Background: 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).
Aim: precise prediction of 5-year survival of local advanced non-small cell lung cancer patients (T3-4N0-2M0).
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.