Cardiopulmonary co-morbidity: a critical negative prognostic predictor for pulmonary resection following preoperative chemotherapy and/or radiation therapy in lung cancer patients

Abstract

Objective. Preoperative therapy is an optional strategy for locally advanced lung cancer, although the indication for pulmonary resection is often marginal, when considering the survival benefi t and perioperative risks. The aim of the present study was to identify prognostic predictors by assessing clinical factors including prethoracotomy co-morbidity.Methods. This was a retrospective analysis of 54 patients who underwent complete resection after preoperative therapy was performed. Results. The overall 5-year survival rate was 38%. In patients without cardiopulmonary co-morbidity the 5-year survival rate was 49%, whereas it was 0% for those who had associated cardiopulmonary co-morbidity (P = 0.004). When analyzing only those who died from lung cancer, the group without cardiopulmonary comorbidity showed a tendency for longer survival than those in the co-morbidity group (P = 0.092). The 5-year survival rate for patients-evaluated with a Charlson Co-morbidity Index (CCI)-with a CCI score of 0, was 45%, which tended to be better than that for those with a CCI score of 1-2 (P = 0.066). Furthermore, patients with a normal prethoracotomy level of carcinoembryonic antigen (CEA) had a 5-year survival rate of 44%, which was better than the 22% for patients with elevated CEA (P = 0.013). The 5-year survival rate for patients without lymph node metastasis was 52%, whereas it was 14% for those with residual node involvement (P = 0.002). Lymph node metastasis and cardiopulmonary co-morbidity were shown to be independent poor prognostic predictors by multivariate analysis.Conclusion. In addition to nodal status, preoperative cardiopulmonary co-morbidity should be noted when considering the operative indications following preoperative therapy for lung cancer patients.

Gas6 derived from cancer-associated fibroblasts promotes migration of Axl-expressing lung cancer cells during chemotherapy

“…The present study includes patients who underwent induction therapy followed by surgery and patients who underwent salvage surgery following a definitive chemotherapy or chemoradiotherapy with good response. Indications for intended surgery following induction therapy or salvage surgery in our hospital were previously described 3 . One patient died perioperatively and was excluded from the analysis.…”

“…Conventional treatment options for non-small cell lung cancer (NSCLC) are surgery, radiotherapy, and chemotherapy 2 . Chemotherapy or chemoradiotherapy followed by surgery is considered a viable treatment option for locally-advanced NSCLC 3 – 5 .…”

Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis

“…Issues investigated deal with the impact of: (I) age (1-4); (II) safety of choice for a combined or staged surgical procedure (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19); (III) on-or off-pump technique on postoperative complications occurrence (12,16,(20)(21)(22)(23)(24)(25)(26)(27); (IV) an extended surgery, due to LC infiltration in the left atrium and/or great vessels, on postoperative outcome (24,(28)(29)(30); (V) videoassisted thoracoscopic surgery (VATS) method on primary LC patients (31)(32)(33)(34)(35)(36); (VI) neo-adjuvant or adjuvant treatment (37)(38)(39)(40); and (VII) factors, other than the aforementioned ones, influencing postoperatively patients operated for primary LC and HD. These factors were: myocardial ischemia (41), arrhythmias (41,42), type of grafts selected (20), high preoperative serum level of lactate dehydrogenase (LDH) (43), low preoperative forced expiratory volume in one second ...…”