. Majority of early stage LELC patients have received surgical resection. Patients older than 65 years had worse survival. Unfortunately, no other prognostic factor has been identified in our study. In addition, we observed that LELC had an ideal prognosis comparing to other types of LCC, AD and SQ. In order to understand pulmonary LELC more thoroughly, more cases are required.     

A bibliometric analysis of segmentectomy versus lobectomy for non-small cell lung cancer research (1992–2019)

Background:This study intends to create a series of scientific maps to quantitatively estimate hot spots and emerging trends in segmentectomy versus lobectomy for non-small cell lung cancer (NSCLC) research with bibliometric methods.Methods:Articles published on segmentectomy versus lobectomy for NSCLC were extracted from the Web of Science Core Collection (WoSCC). Extracted information was analyzed quantitatively using bibliometric analysis by CiteSpace to find hot spots and frontiers in this research area.Results:A total of 362 scientific articles on segmentectomy versus lobectomy for NSCLC were collected, and the annual publication rate increased over time from 1992 to 2019. The leading country and the leading institution were the United States and University of Pittsburgh, respectively. Furthermore, the most prolific researchers were, namely, James D. Luketich, Rodney J. Landreneau, Matthew J. Schuchert, Morihito Okada, and David O. Wilson. The analysis of keywords pointed out that carcinoma, bronchogenic carcinoma, limited resection, segmental resection, and morbidity are hot spots and lymph node dissection, minimally invasive surgery, impact, epidemiology, and high risk are research frontiers in this field.Conclusion:Publications related to segmentectomy versus lobectomy for NSCLC have made great achievements based on bibliometric analysis in recent years. However, further research and global collaboration are still required. Finally, we find that segmentectomy for the treatment of NSCLC is receiving much more attention from researchers globally compared with lobectomy in this research area.     

Validation of completion lobectomy after wedge resection for ≤20 mm non-small cell lung cancer

BackgroundCompletion lobectomy after wedge resection is occasionally performed when final histopathology shows an unexpected primary lung cancer even though the primary lesion has already been resected. The objective of this study was to assess the necessity of completion lobectomy after wedge resection for ≤20 mm non-small cell lung cancer (NSCLC).MethodsBetween 2006 and 2016, a total of 112 patients with NSCLC underwent wedge resection in our department. After exclusions, 40 patients were analyzed. Of these, 17 patients underwent completion lobectomy and 23 patients underwent wedge resection alone. Age, sex, tumor size, histology, other malignant diseases and final surgical procedure were used as prognostic variables. Survival analyses were confirmed using the Kaplan-Meier method and log-rank test.ResultsMedian follow-up was 70.4 months. No significant difference in 5-year overall survival (OS) and relapse-free survival (RFS) were seen in patients who underwent wedge resection alone compared to the completion lobectomy group (OS: 72.6% vs. 62.5%, P=0.34; RFS: 64.2% vs. 50.0%, P=0.35). Multivariate analysis identified age (>65 years old) and male sex as independent prognostic factors for OS and RFS.ConclusionsCompletion lobectomy after wedge resection did not impact OS or RFS compared with wedge resection alone in patients with ≤20 mm NSCLC. These findings suggested that selected patients may not require resection of the remaining lobe or lymph node dissection after initial wedge resection.     

Bronchial sleeve resection or pneumonectomy for non-small cell lung cancer: a propensity-matched analysis of long-term results,survival and quality of life

Background

No randomized studies exist comparing pneumonectomy (PN) and sleeve lobectomy (SL). We evaluated surgical results and long-term quality of life in patients operated on for central non-small cell lung cancer (NSCLC) using either SL or PN.

Methods

A total of 641 NSCLC patients underwent surgery 2000-2010. SL was performed in 40 (6.2%) and PN in 67 (10.5%). In 2011, all surviving patients were sent a 15D Quality of Life Questionnaire which 83% replied. Propensity-score-matching analysis was utilized to compare the groups.

