Kshivets O. Lung Cancer: Role of Adjuvant Chemoimmunoradiotherapy after Surgery

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Oleg Kshivets

Lung Cancer: Role of Adjuvant Chemoimmunoradiotherapy after Surgery

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5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC cell dynamics; 9) EC characteristics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.

Esophageal Cancer: Artificial Intelligence, Synergetics, Complex System Analy...

Oleg Kshivets

Optimization of Management for Esophageal Cancer Patients (T1-4N0-2M0). Kshivets Oleg Surgery Department, Bagrationovsk Hospital, Bagrationovsk, Kaliningrad, Russia ABSTRACT OBJECTIVE: 5-survival (5YS) and life span after radical surgery for esophageal cancer (EC) pa¬tients (ECP)(T1-4N0-2M0) - alive supersysems was analyzed. The importance must be stressed of using complex system analysis, artificial intelligence (neural networks computing), simulation modeling and statistical methods in combination, because the different approaches yield complementary pieces of prognostic information. METHODS: We analyzed data of 563 consecutive ECP (age=56.6±8.9 years; tumor size=6±3.5 cm) radically operated (R0) and monitored in 1975-2024 (m=419, f=144; esophagogastrectomies (EG) Garlock=289, EG Lewis=274, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=170; adenocarcinoma=323, squamous=230, mix=10; T1=131, T2=119, T3=185, T4=128; N0=285, N1=71, N2=207; G1=161, G2=143, G3=259; early EC=112, invasive=451; only surgery=428, adjuvant chemoimmunoradiotherapy-AT=135: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. RESULTS: Overall life span (LS) was 1915.4±2284.8 days and cumulative 5-year survival (5YS) reached 52.6%, 10 years – 46.3%, 20 years – 33.3%, 30 years – 27.5%. 193 ECP lived more than 5 years (LS=4309.1±2507.4 days), 105 ECP – more than 10 years (LS=5860.8±2469.2 days). 228 ECP died because of EC (LS=629.8±324.1 days). AT significantly improved 5YS (69% vs. 49.1%) (P=0.0007 by log-rank test). 5YS of ECP of upper/3 was significantly better than others (65.3% vs.50.3%) (P=0.003). Cox modeling displayed that 5YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), T, G, histology, age, AT, localization, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.019). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and healthy cells/CC (rank=1), PT N0—N12 (2), PT early-invasive EC (3), erythrocytes/CC (4), thrombocytes/CC (5); segmented neutrophils/CC (6), stick neutrophils/CC (7), lymphocytes/CC (8), eosinophils/CC (9), monocytes/CC (10), leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSIONS: 5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC cell dynamics; 9) EC characteristics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and trea

Kshivets Oleg Optimization of Management for Esophageal Cancer Patients (T1-...

Oleg Kshivets

Kshivets_IASLC_Singapore2023.pdf

Oleg Kshivets

5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) EC cell dynamics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.

KshivetsWSCTS2023_Brazil.pdf

Oleg Kshivets

OBJECTIVE: 5-survival (5YS) and life span after radical surgery for esophageal cancer (EC) pa¬tients (ECP) (T1-4N0-2M0) was analyzed. The importance must be stressed of using complex system analysis, artificial intelligence (neural networks computing), simulation modeling and statistical methods in combination, because the different approaches yield complementary pieces of prognostic information. METHODS: We analyzed data of 557 consecutive ECP (age=56.6±8.9 years; tumor size=6±3.5 cm) radically operated (R0) and monitored in 1975-2023 (m=415, f=142; esophagogastrectomies (EG) Garlock=288, EG Lewis=269, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=168; adenocarcinoma=319, squamous=228, mix=10; T1=130, T2=115, T3=184, T4=128; N0=282, N1=70, N2=205; G1=157, G2=142, G3=258; early EC=111, invasive=446; only surgery=425, adjuvant chemoimmunoradiotherapy-AT=132: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. RESULTS: Overall life span (LS) was 1876.9±2219.8 days and cumulative 5-year survival (5YS) reached 52%, 10 years – 45.5%, 20 years – 33.4%, 30 years – 26.9%. 187 ECP lived more than 5 years (LS=4271±2411.9 days), 99 ECP – more than 10 years (LS=5883±2296.6 days). 228 ECP died because of EC (LS=629.8±324.1 days). AT significantly improved 5YS (67.8% vs. 48.7%) (P=0.00084 by log-rank test). Cox modeling displayed that 5YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), T, G, histology, age, AT, localization, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.019). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and healthy cells/CC (rank=1), PT early-invasive EC (2); PT N0—N12 (3), erythrocytes/CC (4), thrombocytes/CC (5); stick neutrophils/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), eosinophils/CC (9), leucocytes/CC (10); monocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSIONS: 5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) EC cell dynamics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5)AT

KshivetsWSCTS2023_Brazil.pdf

Oleg Kshivets

KshivetsWSCTS2023_Brazil.pdf

Oleg Kshivets

5-year survival of GCP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC characteristics; 9) GC cell dynamics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Best diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.

