Stuty Of Postoperative Symptoms And Longitudinal Changes In Non-small Cell Lung Cancer

Objective:1.To explore the incidence and longitudinal variation of common symptoms after surgery for early non-small cell lung cancer（NSCLC）,and analyze the influencing factors of common symptoms;2.To investigate the postoperative symptom changes in locally advanced NSCLC patients who received neoadjuvant chemotherapy combined with immunotherapy.Methods:The first part is about patients with early-stage NSCLC,from October 2021to January 2022,200 patients with clinical stage I-II NSCLC who underwent surgical resection were enrolled,and symptom follow-up was performed before and within three months after surgery to describe the incidence and longitudinal changes of common symptoms after early（stage I-II）NSCLC.And the follow-up about symptoms was conducted before and within three months after surgery for patients with clinical stage I-II NSCLC,and the incidence and longitudinal changes of common symptoms after surgery were described.Count the most obvious or uncomfortable symptoms felt by patients at each time point.And analyze the factors influencing cough.The second part is for patients with stage III NSCLC who were operable or have potential surgical opportunities.From October 2021 to October 2022,92patients received 2-4 cycles of chemotherapy combined with immunotherapy,and patients with surgical indications after treatment were treated with surgery.Symptom follow-up is performed before preoperative treatment,during preoperative treatment,1 day before surgery,and 3 months after surgery,and the incidence of symptoms and their longitudinal changes were described.explore the factors influencing common symptoms.At the same time,lung function data before and after treatment were collected,and the effect of chemotherapy combined with immunotherapy on lung function was analyzed.Results:In Part I,the most common symptoms on the first day after surgery for NSCLC included pain（89.24%）,fatigue（45.57%）,shortness of breath（44.94%）,dizziness（34.81%）,and cough（19.62%）.The incidence and severity of symptoms on the third day after the operation changed significantly,and the incidence and severity of cough and constipation increased significantly.Since then,except for the cough,the incidence and severity of all other symptoms have shown a downward trend.The most common symptoms in the first month after surgery were cough（67.72%）,pain（34.18%）,shortness of breath（29.75%）,fatigue（13.29%）,and insomnia（12.66%）.At 3 months postoperatively,the incidence of cough and shortness of breath（dyspnea）was the highest,34.18%and 14.56%,respectively.The pain was the symptom with the highest incidence and most pronounced feeling in the early stage,returning to preoperative levels 2 months after surgery.Cough became the most pronounced symptom from day 5 postoperatively,and NRS scores did not return to preoperative levels by the end of the follow-up.Female（P=0.023,OR:6.832,95%CI:1.306,35.728）and advanced age（>65）（P=0.01,OR:13.526,95%CI:1.358,9.152）were independent risk factors for moderate cough（NRS score≥4）on day 3 postoperative.Gender and surgical method had significant effects on the longitudinal change of NRS score for postoperative cough.In Part II,92 patients with operable or potential surgical opportunities received preoperative chemotherapy combined with immunotherapy.During treatment,26.09%（24/92）of patients developed ir AEs,the most common was skin toxicity,followed by thyroid dysfunction,of which 1 case delayed surgery due to immune-related liver toxicity（Grade 3）.1 patient was assessed for CR after treatment and did not undergo surgical resection.71.74%（66/92）of patients underwent surgical resection,of which 34.85%（23/66）underwent open surgery or converted from minimally invasive to open surgery,and 22.73%（15/66）underwent sleeve resection.One of these patients had R₁ resection,75.76%（50/66）achieved MPR and PCR,of which 37.87%（25/66）were PCR.Patients had more cough（90%）at presentation,and significantly improved after preoperative treatment（P<0.001）.Nausea and vomiting（P<0.001）,loss of appetite（P<0.001）,dry mouth（P=0.003）,diarrhea（P=0.007）were added or worsened after treatment.The most common symptoms on the first postoperative day included pain（90%）,shortness of breath（62.5%）,fatigue（45%）,cough（42.5%）,dry mouth（37.5%）.On the third postoperative day,the incidence and severity of each symptom changed significantly,pain and dry mouth decreased significantly compared with before,and cough,shortness of breath,fatigue worsened and increased.The five symptoms with the highest incidence at three months postoperative were shortness of breath（35%）,cough（27.5%）,fatigue（22.5%）,pain（20%）,and insomnia（20%）.Among the main symptoms in the early postoperative period,pain is still the most serious symptom,the most severe on the first day after surgery,and then reduced,returning to the preoperative level 1.5 months after surgery.Cough is the most important symptom at the time of consultation,which is significantly reduced after preoperative treatment,the incidence and severity of postoperative cough are significantly increased compared with preoperative and return to the preoperative level within 1 week after surgery.Shortness of breath lasts longer after surgery and begins two weeks after surgery and becomes the most obvious symptom.Patients with MPR had a higher dyspnea NRS score than non-MPR patients,but the difference was not significant（P=0.107）.In male patients,the cough score before and 2 weeks after surgery was significantly higher in locally advanced patients than in early patients,and the shortness of breath score was higher than in early patients before and 2 months after surgery.After receiving chemotherapy and immunotherapy,FVC（P<0.001）,FVC%（P=0.001）,FEV1（P<0.001）,FEV1%（P<0.001）,VC（P=0.005）,VC%（P=0.007）increased,while DLco（P=0.009）and DLco%（P=0.004）decreased.Conclusion:The most common symptoms of patients with early-stage NSCLC after surgery were cough,pain,shortness of breath,and fatigue.Cough is the symptom that affects the patient the most and lasts the longest.Female and elderly age（>65）were independent risk factors for moderate cough on the third day after surgery,and sex and surgical modality（lobectomy and segmentectomy）influenced the change of postoperative cough NRS score.The most common postoperative symptoms of locally advanced NSCLC patients treated with neoadjuvant chemotherapy combined with ICIs were shortness of breath,pain,cough,and fatigue.Shortness of breath is the symptom that affects patients the most and lasts the longest after surgery.Preoperative treatment improves pulmonary ventilation but interferes with diffusion.