Results

Thirty-two bronchial (18 right/14 left), seven vasculobronchial (3 right/4 left), one right wedge SL, and 18 right and 22 left PN were performed. Preoperatively, the Charlson Comorbidity Index (CCI) score, forced expiratory volume in 1 s (FEV1) and diffusion capacity did not differ between groups. The perioperative complication rate and pattern were similar, but SL group had less major complications (P<0.027). One perioperative death (2.5%) occurred in SL group and four (6%) in PN. The 90-day mortality rate was 5% (n=2) for SL and 7.5% (n=5) for PN. In the follow-up total cancer recurrence did not differ (P=0.187). Quality of life measured by 15D showed no significant difference in separate dimensions or total score, except tendency to favor SL in moving or breathing. The 5-year survival did not differ between groups (P=0.458), but no deaths were observed in SL group after 5 years.

Conclusions

Due to less major operative complications and better long-term survival, we would advocate using SL when feasible, but in patients tolerating PN it should be considered if SL seems not to be oncologically sufficiently radical.     

Lobectomy with high-position single-intercostal two-port video-assisted thoracoscope for non-small cell lung cancer is a safe and effective surgical procedure

BackgroundHigh-position single-intercostal two-port video-assisted thoracic surgery (VATS) technique has been used for thoracic diseases. It can effectively avoid postoperative chronic pain compared with the traditional three-port VATS. This study aimed to evaluate the safety and efficacy of high-position single-intercostal two-port video-assisted thoracoscopic lobectomy.MethodsFrom June 2014 to December 2018, a total of 474 patients in our hospital with non-small cell lung cancer (NSCLC) underwent lobectomy with a high-position single-intercostal two-port video-assisted thoracoscope. A retrospective study of these patients was conducted, and follow-up was performed to analyze the patients’ 3- and 5-year survival rates.ResultsOf the total number of patients, 27.6%, 41.4%, and 31% underwent surgery between the third, fourth, and fifth intercostals, respectively. During the operation, 31 patients were converted to open surgery or three-port thoracoscopic surgery. The average surgical time was 160.9±44.9 min, the average postoperative hospital stay was 5.6±3.4 days, the incidence of postoperative complications was 7.2%, and the average number of lymph nodes resected was 13.6±5.3. The 3-year overall survival (OS) rate of IA1, IA2, IA3, IB, IIA, IIB and IIIA was 99.0%, 98.6%, 96.3%, 91.2%, 85.7%, 66.7%, and 60.8%, respectively. Meanwhile, the 5-year OS rate of IA1, IA2, IA3, IB, and IIIA was 99.0%, 94.5%, 87.5%, 85.5%, and 43.3%, respectively.ConclusionsLobectomy with a high-position single-intercostal two-port video-assisted thoracoscope for NSCLC is a safe and effective surgical procedure.     

非小细胞肺癌患者应用胸腔镜肺叶切除术的治疗效果

目的观察胸腔镜肺叶切除术对非小细胞肺癌患者免疫功能的影响。方法依照不同术式将87例非小细胞肺癌患者分为两组,观察组(n=44)采用胸腔镜手术(VATS),对照组(n=43)采用传统开胸术;比较两组患者的手术效果和T淋巴细胞亚群水平差异。结果观察组的手术时间、术中出血量、术中输血量以及住院时间均优于对照组(P0.05);两组患者术后3 d时CD_4~+、CD_8~+均较术前明显降低(P0.05),术后15 d时CD+4水平逐渐恢复至术前,术后3d、15d时CD_4~+/CD_8~+比值均较术前明显增高(P0.05),同期组间比较,治疗15d时观察组CD_4~+、CD_4~+/CD_8~+比值均较对照组明显增高(P0.05);术后3d、15d时NK细胞水平均略低于术前水平,但差异无统计学意义(P0.05)。结论胸腔镜肺叶切除术治疗非小细胞肺癌体现出微创手术优势,对患者免疫功能的抑制更轻,更利于患者的后期康复。     

