Kshivets O. Lung Cancer Surgery: Synergetics and Prediction

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SIGNIFICANT IMPACT OF PHASE TRANSITIONS AND CELL RATIO FACTORS FOR 5-YEAR SURVIVAL OF NON SMALL CELL LUNG CANCER PATIENTS AFTER SURGERY

Transcript of Kshivets O. Lung Cancer Surgery: Synergetics and Prediction

  • SIGNIFICANT IMPACT OF PHASE TRANSITIONS AND CELL RATIO FACTORS FOR 5-YEAR SURVIVAL OF NON SMALL
    CELL LUNG CANCER PATIENTS AFTER SURGERY

    Oleg Kshivets, MD, PhD

    Surgery Department, Siauliai Public Hospital, Lithuania

  • Abstract: N181

    SIGNIFICANT IMPACT OF PHASE TRANSITIONS AND CELL RATIO FACTORS FOR 5-YEAR SURVIVAL OF NON SMALL CELL LUNG CANCER PATIENTS AFTER RADICAL LOBECTOMIES AND PNEUMONECTOMIESOleg KshivetsSurgery Department, Siauliai Public Hospital, Siauliai, LithuaniaOBJECTIVE: The role of phase transitions (PT) in system non-small cell lung cancer (LC)human homeostasis and cell ratio factors (CRF) (ratio between LC cell population: CC and blood cell subpopulations) for 5-year survival (5YS) after lobectomies/pneumonectomies was analyzed.METHODS: In trial (1985-2009) the data of consecutive 490 LC patients (LCP) after complete resections R0 (age=56.78 years; male - 439, female - 51; tumor diameter: D=4.52.1 cm; pneumonectomies - 206, lobectomies - 284, combined procedures with resection of pericardium, atrium, aorta, VCS, carina, diaphragm, esophagus, liver, chest wall, ribs, etc. - 130; squamous cell carcinoma - 308, adenocarcinoma - 147, large cell carcinoma - 35; T1 - 143, T2 - 217, T3 - 107, T4 - 23; N0 - 282, N1 - 115, N2 - 93; G1 - 114, G2 - 140, G3 - 236; early LC: LC till 2 cm in D with N0 - 58, invasive LC - 432) was reviewed. Variables selected for 5YS study were input levels of blood cell subpopulations, TNMG, D. Survival curves were estimated by Kaplan-Meier method. Differences in curves between groups were evaluated using a log-rank test. Neural networks computing, multivariate Cox regression, clustering, discriminant analysis, structural equation modeling, Monte Carlo and bootstrap simulation were used to determine any significant regularity. RESULTS: For total of 490 LCP overall life span (LS) was 18241304 days and real 5YS reached 62%, 10 years 50.3%, 20 years 45.3%. 304 LCP (LS=2597.31037 days) lived more than 5 years without LC progressing. 186 LCP (LS=559.8383.1 days) died because of LC during first 5 years after surgery. 5YS of early LCP was significantly superior (100%) compared with invasive LCP (56.9%) (P=0.000 by log-rank test). 5YS of LCP with N0 was significantly better (78.4%) compared with LCP with N1-2 (39.9%) (P=0.000). Cox modeling displayed that 5YS significantly depended on: PT in terms of synergetics early-invasive LC, PT N0-N12, CRF (P=0.000-0.004). Neural networks computing, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC, (rank=1), PT N0-N12 (2), erythrocytes/CC (3), healthy cells/CC (4), eosinophils/CC (5), lymphocytes/CC (6), monocytes/CC (7), thrombocytes/CC (8), segmented neutrophils/CC (9), leucocytes/CC (10), stab neutrophils/CC (11). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; urea under ROC curve=1.0). CONCLUSION: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive LC; 2) PT N0-N12; 3) CRF; 4) LC characteristics.
  • Data:

    Male...439Female..51Age..56.78 yearsTumor Size.....4.52.1cm
  • Radical Procedures:

    Pneumonectomy...206Bi/Lobectomy........................284In All......490

    *

  • Combined & Extensive
    Radical Procedures with
    Resection of Pericardium,
    Atrium, Aorta, Vena Cava
    Superior, Vena Azygos, Carina, Trachea, Diaphragm, Chest Wall, Ribs, etc..130

