Survival benefit of adjuvant chemotherapy after resection of Stage I lung adenocarcinoma containing micropapillary components

BACKGROUND

The usefulness of postoperative adjuvant chemotherapy (ACT) for patients with stage I lung adenocarcinoma with micropapillary (MIP) components remains unclear. We analyzed whether postoperative ACT could reduce recurrence in patients with stage I lung adenocarcinoma with MIP components, thereby improving their overall survival (OS) and disease-free survival (DFS).

METHODS

Data for patients with pathologically confirmed stage I lung adenocarcinoma with MIP components from January 2012 to December 2018 were retrospectively analyzed. OS and DFS were analyzed in groups and subgroups.

RESULTS

Overall, 259 patients were enrolled. Patients who received ACT in stage IA showed significantly better survival than did those with no-adjuvant chemotherapy (NACT); (5-year OS 89.4% vs. 73.6%, p < 0.001; 5-year DFS 87.2% vs. 66.0%, p = 0.008). A difference was also observed for in-stage IB patients (5-year OS 82.0% vs. 51.8%, p = 0.001; 5-year DFS 76.0% vs. 41.11 %, p = 0.004). In subgroup analysis based on the proportion of MIP components, patients with 1%-5% MIP components had a significantly better prognosis in the ACT group than in the NACT group (5-year OS 82.4% vs. 66.0%, p = 0.005; 5-year DFS 76.5% vs. 49.1%, p = 0.032). A similar difference was observed for patients with MIP ≥5% (5-year OS 80.7% vs. 47.8%, p = 0.009; 5-year DFS 73.11% vs. 43.5%, p = 0.007).

CONCLUSION

Among patients with stage I lung adenocarcinoma with MIP components, those who received ACT showed significant survival benefits compared to those without ACT. Patients with lung adenocarcinoma with MIP components could benefit from ACT when the MIP was ≥1%.

Clinical application of intubation-free anesthesia in radical resection of lung cancer

Background

In recent years, video-assisted thoracic surgery (VATS) has become increasingly widespread. However, the implementation of VATS requires the assistance with lung isolation techniques. Spontaneous breathing with laryngeal masks is also increasingly used in VATS. However, evidence on the characteristics of intubated anesthesia is insufficient.

Objective

This study aimed to explore whether intubation-free anesthesia has more advantages than other intubation methods in the clinical setting.

Methods

Patients with lung tumors who underwent VATS in our hospital between June 2022 and October 2022 were included in the study. Perioperative data of patients, including basic information, intraoperative hemodynamic changes, postoperative inflammatory indicators, and adverse reactions were obtained through the electronic medical record system. According to the protocol of airway management during anesthesia, participants were divided into the following groups: laryngeal mask with spontaneous breathing group (LMSB group), laryngeal mask combined with bronchial blocker group (LM + BB group), double-lumen tube group (DLT group), and tracheal tube combined with bronchial blocker group (TT + BB group). All data were analyzed using SPSS 25.0 software.

Results

At baseline, patients in the LMSB and LM + BB groups had a lower body weight (P = 0.024). Systolic blood pressure (SBP), diastolic BP (DBP), and heart rate (HR) were significantly higher in the DLT group than in the non-intubated group during surgery (SBP: T1 P = 0.048, T4 P = 0.021, T5 P ≤ 0.001, T6 P ≤ 0.001, T7 P = 0.004; DBP: T5 P ≤ 0.001, T6 P ≤ 0.001, T7 P ≤ 0.001; HR: T1 P = 0.021, T6 P ≤ 0.001, T7 P = 0.007, T8 P ≤ 0.001). The input fluid (P = 0.009), urine output (P = 0.010), surgery duration (P = 0.035), and procalcitonin levels (P = 0.024) of the DLT group were also significantly higher than those of the other groups. The recovery duration of the LMSB group was significantly longer (P = 0.003) and the incidence of postoperative adverse reactions, mainly atelectasis, was higher (P = 0.012) than those of the other groups.

Conclusion

Although the intubation-free anesthesia has less stimulation during operation and less postoperative inflammatory response, it has obvious adverse reactions after operation, which may be not the best anesthesia scheme for radical resection of lung cancer in VATS.

Clinical trial registration

https://www.chictr.org.cn/showproj.html?proj=182767, identifier ChiCTR2200066180.

Effects of Osimertinib Combined With Pulmonary Rehabilitation and Health Care Training on Pulmonary Function, Complications, and Quality of Life in Patients After Radical Resection of Lung Cancer

Objective

To explore the effects of osimertinib combined with pulmonary rehabilitation and health care training on pulmonary function, complications, and the quality of life (QOL) in patients after radical resection of lung cancer.