Dynamic nomogram for long-term survival in patients with non-small cell lung cancer after pneumonectomy

BackgroundThe study aims to identify prognostic factors of overall survival (OS) in patients who had pneumonectomy, in order to develop a practical dynamic nomogram model.MethodsA total of 2,255 patients with non-small cell lung cancer (NSCLC) who underwent pneumonectomy were identified from 2010–2015 in the Surveillance, Epidemiology, and End Results (SEER) database. The cohort was divided into a training (2011–2015) and a validation [2010] cohort. A nomogram and a risk classification system were constructed from the independent survival factors in multivariable analysis. The predictive accuracy of the nomogram was measured through internal and external validation.ResultsIndependent prognostic factors associated with OS were gender, age, pathology, tumor size, N stage, chemotherapy, and radiotherapy. The C-index of the nomogram for OS was 0.675 (95% CI: 0.655–0.694). Similarly, the AUC of the model was 0.733, 0.709, and 0.701 for the 1-, 3-, and 5-year OS, respectively. The calibration curves for survival demonstrated good agreement. Significant statistical differences were found in the OS of patients within different risk groups. An online calculation tool was established for clinical use.ConclusionsThis novel nomogram was able to provide a reliable prognosis for survival in patients with NSCLC undergoing pneumonectomy.     

112例非小细胞肺癌淋巴结转移规律分析

目的分析112例非小细胞肺癌淋巴结的转移规律。方法对112例肺癌患者施行手术切除并行广泛肺门、叶间及纵隔淋巴结清扫术。术后病理资料进行统计分析。结果在共清除898组淋巴结中,单纯N1淋巴结转移率为24.1%,N2(包括N1+N2)淋巴结转移率30.4%。原发肺癌(T)分期T1、T2、T3间淋巴结转移率差异有统计学意义(P0.01)。跳跃式转移占N2转移的35.3%。结论非小细胞肺癌的淋巴结转移与T分期有关,具有较多的跳跃性纵隔淋巴结转移发生,肿瘤部位及肺癌的病理学类型与淋巴结的转移无明显关系。外科治疗中应注意广泛清扫肺内、同侧纵隔淋巴结才有可能达到根治目的。     

培美曲塞治疗老年晚期非小细胞肺癌疗效分析

目的观察培美曲塞单药二线治疗老年晚期非鳞癌NSCLC的疗效及毒性反应;方法经病理学或细胞学确诊的25例老年晚期NSCLC患者,均接受培美曲塞化疗,培美曲塞以500 mg/m2,第一天静脉滴注,21天为一周期,每例患者至少行2周期化疗;结果 CR 0例,PR 5例,SD 12例,PD 8例,有效率(RR)20.0%,临床获益率(CBR)68.0%。主要不良反应为骨髓抑制和胃肠道反应;结论培美曲塞治疗老年晚期NSCLC具有一定的疗效,毒性反应轻,耐受性好。     

Risk factors of chest wall invasion in non-small cell lung cancer

BackgroundThe risk factors for the development of chest wall invasion (CWI) in non-small cell lung cancer (NSCLC) patients are unclear. If the risk factors for the development of CWI can be clarified, surgical treatment might be able to be performed before CWI development, thus improving the prognosis.MethodsIn the present study, we enrolled patients who received surgery for NSCLC between January 2008 and December 2019 with available data on the maximum standardized uptake value (SUV_max) on positron emission tomography (PET) with lesions adjacent to the visceral pleura. Furthermore, the preoperative white blood cell (WBC) count, the preoperative neutrophil-to-lymphocyte ratio (NLR), platelet (Plt) count, levels of lactate dehydrogenase (LDH) and C-reactive protein (CRP) were analyzed as predictive factors of CWI.ResultsThe relationships between CWI and clinicopathological variables were analyzed, and there were significant differences between patients with and without CWI in the age (P=0.02), maximum tumor diameter on computed tomography (CT) (P<0.01), diameter of tumors adjacent to the visceral pleura (P_max) (P<0.01), SUV_max (P<0.01), maximum tumor diameter on a pathological examination (P<0.01), WBC count (P=0.03), Plt count (P=0.04), and levels of LDH (P<0.01) and CRP (P=0.01). Logistic regression analyses of the risk factors related to CWI showed that the age (P=0.02), P_max (P=0.02), SUV_max (P=0.01), and LDH (P<0.01) were significant risk factors.ConclusionsThe age, P_max, SUV_max, and LDH levels might be associated with CWI.     

