Health-Related Quality Of Life In Long-Term Survivors Of Locally Advanced Non-Small Cell Lung Cancer And Clinical Outcomes Of Adenoid Cystic Carcinoma Of Lower Respiratory Tract

Part ?:Clinical features and health-related quality of life in long-term survivors of unresectable locally advanced non-small cell lung cancerObjective:Heath-related quality of life(HRQoL)among survivors with unresectable locally-advanced non-small cell lung cancer(LA-NSCLC)treated with radiotherapy and chemotherapy still is not clear.The current study was performed to determine clinical features and HRQoL for long-term survivors with unresectable LA-NSCLC.Methods:A retrospective study of 505 patients with LA-NSCLC receiving radiotherapy and chemotherapy between January 2006 and December 2010 were conducted.The overall survival(OS)and progression-free survival(PFS)were calculated by the Kaplan-Meier method,and the survival difference and univariate prognostic analyses were performed by the log-rank test.The Cox proportional hazards model was used for multivariate prognostic analysis.The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ)-C30 and the lung cancer-specific questionnaire QLQ-LC13 were employed to gather information on HRQoL.Results:The overall survival rates of all patients at 1,2,and 5 years were 73.2%,44.4%and 17.1%,respectively.Staging and treatment regimens were factors significantly influencing OS in the multivariate analysis(P=0.007,P=0.008).Fifty-five out of 82(67%)long-term survivors completed the HRQoL survey.There were more patients received chemoradiotherapy and complete/partial response in survey completed patients than non-survey completed patients(P=0.006,P=0.039).They reported a mild reduction in global health status and physical and emotional functioning.Fatigue,dyspnea,coughing,and financial difficulties ranked the highest scores in the symptom scales.Conclusion:This study provides the first description of the HRQoL of long-term LA-NSCLC survivors receiving radiotherapy and chemotherapy who may experience mild impairment in functioning and symptoms,but with a relatively high HRQoL.Long-term LA-NSCLC survivors need to be assessed regularly and intervention.Part II:Risk factors of health-related quality of life in long-term survivors of unresectable locally advanced non-small cell lung cancerObjective:To identify risk factors for health-related quality of life(HRQoL)of long-term survivors of unresectable locally advanced non-small cell lung cancer(LA-NSCLC).Methods:Among patients with LA-NSCLC receiving radiotherapy and chemotherapy between January 2006 and December 2010,82 long-term survivors beyond 5 years were identified in this cross-sectional study.The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ)-C30 and the lung cancer-specific questionnaire QLQ-LC13 were employed to gather information on HRQoL.HRQoL scores were compared between different subgroups to analyze factors related to HRQoL by the Mann-Whitney U test or the KrusKal-Wallis test.Results:Fifty-five out of 82(67%)long-term survivors completed the HRQoL survey.In global health status and functional scales,survivors of a younger age(?60 years old),exercise,without comorbidity,and never smoker were significantly associated with more favorable scores for global health status.Likely,those with age(?60 years old),exercise and without comorbidity had better physical,role and social functioning(P<0.05).On the examination of the association between symptom load and the characteristics of survivors,fatigue was significantly negatively affected by weight loss<5%and lack of exercise(P<0.05),while dyspnea was significantly negatively affected by gender:male,with at least one comorbidity,radiation pneumonitis(?grade 2),and age(>60 years old)(P<0.05).HRQoL was not significantly affected by other factors.Conclusion:This study showed exercise,comorbidity,smoking status,weight loss,and radiation pneumonitis were associated with HRQoL of long-term LA-NSCLC survivors.Factors related to poorer HRQoL are potential targets for intervention.Part III:Clinical outcomes and prognostic factors of adenoid cystic carcinoma of lower respiratory tractObjective:To investigate results of treatment of adenoid cystic carcinoma(ACC)of lower respiratory tract and evaluate of prognostic factors.Methods:A retrospective study of 150 primary lower respiratory tract ACC patients,including 69 males and 81 females,with a median age of 46 years,who received surgery with or without postoperative radiotherapy(PORT)or radiotherapy with or without chemotherapy in Cancer Hospital CAMS from 1974 and 2016 was conducted.The overall survival(OS)and progression-free survival(PFS)were calculated by the Kaplan-Meier method,and the survival difference and univariate prognostic analyses were performed by the log-rank test.The Cox proportional hazards model was used for multivariate prognostic analysis.Results:Of 150 patients,the tumor was in trachea in 65.3%(98/150),main bronchi in 18.0%(27/150),lung in 16.7%(25/150).Surgical resection of the primary tumor was carried out for 131 patients and 19 patients were treated with radiotherapy or chemoradiotherapy.OS and PFS rates of all patients at 5 years were 76.7%and 50.3%,respectively,and at 10 years 54.4%and 26.9%,respectively.Over time,utilization of radiation has declined while use of radical surgery has increased.Concomitantly,5 years OS has increased from 1984-1993 era to 2004-2016 era.Patients with surgery were significantly higher OS and PFS than those without surgery(P<0.05).OS and PFS rates of patients treated with surgical resection at 5 years were 81.25 and 54.5%,respectively,and at 10 years 59.21 and 29.62%,respectively.Resection margins were grossly and microscopically positive(R1+R2)in 70(53.4%)and negative(R0)in 61(46.6%).PORT was delivered for 72(55%)patients.The prognostic factors in the univariate analysis for both decreased OS and PFS were performance status(KPS scores<80),and for OS only:positive resection margin,and for PFS only:tumor size ? 4cm.There were significant differences in OS between R0 and R1+R2 resection group(P=0.018).Performance status and tumor size were factors significantly influencing PFS in the multivariate analysis(P=0.017,P=0.036).Conclusion:Survival in patients with primary ACC of lower respiratory tract is improving over time.Surgical resection plays a positive prognostic role and the presence of positive margin after resection should be considered as an adverse prognostic factor.PORT may be considered as postoperative radiotherapy for patients with positive margin.Further randomized clinical trials are needed to confirm the influence of PORT.