Methods

The data of 120 patients with radical resection of lung cancer admitted to The First Affiliated Hospital of Zhengzhou University from February 2020 to February 2021 were retrospectively analyzed. According to the order of admission, they were equally divided into group p and group q. All patients were given pulmonary rehabilitation and health care training, and group p was treated with osimertinib, while group q received the treatment of pemetrexed combined with cisplatin. The pulmonary function, the incidence of complications, and QOL between the two groups were compared.

Results

Compared with group q, the pulmonary function was higher (P < 0.001), the incidence of complications was significantly lower (P < 0.05), and QOL scores were markedly higher in group p after treatment (P < 0.001).

Conclusion

The combination of osimertinib and pulmonary rehabilitation and health care training can improve the pulmonary function of patients with non-small cell lung cancer (NSCLC) with radical resection of lung cancer, and reduce their postoperative morbidity, thereby improving their QOL, which is conducive to reducing the patient's and society's medical burden.

Lower Background Infusion of Oxycodone for Patient-Controlled Intravenous Analgesia, Combined with Ropivacaine Intercostal Nerve Block, in Patients Undergoing Thoracoscopic Lobectomy for Lung Cancer: A Randomized, Double-Blind, Controlled Clinical Trial

Purpose

To compare the efficacy of a lower dose background infusion of oxycodone for patient-controlled intravenous analgesia (PCIA) with the conventional dose, following intercostal nerve block, for the management of postoperative pain in patients undergoing thoracoscopic lobectomy for lung cancer.

Patients and Methods

This was a prospective, single-center, randomized, parallel-group, double-blind, controlled clinical trial. In total, 155 patients scheduled for elective radical lobectomy via video-assisted thoracoscopy were recruited from December 2018 to July 2019, of whom 140 were ultimately included in the study population. Patients were randomized to receive either oxycodone 0.25 mg/h (low-dose group, n=70) or oxycodone 0.5 mg/h (control group, n=70) as a background infusion for PCIA, following ropivacaine intercostal nerve block, for postoperative pain management. The primary endpoints were rest and dynamic visual analogue scale (VAS) scores within 72 h of the operation. The secondary endpoints were patient satisfaction scores, consumption of postoperative analgesics, times of patient-controlled analgesia (PCA), and adverse events.

Results

All 140 enrolled patients completed the study requirements and were included in the final analysis. The rest and dynamic VAS scores at 4 h, 24 h, 48 h, and 72 h postoperative were comparable between the low-dose group and the control group (P>0.05). However, the low-dose group had statistically significantly higher patient satisfaction scores (P<0.001) and lower postoperative analgesic consumption (P<0.001) as well as lower incidence of nausea and vomiting (P<0.05). The times of PCA was not statistically significantly different between the two groups, and no serious adverse events occurred in either group (P>0.05).

Conclusion

A low-dose background infusion of oxycodone for postoperative PCIA can achieve a comparable analgesic effect to the conventional dose after thoracoscopic lobectomy for lung cancer. Furthermore, the low-dose regimen was associated with reduced consumption of oxycodone and increased patient satisfaction.

A case report of right upper lung adenosquamous carcinoma resection following neoadjuvant targeted therapy

The patient was a middle-aged male smoker who had space-occupying lesions in the right upper lung, Positron emission tomography-computed tomography (PET-CT) suggested right upper lung cancer with multiple mediastinal lymph node metastases. Endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-GS-TBLB) performed in the bronchus of the right apical segment confirmed the lesion as squamous cell carcinoma. Neoadjuvant therapy was planned. Because genetic testing revealed the epidermal growth factor receptor (EGFR) L858R mutation, the possibility of adenosquamous carcinoma was considered. The patient was clinically diagnosed with right upper lung squamous cell carcinoma c-T3N2M0, stage IIIB, and PS 1 point. Dacomitinib was selected for the targeted therapy. Eight weeks after the initiation of treatment, efficacy was assessed as a partial response (PR), suggesting a possibility of R0 resection. After sufficient communication with the patient and his family members, on July 1, 2020, thoracoscopic radical resection of the right upper lung cancer was performed under general anesthesia. Postoperative pathology confirmed adenosquamous carcinoma, of which 80% were adenocarcinoma and 20% were squamous cell carcinoma; no tumor thrombus was seen in the interstitial vessels; and the tumor did not invade the visceral pleura. There was no cancerous infiltration in the bronchial stump of the right upper lung. The following were the results for lymph nodes submitted for examination: L2 (0/1), L4 (0/4), L7 (0/3), L8 (0/7), L10 (0/1), L11 (0/2) and L11 (frozen 0/1) showed no cancer metastasis. The postoperative diagnosis was as follows: adenosquamous carcinoma of the right upper lung p-T2N0M0, stage Ib. After surgery, 4 cycles of the GC (gemcitabine + carboplatin) chemotherapy regimen were given, with continued targeted therapy recommended for 2 years. The patient has been followed-up and is in good condition.