Changing paradigm in advanced and metastatic non-small cell lung cancer

Lung cancer is the most common cancer worldwide. Approximately 18% of all deaths related to cancer are associated with lung cancer. Management of non-small cell lung cancer (NSCLC) has been changing rapidly in last few years. For patients with unresectable non-metastatic disease, maintenance durvalumab is now given after offering chemo-radiation concurrently based on the result from the PACIFIC trial. Management of metastatic disease greatly depends on the status of sensitizing driver mutation and PD-L1 level of the tumor cells. In this review article, we will summarize the outcome of various clinical trials and will provide the most up-to-date information on the management of patients with advanced and metastatic NSCLC.     

Trichosanthin inhibits cell growth and metastasis by promoting pyroptosis in non-small cell lung cancer

BackgroundA number of studies have demonstrated that trichosanthin (TCS) can induce apoptosis in numerous types of tumor cell lines. However, whether TCS can induce pyroptosis has not yet been reported. This study aimed to investigate the role of TCS and its inhibitory effect on tumor growth by modulating pyroptosis in non-small cell lung cancer (NSCLC).MethodsEffects of different concentrations of TCS on the cell viability, proliferation, migration and invasion of NSCLC were detected by Cell Counting Kit-8 (CCK-8), colony formation, migration, and invasion assays. Immunofluorescence was used to detect the effect of TCS on the expression of pyroptosis marker protein gasdermin-D (GSDMD)-N in A549 cells. A tumor xenograft animal model was established by injecting A549 cells into nude mice.ResultsIn the present study, we found that TCS significantly inhibited the proliferation, migration, and invasion of A549 cells in a concentration-dependent manner. In addition, TCS at a high concentration (40 µg/mL) significantly promoted the expression of pyroptosis-related proteins [GSDMD-N, NLR family pyrin domain containing 3 (NLRP3), apoptosis-associated speck-like protein containing a CARD (ASC), caspase-1, and GSDMD], which showed an inhibitory effect on the pyroptosis of A549 cells. Additionally, we found that necrosulfonamide (NSA) significantly reversed the inhibitory effect of high concentrations of TCS on the pyroptosis of A549 cells. The in vivo experiments showed that TCS effectively reduced the tumor volume and inhibited the expression of Ki-67, whereas it increased the expression of GSDMD-N.ConclusionsTaken together, these results indicated that TCS could inhibit the progression of NSCLC by promoting pyroptosis. These findings provide further information on the possible underlying mechanism of TCS in the treatment of NSCLC.     

