Postoperative adjuvant therapy for resectable early non-small cell lung cancer: A protocol for a systematic review and meta-analysis

Postoperative tumor treatment strategies: From basic research to clinical therapy

Despite progression in advanced treatments for malignant tumors, surgery remains the primary treatment intervention, which removes a large portion of firm tumor tissues; however, the postoperative phase poses a possible risk for provincial tumor recurrence and metastasis. Consequently, the prevention of tumor recurrence and metastasis has attracted research attention. In this review, we summarized the postoperative treatment strategies for various tumors from both basic research and clinical perspectives. We delineated the underlying factors contributing to the recurrence of malignant tumors with a substantial prevalence rate, related molecular mechanisms of tumor recurrence post‐surgery, and related means of monitoring recurrence and metastasis after surgery. Furthermore, we described relevant therapeutic approaches for postoperative tumor recurrence, including chemotherapy, radiation therapy, immunotherapy, targeted therapy, and photodynamic therapy. This review focused on the emerging technologies used for postoperative tumor treatment in recent years in terms of functional classification, including the prevention of postoperative tumor recurrence, functional reconstruction, and monitoring of recurrence. Finally, we discussed the future development and deficiencies of postoperative tumor therapy. To understand postoperative treatment strategies for tumors from clinical treatment and basic research and further guide the research directions for postoperative tumors.

Prognostic value of PD-1, PD-L1 and P53 in patients with non-small cell lung cancer after postoperative adjuvant chemoradiotherapy

OBJECTIVE

To explore the value of programmed cell death protein 1 (PD-1), programmed cell death ligand 1 (PD-L1) and protein 53 (P53) in estimating the prognosis of patients with non-small cell lung cancer (NSCLC) after postoperative adjuvant chemoradiotherapy.

METHODS

The clinical data of 100 patients with NSCLC who were treated with adjuvant chemoradiotherapy after pulmonary lobectomy in our hospital were retrospectively analyzed. The expression levels of PD-1, PD-L1 and P53 in tumor tissues were detected by immumohistochemical staining. The efficacy of chemoradiotherapy and survival time between patients with positive and negative expression of PD-1, PD-L1 and P53 were compared respectively to evaluate the correlation of PD-1, PD-L1 and P53 with chemoradiotherapy results in NSCLC. General data of patients were analyzed by single factor analysis. Multivariate logistic regression analysis was used to identify independent risk factors impacting the prognosis of NSCLC patients with postoperative adjuvant chemoradiotherapy.

RESULTS

A significantly lower chemoradiotherapy effective rate and a remarkably shorter survival time were found in NSCLC patients with positive expression levels of PD-1, PD-L1 and P53 in tumor tissues as compared with those of negative results (all P<0.05). Single factor analysis revealed that gender, age, history of smoking, histological type, degree of differentiation, T stage, lymph node metastasis, expression levels of PD-1, PD-L1 and P53 showed significant correlations with the prognosis of NSCLC patients with postoperative adjuvant chemoradiotherapy (all P<0.05). High T stage (odds ratio (OR)=7.269), history of smoking (OR=5.128), lymph node metastasis (OR=4.647), PD-1 (+) (OR=7.556), PD-L1 (+) (OR=6.674), P53 (+) (OR=9.070), PD-1 (+) PD-L1 (+) (OR=6.095), PD-1 (+) P53 (+) (OR=6.752), PD-L1 (+) P53 (+) (OR=7.363), and PD-1 (+) PD-L1 (+) P53 (+) (OR=8.524) were determined by multiple logistic regression analysis to be independent risk factors influencing the effect of postoperative adjuvant chemoradiotherapy in NSCLC patients.

CONCLUSION

There are numerous risk factors affecting the effect of postoperative adjuvant chemoradiotherapy in NSCLC patients, of which NSCLC patients with positive expression of PD-1, PD-L1 and P53 had a worse prognosis than those with negative results. PD-1, PD-L1 and P53 can serve as effective prognostic indicators for NSCLC after chemoradiotherapy. In clinical practice, monitoring these three indicators contributes to the adjustment of therapeutic regimen and gives some guidance.

