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Disclosure of Interest: None DeclaredPoster 1147
LOCAL ADVANCED
LUNG CANCER:
PRECISE PREDICTION
OF 5-YEAR SURVIVAL
AFTER C...
METHODS: We analyzed data of 167 consecutive LCP (age=58±8.1
years; tumor size=6.8±2.6 cm) radically operated and monitore...
LOCAL ADVANCED LUNG CANCER:
PRECISE PREDICTION OF 5-YEAR
SURVIVAL AFTER COMBINED
LOBECTOMIES/PNEUMONECTOMIES
Oleg Kshivets...
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Kshivets Oleg LOCAL ADVANCED LUNG CANCER: PRECISE PREDICTION

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LOCAL ADVANCED LUNG CANCER: PRECISE PREDICTION OF 5-YEAR SURVIVAL AFTER COMBINED LOBECTOMIES/PNEUMONECTOMIES
Oleg Kshivets
Surgery Department, Kaluga Cancer Center, Kaluga, Russia

OBJECTIVE: We examined factors in terms of precise prediction of 5-year survival (5YS) of local advanced non-small cell lung cancer (LC) patients (LCP) (T3-4N0-2M0) after complete (R0) combined lobectomies/pneumonectomies (LP).
METHODS: We analyzed data of 167 consecutive LCP (age=58±8.1 years; tumor size=6.8±2.6 cm) radically operated and monitored in 1987-2014 (m=150, f=17; lobectomies=70, pneumonectomies=97, combined LP with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=167; only surgery-S=105, adjuvant chemoimmunoradiotherapy-AT=62: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T3=117, T4=50; N0=79, N1=38, N2=50, M0=167; G1=36, G2=44, G3=87; squamous=113, adenocarcinoma=41, large cell=13. 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 1483.1±1412.6 days and cumulative 5YS reached 60.3%, 10 years – 45.9%, 20 years – 30.1%. 77 LCP lived more than 5 years without cancer (LS=2616.2±1341. days). 61 LCP died because of LC (LS=466.1±360.0 days). AT significantly improved 5YS (77.2% vs. 51.4%) (P=0.0004 by log-rank test). Cox modeling displayed (Chi2=68.5, df=10, P=0.000) that 5YS of LCP significantly depended on: T3-4, N0-2, tumor size, cell ratio factors (ratio between cancer cells and blood cells subpopulations), prothrombin index, heparin tolerance, fibrinogen B, AT (P=0.000-0.033). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and AT (rank=1), N0-2 (rank=2), T3-4 (3), prothrombin index (4), thrombocytes/cancer cells (5), lymphocytes/cancer cells (6), tumor size (7). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
CONCLUSIONS: 5YS of local advanced non-small cell lung cancer patients after radical procedures significantly depended on: tumor characteristics, cell ratio factors, hemostasis system and adjuvant treatment.