    Sistematic Mediastinal

    Lymph Node-N2 Dissection..490

  • Staging:

    T1..143 N0..282 G1..114T2..217 N1..115 G2..140T3..107 N293 G3..236T423 Early LC...58 Invasive LC...432Squamous Cell Carcinoma...308Adenocarcinoma147Large Cell Carcinoma.35Central202 Peripherical..288

    *

  • Survival Rate of Lung Cancer Patients after Lobectomies and Pneumonectomies (R0) (n=490):

    5-Year Survivors...304 (62%) Losses from Lung Cancer.186 (38%)Life Span...18241304 days10-Year Survival.50.3% 20-Year Survival.45.3%5-Year Survival for Early LC100%5-Year Survival for Invasive LC56.9% 5-Year Survival for LC with N078.4%5-Year Survival for LC with N1-2.39.9%
  • Product-Limit (Kaplan-Maier) Analysis Results in Prediction of Lung Cancer Patients Survival after Lobectomies and Pneumonectomies (n=490):

    2.unknown
  • Survival of Early LCP was Significantly Better Compared to Invasive LCP:

  • Survival of LCP with N0 was Significantly Better Compared to LCP with N1-2:

  • Results of Multivariate Proportional Hazard Cox Regression Modeling in Prediction of LCP Survival after Lobectomies and Pneumonectomies (n=490):
    Global 2=131.51; Df=7; P=0.000

  • Results of Discriminant Function Analysis in Prediction of LCP survival after lobectomies and pneumonectomies (n=490):

    Wilks' Lambda=0.785; approx. F (4,485)=33.159 P=0.000

    Correct Classification Rate=72%

    Wilks' - LambdaPartial - LambdaF-remove - (1,485) PToler.1-Toler. - (R-Sqr.)Phase Transition Early LC---Invasive LC0.8008610.9805129.639570.0020.9052120.094787Eosinophils/Cancer Cells0.7972770.9849207.425550.0070.8375850.162415Lymphocytes/Cancer Cells0.7925520.9907914.507720.0340.8228030.177197Phase Transition N0---N120.8794530.89288958.180340.0000.9471100.052890
  • Results of Multifactor Clustering of Cell RatioFactors in Prediction of Lung Cancer Patients Survival after Lobectomies and Pneumonectomies (n=490):
    Correct Classification Rate=81%

  • Neural Networks in Prediction of Lung Cancer Patients Survival after Lobectomies and Pneumonectomies (n=490):

    Losses 5-year survivors Baseline Errors=0.000;Total 186 304 Area under ROC curve=1.0; Correct 186 304 Correct Classification Rate= 100%Wrong 0 0
  • Results of Neural Networks Computing in Prediction of 5-Year Survival of LCP after Lobectomies and Pneumonectomies (n=490):

  • Results of Bootstrap simulation in Prediction of Lung Cancer Patients Survival after Lobectomies and Pneumonectomies (n=490):

  • Results of Kohonen Self-Organizing Neural Networks Computing in Prediction of Lung Cancer Patients Survival after Lobectomies and Pneumonectomies (n=490):

  • Holling-Tenner Models of Alive Supersystem Lung Cancer-Cytotoxic Cell Population

  • Lung Cancer Dynamics:

  • SEPATH Networks in Prediction of Lung Cancer Patients Survival after Lobectomies and Pneumonectomies (n=490):

  • Conclusions:

    5-year survival and life span of lung cancer patients after complete lobectomies and pneumonectomies significantly depended on: 1) phase transition early---invasive lung cancer; 2) phase transition N0---N12; 3) cell ratio factors (ratio between blood cell subpopulations and cancer cell population); 4) lung cancer characteristics.
  • Address:

    Oleg Kshivets, M.D., Ph.D.Thoracic Surgeon, Dep.of Surgery, Siauliai Public Hospital,Tilzes:42-16, Siauliai, LT78206, LithuaniaTel. (37041)416614 kshivets@yahoo.comhttp//:myprofile.cos.com/Kshivets

    Survival Function

    5-Year Survival=62%

    10-Year Survival=50.3%

    20-Year Survival=45.3%

    Complete

    Censored

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    Years after Surgery

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    Cumulative Proportion Surviving