Kshivets_WCGIC2023.pdf

Oleg Kshivets

OBJECTIVE: 5-survival (5YS) and life span after radical surgery for non-small cell lung cancer (LC) pa¬tients (LCP) (T1-4N0-2M0) was analyzed. METHODS: We analyzed data of 771 consecutive LCP (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated and monitored in 1985-2022 (m=662, f=109; upper lobectomies=278, lower lobectomies=178, middle lobectomies=18, bilobectomies=42, pneumonectomies=255, mediastinal lymph node dissection=771; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=194; only surgery-S=620, adjuvant chemoimmunoradiotherapy-AT=151: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=322, T2=255, T3=133, T4=61; N0=518, N1=131, N2=122, M0=771; G1=195, G2=243, G3=333; squamous=418, adenocarcinoma=303, large cell=50; early LC=215, invasive LC=556; right LC=413, left LC=358; central=291; peripheral=480. Variables selected for study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Regression modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine significant dependence. RESULTS: Overall life span (LS) was 2240.9±1748.8 days and cumulative 5-year survival (5YS) reached 73%, 10 years – 64.2%, 20 years – 43%. 503 LCP lived more than 5 years (LS=3126.6±1536 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.7% vs.63.4%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.035). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), eosinophils/CC (4), erythrocytes/CC (5),healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: PT early-invasive cancer; PT N0--N12; cell ratio factors; blood cell circuit; biochemical factors; hemostasis system; AT; LC characteristics; surgery type; anthropometric data.

Kshivets_ELCC2023.pdf

Oleg Kshivets

OBJECTIVE: 5-survival (5YS) and life span after radical surgery for non-small cell lung cancer (LC) pa¬tients (LCP) (T1-4N0-2M0) was analyzed. METHODS: We analyzed data of 771 consecutive LCP (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated and monitored in 1985-2022 (m=662, f=109; upper lobectomies=278, lower lobectomies=178, middle lobectomies=18, bilobectomies=42, pneumonectomies=255, mediastinal lymph node dissection=771; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=194; only surgery-S=620, adjuvant chemoimmunoradiotherapy-AT=151: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=322, T2=255, T3=133, T4=61; N0=518, N1=131, N2=122, M0=771; G1=195, G2=243, G3=333; squamous=418, adenocarcinoma=303, large cell=50; early LC=215, invasive LC=556; right LC=413, left LC=358; central=291; peripheral=480. Variables selected for study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Regression modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine significant dependence. RESULTS: Overall life span (LS) was 2240.9±1748.8 days and cumulative 5-year survival (5YS) reached 73%, 10 years – 64.2%, 20 years – 43%. 503 LCP lived more than 5 years (LS=3126.6±1536 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.7% vs.63.4%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.035). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), eosinophils/CC (4), erythrocytes/CC (5),healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data.

Kshivets_ELCC2023.pdf

Oleg Kshivets

OBJECTIVE: 5-survival (5YS) and life span after radical surgery for non-small cell lung cancer (LC) pa¬tients (LCP) (T1-4N0-2M0) was analyzed. METHODS: We analyzed data of 771 consecutive LCP (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated and monitored in 1985-2022 (m=662, f=109; upper lobectomies=278, lower lobectomies=178, middle lobectomies=18, bilobectomies=42, pneumonectomies=255, mediastinal lymph node dissection=771; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=194; only surgery-S=620, adjuvant chemoimmunoradiotherapy-AT=151: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=322, T2=255, T3=133, T4=61; N0=518, N1=131, N2=122, M0=771; G1=195, G2=243, G3=333; squamous=418, adenocarcinoma=303, large cell=50; early LC=215, invasive LC=556; right LC=413, left LC=358; central=291; peripheral=480. Variables selected for study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Regression modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine significant dependence. RESULTS: Overall life span (LS) was 2240.9±1748.8 days and cumulative 5-year survival (5YS) reached 73%, 10 years – 64.2%, 20 years – 43%. 503 LCP lived more than 5 years (LS=3126.6±1536 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.7% vs.63.4%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.035). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), eosinophils/CC (4), erythrocytes/CC (5),healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data.