Bone metastases in non-small cell lung cancer: a narrative review

Background and ObjectiveBone metastases are common in patients with non-small cell lung cancer (NSCLC) and remain a significant source of morbidity, mortality, and diminished quality of life, despite the considerable progress made in the overall management of patients with metastatic NSCLC over the last decade. Understanding the molecular pathogenesis of bone metastases is critical to improving survival, preserving function, and managing symptoms in this patient population. The objective of our review is to provide a comprehensive review of the pathophysiology, clinical presentation, management, and factors predicting the development and prognosis of patients with NSCLC with bone metastases.MethodsAn online electronic search was performed on PubMed and Google Scholar of all English-language literature using combinations of the following keywords: bone metastases, non-small cell lung cancer, pathophysiology, skeletal related events, response to therapy, predictive factors, and immunotherapy. Bibliographies of identified papers were reviewed for additional articles of interest. Observational cohort, retrospective studies, randomized controlled trials (RCTs), meta-analyses, and review articles were examined for this review.Key Content and FindingsBone metastases in lung cancer patients remain a common occurrence, impacting morbidity, mortality, and quality of life. Patients with skeletal related events (SREs) have worse prognosis. There is data supporting use of bisphosphonates and/or denosumab, and these should be considered in all patients with bone metastases. Novel studies comparing the genomic alterations of skeletal metastases and primary tumors are needed. As therapy for patients with advanced disease evolves, more studies are needed to evaluate the interplay between immunotherapy and bone metastases, and in determining the response to treatment in bone.ConclusionsPredicting development and progression of bone metastases could allow earlier and targeted therapy in patients with bone metastases. Predicting and evaluating response to conventional chemotherapy and immune checkpoint inhibitors in NSCLC patients with bone metastases remains an unmet need and merits further study.     

True video-assisted thoracic surgery for early-stage non-small cell lung cancer

Since its inception, minimally invasive surgery has made a dramatic impact on all branches of surgery. Video-assisted thoracic surgery (VATS) lobectomy for early-stage non-small cell lung cancer (NSCLC) was first described in the early 1990s and has since become popular in a number of tertiary referral centers. Proponents of this relatively new procedure cite a number of potentially favorable perioperative outcomes, possibly due to reduced surgical trauma and stress. However, a significant proportion of the cardiothoracic community remains skeptical, as there is still a paucity of robust clinical data on long-term survival and recurrence rates.The definition of 'true' VATS has also been under scrutiny, with a number of previous studies being considered 'mini-thoracotomy lobectomy' rather than VATS lobectomy. We hereby examine the literature on true VATS lobectomy, with a particular focus on comparative studies that directly compared VATS lobectomy with conventional open lobectomy.     

Pyruvate dehydrogenase E1α represents a reliable prognostic predictor for patients with non-small cell lung cancer resected via curative operation

BackgroundLung cancer is associated with a high morbidity and mortality rate worldwide; however, no reliable and independent prognostic predictor for non-small cell lung cancer (NSCLC) after curative surgery is available. Glucose metabolism is correlated with cancer cell proliferation. Pyruvate dehydrogenase E1α (PDH-E1α) catalyzes the conversion of pyruvate to acetyl-CoA and promotes aerobic glucose metabolism. In this study, we examined the relationship between PDH-E1α expression and clinicopathological factors associated with NSCLC to identify a reliable prognostic predictor of NSCLC after curative surgery.MethodsA total of 445 patients with NSCLC who underwent curative resection were enrolled in this study. PDH-E1α expression was evaluated via immunohistochemistry. We analyzed the correlation between PDH-E1α expression and clinicopathological features of the patients.ResultsIn total, 248 (56%) of the 445 patients with NSCLC were PDH-E1α-positive, and 197 patients were PDH-E1α-negative. PDH-E1α positivity was significantly correlated with the presence of adenocarcinoma (P<0.001) compared to the PDH-E1α-negative group. Patients with NSCLC showing PDH-E1α-negative expression had a significantly poorer overall survival rate (P=0.007) than those showing PDH-E1α-positive expression, especially at stage II. Patients with PDH-E1α negative expression also showed a poorer disease-free survival rate (P=0.02). Multivariate analysis revealed that PDH-E1α negativity (P=0.037) and male sex (P<0.001) were significantly correlated with a poor overall survival.ConclusionsPDH-E1α may represent a reliable prognostic predictor for NSCLC in patients that have recently undergone curative resection, especially at stage II.     

