| BACKGROUND:Primary bronchial lung cancer,a unable difficulty to overcome currently,is one of the most common malignant tumor in the world.Its high incidence and mortality caused extensive concern of the global health community.In our country,the development of lung cancer is also showing a rising trend,and the morbidity and mortality are listed as the first in all kinds of malignant tumors.Non-small cell lung cancer(non-small cell lung cancer,NSCLC),as the main type of lung cancer,accounts for eighty-five percent of the total number.Over the last few years,with the rapid development of science and technology and molecular biology research,great changes have taken place in the diagnosis and treatment of lung cancer.However.T N M staging system still plays indispensable role in the diagnosis,clinical decision-making and prognostic judgement of non-small cell lung cancer.In the eighth edition implemented On January 1,2017,part or whole obstructive pneumonia or atelectasis is due to T2 stage,and the T2 and T3 tumor size boundary have also changed from the 7 cm to 5 cm.We conducted this retrospective study to search prognostic effect of preoperative obstructive pneumonitis or atelectasis and its possible mechanism.What's more,we also compared the prognostic value of preoperative obstructive pneumonitis or atelectasis with tumor size to testify the rationality of the division in the eighth T N M staging system.METHODS:We collected clinical characteristics,preoperative hematological indicators,follow-up information of 1177 non-small cell lung cancer patients receiving lung cancer surgery in Shandong Provincial hospital between January,2006 and December,2011,including age,gender,pathological TNM stage,histology,tumor location,tumor size,tumor differentiation degree,presence of obstructive pneumonitis/atelectasis,neutrophil count,lymphocyte count,platelet count,monocyte count,ESR,overall survival(OS),recurrence-free survival(RFS).Chi-square test was used to search relationship between preoperative obstruction pneumonitis or atelectasis and other clinopathological factors including hematological indicators.Kaplan-Meier curves and cox regression methods were used for survival analysis of preoperative obstruction pneumonitis or atelectasis.RESULTS:Preoperative obstructive pneumonitis or atelectasis indicated shorter OS(overall survival,HR:1.308;95%CI:1.058-1.619)and RFS(recurrence free survival,HR:1.276;95%CI:1.032-1.579)as an independent factor for non-small cell lung cancer.In comparison with tumor size,we found patients with preoperative obstructive pneumonitis or atelectasis and T1(size<3cm)size tumor had more similar prognosis to those with T2(3cm<size<5cm)size but without preoperative obstructive pneumonitis or atelectasis,and OS,RFS of patients with preoperative obstructive pneumonitis or atelectasis and T2 size were shorter than patients with T2 size and without preoperative obstructive pneumonitis or atelectasis,but similar to patients with T3(5cm<size<7cm)tumor size but without preoperative obstructive pneumonitis or atelectasis according to division by the eighth edition of lung cancer T N M system.We also found preoperative obstructive pneumonitis or atelectasis was significantly related to higher neutrophil(p<0.001),platelet(p<0.001),monocyte(p<0.001),neutrophil lymphocyte ratio(NLR,p<0.001),platelet lymphocyte ratio(PLR,p=0.002),erythrocyte sedimentation rate(ESR,p<0.001)and lower lymphocyte monocyte ratio(LMR,p<0.001).CONCLUSIONS:Preoperative obstructive pneumonitis or atelectasis predicted poor survival independently in operable non-small cell lung cancer.The poor effect may be related to abnormal change of neutrophil,platelet,or monocyte numbers.And we suggested which T staging group the patients with obstructive pneumonitis or atelectasis would be divided to should take the tumor size into consideration in the lung cancer T N M staging system. |
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