PD-L1 expression correlation with metabolic parameters of FDG PET/CT and clinicopathological characteristics in non-small cell lung cancer

BACKGROUND

Immunotherapy targeting programmed cell death 1 (PD-1) or its ligand 1 (PD-L1) has shown promising results in non-small cell lung cancer (NSCLC) patients. Exploring PD-L1 expression could help to select NSCLC candidates for immunotherapy. Fluorine-18 fluorodeoxyglucose (FDG) PET/CT could provide phenotypic information on malignant tumors. Thus, this study investigated PD-L1 expression correlation with metabolic parameters of FDG PET/CT and clinicopathological characteristics in NSCLC.

METHODS

FDG PET/CT metabolic parameters including maximum standard uptake (SUVmax), metabolic tumor volume and total lesion glycolysis of primary lesion (MTV-P, TLG-P), and combination of primary lesion and metastases (MTV-C, TLG-C) were compared with PD-L1-positive expression in patients with NSCLC. Moreover, clinicopathological characteristics, including age, gender, smoking history, serum tumor markers, tumor location, size, TNM stage, and genetic mutation were also reviewed.

RESULTS

All 374 patients (215 men; 159 women; age 63 ± 9 years) included 283 adenocarcinomas (ACs) and 91 squamous cell carcinomas (SCCs). PD-L1 expression was positive in 27.8% (104/374) cases. SUVmax, TLG-P, and TLG-C of PD-L1 positivity were significantly higher than PD-L1 negativity. Moreover, PD-L1 expression was obviously correlated with man, smoking, and central NSCLC. If ACs and SCCs were separately analyzed, PD-L1 positivity in ACs and SCCs was 21.6% (61/283) and 47.5% (43/91), respectively, and only SUVmax was obviously associated with PD-L1 expression. Furthermore, multivariate analysis revealed that only SUVmax was an independent predictor of PD-L1 positive expression in overall NSCLC, AC, and SCC. Using a SUVmax cut-off value of 12.5, PD-L1 status of NSCLC was predicted by FDG PET/CT with sensitivity, specificity, and accuracy of 65.4%, 86.7%, and 80.7%, respectively.

CONCLUSIONS

PD-L1 expression of NSCLC was related to SUVmax, TLG, man, smoking, and central location. However, only SUVmax was an independent predictor of PD-L1 positivity, which could help to explore the existence of immune checkpoints.

Research on Current Curative Expenditure among Lung Cancer Patients Based on the "System of Health Accounts 2011": Insights into Influencing Factors

PURPOSE

To investigate the total current curative expenditure (CCE) of lung cancer in Hunan Province, China under the framework of the System of Health Accounts 2011 (SHA 2011) and explore the effect of insurance status, surgery and length of stay on the hospitalization expenses of patients with lung cancer.

METHODS

Through multistage stratified cluster random sampling, a total of 46,214 patients with lung cancer were enrolled from 1,072 medical institutions in Hunan Province in 2016. Under the SHA 2011 framework, the lung cancer CCE was analyzed. The relationships between hospitalization expenditure and the following factors (surgery, type of hospital, insurance status, length of stay, institution level, age and sex) were analyzed using Spearman's correlation analyses, and how these factors influenced hospital expenditure was explored through multiple stepwise regression analysis and structural equation modelling.

RESULTS

The CCE for lung cancer patients was 8063.75 million CNY. In total, 96.03% of the CCE for lung cancer occurred in hospitals and 58.88% of the expenditure flowed to general hospitals. The highest expenditures were incurred in the group aged 55-74 y, which accounted for 61.58% of the CCE. Drugs accounted for the greatest share expenditure to lung cancer patients at 34.31% of the CCE. Surgery, insurance status, institution level, sex and hospital type explained 57.5% of the variance in hospital expenses. The hospitalization expenses were related to surgery, insurance status, institution level and sex (rs = 0.033-0.688, p < 0.001). Surgery, insurance status and length of stay had direct effects on hospitalization expenses. Length of stay mediated the relationship between surgery and hospitalization expenses for lung cancer patients. Surgery mediated the relationship between insurance status and hospitalization expenses. All of these variables can explain 45% of the variance in hospitalization expenses.

CONCLUSIONS

The CCE of lung cancer is extremely high. The problems related to treatment efficiency and equity are serious for lung cancer patients in China. It is essential to expand health insurance coverage and reduce the curative expenditure of lung cancer.