Lung Cancer: Precise Prediction

Oleg Kshivets

Kshivets_SPB_WSCTS2022Eso.pdf

Oleg Kshivets

Kshivets_SPB_WSCTS2022Lung.pdf

Oleg Kshivets

OBJECTIVE: We examined factors significantly affecting lung cancer (LC) cell dynamics. METHODS: We analyzed data of 768 consecutive non-small cell LC patients (LCP) (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated and monitored in 1985-2022 (m=660, f=108; upper lobectomies=277, lower lobectomies=177, middle lobectomies=18, bilobectomies=42, pneumonectomies=254, mediastinal lymph node dissection=768; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=193; only surgery-S=618, adjuvant chemoimmunoradiotherapy-AT=150: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=320, T2=255, T3=133, T4=60; N0=516, N1=131, N2=121, M0=768; G1=194, G2=243, G3=331; squamous=417, adenocarcinoma=301, large cell=50; early LC=214, invasive LC=554; right LC=412, left LC=356; central=290; peripheral=478. Variables selected for study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Regression modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine significant dependence. RESULTS: Overall life span (LS) was 2244.9±1750.3 days and cumulative 5-year survival (5YS) reached 72.9%, 10 years – 64.3%, 20 years – 43.1%. 502 LCP lived more than 5 years (LS=3128.7±1536.8 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days). Regression modeling displayed LC cell dynamics significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, histology, T, G, LC growth, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), ESS, glucose, bilirubin (P=0.000-0.033). Neural networks simulation revealed relationships between LC cell dynamics and segmented neutrophils (rank=1), lymphocytes (2), PT N0—N12 (3), PT early-invasive LC (4), leucocytes (5), stick neutrophils (6), eosinophils (7), erythrocytes (8), monocytes (9), thrombocytes (10), Hb (11), ESS (12). Prediction was 92-95% by neural networks computing. CONCLUSIONS: Lung cancer cell dynamics significantly depended on blood cell circuit, biochemical factors, hemostasis system, cancer characteristics, anthropometric data.

Lung cancer cell dynamics significantly depended on blood cell circuit, bioch...

Oleg Kshivets

OBJECTIVE: 5-survival (5YS) and life span after radical surgery for esophageal cancer (EC) pa¬tients (ECP) (T1-4N0-2M0) was analyzed. METHODS: We analyzed data of 556 consecutive ECP (age=56.5±8.9 years; tumor size=6±3.5 cm) radically operated (R0) and monitored in 1975-2022 (m=415, f=141; esophagogastrectomies (EG) Garlock=287, EG Lewis=269, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=167; adenocarcinoma=318, squamous=228, mix=10; T1=129, T2=115, T3=184, T4=128; N0=281, N1=70, N2=205; G1=157, G2=141, G3=258; early EC=110, invasive=446; only surgery=424, adjuvant chemoimmunoradiotherapy-AT=132: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. RESULTS: Overall life span (LS) was 1877±2221.6 days and cumulative 5-year survival (5YS) reached 52%, 10 years – 45%, 20 years – 33.4%, 30 years – 27%. 186 ECP lived more than 5 years (LS=4283.3±2412.6 days), 99 ECP – more than 10 years (LS=5883±2296.6 days). 227 ECP died because of EC (LS=631.8±323.4 days). AT significantly improved 5YS (60.3% vs. 42%) (P=0.0029 by log-rank test). Cox modeling displayed that 5YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), T, G, histology, age, AT, localization, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.021). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and P PT early-invasive EC (rank=1); healthy cells/CC (2), erythrocytes/CC (3), PT N0—N12 (4) thrombocytes/CC (5); segmented neutrophils/CC (6), stick neutrophils/CC (7), lymphocytes/CC (8), monocytes/CC (9); leucocytes/CC (10); eosinophils/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSIONS: 5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.