The Effect of Lidocaine on Postoperative Quality of Recovery and Lung Protection of Patients Undergoing Thoracoscopic Radical Resection of Lung Cancer

Purpose

To evaluate the effectiveness and safety of lidocaine on postoperative quality of recovery and lung protection of patients undergoing thoracoscopic radical resection of lung cancer.

Patients and Methods

Seventy ASA II–III patients undergoing thoracoscopic radical resection of lung cancer were randomly assigned into either the lidocaine group (Group L) or control group (Group C). Patients in Group L received lidocaine with a 1.5 mg/kg bolus before induction of anesthesia, followed by 2.0 mg/kg/h until the end of the operation while the patients in Group C received volume-matched normal saline at the same rate. The main outcome was the quality of recovery-40 score (QoR-40 score) at 24 h postoperatively. The peak airway pressure (Ppeak) and plateau airway pressure (Pplat), the partial pressure of oxygen in arterial blood (PaO₂), partial pressure of carbon dioxide in arterial blood (PaCO₂), alveolar-arterial oxygen gradient (A-aDO2), oxygenation index (OI), time to first flatus and defecation, intraoperative hemodynamics and opioid consumption were also recorded.

Results

There were no statistically difference at patients’ baseline characteristics. The QoR-40 score of Group L was significantly higher than that of Group C at 24 h after surgery (P=0.014). Ppeak, Pplat, and A-aDO₂ of Group L were significantly lower than those of Group C (P<0.001, P<0.001, P=0.025, respectively) after the ventilation recovery of both lungs, and the PaO₂ and OI of the Group L were significantly higher than those of Group C (P=0.027, P=0.027, respectively). Time to first flatus and defecation in Group L was significantly lower compared with Group C (P=0.037, P=0.025, respectively).

Conclusion

Intravenous lidocaine can improve the quality of recovery of patients undergoing thoracoscopic radical resection of lung cancer, while also providing lung protection, favorable postoperative analgesia, a reduction in the time to first flatus and defecation after surgery.

Effect of dexmedetomidine on perioperative inflammation and lung protection in elderly patients undergoing radical resection of lung cancer

OBJECTIVE

To investigate the effects of dexmedetomidine on perioperative inflammation and lung protection in elderly patients undergoing thoracoscopic radical resection of lung cancer.

METHODS

A total of 116 elderly patients undergoing elective radical resection of lung cancer in the Second Affiliate Hospital of Soochow University were selected and divided into two groups by random number table method, 58 cases in each group. Observation group was given 1 μg/kg loading dose of dexmedetomidine by continuously intravenous pump for 10 min before anesthesia induction, which was maintained at a rate of 0.3 μg/(kg·h) until 20 min before the end of operation. Control group was given equal volume of normal saline. Heart rate, mean arterial pressure, and alveolar-arterial oxygen pressure difference (P(A-a)O₂) were measured and recorded respectively at before anesthesia induction (T0), immediately after endotracheal intubation (T1), 1 h after one-lung ventilation (T2) and 10 min before the end of operation (T3).

RESULTS

Compared with control group, heart rate, P(A-a)O₂, interleukin-6, interleukin-8 and malondialdehyde levels at T1-T3 in observation group were significantly lower; the superoxide dismutase level was significantly higher (all P<0.05), and alveolar damage index of quantitative assessment and apoptotic index at T3 in observation group were significantly lower (P<0.05). The incidence of postoperative pulmonary complications was 3.4% in observation group and 25.8% in control group (P<0.05). The postoperative awake and spontaneous breathing recovery time in the observation group was significantly shorter compared with control group (P<0.05). There was no significant difference in mean arterial pressure at each time point between the two groups (P>0.05).

CONCLUSION

Dexmedetomidine can reduce inflammatory response and oxidative stress response in elderly patients undergoing radical resection of lung cancer, and reduce the occurrence of postoperative pulmonary complications, thus playing a role in lung protection.