A propensity-matched analysis of stereotactic body radiotherapy and sublobar resection for stage I non-small cell lung cancer in patients at high risk for lobectomy: the results in a Chinese population

BackgroundTo investigate the comparative effectiveness of stereotactic body radiotherapy (SBRT) and sublobar resection (SLR) in patients with stage I non-small cell lung cancer (NSCLC) considered to be high-risk lobectomy patients.MethodsFrom January 2012 to December 2015, patients who underwent SBRT or SLR for clinical stage I NSCLC were examined retrospectively. Propensity score matching (PSM) was performed to reduce selection bias in SBRT and SLR patients.ResultsData from 86 SBRT and 79 SLR patients was collected. Median follow-up periods of the SBRT and SLR groups were 32 and 37 months, respectively. Patients treated with SBRT exhibited significantly higher age, higher likelihood of being male, larger tumor diameter, lower forced expiratory volume in 1 second (FEV1), and poorer performance status compared with SLR patients. There were no significant differences between SBRT and SLR patients for 3-year overall survival (OS) (80.3% and 82.3%, P=0.405), cause-specific survival (CSS) (81.3% and 83.4%, P=0.383), and local control (LC) (89.7% and 86.0%, P=0.501). Forty-nine patients were identified from each group after performing PSM. After patients were matched for age, gender, performance status, tumor characteristics and pulmonary function, no significant differences were observed in 3-year OS (85.4% and 73.3%, P=0.649), CSS (87.2% and 74.9%, P=0.637) and LC (95.6% and 82.1%, P=0.055). Prevalence of significant adverse events (grade 3 or worse) was 0% and 10.2% in the matched SBRT and SLR groups (P=0.056), respectively.ConclusionsDisease control and survival in the SBRT patients was equivalent to that seen in SLR patients with stage I NSCLC considered high-risk lobectomy candidates. SBRT could therefore be an alternative option to SLR in treating patients with a high operative risk.     

Prognostic value of lactate dehydrogenase in non-small cell lung cancer patients with brain metastases: a retrospective cohort study

BackgroundAt present, although there are some known molecular markers for the prognosis of non-small cell lung cancer (NSCLC) brain metastases, but there are still shortcomings in sensitivity and specificity. Lactate dehydrogenase (LDH) is one of the key enzymes involved in malignancy vital glycolytic pathway. Elevated serum LDH levels are reported significantly associated with a poor prognosis in various malignancies. However, there is currently no consensus regarding the prognostic value of LDH in NSCLC patients with brain metastases.MethodsWe retrospectively analyzed 224 patients diagnosed with lung cancer brain metastases between January 2006 and June 2020 after excluding patients meeting combined with other malignancies and inaccurate clinical information. The LDH cutoff values were obtained using a restricted cubic spline (RCS) model, and the patients were divided into two groups according to the optimal cut-off value (180 U/L). 107 patients with LDH ≤180 (47.77%) and 117 patients with LDH >180 (52.23%) were identified. Univariate and multivariate logistic regression analyses were performed to identify the risk factors. The overall survival (OS) time was defined as the time from the first diagnosis of brain metastases to the last follow-up or death. Of the included patients, 147 survived and 77 died. The Kaplan-Meier method was used to illustrate the OS difference between the two groups. Finally, sensitivity analysis was employed to evaluate the robustness of the results.ResultsThe OS rate was significantly lower in the high LDH group versus the low LDH group (P=0.009). The median survival times of the high and low LDH groups were approximately 16 and 33 months, respectively. Multivariate analysis showed that high LDH was associated with a significantly worse OS [adjusted hazard ratio (aHR), 1.567; 95% confidence interval (CI): 1.058 to 2.32, P=0.025] with adjustment for covariables that P<0.05 in univariate analysis. Sensitivity analysis indicated that the results of this study are robust, despite potential unmeasured confounders.ConclusionsHigh level of serum LDH indicates poor prognosis for patients with NSCLC brain metastases. This finding may provide useful prognostic information for patients and clinicians to choose more aggressive treatment strategies.