Publié dans : Santé & Médecine

Kshivets Oleg LOCAL ADVANCED LUNG CANCER: PRECISE PREDICTION

  1. 1. Disclosure of Interest: None DeclaredPoster 1147 LOCAL ADVANCED LUNG CANCER: PRECISE PREDICTION OF 5-YEAR SURVIVAL AFTER COMBINED LOBECTOMIES/ PNEUMONECTOMIES Surgery Department Kaluga Cancer Center, Kaluga, Russia Oleg Kshivets, MD, PhD 4.8 Scientific Studies - Treatment
  2. 2. METHODS: We analyzed data of 167 consecutive LCP (age=58±8.1 years; tumor size=6.8±2.6 cm) radically operated and monitored in 1987-2014 (m=150, f=17; lobectomies=70, pneumonectomies=97, combined LP with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=167; only surgery-S=105, adjuvant chemoimmunoradiotherapy-AT=62: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T3=117, T4=50; N0=79, N1=38, N2=50, M0=167; G1=36, G2=44, G3=87; squamous=113, adenocarcinoma=41, large cell=13. 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 1483.1±1412.6 days and cumulative 5YS reached 60.3%, 10 years – 45.9%, 20 years – 30.1%. 77 LCP lived more than 5 years without cancer (LS=2616.2±1341. days). 61 LCP died because of LC (LS=466.1±360.0 days). AT significantly improved 5YS (77.2% vs. 51.4%) (P=0.00043 by log-rank test). Cox modeling displayed (Chi2=68.5, df=10, P=0.000) that 5YS of LCP significantly depended on: T3-4, N0-2, tumor size, cell ratio factors (ratio between cancer cells and blood cells subpopulations), prothrombin index, heparin tolerance, fibrinogen B, AT (P=0.000-0.033). LOCAL ADVANCED LUNG CANCER: PRECISE PREDICTION OF 5-YEAR SURVIVAL AFTER COMBINED LOBECTOMIES/PNEUMONECTOMIES Oleg Kshivets Poster 1147 Disclosure of Interest: None Declared OBJECTIVE: We examined factors in terms of precise prediction of 5-year survival (5YS) of local advanced non-small cell lung cancer (LC) patients (LCP) (T3-4N0-2M0) after complete (R0) combined lobectomies/pneumonectomies (LP). Variables in the Equation Cox Chi2=68.5; df=10; P=0.000 B SE Wald df Sig. Exp(B) T3--4 -,453 ,212 4,559 1 ,033 ,636 N12--N0 9,820 2 ,007 N12--N0(1) -,650 ,208 9,803 1 ,002 ,522 N12--N0(2) -,383 ,234 2,675 1 ,102 ,682 Tumor Size ,140 ,046 9,253 1 ,002 1,150 Prothrombin Index ,033 ,008 18,528 1 ,000 1,033 Fibrinogen-B ,442 ,152 8,441 1 ,004 1,556 Heparin Tolerance ,002 ,001 4,748 1 ,029 1,002 Adjuvant Chemoimmunoradiotherapy -,306 ,101 9,164 1 ,002 ,736 Thrombocytes/Cancer Cells ,004 ,001 9,835 1 ,002 1,004 Lymphocytes/Cancer Cells -,261 ,109 5,700 1 ,017 ,770
  3. 3. LOCAL ADVANCED LUNG CANCER: PRECISE PREDICTION OF 5-YEAR SURVIVAL AFTER COMBINED LOBECTOMIES/PNEUMONECTOMIES Oleg Kshivets Bootstrap Simulation for 5-Year Survival Significant Factors (Number of Samples=3333) Rank Kendal Tau-A P < Prothrombin Index 1 -0.211 0.00 1 Erythrocytes/Cancer Cells 2 0.155 0.01 Erythrocytes Weight 3 4 0.152 0.151 0.01 0.01 Monocytes/Cancer Cells 5 0.145 0.05 Glucose 6 0.144 0.05 Healthy Cells/Cancer Cells 7 0.131 0.05 ESS 8 -0.127 0.05 N0---N12 9 -0.119 0.05 Eosinophils/Cancer Cells 10 0.115 0.05 Poster 1147 Disclosure of Interest: None Declared CONCLUSIONS: 5YS of local advanced non-small cell lung cancer patients after radical procedures significantly depended on: tumor characteristics, cell ratio factors, hemostasis system and adjuvant treatment. Neural Networks Computing for 5-Year Survival Factor Rank Sensitivity Adjuvant Chemoimmunoradiotherapy 1 2877 N0---N12 2 2525 T3-4 3 2246 Prothrombin Index 4 1640 Thrombocytes/Cancer Cells 5 1538 Lymphocytes/Cancer Cells 6 1325 Tumor Size 7 1264 Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and AT (rank=1), N0-2 (rank=2), T3-4 (3), prothrombin index (4), thrombocytes/cancer cells (5), lymphocytes/cancer cells (6), tumor size (7). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).

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