Esophageal Cancer: Precise Prediction

Oleg Kshivets

OBJECTIVE: This study aimed to determine surgery type influence for 5-year survival (5YS) of non-small cell lung cancer (LC) patients (LCP) after complete en block (R0) lobectomies and pneumonectomies. METHODS: We analyzed data of 765 consecutive patients (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated (R0) and monitored in 1985-2022 (m=659, f=106; bi/lobectomies=512, pneumonectomies=253, mediastinal lymph node dissection=765; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=192; only surgery-S=616, adjuvant chemoimmunoradiotherapy-AT=149: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=318, T2=255, T3=133, T4=59; N0=514, N1=131, N2=120, M0=765; G1=194, G2=241, G3=330; squamous=417, adenocarcinoma=298, large cell=50; early LC=212, invasive LC=553. Multivariate Cox modeling, discriminant analysis, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. RESULTS: Overall life span (LS) was 2240.1±1751.6 days and cumulative 5-year survival (5YS) reached 72.8%, 10 years – 64.2%, 20 years – 42.9%. 499 LCP lived more than 5 years (LS=3126.8±1540 days), 143 LCP – more than 10 years (LS=5083.3±1518.6 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.6% vs.63.1%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). 5YS of LCP after Lobectomies (77.6%) was significantly superior in comparison with LCP after pneumonectomies (63%) (P=0.00001 by log-rank test). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12(rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), monocytes/CC (9); stick neutrophils/CC (10), leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) surgery type: lobectomy/pneumonectomy; 10) anthropometric data.

Survival of Lung Cancer Patients after Lobectomies was Significantly Superior...

Oleg Kshivets

OBJECTIVE: We examined cell ratio factors (CRF) significantly affecting gastric cancer (EC) patients GCP) survival. CRF - ratio between cancer cells (CC) and blood cells subpopulations. METHODS: We analyzed data of 799 consecutive GCP (T1-4N0-2M0) (age=57.1±9.4 years; tumor size=5.4±3.1 cm) radically operated (R0) and monitored in 1975-2022 (m=558, f=241; total gastrectomies=173, distal gastrectomies=461; proximal gastrectomies=165; combined gastrectomies=247 with resection of esophagus, pancreas, liver, duodenum, diaphragm, colon transversum, splenectomy, etc; only surgery-S=624, adjuvant chemoimmunotherapy-AT=175 (5-FU + thymalin/taktivin); T1=238, T2=220, T3=184, T4=157; N0=437, N1=109, N2=253, M0=799; G1=222, G2=164, G3=413. Variables selected for prognosis study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of GCP were evaluated using a log-rank test. Multivariate Cox modeling, discriminant analysis, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. RESULTS: Overall life span (LS) was 2128.9±2300.3 days and cumulative 5-year survival (5YS) reached 58.4%, 10 years – 51.9%, 20 years – 39%, 30 years – 27.2%. 318 GCP lived more than 5 years (LS=4304.5±2290.6 days), 169 GCP – more than 10 years (LS=5919.5±2020 days). 290 GCP died because of GC (LS=651±347.2 days). Cox modeling displayed that G CP survival significantly depended on CRF: healthy cells/CC, erythrocytes/CC, monocytes/CC, phase transition (PT) in terms of synergetics early—invasive cancer; PT N0--N12, age, G1-3, hemorrhage time, ESS, sex, AT, prothrombin index, residual nitrogen. Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early—invasive cancer (rank=1); PT N0--N12 (2); healthy cells/CC (3), erythrocytes/CC (4), thrombocytes/CC (5), monocytes/CC (6), segmented neutrophils/CC (7), leucocytes/CC (8), lymphocytes/CC (9), stick neutrophils/CC (10), eosinophils/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSIONS: GCP survival after radical procedures significantly depended on CRF.

• Gastric cancer prognosis and cell ratio factors

Oleg Kshivets

It was revealed that separation of LCP with early LC (n=215) from invasive LCP (n=555) significantly depended on: Hb, leucocytes (abs, total), thrombocytes (abs, tot), erythrocytes (abs, tot), segmented neutrophils (%, abs, total), stick neutrophils (%, abs, total), lymphocytes (%), monocytes (abs, tot), ESS, coagulation time, fibrinogen, cell ratio factors (CRF) (ratio between cancer cells- CC and blood cells subpopulations), tumor size, age, tumor growth, T1-4, G1-3, PT N0---N12 (P=0.046-0.000). Neural networks computing, genetic algorithm selection and bootstrap simulation revealed relationships of PT early—invasive cancer and CRF: healthy cells/CC (rank=1), erythrocytes/CC (2), stick neutrophils/CC (3), thrombocytes/CC (4), eosinophils/CC (5), segmented neutrophils/CC (6), lymphocytes/CC (7), monocytes/CC (8), leucocytes/CC (9). Correct classification PT early—invasive cancer was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSION: Blood cell circuit significantly influenced the phase transition early—invasive lung cancer.

Kshivets elcc2022

Oleg Kshivets

10-Year survival of GCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.

Kshivets gc 10_ys_wjarr-2021-0659

Oleg Kshivets

Conclusions: 10-Year survival of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.

Kshivets lc10 ys_wjarr

Oleg Kshivets

10-Year survival after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.

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