Manuscript Information Authors

[1]	Oleg Kshivets, Surgery Department, Clinic N1, Khimki, Moscow, Russia.

Abstract

Objective: The role of phase transitions (PT) in system “non-small cell lung cancer (LC)—human homeostasis” and cell ratio factors (CRF) (ratio between LC cell population: CC and blood cell subpopulations) for 5-year survival (5YS) after lobectomies/pneumonectomies was analyzed. Methods: In trial (1985-2016) the data of consecutive 490 LC patients (LCP) after complete resections R0 (age=56.7±8 years; male - 439, female - 51; tumor diameter: D=4.5±2.1 cm; pneumonectomies - 206, lobectomies - 284, combined procedures with resection of pericardium, atrium, aorta, VCS, carina, diaphragm, esophagus, liver, chest wall, ribs, etc. - 130; squamous cell carcinoma - 308, adenocarcinoma - 147, large cell carcinoma - 35; T1 - 143, T2 - 217, T3 - 107, T4 - 23; N0 - 282, N1 - 115, N2 - 93; G1 - 114, G2 - 140, G3 - 236; early LC: LC till 2 cm in D with N0 - 58, invasive LC - 432) was reviewed. Variables selected for 5YS study were input levels of blood cell subpopulations, TNMG, D. Survival curves were estimated by Kaplan-Meier method. Differences in curves between groups were evaluated using a log-rank test. Neural networks computing, multivariate Cox regression, clustering, discriminant analysis, structural equation modeling, Monte Carlo and bootstrap simulation were used to determine any significant regularity. Results: For total of 490 LCP overall life span (LS) was 1824±1304 days and real 5YS reached 62%, 10 years – 50.3%, 20 years – 45.3%. 304 LCP (LS=2597.3±1037 days) lived more than 5 years without LC progressing. 186 LCP (LS=559.8±383.1 days) died because of LC during first 5 years after surgery. 5YS of early LCP was significantly superior (100%) compared with invasive LCP (56.9%) (P=0.000 by log-rank test). 5YS of LCP with N0 was significantly better (78.4%) compared with LCP with N1-2 (39.9%) (P=0.000). Cox modeling displayed that 5YS significantly depended on: PT in terms of synergetics “early-invasive LC”, PT N0-N12, CRF (P=0.000-0.004). Neural networks computing, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT “early-invasive LC”, (rank=1), PT N0-N12 (2), erythrocytes/CC (3), healthy cells/CC (4), eosinophils/CC (5), lymphocytes/CC (6), monocytes/CC (7), thrombocytes/CC (8), segmented neutrophils/CC (9), leucocytes/CC (10), stab neutrophils/CC (11). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; urea under ROC curve=1.0). Conclusion: 5YS of LCP after radical procedures significantly depended on: 1) PT “early-invasive LC”; 2) PT N0-N12; 3) CRF; 4) LC characteristics.

Keywords

Lung Cancer, Surgery, Survival, Prediction

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