Intercellular adhesion molecule-1 and S-100β in sevoflurane combined with epidural anesthesia for radical resection of lung cancer

Significance of intercellular adhesion molecule-1 (ICAM-1) and S-100β protein (S-100β) were investigated in sevoflurane combined with epidural anesthesia for radical resection of lung cancer. In total, 172 patients who underwent radical resection of lung cancer from May 2014 to January 2016 and 160 blood samples from healthy patients in the same period were selected for prospective analysis. Lung cancer patients were the therapy group (TG). Venous blood (2 ml) was taken from patients before anesthesia (T1) and after anesthesia at 30 min (T2), 3 h (T3) and 24 h (T4), respectively. Healthy physical examination samples were the control group (CG). Enzyme linked immunosorbent assay (ELISA) was used to detect the concentration of ICAM-1 and RT-PCR to detect the concentration of S-100β. The changes of ICAM-1 and S-100β concentrations and their significance to patients were analyzed. The serum ICAM-1 and S-100β concentrations in TG were significantly higher than those in CG (P<0.001), and were the highest at T1 (P>0.001), followed by T2 (P<0.001). Of the 172 patients 27 cases had adverse complications during the perioperative period. Patients were divided into the ICAM-1 high concentration group (CHCG), the ICAM-1 low concentration group (CLCG) and the S-100β high concentration group (SHCG) and the S-100β low concentration group (SLCG). The 3-year survival rate of CHCG was significantly lower than CLCG and SLCG (P<0.001). ICAM-1 and S-100β protein in sevoflurane combined with epidural anesthesia for radical resection of lung cancer can effectively predict the perioperative adverse complications of patients, and have better monitoring significance for the prognosis of patients.

Effects of different doses of cisatracurium besilate on hemodynamics and postoperative cognitive function in patients undergoing radical resection of lung cancer

The effects of different doses of cisatracurium besilate on perioperative hemodynamics and early postoperative cognitive function in patients undergoing radical resection of lung cancer were investigated. One hundred and thirty-six patients who underwent radical resection of lung cancer from June 2013 to June 2016 in Dongying People's Hospital were retrospectively analyzed. Patients who were not given atracurium were selected as the control group (n=35). According to the different anesthetic doses, patients in the experimental group were separated into low dose (0.15 mg/kg cisatracurium besilate) group (LD group, n=34), medium dose (0.2 mg/kg cisatracurium besilate) group (MD group, n=36) and high dose (0.3 mg/kg cisatracurium besilate) group (HD group, n=31). The mean arterial pressure and heart rate (HR) were recorded before induction of anesthesia (T0), at the time of entering pleural cavity (T1), at the end of surgery (T2), and 1 day after surgery (T3). The Mini-Mental State Examination (MMSE) was used to evaluate the postoperative cognitive function scores of the 4 groups 1 day before operation and on the 1st, 3rd and 7th day after surgery. The agitation of patients at 6 and 12 h after operation was evaluated by Ramsay sedation score. There was no significant difference in arterial pressure among the four groups at T2 and T3 (P>0.05). There was no significant difference in terms of MMSE among the four groups 1 day before operation, 3 days after operation and 7 days after operation, but the MMSE score of the control group was significantly lower than that of the LD, MD and HD groups 1 day after surgery (P<0.05). Therefore, cisatracurium besilate can stabilize hemodynamics during radical operation of lung cancer and reduce the incidence of postoperative cognitive dysfunction, and it has no close association with the dose.

Effect of anesthetic methods on postoperative CD3+, CD4+ and CD4+CD25+ in patients with lung cancer undergoing radical operation

