Prognostic factors for pN2 non-small cell lung cancer: a comprehensive evidence from 73 studies involving 23,772 patients*

Abstract

ObjectiveNon-small-cell lung cancer (NSCLC) is a common malignancy. pN2 NSCLC, with pathologically confirmed ipsilateral mediastinal/subcarinal nodes metastasis, has been known as a very heterogeneous subgroup in terms of its anatomical, biological and patient characteristics. Prognostic factors based on patient characteristics were not well determined yet in this subgroup, and there is currently no standard treatment recommendation for these heterogeneous pN2 subjects. Apparent disagreements and inconsistency exist in study reports concerning the prognostic significance of certain factors in pN2 NSCLC, especially regarding to the issue about whether skip N2 metastasis benefit from surgery.MethodsWe therefore performed this comprehensive summary of the published literatures to draw a more precise and less uncertain conclusion. After a comprehensive literature search, a total of 73 studies involving 23,773 subjects were included according to eligibility criteria.ResultsAs expected, most of the investigated factors, such as old age, male, advanced pathological T stage, advanced clinical N stage, multiple N2 stations, extended surgical resection (pneumonectomy), and incomplete resection, but not post-operation treatment (eg. chemotherapy and radiotherapy) were significantly associated with poor survival. However, skip N2 metastasis was favourable prognostic factors in operable pN2 NSCLC subjects. Other factors (histological type and primary tumour side) were neutral in terms of association with overall survival. We highlighted a number of important prognostic factors for pN2 NSCLC patients. Particularly, patients with skip N2 disease benefit from surgery.ConclusionOur findings could be used as reference information for decision-making in clinical practice and future study design.

Analysis of the adverse reactions of atezolizumab: A real-world study based on FAERS database

“…The reporting frequency of ADEs can reveal the incidence rate of ADRs and reflect the impact of ADRs on the patients' health, thus indicating the key direction for risk management [2] . In this study, 4796 cases of ADEs related to atezolizumab use were analyzed.…”

“…The number of "product usage problems" and "incorrect product management approaches" was 9. There was no relevant description in the MedDRA, which might be because of terminology changes due to the MedDRA biannual updates [2,6] . The ROR method was used to detect the signal strength of ADEs, and five ADEs with strong ADR signals were selected from the top ten composition of sex differences: if the number of adverse drug events in males is χ1 and that in females is χ2, the positive number of adverse drug events in males in the cross table is χ1, and the negative number is total -χ1; the positive number of adverse reaction events in females is χ2, and the negative number is total -χ2.…”

“…Because of its rich content, extensive coverage, and large scale, the FAERS database has an important research value in drug safety evaluation [1] .Atezolizumab is the first clinically approved synthetic immunoglobulin (Ig) G1 monoclonal antibody developed against programmed death-ligand 1 (PD-L1). Because of its favorable safety and efficacy, it was approved by the US FDA in 2016 as a second-line treatment for advanced non-small-cell lung carcinoma (NSCLC) and urothelial bladder cancer [2][3][4] . Fig.…”