Effects of anesthesia methods on immune function in patients with lung cancer undergoing radical operation were investigated. A total of 122 patients undergoing radical resection of lung cancer who were treated in Zhejiang Cancer Hospital from September 2013 to April 2016 were randomly divided into the combined anesthesia group and the intravenous anesthesia group, with 61 cases in each group. The patients in the combined anesthesia group were given intravenous combined epidural anesthesia. Patients in the intravenous anesthesia group were given intravenous anesthesia. The change of CD3⁺, CD4⁺ and CD4⁺CD25⁺ at time-point T0 (before anesthesia), T1 (the time of anesthesia), T2 (after operation), T3 (24 h after operation), T4 (72 h after operation) were compared between the two groups. The levels of CD3⁺, CD4⁺ and CD4⁺CD25⁺ at T1, T2, T3 and T4 in the combined anesthesia group were higher than that in the intravenous anesthesia group (P<0.05). Αfter starting anesthesia, the levels of CD3⁺, CD4⁺ and CD4⁺CD25⁺ began to decrease in both groups. The levels of CD3⁺, CD4⁺ and CD4⁺CD25⁺ at T2 and T1 were lower than those at T0 (P<0.05). The levels of CD3⁺, CD4⁺ and CD4⁺CD25⁺ at T2 were lower than T1 (P<0.05). After T3, the levels of CD3⁺, CD4⁺ and CD4⁺CD25⁺ began to increase in both groups. Τhe levels of CD3⁺, CD4⁺ and CD4⁺CD25⁺ at T3 and T4 were higher in both groups than those at T2 and T1 (P<0.05), and the levels of CD3⁺, CD4⁺ and CD4⁺CD25⁺ at T4 were higher in both groups than those at T3, but the levels of CD3⁺, CD4⁺ and CD4⁺CD25⁺ at T3 and T4 were lower than those at T0 (P<0.05). Intravenous combined epidural anesthesia can maintain a relatively stable immune function compared with simple intravenous anesthesia patients.

[Protective effect of dexmedetomidine against perioperative inflammation and on pulmonary function in patients undergoing radical resection of lung cancer]

OBJECTIVE

To study the protective effect of dexmedetomidine against perioperative inflammation and on pulmonary function in patients undergoing radical resection of lung cancer.

METHODS

From May, 2014 to May, 2016, 124 patients with lung cancer receiving radical surgeries were randomized into experimental group (n=62) and control group (n=62). The patients in the control group received a single anesthetic agent for anesthesia, and additional dexmedetomidine was given in the experimental group. The levels of serum interleukin-1β (IL-1β), IL-10, and tumor necrosis factor-alpha (TNF-α) were measured before the operation (T₀), at 30 min (T₁) and 60 min (T₂) during one lung ventilation (OLV) and at the end of operation (T₃). Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of malondialdehyde (MDA), myeloperoxidase (MPO) and xanthine oxidase (XOD), and the arterial oxygen partial pressure (PaO₂), oxygenation index (OI), airway plateau pressure (APP) and airway resistance (AR) were also recorded.

RESULTS

At the time points of T₁ and T₂, IL-1β, IL-10, MDA, MPO, TNF-α, and XOD levels were significantly increased in both of the groups, but the levels of IL-1, IL-10, TNF-α and MDA were significantly lower and MPO and XOD levels significantly higher in the experimental group than in the control group (P<0.05). In both groups, PaO₂ and OI decreased and APP and AR increased significantly at T₁ and T₂, but APP and AR were significantly lower and PaO₂ and OI significantly higher in the experimental group than in the control group (P<0.05).

CONCLUSION

Anesthesia with dexmedetomidine in lung cancer patients undergoing radical surgery can effectively reduce the inflammatory response of the lungs and protect the lung function of the patients.

Effect of preemptive analgesia with parecoxib sodium in patients undergoing radical resection of lung cancer

OBJECTIVE

To discuss the effect of preemptive analgesia with parecoxib sodium in patients undergoing radical resection of lung cancer.

METHODS

115 cases of lung cancer patients with American society of anesthesiologists class (ASA) grade I~II who received selective operation were randomly divided into the research group and the control group. The research group patients were given preoperative parecoxib sodium 40 mg plus postoperative normal saline 2 ml, while the control group patients were treated with preoperative normal saline 2 ml plus postoperative parecoxib sodium 40 mg. The pain condition at postoperative 1, 2, 4, 8, 12, 24 and 48 h were evaluated by visual analogue scale (VAS), and emergence agitation was tested by agitation score.

RESULTS

Finally there were 56 cases and 57 cases can be used for evaluation in the research group and control group. The VAS scores after 1, 2, 4, 8, 12, 24 and 48 h in the research group and control group were [2.23±0.45, 2.35±0.48, 2.51±0.51, 2.41±0.45, 2.28±0.42, 2.16±0.39, 2.11±0.40] and [3.80±0.62, 4.01±0.64, 4.31±0.67, 4.10±0.64, 3.65±0.70, 3.12±0.66, 2.46±0.53], respectively. The research group were obviously lower than the control group, the difference were statistically significant (P<0.05). The rate of agitation was 24.44% (11/56) in the research group, significantly lower than the control group of 59.65% (34/57) (P<0.05).

CONCLUSION

Preemptive analgesia with parecoxib sodium can obviously relieve acute pain using in patients undergoing radical resection of lung cancer, and is helpful to reduce the incidence of emergence agitation.